About The Position

An exempt position responsible for providing primary care to patients, including assessment, treatment, care planning, and evaluation of medical care. The nurse obtains consent, protects patient confidentiality, gathers and documents health information, assesses conditions and risks, and provides care according to practice guidelines, standards of care, and applicable laws and regulations. The role includes administering prescribed medications and treatments, monitoring and documenting patient responses, delegating as permitted, coordinating with other providers and community resources, and educating patients and families. The nurse also documents care in medical records, participates in multidisciplinary teams, and tracks quality assurance data and acute and chronic care management. The position may participate in supervising medical assistants, medical administrative assistants, licensed practical nurses, and certified nursing assistants. Work takes place in medical exam and treatment rooms and medical offices. Environmental hazards may be unpredictable, including exposure to communicable diseases and biohazards. Physical activity includes standing, walking, bending, grasping, manipulating, and squatting, with occasional lifting of patients during transfers or turns. Workload and complex cases may cause stress.

Requirements

  • Completion of nursing training from an accredited school of nursing.
  • Minimum of one year of professional nursing experience.
  • Current state registered nurse license.
  • Current CPR certificate.
  • Knowledge of nursing processes, health care systems, structure and functions, and community resources.
  • Understanding of health care technology, equipment, and supplies.
  • Familiarity with state nursing laws, nurse practice guidelines, and clinic policies and procedures.
  • Knowledge of wellness and illness, growth and development, human behavior, psychosocial factors, and alternative health care treatments.
  • Knowledge of medical record documentation requirements and federal and state laws related to release of health care information.
  • Skills in time management, problem solving, multitasking, prioritizing, and medical care coordination.
  • Ability to initiate appropriate crisis interventions and emergency response, and to triage patients in person and by phone.
  • Ability to analyze options, counsel patients and families, and make referrals to other providers and resources.
  • Ability to engage clients and families in developing and implementing a care plan.
  • Ability to read and interpret physicians’ orders and notes from other providers.
  • Ability to calculate and administer drug dosages and injections and measure results.

Nice To Haves

  • Bachelor of Science in Nursing (BSN).
  • Clinic experience.

Responsibilities

  • Obtain patient consent for care and ensure patient confidentiality.
  • Obtain and document health history, chief complaint, vital signs, and health risk factors; assess disease conditions.
  • Provide patient care in accordance with practice guidelines, standards of care, and federal and state laws and regulations.
  • Carry out prescribed treatments and medical interventions, administer prescribed medications, and monitor and document treatment progress and patient response.
  • Delegate duties as permitted under the Nurse Practice Act.
  • Refer to and consult with physicians, other health providers, and community resources to prevent or resolve problems and concerns.
  • Educate patients and families about health status, health maintenance, and management of acute and chronic conditions.
  • Document patient assessment and intervention data using established medical record forms or automated systems and documentation practices.
  • Participate in multidisciplinary teams to improve patient care processes and outcomes.
  • Track quality assurance data and monitor acute and chronic care management.
  • May participate in supervision of medical assistants, medical administrative assistants, licensed practical nurses, and certified nursing assistants.
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