The Registered Nurse provides professional nursing services in clients’ homes and manages care for assigned primary patients. The role plans, coordinates, and assures quality care for patients and their families, monitors changing needs and clinical outcomes, and oversees progress toward care goals. Working with patients or their representatives, the nurse develops, implements, and monitors plans of care. The position also completes clinical documentation, including OASIS, evaluations, orders, and care-coordination records; collaborates with physicians, discharge planners, other disciplines, clinical leadership, office staff, and community health resources; and promotes patient and caregiver health education. The role includes participation in interdisciplinary conferences and ongoing professional development.
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