RN Primary MNA, Martha's Vineyard, VNA of Cape Cod

Cape Cod Healthcare•Tisbury, MA

About The Position

The RN Primary provides direct patient care to assigned patients and evaluates their clinical needs. The nurse initiates, develops, implements, and revises each patient’s plan of care, addressing and documenting all problems in the plan. The role includes using clinical grouping guidelines, including interdisciplinary utilization guidelines, to capture and enter the initial visit frequency, and ensuring that the OASIS assessment accurately reflects the documentation and vice versa. The RN Primary participates in interdisciplinary patient case conferences and helps evaluate the effectiveness of established plans of care. The nurse provides instruction and documented supervision for the Home Health Aide plan of care every 14 days, communicates significant changes in a patient’s condition to the physician and other involved care providers and the Clinical Team Manager, and completes admission and other paperwork promptly. The role requires clear, concise, and complete narrative documentation of skilled care, including teaching, direct care, and the patient’s or caregiver’s response. The nurse obtains and clarifies valid physician orders for all care delivered. In collaboration with the Clinical Manager and interdisciplinary team, the RN plans and coordinates discharges, informs the patient and physician, documents the patient’s disposition in the discharge summary, and completes required discharge paperwork. Other duties may be assigned.

Requirements

Successful passage of the VNA pre-hire medication test.
Current Massachusetts RN license and other related credentials required for the specialty.
At least one year of nursing experience, or six months of nursing experience with a BSN.
CPR certification.

Nice To Haves

Home care experience.
IV experience.
Computer skills.
BSN.

Responsibilities

Provide direct patient care to assigned patients.
Evaluate patients’ clinical needs and initiate, develop, implement, and revise plans of care; address and document all problems in the plan.
Use clinical grouping and interdisciplinary utilization guidelines to capture and enter the initial visit frequency.
Ensure OASIS assessments accurately reflect documentation and vice versa.
Update the Clinical Manager regarding referrals to community resources as appropriate.
Participate in interdisciplinary patient case conferences and assist in evaluating the effectiveness of established plans of care.
Instruct and document supervision of the Home Health Aide plan of care every 14 days.
Notify the physician, other involved care providers, and Clinical Team Manager of significant changes in a patient’s condition.
Complete admission and other paperwork on time.
Document skilled care clearly, concisely, and completely, including teaching, direct care, and patient or caregiver response.
Obtain and clarify valid physician orders for all care delivered.
Plan and coordinate discharges with the Clinical Manager and interdisciplinary team; inform the patient and physician, document disposition in the discharge summary, and complete required discharge paperwork.
Perform other duties as assigned.