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Macon, GA, United States
Job ID: 157741
Shift: Night
Job Type: Regular
Overview
NAVICENT HEALTH
JOB DESCRIPTION/ PERFORMANCE REVIEW TOOL
Job Title: Clinical Nurse Job Grade: N01 Job Code: JA10, JA11, JA12, JW10, JW11, JW12 FLSA: Non-Exempt
Department Name: Various Company Number: 200 Department Number: Various
Reports To (Title): Director
Job Summary: Provides professional nursing care for assigned patient(s) in one or more patient care departments according to State Board of Nursing Practice Act, American Nursing Association Code of Ethics and standards of practice and professional performance. Responsible for assessment, diagnosis, outcomes identification, planning, implementation and evaluation for patients served. As an active participant in decisions related to patient care and nursing practice, serves as instructor, colleague, researcher, advocate and leader. Must demonstrate competency in assuring quality care, Process Improvement, patient and employee safety, collaboration, consultation and professional development. Assumes responsibility for planning, organizing, delegating and evaluating patient care rendered by LPNs, technicians, medical receptionists and other staff.
Cultural Behaviors | Measurement |
Problem Solving and Decision-Making: Approaches problems using a methodical approach and analyzes information to make well thought-out decisions. | Anchors |
Environment of Care Consciousness: Demonstrates awareness of best practices and promotes patient safety. Is compliant with Fire Safety, General Safety, Hazardous Materials and Wastes, Emergency Management, Medical Equipment, and Security and Utility Systems policies, procedures, and guidelines. | Anchors |
Operation Excellence/Diversity: Embrace, practice and promote the principles of Operation Excellence by offering assistance and meeting the needs of patients, visitors, physicians, and co-workers with a sense of urgency and in alignment with organizational metrics for Experience. Creates an inclusive welcoming environment and recognizes the importance of individual, religious and cultural diversity in developing effective teams/ workgroups. | Anchors |
Personal Accountability: Takes responsibility and demonstrates reliability and dependability by taking initiative, following through on commitments, and assuming ownership for successfully completing job responsibilities. | Anchors |
Performance/Quality Improvement/Contribution to Achieving Goals: Contributes to positive outcomes for the department, strives for excellence and helps to achieve departmental goals. Practices and contributes to the organization’s vision, mission and values by identifying opportunities for improving services, processes, or outcomes and participating in defining and implementing solutions. Continually develops personally and professionally. | Anchors |
Corporate/ Regulatory Compliance/Ethics: Demonstrates understanding and assures compliance with federal and state regulations and accrediting agency standards. Is familiar with and complies with departmental and organizational policies and procedures. | Anchors |
Patient Satisfaction/Employee Satisfaction: Identifies and communicates direct relationship between employee satisfaction and patient satisfaction. Strive for high employee and patient satisfaction at all times. | Anchors |
Job Criteria - Major Job Functions | Measurement |
Assessment: Involves the patient, family, other healthcare providers in collecting and prioritizing patient health information (PHI). Uses appropriate evidence - based assessment techniques and tools. Documents relevant data in the appropriate format. Performs initial and ongoing assessments. Notifies physician of significant changes in patient status, including critical results. Interprets and documents PHI for determining plan of care. Identifies and documents patient/family learning and discharge needs. Incorporates information from other resources in assessment and planning care of the patient. Assesses discharge barriers on admission and when appropriate. | Observation, documentation, feedback, |
Nursing diagnosis: Identifies and documents the diagnoses, problem list or issues based on assessment. Validates the diagnoses, problem list or issues with the patient, family, and others when appropriate. | Observation, documentation, feedback, |
Outcomes Identification: Involves the patient, family, and other healthcare providers in identifying and documenting expected outcomes & timelines. Defines expected outcomes in terms of the patient, patient values, ethical and cultural considerations, environment, situation and continuity of care. | Observation, documentation, feedback, |
Planning: Involves the patient, family and other healthcare providers in developing and documenting a plan of care that is culturally sensitive, to include discharge and learning needs. Updates the care plan to address each of the identified diagnoses, problems or issues and assures plans are achievable and patient-centered. Utilizes the plan to assure continuity of care. Integrates evidence based practice and research affecting care in the planning process. | Observation, documentation, feedback, |
