Dialysis Outpatient Licensed Practical Nurse

PURPOSE AND SCOPE:

Functions as a member of the hemodialysis health care team in providing safe and effective dialysis therapy for patients under the direct supervision of a registered nurse in accordance with Fresenius Kidney Care (FKC) policies, procedures, and training and in compliance with regulations set forth by the corporation, state, and federal agencies.  Assists with clinical orientation precepting and on-going training of all appropriate direct patient care personnel as well as the orientation of all facility staff to FKC.  Participates in the implementation and evaluation of patient care. Promote and assist in the maintenance of a safe and clean working environment. Supports the FKC commitment to the Quality Enhancement Program (QEP) and Quality Assurance Indicators (QAI) activities, including those related to patient satisfaction and actively participates in process improvement activities that enhance the likelihood that patients will achieve the FKC Quality Enhancement Goals (QEP).

PRINCIPAL DUTIES AND RESPONSIBILITIES:

STAFF RELATED

• Participates in the recruitment process for new clinical staff.

• Assists with clinical orientation and on-going training of all appropriate direct patient care personnel as well as the orientation of all facility staff to FKC.

• Functions as preceptor in direct patient care training programs to support the delivery of quality patient care as per the standards set forth in the FKC Clinical Services Clinical Training Manual(s), FKC policies and procedures, and FKC training standards.

• Delivers and maintains on-going competency evaluations/audits to ensure ongoing performance of other LPNs and PCTs.

• Collaborates with the Clinical Manager and Education Coordinator in driving FKC quality standards through education regarding all Chronic Kidney Disease (CKD) regulatory and legal requirements and the practice of Continuous Quality Improvement.

• Assists in training of applicable direct patient care staff on appropriate programs.

• Provides coaching and developmental support to applicable clinical and facility staff.

Education/Communication:

• Partners with RN and IDT staff to educate the appropriate personnel regarding the integrity and safety of the facility water systems, as allowed by local regulations.

• Partners with RN and IDT staff to educate the appropriate personnel regarding the maintenance of environmental integrity, including patient and staff safety, of the facility.

• Ensures a strong communication process between the Clinical Managers, Education Coordinators, direct patient care staff, and all support staff at the facility regarding appropriate training and organizational development programs and initiatives.

• Participates in implementing and potentially designs creative educational programs for direct patient care staff including contests and other team-based programs.

• Monitors processes in the delivery of patient care through regular Quality Assurance Indicator (QAI) activities.

• Ensures all FKC business policies, procedures and systems are incorporated into training, including compliance with ethical business practices.

PATIENT RELATED:

Education:

• Assists other health care members in providing patient specific detailed education regarding adequacy measures where appropriate - Online Clearance Monitoring (OLC), Adequacy Monitoring Program (AMP), Urea Kinetic Modeling (UKM), and regarding disease process/access.

Treatment:

• Welcomes assigned patients and inquire as to their well-being since their last treatment.

• Evaluates vascular access for patency.

• Obtains necessary pre- and post -treatment vital signs and weight.

• Performs vascular access evaluation pre-treatment.

• Performs vascular access cannulation.

• Performs administration of Heparin, as delegated or as allowed by state law.

• Responsible for the setup and operation of hemodialysis machines. 

• Initiates dialysis treatment according to prescribed orders including blood flow (QB) and dialysate flow (QD).

• Evaluates intradialytic problems and provides intervention as prescribed by physician order or as directed.

• Monitors patients' response to dialysis therapy.

• Obtains vital signs prior to reinfusion; performs all relevant functions necessary for the discontinuation of treatment

• Discontinues dialysis treatment according to established procedures.

• Evaluates patient prior to termination of venous access - standing & sitting blood pressure.

• Obtains Hemostasis and applies appropriate dressings.

• Evaluates the patient prior to discharge.

• Performs and records pre and post dialysis evaluation, weight and vital signs with initial identification.

• Responsible for calculating and entry of individual patients' dialysis machine programming for Ultrafiltration (UF) goal; treatment time; Sodium (Na) modeling; and UF modeling as prescribed.

• Responsible for ensuring appropriate safety alarms are enabled, including Narrow Venous Limits, (NVL) 160.

• Records accurate and timely information regarding vital signs and treatment parameters onto the Hemodialysis Treatment Sheet with initial identification.

• Responsible for accurate documentation of information related to patient treatment, including completion of Hemodialysis Treatment Sheet and, if applicable, progress notes.

• Reports directly to the nurse supervisor.

