Description
Summary Uses the nursing process and evidence-based practice to collaborate with the Teamlet and larger Team (family/caregiver, internal and community-based services involved in providing care to the patient) in developing and patient -driven holistic care plan for life. Responsibilities - Provides patient and family health education with a focus on self-management, prevention, and wellness, based on the patient's goals. - Follows the patient's personalized health care plan as designated by the patient and Patient Aligned Care Team (PACT). - Demonstrates advanced clinical knowledge in assessing planning, implementing, documenting, and evaluating care for a designated group of patients across the continuum of care - Triages and applies a collaborative team approach in identifying, analyzing, and resolving patient care problems. - Time management skills and excellent communication skills which enhance the nurse's ability to effectively work with others to facilitate the day-to-day mission of the clinic. - Patients are to be triaged in a timely manner within 45 minutes of check in time and appointment is to be completed within 30 minutes. - Provides indirect patient care in collaboration with the interdisciplinary team; serves as clinical resource expert; and functions as an educator for the team and patient. - Functions as a systems coordinator; monitors progress and intervenes as necessary to ensure that patient outcomes are achieved within anticipated timeframes. Monitors progress along clinical pathways, analyzes variations and initiates appropriate actions. - Is a role model in the provision of excellent customer service. - Reviews Message Manager and assist Team to address/complete pending alerts communicated throughout tour of duty to facilitate care and address needs of the caller within 48 hours. - Completes and documents Nursing Notes in CPRS, as applicable, in a timely manner and closes the Encounter Notes for patients not seen by a provider. Notes will be closed by the end of tour of duty daily. Areas to be addressed include: Encounters: reasons for visit-Service Connection; Primary assignment-Service connected conditions under the Diagnosis tab; Procedures, ACSC conditions, etc. - Completes all clinical reminders that may be completed by the RN or LVN prior to the due date. - Provides Care Management to patients with Ambulatory Care Sensitive Conditions (ACSCs) including reviewing the patient record, decide if the patient needs more in-depth education (formal and/or informal); nursing visits and/or telephone calls between provider visits to assist in care management. Collaborates with the High Risk Care Coordinators, Home Telehealth, social work, and/or dieticians for referrals and care management. - Complete the Blood Glucose meter check daily, as applicable. After completing quality check, if applicable, and entering correct patient information for testing. - Completes and documents secure messaging within 72 hours. Surrogate is identified at all times. Escalation of secure messaging must be maintained at 10% or less. Diverts messages to appropriate care lines as needed. Alerts MyHealtheVet coordinator for assistance to prevent incomplete or escalation of messages. - Provides patients with personalized, proactive, and patient-driven health care through such activities as assisting in developing a personal health plan, listening to the patient and addressing their needs/goals, engaging in group appointments, encouraging and supporting Telehealth modalities, and creating an environment that benefits the veteran. - Delivers patient centered care to all patients and employs population health management principles to optimize health and wellbeing for the patient through such activities as use of evidenced-based practice recommendations, completing clinical reminders, tracking high risk behaviors, maintains an awareness of access with an awareness of third next available appointments and assisting the patient to develop coping mechanisms, assisting the patient to identify health care goals and actions to take to meet those goals and evaluating progress. - Actively educates the patient and family on health promotion and disease prevention strategies and options for care and treatment. Other duties as assigned VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for performance awards Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year) Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Licensure: 1 full and unrestricted license from any US State or territory Work Schedule: Monday-Friday, 08:00am-04:30pm Telework: Available Ad Hoc Only Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Requirements Conditions of Employment U. S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA. Selective Service Registration is required for males born after 12/31/1959. You may be required to serve a probationary period. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Must pass pre-employment physical examination. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Veterans Health Administration Health Care Personnel (HCP) - See "Additional Information" below for details. Qualifications Basic Requirements: English Language Proficiency. In accordance with 38 U. S. C. 7403(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge pro
Compensation Information:
$0.0 / - $0.0 /
Starting At: 0.0
Up To: 0.0
Apply on company website
Find Connections via Linkedin