Implementation: Provides/ documents age appropriate care into a culturally sensitive manner. Provides nursing care based on patient-focused outcomes and are evidence based standards of care. Safely administers patient care, medications and treatments in accordance with standards of practice. Recognizes and responds appropriately to emergency situations. Utilizes community and other resources and systems to implement the plan, facilitating referrals when appropriate. | Observation, documentation, feedback, |
Coordination of Care and Professional Models of Care: Coordinates all facets of care. Coordinates implementation of the plan, documenting in a timely and appropriate manner. Demonstrates familiarity and awareness of regulatory agency impact on various aspects of care. Demonstrates how the patient/family centered care model addresses patient’s needs and patient satisfaction. Assists the patient and family in identifying and securing appropriate and available services and resources to address health-related needs. Assists the patient and family in becoming informed consumers about the options and benefits of treatment and care. Demonstrates application of Benner’s novice to expert model in patient education and staff competency. Demonstrates understanding of shared governance participation providing input, feedback and varying degrees of involvement and participation to assure involvement in budget and resource development and accountable care. | Observation, documentation, feedback, |
Evaluation: Evaluates and documents the effectiveness of the plan. Uses ongoing assessment data to revise the nursing diagnoses, outcomes, plan and the implementation as needed. | Observation, documentation, feedback, |
Quality: Uses the results of quality improvement activities, creativity and innovation to improve patient care. Incorporates new knowledge to initiate changes in nursing practice. Verbalizes/participates in, unit-specific nurse-sensitive/ National Patient Safety Goals/ core measures/ throughput indicators being monitored, results and actions taken to improve coordination and delivery of care. Maintains awareness of current professional trends and procedure/policy changes, which affect the delivery of patient care and unit activities. Ensure documents are legible using concise terms, correct terminology and approved abbreviations. Assures timely throughput patient processes via demonstration of “pull” behavior, effective/ proactive discharge planning, utilization of visual and RFID technology to enable communication and flow, monitoring and intervening to assure appropriate turnaround times. | Participation/ observation, documentation, meeting rosters, reports. |
Education/Teaching/Community Involvement: Participates in at least 4 hours of education beyond the mandatories. Maintains professional records that provide evidence of competency and acquired knowledge, skills and certification appropriate to the practice setting. Participates in at least one community activity, which does not have to be nursing or hospital-related. Teaches others to succeed by mentoring, in-servicing, role modeling, precepting, orienting, and facilitating new graduate transition. |
Participation/ observation, documentation, CE transcripts, meeting rosters |
Professional Development: Engages in self-evaluation to include peer feedback on a regular basis, identifying areas of strength and opportunity. Participates in at least one peer review activity, which may include chart review, interviews, feedback, and audits, among others. Develops and implements plans to achieve identified personal/ professional goals. Participates in at least 50% of unit meetings, reading and initialing minutes of all meetings not attended. Utilizes effective interpersonal skills to facilitate optimal patient care and unit activities. Recognizes peer accomplishments and accepts and gives constructive feedback appropriately. Demonstrates “Commitment to Co-workers” in daily practice. | Participation/ observation, feedback, documentation, meeting rosters |
Collegiality: Shares knowledge and skills with peers and colleagues via conferences, presentations, discussions, and serving as a resource in areas of expertise. Verbalizes/ demonstrates how to manage interdisciplinary conflict. Demonstrates effective interdisciplinary collaboration. Contributes to a supportive and healthy work environment to help recruit/retain the best co-workers. | Participation/ observation, feedback |
Collaboration, Consultation, Resources and Autonomy: Demonstrates effective utilization of available nursing resources, including policies- procedures and literature in providing patient care. Demonstrates ability to exercise independent judgment in resolving patient care issues. |
Participation/observation, feedback |
Ethics: Uses the ANA Code of Ethics for Nurses to resolve ethical issues. Delivers care in a manner that preserves and protects patient autonomy, dignity, rights, confidentiality, privacy and security. Serves as a patient advocate. Maintains a therapeutic and professional patient-nurse relationship with appropriate professional role boundaries. Demonstrates a commitment to practicing self-care. Verbalizes avenues for confidential and anonymous reporting of unsafe practices/ environment. |
Participation/observation, feedback |
