Hospice Transitional Nurse Liaison (HNS Legacy Hospitals)

Graham Healthcare Group • Northbrook, IL

1d • Hybrid

About The Position

This role serves as the primary interface to the Agency’s referral sources, including physicians, Hospital Social Workers and discharge planners, hospital RNs, and all staff in the acute care setting. The Hospice Transitional Nurse Liaison is responsible for obtaining complete and accurate information from patient medical records for hospice services, ensuring a safe transition from one level of care to another, and gathering and sharing complete information on complex patients.

Requirements

• Associate degree from an accredited School of Nursing
• A minimum of two (2) years of experience working as a Registered Nurse including acute care or oncology experience, hospice experience preferred
• Experience with technologies such as Microsoft Office Suite, EPIC, and HCHB preferred
• Able to meet the physical demands of providing nursing care, ambulating patients, transferring patients, assisting with exercises, etc.
• Able to transfer patients as needed according to proper techniques of body mechanics to promote patient and staff safety
• Able to use good and sound clinical judgment
• Able to document accurately and appropriately
• Hold, in good standing, a license as a Registered Nurse
• CPR certified
• Empathetic, non-judgmental, tactful, responsible, and organized
• Understand the team approach and be a supportive team member

Nice To Haves

• Hospice experience preferred
• Experience with technologies such as Microsoft Office Suite, EPIC, and HCHB preferred

Responsibilities

• Complete an initial, comprehensive, and ongoing assessment of patient and family to determine hospice needs, including a complete physical assessment and history of current and previous illness(es)
• Obtain complete/accurate demographic information and medical history, including diagnosis for care and primary care physician information
• Introduce the Agency to the patient/caregiver, explain scope of our services and skilled services requested, and coordinate start-of-care visit
• Order requested DME, supplies, and medications related to hospice care
• Deliver community education as requested for assisted living facilities, skilled nursing facilities, and hospitals
• Provide patient education at bedside regarding hospice, disease progression, and end-of-life care
• Attend discharge planning meeting as requested, working with the facility team to provide a safe and successful discharge home
• Determine hospice eligibility and appropriate level of care
• Communicate with the clinical team on all complex, chronically ill patients, assisting staff and referral sources to prevent re-hospitalizations
• Use Liaison Coordination note to communicate information
• Assist in obtaining regulatory documentation as required
• Provide professional nursing care by utilizing all elements of nursing process
• Regularly re-evaluate patient and family/caregiver needs
• Initiate the plan of care and make necessary revisions as patient status and needs change
• Uses health assessment data to determine nursing diagnosis
• Develop a care plan that establishes goals based on nursing diagnosis and incorporates palliative nursing actions; include the patient and family in the planning process
• Counsel the patient and family in meeting nursing and related needs
• Provide health care instructions to the patient as appropriate per assessment and plan
• Complete, maintain, and submit accurate and relevant clinical notes regarding patient condition and care given
• Record pain/symptom management changes/outcomes as appropriate
• Communicate with the physician regarding the patient's needs and report changes in the patient's condition; obtains/receives physicians' orders as required
• Communicate with community health-related persons to coordinate the plan of care
• Teach the patient and family/caregiver self-care techniques as appropriate
• Provide medication, diet, and other instructions as ordered by the physician and recognize and utilize opportunities for health counseling with patients and families/caregivers
• Work in concert with the interdisciplinary group
• Provide and maintains a safe environment for the patient
• Assist the patient and family/caregiver and other team members in providing continuity of care
• Follow up as needed and appropriately with doctor's office and clinical and management staff pertaining to any concerns regarding patient care
• Participate in on-call duties as defined by the on-call policy
• Supervise ancillary personnel and delegate responsibilities when required
• Assume responsibility for personal growth and development and maintain and upgrade professional knowledge and practice skills through attendance and participation in continuing education and in-service classes
• Actively participate in quality assessment performance improvement teams and activities
• Prepare and maintain clinical documentation according to Agency policies and acceptable nursing standards
• Act as a Customer Service Liaison between the company and GIP facilities
• Comply with Company’s Core Values and Core Competencies
• Perform other duties as assigned by supervisor

Benefits

• Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.
• By supplying your phone number, you agree to receive communication via phone or text.
• By submitting your application, you are confirming that you are legally authorized to work in the United States.

What This Job Offers

• Career Level: Mid Level
• Education Level: Associate degree