• Responsible for reporting and documenting any significant information and/or change in patient condition, all new or unusual incidents, information, complaints, or problems to the nurse supervisor.

• Observes patient, and conducts machine safety checks according to facility policy.  Reports any change or unusual findings to the nurse supervisor.

• Performs and documents any intervention for unusual patient status and document patients' response to intervention.

• Evaluates patients' vascular access during treatment including arterial and venous monitoring pressures; provides appropriate intervention as needed, documents and reports any unusual findings to the nurse supervisor.

• Obtains all prescribed laboratory testing and prepare specimens for collection.

• Assists in developing and following the teaching plan to educate the patient and family regarding end stage renal disease, dialysis therapy, diet, and medications.

• Assists with all emergency operational procedures.

• Administers medications including intravenous in accordance with physician orders and state nurse practice laws.

• Initiates basic CPR measures in the event of cardiac and/or pulmonary arrest and respond to emergency situations related to dialysis treatment.

INFECTION CONTROL SPECIALIZATION:

• Assists with facility Quality Assurance Indicators (QAI) infection control audits.

• Acts as a change agent for infection control practices within clinic.  Under the direction of the CM or designee, monitors staff and patient adherence to infection control practices.

• Reinforces new hire employee adherence to infection control Policies and Procedures.

• Supports ongoing staff and patient engagement on infection control practices under the direction of CM or designee for example participation in patient lobby days and staff meetings to reinforce infection control practice.

• Quarterly and under the direction of the CM reinforces patient and staff adherence to infection control Policies and Procedures through visual media such as posters, flyers or bulletin boards.

• Under the direction of the Education Department, participates in education response to internal and external facility surveys.

• Participates in and reinforces infection control education of new patients and families under the direction of the CM or designee.

MAINTENANCE/TECHNICAL:

• Maintains environmental integrity and aesthetics; ensures all areas are safe and clean.

• Cleans and disinfects dialysis machine surface, chair, equipment, and surrounding area between treatments according to facility policy.

• Conducts all tasks necessary for preparation for dialysis treatment and document where appropriate.

• Performs all required pretreatment dialysis machine alarm testing including Pressure Holding (PHT).

• Initiates Solution Delivery System (SDS) system.

• Ensures that all blood spills are immediately cleaned with appropriate disinfectant according to facility policy.

• Prepares, organizes, and efficiently utilizes supplies and equipment to prevent wastage.

RECORD KEEPING:

• Completes and documents ongoing participation in Quality Assurance Indicators (QAI) activities.

• Enters all treatment data into the designated clinical application in an accurate and timely manner.

• Reviews treatment sheets for completeness, ensure nursing signatures are documented, and ensure omitted entries are completed or corrected where appropriate.

• Prepares initial patient chart for admission and compile paperwork for appropriate placement in chart.

• Prepares lab requisitions for prescribed or stat Lab specimens according to laboratory destination.

• Collects, labels, appropriately prepares and stores lab samples according required laboratory specifications.

• Ensures collection of lab specimens by appropriate lab courier.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

• The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Day to day work includes desk and personal computer work and interaction with patients, facility staff and physicians. The position requires travel between assigned facilities and various locations within the community. Travel to regional, Business Unit and Corporate meetings may be required.

• The work environment is characteristic of a health care facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials.

• The position provides direct patient care that regularly involves heavy lifting and moving of patients, and assisting with ambulation.  Equipment aids and/or coworkers may provide assistance.  This position requires frequent, prolonged periods of standing and the employee must be able to bend over. The employee may occasionally be required to move, with assistance, machines and equipment of up to 200 lbs., and may lift chemical and water solutions of up to 30 lbs. up as high as 5 feet.  There is a two-person assist program and material assist devices for the heavier items.

EDUCATION AND LICENSES:

• Graduate of an accredited School of Practical Nursing (LPN, LVN)

• Current appropriate state licensure

• Attendance and active participation in all applicable preceptor training programs as established by the Regional Education Manager

• Attends FKC and publicly offered skill-based training as assigned by Clinical Manager

• History of high performance as measured by no lower than a commendable performance evaluation rating on reviews with no recent corrective actions

• Participation in our Leading with Values and Patient Experience workshops desired

EXPERIENCE AND REQUIRED SKILLS:

• At least five years patient care experience in a hospital setting or a related facility preferred

• Employees must meet the necessary requirements of Ishihara's Color Blindness test as a condition of employment

• Continued employment is dependent on successful completion of the FKC dialysis training program and successful completion of CPR certification

• Intravenous Certification if required by State Nurse Practice Act

• Excellent  communication skills - both verbal and written

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.