PGH/WRH Residential Delegation RN

POSITION SUMMARY: The house nurse is an integral part of the general health of clients (stability and recovery). They are responsible for medication administration, maintaining client health records, training and delegating tasks of nursing and acts as an advisor to the house administrator.

SUPERVISION: The registered nurse works directly for and is supervised by the administrator and Director of Nursing or owners (in the administrator's absence). The Registered Delegating Nurse will work with the Registered Nurse or any other House Nurse related to RN duties.

ESSENTIAL DUTIES:

General

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• Maintain current nursing license through the Oregon State Board of Nursing.
• Have knowledge of applicable Oregon Administrative Rules, Division 45 Rules, Division 47 Rules, and Fire Marshal Rules pertaining to residential treatment facilities. Schedule time for ongoing training available online.
• Complete the Oregon Community Based RN Delegation Process Self Study Course and obtain an RN Delegation Certificate (worth 4 CEU)
• Prepare for RTF Meetings with administrator, health services coordinator and skills trainer to ensure resident needs are addressed. Designate one to fill-in ACT online charts for our residents in a succinct manner. Serve as a member of the Team as required.
• Provide input and sign all residential service plans.
• Educate residents on their medications (i.e. purpose, side effects, etc.) as required.
• Make recommendations on clients' abilities to self-administer medication.
• Collaborate with like programs.
• Attend nursing/medication meetings as required.
• Monitor HSC in the review of, taking action on, and initial all health related correspondence coming into the office.
• Report all incidents, illnesses of residents, staff issues and any other pertinent information to the administrator.
• Day to day activities
  • Coordinate and establish priorities with the assistance of the health services coordinator.
  • Complete nursing tasks as required.
  • Monitor client mental and physical status by establishing rapport with and engaging all clients individually at least weekly to ensure health needs are being met (i.e. diabetic foot care, symptoms).
  • Read tuberculosis tests or refer to PCP on off days.
  • Collect urinalysis or refer to PCP for collection.
  • Conduct blood/lab draws or refer to PCP for collection.
  • Administer inoculations or Intramuscular injections as prescribed. Do you mean intramuscular injections in general?
  • Coordinate with House admin for on-call consultation schedule. When on-call ascertain physical symptoms, clarify physician orders, take verbal doctors' orders, and determine care requirements to preclude excessive emergency room visits. Track time spent away from the program but conducting business for the home and submit to the Administrator or Assistant Administrator in a timely manner for payroll purposes.
  • Be cognizant of compliance issues involving the health services coordinator and all medication aids. Report issues that cannot be resolved to the administrator.

Training and delegation

• Delegate nursing tasks to Residential Home staff as required by Oregon Administrative Rules, Division 45 Rules, Division 47 Rules, and at the direction of the administrator. The decision to delegate is at the discretion of the Delegating RN ONLY. This is very clear in all pertinent Nursing OARs.
• Train, delegate, and authorize staff members to administer medication as prescribed.
• Train, delegate, and authorize staff members to administer pro re nata (PRN) medication and treatment.
• Train, delegate, and authorize staff to supervise client self-administration of insulin injections.
• Train staff members to perform various client care activities.
• Keep delegation/client care protocol books current.
• Provide 15 minutes of medication administration sustainment/refresher training to employees at monthly staff meetings and/or administer quizzes as required.
• Document deficiencies (i.e. kind of error, quantity, etc.) and schedule, conduct, and record specific remedial training for individual employees.
• Observe medication aids conduct a med pass six months after initial delegation then every year thereafter.
• Re-delegate medication aids as required.

Medication Administration and Management

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• Transcribe verbal physicians' orders.
• Obtain clarification on standing physician's orders to determine their desire to be notified if a client's medication is missed, declined, etc.
• Observe and document whether a client is able to self-administer insulin correctly.
• Ensure all medication parameters are correctly entered on the MARs.
• Manage the destruction of discontinued, expired and no longer required medication (including class "C") and document accordingly.
• Review MARs weekly for changes in order to keep self-administration orders current.
• Ensure MARs is accurate and format is consistent for all residents (i.e. PRN-NTE, time between doses, purpose of medication, side effects, self-admin, notification parameters for CBG and/or BP results, etc.)
• Verify and coordinate with physicians and pharmacy pre-authorization and insurance pre-approval requirements.
• Collaborate, communicate, and coordinate with medication aids to ensure physician's orders are carried out. If you direct medication aids or health services coordinator to deviate from medication administration protocols, instruct them to make an annotation of such in the QuickMar files. You must exercise highest judgment in these instances as you will be held responsible if your judgment is in error.
• Report all medication errors and non-compliance issues to the administrator.
• Responsible for the following in the absence of the health services coordinator:
  • Set up the medication cart for the month and for clients when they are out of the facility.
  • Check the pharmacy's automated physician's orders for accuracy and correct information when they come in for the new month, or as updates occur.
  • Work the new cycle-fill in accordance with policies and procedures to ensure all medications are in and correct.
  • Identify and order new medication from the pharmacy and keep at least a five- day supply of medication in the medication cart and cabinet by conducting an inventory no later than noon Thursday each week.
  • Obtain a written physician's order for each medication prescribed to a resident.
  • Collaborate, communicate, and coordinate with medication aids to ensure physician's orders are carried out.
  • Coordinate with the Administrator for qualified help to destroy medication in accordance with house policy and procedure.
  • Coordinate with the health services coordinator and ensure adequate stock of all medical supplies.

QUALIFICATIONS, TRAININGS AND EXPERIENCE:

• Able to establish and maintain effective working relationships with county mental health providers, health care providers, and employees.
• Able to act independently.
• Able to interact and relate to clients and others with professionalism, respect and dignity.
• Able to read and understand employment statutes and Oregon Administrative Rules as they pertain to residential services.
• Able to problem-solve complex issues by developing alternatives and solutions.
• Able to organize and establish priorities.
• Able to negotiate conflicts and resolve problems.
• Able to write chart notes and general correspondence.
   

CONFIDENTIALITY: This position requires the handling of highly confidential information. Must adhere to rules and laws pertaining to client confidentiality.

COMMUNICATION SKILLS: Must be able to communicate information in both oral and written form with the ability to present and exchange information internally across teams and co-workers, and externally with clients and the public, Information communicated ranges from routine/ basic information to complex and confidential information

LEADERSHIP & TEAMWORK: Must be able to work effectively and constructively with other office staff, clinicians, the administrative team and all other staff. Participates in staff meetings.

PHYSICAL DEMAND:

This position requires you to be regularly available for work as scheduled. Position requires professional and personal skills to cope with stress associated with work involving a high degree of mental, emotional and physical demands. This position also requires the ability to bend, stoop, push and pull. While performing the essential duties of this job, the employee is regularly required to sit; talk and hear; use hands and fingers and handle or feel; reach with hands and arms. Reasonable accommodations may be made to enable persons with disabilities to perform the essential functions of this position.

WORK ENVIRONMENT:

Work is performed in an office environment and the noise level is usually moderate, but occasionally may be exposed to loud noise such as raised voice levels and alarms. Occasionally the work environment may extend to other community offices, residential houses, and off-site locations.

This position may be exposed to the everyday risks or discomforts which require normal safety precautions typical of such places as an office (i.e., moving mechanical parts, airborne particles, and electrical shock). This person will be serving clients from all demographics within the community.

WVCW is a Trauma informed Organization and this person is expected to be a leader and example of Trauma Informed Care in the workplace.  Reasonable accommodations may be made to enable persons with disabilities to perform the essential function.

Wallowa County Center for Wellness is an equal opportunity employer.