Research: Utilizes the best available evidence and research findings to guide practice decisions. Participates in research activities which may include: identifying clinical problems; participating in data collection, serving on task forces; sharing research findings and activities; conducting research; analyzing and interpreting research and incorporating research as a basis for learning. |
Participation/observation, documentation, meeting rosters |
Leadership: Verbalizes organizational pillars/ goals and nursing/ departmental goals and role in achieving. Exhibits creativity, flexibility and high personal standards for quality work. Willingly accepts mistakes by self and others, thereby creating a non-punitive culture. Inspires loyalty through valuing of people. Effectively utilizes scheduling and staffing processes, supplies, equipment and other resources. Assigns or delegates tasks based on patient acuity, task complexity, staff competency, skill mix, and Practice Acts. Demonstrates and assures utilization of proper body mechanics and lift devices, techniques and resources. Participates in the evaluation, competency assessment and orientation of other employees. Complies with unit-specific articulated job expectations. | Participation/ observation, feedback, documentation, CE transcripts, meeting rosters, reports |
Demonstrates competency in Charge Nurse role including, but not limited to, the following where appropriate to the unit: Assure Quality Control activities completed including narcotics count/ reconciliation, crash cart/ suction checks, refrigerator temperature checks, point of care testing, defibrillator, among others. Assure equipment in appropriate working order to meet patient needs. Collaborate with management to assure adequate staff available for current and on-coming shift, utilizing appropriate resources, acuity/ classification systems and staffing budget and following communication pathway for involving Coordinator/ Nursing Administration. Appropriately documents patient throughput and staffing decisions. Makes appropriate patient room assignments based on patient need, infection risk, fall risk, restraints and other safety factors. Makes assignments based on skill level, competency, anticipated discharges and admissions. Maintains frequent communication with staff regarding patient status, workload and assignments. Makes patient/ family rounds to assist with prioritization and assuring needs met, quality care provided and concerns addressed. Assures patient log kept current. Notifies management/ Coordinator of any patient injuries, unresolved complaints, employee injuries or unexpected/ unusual situations, documenting on appropriate forms. Assures timely, concise, pertinent hand off communication from nurse to nurse and CN to CN, assuring continuity of care during change of shifts. | Observation/ documentation, chart reviews, feedback, continuing education rosters. |
Assists in achieving unit quality scores which meet or exceed hospital/ national average for nurse-sensitive quality indicators such as skin breakdown, falls, and others as appropriate for the unit. | Reports, observation, |
Specifications:
___ Infant (0 – 12 months) ___ Toddler (1 - 3 years) ___ Preschooler (3 – 6 years)
___ School age (6 – 12 years) ___ Adolescent (12 – 16 years) ___ Adult (17 – 65 years)
___ Geriatric (65 + years) ___Appropriate for unit population ___N/A - Does not provide direct patient care.
A. (X) This position will involve performing procedures or other job‑related tasks that has an inherent potential of contact with blood, body fluids, or other infectious materials as defined by OSHA to an individual's skin or mucous membranes will occur. The procedures or tasks could also result in spills or splashing on an individual's skin or mucous membranes. I understand that I must have a clear understanding of the proper use of protective attire and where this attire is maintained for use before performing any duties. I will discuss this with my supervisor and review a detailed list of these tasks found in my department's Policy and Procedure Manual.
B. ( ) This position may involve performing procedures listed in #1 and proper training is the same.
C. ( ) This position will involve NO exposure to blood, body fluids, or infectious materials.
I have read this job description and fully understand the requirements set forth therein. I hereby accept the position and agree to perform the identified essential functions in a safe manner and in accordance with the organization’s established Procedural Guidelines. I understand that my job duties may be changed and amended from time to time as is needed to ensure quality care is administered, or to meet business needs of the organization. The organization reserves the right to amend this job description at any time.
I understand that my employment is at-will. This means that an associate has the right to terminate employment at any time, with or without cause, and the organization has a similar right. This document does not create any implied or expressed contractual obligation on the part of the organization. I further understand that I may also be exposed to the Hepatitis B Virus and that the organization makes available to me, free of charge, the Hepatitis B Vaccination.
