POSITION: REGISTERED NURSE

REPORT TO: DON/ADON

PURPOSE OF POSITION: As a member of the interdisciplinary team, the Registered Nurse assumes responsibility and accountability for nursing services delivered to all residents of a designated team for one shift. The Registered Nurse provides direct care, administers treatments and medications, organizes and distributes daily assignments to direct care staff consistent with staff competency and each individual resident’s comprehensive resident assessment and plan of care. Supervises direct care staff and makes decisions about resident care needs during shift within scope of clinical competence, consistent with facility policies and procedures. Frequently serves as relief for charge nurse.

MINIMUM QUALIFICATION STANDARDS

Education: Graduate of an accredited school of nursing.

Certificate/Licenses: Current, active license as Registered Nurse or Practical/Vocational Nurse in Florida.

Work Experience: One year experience providing direct care to residents in a long term care setting. Prior Experience as Charge Nurse or similar supervisory experience preferred.

PERFORMANCE REQUIREMENTS:

• Knowledge of nursing principles and professional standard of nursing practice and ability to apply to resident specific circumstances. Able to identify, implement and evaluate appropriate objectives and interventions for residents.

• Demonstrate competency in clinical skills needed for facility resident population.

• Demonstrate competency in physical, behavioral and functions capacity assessment of long term care residents.

• Working knowledge of laws and regulations that influence provision of care and services in nursing facilities.

• Working knowledge and ability to interpret and demonstrate facility policies and procedures to direct care staff.

• Sufficient organizational and interpersonal skills to assign, motivate staff, elicit work out put, improve quality and interact effectively with residents, families, interdisciplinary team members, administration, government officials, consultants and others in addition to staff.

• Carries out all duties in accord with the facility mission and philosophy.

• Demonstrates knowledge of and respect for the rights, dignity and individuality of each resident in all interactions.

• Appreciates the importance of maintaining confidentiality of resident and facility information.

• Demonstrates honesty and integrity at all times in the care and use of resident and facility property.

• Able to understand and to follow written and verbal directions. Able to express adequately in written and/or oral communication (including documentation in clinical records) with direct care staff, interdisciplinary team members, administration, physicians, and government officials.

• Knowledge of emergency and disaster procedures of the facility. Able to locate the nearest exit, to understand and respond to written or oral instruction in case of emergency.

• Sufficient mobility to move freely through the building to assure resident safety at all times and to assist, transfer or otherwise move residents of facility out of danger in case of emergency.

• Demonstrates respect for co-workers and responds to needs of residents by complying with facility policies on attendance and punctuality and dress code. Able to arrive and to begin work on time and to report for duty on all shifts, weekends and holidays.

• Working knowledge and ability to comply with facility policies and procedures for workplace safety including infection control procedures, application of universal precautions for blood borne pathogens, use of personal protective equipment and handling of hazardous materials.

• Demonstrates ability to prioritize tasks/responsibilities and complete duties/projects within allotted time.

• Able to respond to change productively and to handle additional tasks/ projects as assigned.

• Able to carry out the essential functions of this job (with or without reasonable accommodation) without posing specific, current risk of substantial harm to health and safety of self and others.

• Reports information to DON/ADON as part of staff performance evaluations.

• Completes required documentation of care and services delivered during shift including subjective findings, objective symptoms, interventions and resident responses to interventions. Completes required documentation of special circumstances including accident/incident reports in compliance with state and federal laws and regulations.

• Completes written 24 hour facility report for team/unit. Gives and listens to verbal shift report making special note of significant changes in condition, admissions, transfers, discharges, initiation or use of physical or chemical restraints unnecessary use of any drug, incidents, unexplained injuries, medication errors, loss of resident property or evidence of resident or family dissatisfaction.

• Informs the resident in advance about care and treatment and any changes to the plan of care.

• Immediately informs the residents, consults with the resident’s physician and notifies the designated family member and/or the resident’s legal representative when there is an accident involving an injury which has potential for requiring physician intervention; a significant change in the resident’s physical, mental or psycho social status; a need to alter treatment significantly or a decision to transfer or discharge the resident from the facility. Promptly notifies the resident, designated family member and/or resident’s legal representative when there is a change in room or roommate.

