Outpatient Registered Nurse

PURPOSE AND SCOPE:
Functions as part of the hemodialysis health care team as a Team Leader Registered Nurse to ensure provision of quality patient care on a daily basis in accordance with FMS policies procedures and training. Support FMCNA's commitment to the Quality Enhancement Program (QEP) and CQI Activities including those related to patient satisfaction. Actively participate in process improvement activities that enhance the likelihood that patients will achieve the FMCNA Quality Enhancement Goals (QEP). Supports FMCNA's mission vision values and customer service philosophy. Adhere to all requirements of the FMCNA Compliance Program and FMS patient care and administrative policies.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

General and Staff Related:

* Directs Patient Care Technician's provision of safe and effective delivery of chronic hemodialysis therapy to patients in compliance with standards outlined in the facility policy procedure manuals as well as regulations set forth by the corporation state and federal agencies.
* Delegates tasks to all direct patient care staff including but not limited to LVN/LPNs Patient Care Technicians and Dialysis Assistants.
* Ensures adequate staffing through daily management of staff scheduling when appropriate.
* Assesses daily patient care needs and develops appropriate patient care assignments.
* Routinely monitors patient care staff for appropriate techniques and adherence to facility policy and procedures.
* Assists Clinical Manager with staff performance evaluations.
* Participates in staff training and orientation of new staff as assigned.
* Participates in all required staff meetings as scheduled.
* Functions as Team Leader.
* Enforces all company approved policies and procedures as well as regulations set forth by state and federal agencies and departments.
* Maintains overall shift operation in a safe efficient and effective manner.
* Act as a resource for other staff members.
* Routinely meets with the Clinical Manager to discuss personnel and patient care status issues and information.
* Collaborate and communicate with physicians and other members of the healthcare team to interpret adjust and coordinate care provided to the patient.
* Provides assistance as needed to patients regarding prescription refills according to FMCNA Policies.
* Ensures all physician orders are transcribed and entered into the Medical Information system in a timely manner.
* Oversees all documentation of patient information.
* Maintains facility drug list for all required stock medications.
* Maintains competency with all emergency operational procedures and initiates CPR and emergency measures in the event of a cardiac and/or respiratory arrest.
* Ensures verification and availability of adequate emergency equipment.
* Ensures provision of appropriate vaccinations immunizations and annual Tuberculosis (TB) testing.
* Administers medications as prescribed or in accordance with approved algorithm(s) and documents appropriate medical justification if indicated.
* Administers PRN medications as prescribed and completes appropriate documentation of assessment of effectiveness.
* Maintains appropriate recording of controlled substances as required by law.
* Assists with the coordination of patient transportation if necessary.

Patient Care Education:

* Ensures educational needs of patients and family are met regarding End Stage Renal Disease (ESRD).
* Provides ongoing education to patients regarding their renal disease vascular access and dialysis therapy and other related health conditions.
* Discusses with patient and records education related to diet/fluid and medication compliance.
* Provides patient specific detailed education regarding adequacy measures where applicable - Online Clearance Monitoring (OLC) Adequacy Monitoring Program (AMP) Urea Kinetic Modeling (UKM).
* Ensures transplant awareness modality awareness and drive catheter reduction.
* Educates patients regarding laboratory values and the relationship to adequate dialysis therapy compliance with treatment schedule medications and fluid.

Dialysis Treatment:

* Provides safe and effective delivery of care to patients with ESRD.
* Accurately implements treatment prescriptions including Sodium (Na) modeling prescription and Ultrafiltration modeling (where appropriate) to ensure stable treatment therapy as indicated.
* Assesses patients' responses to hemodialysis treatment therapy making appropriate adjustments and modifications to the treatment plan as indicated by the prescribing physician. Communicates problems or concerns to the Clinical Manager or physician.
* Identifies and communicates patient related issues to the Clinical Manager or physician.
* Initiates Initial and Annual Nursing Assessment and ongoing evaluation and documentation of patient care needs according to FMC Policies and Procedures.
* Actively participates in the pre-evaluation initiation monitoring termination access homeostasis and post evaluation of patients receiving hemodialysis treatment therapy according to established FMC procedures.
* Takes appropriate intervention for changes in patient adequacy status and troubleshooting access flow issues as identified by OLC/AMP yellow lights.
* Provides supervises (if applicable) and monitors hemodialysis access care according to established procedures.
* Implements administers monitors and documents patient's response to prescribed interdialytic transfusions including appropriate notification of adverse reactions to physician and appropriate blood supplier.
* Ensures accurate and complete documentation by Patient Care Technician on the Hemodialysis Treatment Sheet.