_______________ _____________________________________
Date Signature
_______________ _____________________________________
Date Witness
Department | Required Certifications/Course | Time Frame |
M9 11800 | ONS Chemotherapy and Biotherapy Course | Within 1 year of hire and every 2 years after |
M8 - Ortho/Telemetry | BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 6 months of hire |
M7 - Center for Joint Care - 11350 | ||
H7 Medical Cardiology - 12100 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 6 months of hire | |
M6 - Academic Medical/Surgical - 11500 | ||
E6 - Psychiatric Services - 12000 | ||
H6 - Cardiac Short Stay/COU - 23950 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 6 months of hire | |
E5 - GNC Neuro/Tele - 12500 | BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 6 months of hire |
National Institute of Health Stroke Course - successful completion | Within 6 months of hire | |
H5 - IP Cardiac Procedural Telemetry - 12400 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 6 months of hire | |
M5 - Admission Unit - 11300 | ||
E4 - GNC Neuro - 11000 | National Institute of Health Stroke Course - successful completion | Within 6 months of hire |
W3E - Renal Services - 11100 | ||
NNIC Intensive Care Nursery/ L2N - Newborn Level II Nursery | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
Family Birth Center - Mother/Baby - 10200 | NRP - Neonatal Resuscitation Program - Provider or Instructor | Within 6 months of hire |
Labor & Delivery/OB Assessment/Perinatal Unit - 16100 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
Basic Fetal Monitoring Course - successful completion | Within 6 months of hire | |
Intermediate Fetal Monitoring Course - successful completion | Within 6 months of hire | |
NRP - Neonatal Resuscitation Program - Provider or Instructor | Within 6 months of hire | |
3E - 10100 | ||
Acute Dialysis Unit - 16300 | ||
Discharge Unit - 17100 | ||
Medical Observation Unit (MOU) - 16700 | ||
Surgical Trauma Intensive Care Unit - STICU - 13200 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 6 months of hire | |
Neuro Intensive Care Unit - NICU - 13300 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 6 months of hire | |
Medical Intensive Care Unit (MICU) - 13700 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 6 months of hire | |
Critical Care Unit (CCU) - 12300 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 6 months of hire | |
Cardiovascula Intensive Care Unit (CVICU) - 13100 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 90 days of hire | |
M4 - CVSDU/SV Surgical - 11200 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
Centralized Remote Telemetry | BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 90 days of hire |
EKG (Cardiac Monitoring) | BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 90 days of hire |
Flex Pool and Bionic Nurse | BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 90 days of hire |
ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire | |
PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire | |
Central GA Breast Care Center | ||
Infusion Center - 17500 | ||
Cancer Life Center | ||
C3M General Pediatrics -10300 | Association of Pediatric Hemotology Oncology Nurses (APHON) Chemotherapy Course - successful completion | Within 6 months of hire |
PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire | |
Children's Hospital OP Svcs (CHOPS) - 10320 | PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire |
Pediatric Intensive Care Unit (PICU) - 13400 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
Association of Pediatric Hemotology Oncology Nurses (APHON) Chemotherapy Course - successful completion | Within 6 months of hire | |
PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire | |
Pediatric Intensive Care Unit (PICU) Transport Team - 13400 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | On Hire |
PALS - Pediatric Advanced Life Support - Provider or Instructor | On Hire | |
Emergency Nurse Pediatric Course (ENPC) - successful completion | Within 2 years of hire | |
Nursery Intensive Care Unit (NNICU) - 13500 | NRP - Neonatal Resuscitation Program - Provider or Instructor | Within 6 months of hire |
Nursery Intensive Care Unit (NNICU) Transport Team - 13500 | PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire |
Main OR - 15040 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire | |
Just for Today - OP Holding - 15050 | ||
PACU - 15070 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire | |
Guest Relations - Chart Room - 15080 | Within 6 months of hire | |
Endoscopy/Cysto - 15700 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
ASC Pre-Op/Post Op - 15810 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire | |
ASC OR - 15820 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire | |
ASC PACU - 15830 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire | |
Heartburn Treatment Center - 15895 | ||
PICC Service - 17700 | ||
Vascular & Interventional Radiology - 21200 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
Interventional Radiology - 23000 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
Non Invasive Radiology - 23100 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
Advanced Heart Failure - 23410 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 90 days of hire | |
Arrhythmia Center - 23500 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
BRSIC (Basic Rhythm Strip Interpretation Course) - successful completion | Within 90 days of hire | |
Acute Recovery Unit - 23900 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
Central GA Wound-Hyperbaric Med - 25000 | Hyperbaric Oxygen Course - successful completion | Within 1 year of hire |
Emergency Center - 28000 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
Select ECCO modules online | Within 90 days of hire | |
PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire | |
National Institute of Health Stroke Course - successful completion | Within 1 year of hire | |
Quick Meds - | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
PALS - Pediatric Advanced Life Support - Provider or Instructor | Within 6 months of hire | |
Family Health Center - 54300 | ACLS - Advanced Cardiac Life Support - Provider or Instructor | Within 6 months of hire |
Children's Health Center - 54700 | ||
Children's Hema-Onc Center - 54750 | ||
Anderson Health Center - 54900 | ||
Central GA Urogynecology - 54995 | ||
GA Gastroenterology Center - 56605 | ||
Inpatient Hospice - 72930 | ||
Heartworks - 23300 | ||
GA Pediatric Surgical Assoc - 40755 | ||
Physicians - Surgical Oncology - 51105 | ||
NHPG - Hospitalist - 51705 | ||
Pediatric Gastroenterology - 56605 |