• Report relevant information to the DON/ADON including, interdisciplinary team functioning and communication, regulatory compliance issues, resident risk factors, sudden changes in resident behavior (positive and negative). Staffing needs, equipment and supply needs, opportunities to revise policies, procedures, improve quality.

• Ensures staff fulfillment of Restorative Nursing Measures and documentation on team.

• Monitors staff for compliance with OSHA mandates on work place safety including hazard communication and blood borne pathogens. In cases of workplace exposure, provides immediate first-aide and refers employee to appropriate facility staff member for post-exposure follow-up.

• Reports all injuries to self or others to supervisor immediately.

• Takes job actions with staff members under appropriate circumstances. Applies facility policies about progressive discipline correctly. Removes staff member from unit if necessary to avoid endangerment to health or safety of residents of other staff members. Reports all job actions taken to DON/ADON promptly.

• Attends in-service education programs as assignee. Applies information to job tasks.

• Ensures completion of resident charges for supplies utilized on that shift.

• Assists DON/ADON with preparation for long term care survey. Attends survey training, interacts with state surveyors as instructed by supervisor.

PHYSICAL, PSYCHOLOGICAL AND ERGONOMIC REQUIREMENTS:

Successful performance of essential functions can best be achieved through consistent application of current knowledge, use of good judgement, common sense, ability to establish and carry out priorities, effective use of interpersonal skills and ongoing communication with residents, staff, families, interdisciplinary team members, and government officials, including state surveyors and ombudsmen.

This job cannot be performed without the stresses associated with an intimate 24 hour residential care environment that delivers care and services primarily to disabled and cognitively impaired residents with an average age of 80 years.  Examples of these stresses include, but are not limited to; shift rotation, weekend and holiday duty, unusual or impaired behavior by residents, family reactions to having a loved one in the nursing home, death and dying, oversight of state surveyors, ombudsmen and federal officials, presence of consultants and attorneys, and variable involvement of medical staff.

Essential functions are carried out in variety of positions including standing and sitting. To meet residents’ needs. Virtually all positions require the ability to move freely through the building. Stooping, bending, lifting and carrying, as well as other physical demands may be required as described in the Essential Physical Demands of this position.

ESSENTIAL PHYSICAL DEMANDS OF THE TEAM LEADERS JOB:

These are the essential physical demands to perform the essential functions of this job as determined by your job analysis of this position.

• MOBILITY: Ability to move throughout the facility.

• LIFTING: Infrequent assistance in lifting 50 pounds.

• CLIMBING/BALANCING: Minimal stepping up.

• STOOPING/BENIDNG: Frequent. 

• PUSHING: Frequent – medical treatment cart.

• STANDING/SITTING: Frequent.

• REACHING: Moderate.

• HEARING: Necessary for communication and observation.

• VISION: Necessary for reading

• COLOR VISION: N/A

ESSENTIAL ENVIRONMENTAL DEMANDS OF THIS JOB:

These demands document the environment of the specific environment of the job-site for this position.

• INSIDE/OUTSIE: Inside only.

• COLD/HEAT: No Extremes.

• WET/HUMIDITY: No extremes.

• NOISE/VIBRATIONS: No extremes.

• DRY/DUST: No extremes.

• FUMES/ODORS/CHEMICAL EXPOSURE: No extremes.

• OTHER ENVIRONMETAL HAZARDS: The Occupational Safety and Health Administration (OSHA) have determined that certain employees in nursing homes are at significant risk of exposure to blood borne pathogens such as Hepatitis B and Human Immunodeficiency Virus (HIV).

Potential contact with blood and body fluids.

DUTIES 3 – 11 SHIFT NURSES

• Report on duty begin at least by 3:00 pm and obtain keys.

• Make walking rounds with 7 -3 nurses.

• Assure all assigned staff members are present and ready for work

• Count with 7 – 3 nurse and sign off on narcotic sheet.

• Get report from day nurse in charge, making sure you understand the care and treatments of each patient in your care.

• Update you aide’s assignment cards and give them a report of any changes in their patients’ conditions.

• Make aides assignment on the board and on paper:

- Check appointment log

- Add showers to assignment sheet

- Add CNA break times

- Add CNA dining room rotation schedule

• Get patients up from afternoon naps, walk, put in wheelchair, and take to activities.

