Visiting After Hours Nurse

InnovAge•Charlottesville, VA

3d•$39 - $50•Remote

About The Position

Our Visiting After Hours Registered Nurse (RN) work a rotational on-call after-hours schedule as part of the comfort care and after-hours team. They respond timely to afterhours calls from staff or the participant (or their family) to assess and triage the situation. As licensed clinician they determine the appropriate response or treatment which may include performing a home visit, communicating with the provider on call and/or coordinating care at a facility. The work also includes providing clinical guidance and education to the participant, family and caregivers as needed. Our Visiting After Hours Nurse (RN) works with the In-Home Services and Primary Care team reporting into the Director of After-Hours Nursing and Comfort Care Services team. The work-from-home role involves responding to phone calls, triaging care, and potentially visiting a participant's residence when medically necessary. The nurse will support enrolled participants for their designated PACE center. From incoming calls, the nurse supports on-call assessments with participants/families, initiating appropriate intervention, identifying and responding to emergency situations, and handling on-call assessments and triage appropriately. The VAN uses discretion to assess symptoms, analyze potential diagnoses, and determine the appropriate level of intervention (e.g., education, clinic visit, urgent care, emergency room), recommend a course of treatment, and begin treatment. The role includes developing a comprehensive assessment of the participant’s needs, following the plan of care, providing specialized nursing skills, counseling clients and families, coordinating services, informing physicians and staff of changes in client needs, and assisting with transfers of care. The nurse demonstrates assessment ability by applying clinical judgment related to the patient population served. They must be able to make an appropriate analysis of calls, work with providers to determine the necessity of an order or higher level of direction, and initiate appropriate intervention/triage when necessary. The nurse initiates appropriate preventive and rehabilitative nursing procedures and provides treatments and procedures that contribute to the physiological and psychosocial outcomes and stability of the patient. They demonstrate the ability to delegate and prioritize tasks to facilitate quality participant care and ensure all participant care needs are met, using discretion to determine call priority by distinguishing between emergent and non-emergent clinical needs. The nurse recognizes and responds to variances of patient care/condition and appropriately notifies the physician and team in a timely manner, utilizing the latest PACE standards per departmental policy. They educate and counsel family members on the end-of-life process, including interpreting changes in a participant’s condition, stages of the dying process, interactions with the participant during the final phase of life, and how family members can manage their emotions. The role supports proactive visits and calls to participants based on recommendations from the clinical or other interdisciplinary team members and is responsible for facility transition planning when on call. The nurse demonstrates flexibility and ensures patients receive consistent, competent, and ethical care, addressing customer needs regardless of assignment in a timely manner. They perform a handoff with peers and center-based teams when changing shifts, reporting the current condition and needs of high-risk participants for after-hours care. The nurse participates in interdisciplinary and clinical team huddles on care plan reviews virtually or in person on a regular basis. They come into the PACE Center on a regular basis and as requested to work with the clinical team, attend educational programs, demonstrate competency, and participate in meetings. Accurate completion of all required clinical documentation consistently per InnovAge standards in the electronic medical record, including completing and signing or routing participant EMR notes and orders to the physician, is essential. The nurse maintains a safe patient care environment by complying with InnovAge policies/procedures/regulatory requirements that support National Safety Patient Goals, ADC and PACE Federal regulations and Quality Initiatives. Completing required continuing education classes applicable to related services, as assigned in a timely manner, and staying current in clinical knowledge is also required.

Requirements

Current State issued Registered Nurses License
Current First Aid and BLS certifications are required prior to hire. Acceptable vendors for certifications are from either American Heart Association and/or American Red Cross.
2+ yrs health care with an emphasis in geriatrics, with at least one year home health services
Requires reliable personal transportation, current state issued driver’s license, good driving record and auto insurance.
Associates Degree in Nursing

Nice To Haves

Bachelor’s degree in nursing
3+ yrs health care experience with emphasis in geriatrics
Experience and knowledge of supportive/bereavement counseling techniques, strategies and available resources and the ability to apply/inform family members and/or caregivers.
Experience in end of life/hospice setting.
Bi-lingual-Spanish, Russian, Punjabi or Hmong

Responsibilities

Work-from-Home, responding to phone calls triaging care which may include visiting participant's residence when medically necessary
Respond timely to afterhours calls from staff or the participant (or their family) to assess and triage the situation.
Determine the appropriate response or treatment which may include performing a home visit, communicating with the provider on call and/or coordinating care at a facility.
Provide clinical guidance and education to the participant, family and caregivers as needed.
Provides phone triage and drives to participant’s home/community for direct care as needed.
Support enrolled participants for their designated PACE center.
Supports on-call assessments with participant/family initiating appropriate intervention, including identifying and respond to emergency situations with the ability to handle on-call assessments and triage appropriately.
Use discretion to assess symptoms (through a physical or verbal assessment, or a telephonic conversation), analyze potential diagnoses, and based on such diagnoses, determine the appropriate level of intervention (i.e.; education, clinic visit, urgent care, emergency room), recommend a course of treatment, and begin treatment.
Develops a comprehensive assessment of the participant’s needs (assimilating participant’s history from various sources), follows plan of care implemented by IDT team, provides services and/or treatments requiring specialized nursing skill, councils the client and family in meeting nursing need, coordinates services, informs the physician and other staff of changes in the client's needs, and assists with transfers of care (respite, discharge from facility).
Demonstrates assessment ability by applying clinical judgment as it relates to the patient population served.
Make an appropriate analysis of calls, including working with providers to determine, based on clinical judgment, the necessity of an order or higher level of direction, and initiate appropriate intervention/triage when necessary.
Initiates appropriate preventive and rehabilitative nursing procedures and provides treatments and procedures that contribute to the physiological and psychosocial outcomes and stability of the patient.
Demonstrates ability to delegate and prioritize tasks to facilitate quality participant care and ensure all participant care needs are met.
Use discretion to determine call priority by distinguishing between emergent situations, such as end of life crises, and non-emergent clinical needs.
Recognizes and responds to variances of patient care/ condition and appropriately notifies physician and team in a timely manner, utilizing the latest PACE standards per departmental policy.
Educates and counsels family members on the end-of-life process including the interpretation of changes to a participant’s condition, stages of the dying process, interactions with the participant during the final phase of life, and how family members can manage their emotions during this time.
Supports proactive visits and calls to participants based on the recommendation of the clinical or other interdisciplinary team members.
Responsible for facility transition planning when on call.
Demonstrates flexibility and assures patients receive consistent, competent, and ethical care.
Addresses customer’s needs, regardless of assignment, within a timely manner.
Performs a handoff with peers and center-based teams when changing shifts reporting current condition and needs of high-risk participants for after-hours care.
Participates in interdisciplinary and clinical team huddles on care plan reviews either virtually or in person on a regular basis.
Comes into the PACE Center on a regular basis and as requested to work with the clinical team, attend educational programs, demonstrate competency, and participate in meetings.
Accurately completes all required clinical documentation consistently per InnovAge standards in electronic medical record which includes completing and signing or routing participants EMR notes and l orders to physician.
Maintains a safe patient care environment by complying with InnovAge policies/procedures/regulatory requirements that support National Safety Patient Goals, ADC and PACE Federal regulations and Quality Initiatives.
Completes required continuing education classes applicable to related services; as assigned in a timely manner and stays current in regards to clinical knowledge.