Laboratory-related:

* Reviews transcribes and enters physician lab orders accurately into the Medical Information System.
* Ensures appropriate preparation of lab requisitions for Spectra or alternate lab.
* Ensures correct labs tubes are utilized for prescribed lab specimens and that lab draw and processing procedures are performed appropriately for all lab samples.
* Identifies and ensures appropriate follow-through regarding missed labs and specimens reported to be insufficient according to company policies and procedures.
* Ensures all specimens are appropriately packaged according to Department of Transportation (DOT) policies and procedures relating to shipment of blood or body fluid specimens and potentially hazardous material.
* Ensures that all labs are directed and delivered to appropriate labs.
* Reports alert/panic and abnormal labs results to appropriate physician.
* Ensures lab results are forwarded to physicians as requested.

Maintenance/Technical:

* Ensures a clean safe and sanitary environment in the dialysis facility treatment area.
* Ensures competency in the operation of all dialysis-related equipment safely and effectively.
* Ensures all patient stations including machines and chairs are clean and free of blood and placed appropriately.
* Ensures that all blood spills are immediately addressed according to FMCNA Bloodborne Pathogen Control Policies.

Medical Records & Documentation:
General

* Ensures all relevant data including physician orders lab results vital signs and treatment parameters and patient status are documented appropriately and entered into Medical Information System.
* Ensures all appropriate patient related treatment data is entered into the Medical Information System.
* Ensures all FMCNA policies regarding patient admission transfer and discharge are appropriately implemented.
* Ensures and verify accuracy of Patient Care Technician documentation.

Daily

* Reviews and ensures appropriate daily completion of Hemodialysis Treatment Sheets by all patient care staff.
* Ensures that all appropriate procedures are followed regarding opening and closing procedures inclusive of monitoring that all staff and patients have safely left the premises.

Monthly

* Initiates documents and completes ongoing Continuous Quality Improvement (CQI) activities including monthly reports.
* Completes monthly nurses' progress note.
* Ensures patient medical records are complete with appropriate information documentation and identification on each page (Addressograph label is on all chart forms).
* Reviews transplant status and follows established procedure regarding appropriate action to be taken.
* Completes patient care plans for new patients within the initial 30 days or any patients deemed unstable requiring monthly patient care plans.
* Completes any long-term programs that are due.

Annually

* Completes initial and annual Nursing History and Assessment physical.
* Ensures completion of Annual Standing Order Review with each physician as required.

Other:
Performs additional duties as assigned.

Relationships:

* Internal Contacts: Direct Patient Care staff Facility support staff and management team.
* External Contacts: Physicians Back-up Hospitals; as needed regarding patient care as directed by the supervisor

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.

The duties listed in this job description are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar related or a logical assignment to the position.

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.
* Employees are required to take the Ishihara's Color Blindness test as a condition of employment. Note that: Failing the Ishihara Test for Color Blindness does not preclude employment. The Company will consider whether reasonable accommodations can be made.
* 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.

EDUCATION :

* Graduate of an accredited school of Nursing (R.N.)
* Current appropriate state licensure.
* Must meet the practice requirements in the state in which he or she is employed.

EXPERIENCE AND REQUIRED SKILLS:

* 9 months of nursing experience and an additional 3 months of clinical experience in dialysis.
* RN Team Leaders assuming responsibility for nursing and patient services in the absence of the Clinical Manager must have one-year clinical experience and six months ESRD experience.
* Supervisory or management experience preferred.
* Successfully complete a training course in the theory and practice of hemodialysis.
* Good communication skills - verbal and written.
* Must meet appropriate state requirements (if any).

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.
"The rate of pay for this position will depend on the successful candidate's work location and qualifications, including relevant education, work experience, skills and competencies and may fall outside of the range shown.

Hourly Rate: $37.00 - $63.00'