Community Health Registered Nurse - Per Diem

Institute on Aging•San Francisco, CA

7d•$59 - $63

About The Position

IOA is on the forefront of revolutionary healthcare models, reshaping the way people can age in place. Our innovative models transform lives, enhance communities, and save healthcare systems millions of dollars. Rather than focusing on archaic outdated design, we strive to consistently question the “status-quo” and create new and more innovative ways to help aging adults and adults with disabilities maintain their quality of life. With over 23 programs, we offer multiple ways to aid seniors maintain their health, well-being, independence and participation in the community, fulfilling our mission. The Community Health Registered Nurse implements and coordinates the plan of care for PACE participants who reside in facilities, including Residential Care Facilities for the Elderly (RCFEs), Skilled Nursing Facilities (SNFs), and other congregate living environments. This role collaborates with facility staff and Interdisciplinary Team (IDT) members to support appropriate discharges and transitions of care between hospitals, facilities, and the participant's home. This is a per diem role with an expected workload of approximately 8 hours per week and a minimum commitment of two days per month.

Requirements

Nursing degree from an accredited school required
Current California Registered Nurse license.
A minimum of two years of nursing experience required.
A minimum of one-year experience with older adults is required.
Ability to work as part of an interdisciplinary team with initiative, compassion, resourcefulness and flexibility.
Independence in clinical practice.
Computer literacy required.
Ability to comprehend complex written material and verbal instructions
Ability to communicate and speak clearly in English

Nice To Haves

Bachelor's Degree in nursing preferred.
Public Health Nurse Certificate preferred.
Preference will be given to those with experience in public health nursing, work with the elderly and/or acute care nursing.
Some supervisory experience preferred.
Bilingual skills preferred.
Interest and willingness to work in a multilingual, multicultural environment.

Responsibilities

Implements, directs, supervises and evaluates nursing care for participants who reside in RCFEs, SNFs and other congregate settings, including: Conducts scheduled assessments and recurring monitoring visits as appropriate and as directed by the physicians. Evaluates the acute illnesses of assigned participants in collaboration with other clinic staff. Teaches, supervises and evaluates the participant and caregivers regarding nursing care needs and other related problems of the participant. Initiates preventative and rehabilitative nursing procedures as appropriate for the participant's care and safety.
Collaborates with facility staff and IDT members to support safe discharges and transitions of care, including: Serves as the primary point of contact between hospital discharge planners and the Participant's IDT to ensure smooth and coordinated hospital discharges. Coordinates with other IDT members to arrange for transitional care stays. This includes ensuring the Participant has all necessary supplies, medications, and personal items and the accepting facility has all necessary paperwork and documentation. Serves as the liaison between the transitional care facility and the IDT to monitor the established goals for the transitional care stay, and help guide discharge planning and/or custodial placement decisions as indicated.
Oversees the transition to long-term placements in RCFE and SNFs, when indicated, and provides on-going monitoring and care coordination with the IDT.
Acts as a nursing consultant to other staff and provides health teaching and advocacy within his/her scope of practice.
Actively participates in guiding participant care as a member of the PACE IDT.
Serves as a liaison between facility staff and the PACE IDT.
Ensures appropriate departmental documentation in the EHR for consistency with the clinic and homecare plan of care.
Meets all the administrative requirements, including attending staff meetings.
Actively participates in and encourages actions that promote good public relations and providing high quality care and extraordinary service to the participants, their families and friends, visitors and the community.
Participates in QI activities, such as risk for skin ulcers, end of life, medication compliance, immunizations and access to medical and non-medical specialists.
All other reasonably related duties as assigned.