• Check vital signs on all critically residents, and any resident with a change in their condition. 

• Give out and chart medicines at prescribed times.

• See that residents and staff who are assigned get to dining room.

• See that those who have trays in their room have proper diet and that they are assisted as needed.

• Work on your treatments such as decubitus care, dressings, B/P, etc. at proper times.

• Arrange dinner times with fellow nurses so unit is covered between 6:00 pm - 8:00 pm.

• Give out and chart H.S. medication. 

• Need to insert dining break, coverage for other nurse.

• Supervise aides to see that patients have good H.S. care.

• Check resident’s bedrails, positions of beds, and if mats and bed monitors are on and functioning as ordered.

• Write reports on chart of patients with change in condition.

• Make out any accident reports, if needed, and follow procedure.

• If any call-offs make out absence sheet, and report to Nurse Manager on-call duty for instructions. It is also your responsibility to contact employees and locate a replacement.

• Supervise CNA completing flow sheet, bowel and bladder grids, and turning residents’ in bed per policy.

• Weekly summaries as assigned, and Skin Assessments.

• Count with oncoming 11 – 7 nurse and sign on and off narcotic sheet. 

• Complete 24 hr. report for shift.

• Admit and discharge residents. 

- Inform nursing personnel of new admissions their expected time of arrival, room assignment, etc.

- Ensure that rooms are ready for new admissions.

- When residents are admitted make sure all paperwork is complete including clothing list.

- When resident is discharged ensure that they are escorted out of building by staff.

- Ensure that discharged residents are escorted to the pick-up are.

• Complete Behavior Monitoring Sheets.

• Give report to nurse coming on duty at 11:00 pm and turn over keys.

• Make walking rounds with 11 – 7 shift.

• Implement and maintain established nursing objectives and standards.

• Notify the resident’s attending physician immediately when the resident is involved in an accident or incident.

• Administer professional services such as; catheterization tube feedings, suction, applying and changing dressings/bandages, packs, colostomy, and drainage bags, taking blood, giving massages and range of motion exercises, care for the dead/dying etc., as required.

• Ensure that residents who are unable to call for help are checked frequently.

• Ensure that discharged residents are escorted to the pick-up area.

HEALTH REQUIREMENTS

1. Physical and skin test prior to employment. Must show evidence of good health and be free of communicable diseases.

2. Must have adequate vision and hearing.

3. Must be able to lift at least 50 lbs., must be able to bend and stretch. Standing and walking most of the day.

WORKING CONDITONS

1. Sitting, standing, bending, lifting, and moving intermittently during working hours.

2. Works in well lighted/ventilated office areas of the facility.

3. Subject to frequent interruptions.

4. Willingness to work beyond normal working hours, and in other positions temporarily, when necessary.

5. Attend and participate in continuing educational programs.

6. Subject to cuts, bruises, falls, odors, etc.

7. May be subjected to infectious diseases, substances, contaminated articles, etc.

8. Communicates with nursing personnel, and other department personnel.

TEAM NURSE RESPONSIBLITIES

3 – 11 SHIFT

The 3 - 11 Team Leader will be held accountable for ensuring the following routine duties are completed as designated on time. The nursing office must be notified anytime a duty is not complete on duty for any reason.

DAILY:

CNA assignment

Medications/flushes/ tube feeders

Calling physicians

Do accu-check and charted with correct coverage

Skilled Medicare charting

Monitor CNA’s

Supervise residents / CNA’s to dining room

Put away drug orders (Verify and check against FAX)

Dining room duty (4:45 pm.)

Labs

Follow up as needed from previous shift

 Dietary recommendation

Follow up on doctor visit

Follow up on residents returning from appointments

Admissions

Behavior Monitoring Sheets

Handle Report to CNA

MISCELLANEOUS:

Update Kardex

WEEKLY:

Weekly summaries

DUTIES:

P.O. medication pass

Medication orders (FAXING)

Monitor MAR’S and narcotic records

Treatments

Keep medication cart and treatment cart orderly and stocked

Foley catheter tube changes PRN

Enemas PRN

Monthly summaries

Hang new pump sets at time assigned.

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