Under the supervision of the department of nursing, this position as a licensed registered nurse bears responsibility and accountability for the nursing care. Inherent in the practice is the nursing process, the assessment of the patient status, the plan of nursing actions, the implementation of that plan, and the evaluation of the plan. The registered nurse assesses, and monitors clients’ health status and physical care needed at admission and while clients are in the program. The registered nurse performs comprehensive assessments, takes off physician’s orders, monitors- reconciles medications and provides health education for clients and families as needed or requested. They function as a member of the Multidisciplinary Treatment Team and perform administrative, clerical, and other tasks according to program policy. They demonstrate professionalism in all aspects of performance.
1. Performs comprehensive admission assessment to obtain presenting complaints, history, listing all medications.
2. Prepares patient’s Medication Administration Record (MAR) listing all Allergies and notes response to medications.
3. Develops a nursing plan of care, implements and documents nursing interventions that are part of the Multi-Disciplinary Treatment Plan.
4. Consults with Medical Director/Provider, Psychiatrist, Therapists and other Healthcare providers in Multi-Disciplinary Treatment Plan.
5. Attends Treatment Team meetings to discuss and update Nursing Care Plan section of Multi-Disciplinary Treatment Plan.
6. Initiates and conducts individual and group nursing education sessions.
7. Checks for consents.
8. Assists patient in understanding their diagnosis and accepting need for treatment.
9. Communicates relevant clinical and other client care information to Program Director (or organization’s equivalent), Medical Director/Provider and Treatment Team members as necessary and appropriate.
10. Monitors clients on an ongoing basis to identify health needs, problems, and/or symptoms.
11. Provide prompt efficient and responsive patient care.
12. Coordinates and documents clients’ care in cases of medical or psychiatric emergency, providing a report to the Emergency Department or other appropriate resource.
13. Educates clients regarding bowel activity patterns to maintain regularity, prevent constipation and impaction.
14. Monitors, observes and records patient behaviors.
15. Participates in the completion of maintenance of clients’ medical records.
16. Monitors environment of care to ensure a safe and secure area for patient, staff and visitors.
17. Participates in unit QAPI activities per leadership request.
18. Provides patient, family, and caregiver’s education on health-related topics.
19. Assists clients with personal care needs (bathroom, etc.) as needed or requested.
20. Coordinates clients’ meals and transportation as requested or in absence of Unit Clerk.
21. Will complete other duties as assigned by Program Director.
Graduate of an:
Accredited College/School of Nursing, with an Associate or Bachelor’s degree.
Current state licensure as RN.
AGE SPECIFIC COMPETENCIES:
Demonstrates knowledge, skills, and behaviors appropriate to the populations (s) served, and meets specific criteria and/or specific considerations, as follows:
The employee will be required to perform the following physical activities in the performance of their job duties: