The primary purpose of the Integrated Care Nurse is to serve patients in the serious mental illness intensive outpatient program as part of an integrated health team to provide care assessment and promote and support restoring a patient's mental and physical health through collaboration with physicians, nurse practitioners and multidisciplinary healthcare team members. The Integrated Care Nurse will ensure delivery of whole health care to patients including collaboration and referral to care team for community social service and behavioral health supports that will ensure quality mental health care for patients of ARH’s intensive outpatient program. The position will supervise assigned team members and students. The Integrated Care Nurse position requires substantial specialized knowledge, judgement and nursing skills based upon the principles of psychological, biological, physical, and social sciences in the application of the nursing process. If transportation is offered by the hospital, the Integrated Care Nurse will assist with transportation of patients from assigned destinations to pick up and deliver patients and/or supplies and may be required to assist patients in and out of vehicles. |
• Completes patient assessments and consultation if requested by psychiatric provider to obtain detailed psychological history and risk factors assessing psychological and social needs. formulates plan of care, oversees implementation of plan of care, evaluate and adjust plan of care utilizing critical thinking skills
• Develops care plans in collaboration with the patient and his/her care team that is reflective of patient’s goals and that provides support and/or referrals service that will aid the patient in achieving set goals and objectives.
• Lead educational groups and individual nursing education and self-management skills to targeted populations with mental health conditions, behavioral health concerns and other health related conditions that impact bio-psychological health and functioning.
• Performs, supervises, delegates and follows-through overseeing other personnel in the performance of activities relating to nursing care. (Medication administration, patient observations, as well as other skills performed by the Licensed Practical Nurse, Certified Nursing Assistant, Unit/Clinic Clerk, and students as ordered by a LIP.
• Mentors and precepts students and orient new staff as assigned
• Participates on various teams, committees or performance improvement initiatives
• Participates in Treatment Team /Discharge Planning and Transition of Care (able to define pt needs)
• Serves as a patient advocate and escalates patient related concerns timely.
• Responsible for maintaining accurate electronic patient records while remaining in compliance with all HIPAA and confidentiality policies and procedures. Timely documents pertinent findings in medical record
• Maintains exceptional level of customer service; address and resolve complaints; serve as an example by providing excellent service to internal and external customers, employees, and visitors.
• Practices Hands Off communication utilizing SBAR. Coordinates and documents clients’ care in cases of medical or psychiatric emergency, providing a report to the Emergency Department or other appropriate resource.
• Assist patients in performing activities of daily living and functions as an active team member
• Utilizes effective communication skills and active listening, exhibits compassionate and empathetic attitude
• Assumes responsibility for personnel professional development
• Respects dignity and confidentiality of all matters relating to patients
• Functions as a positive influence, role model and adheres to professional code of conduct
• Refer to Special Addendum and Staff
• Performs other job duties as assigned.
• Reports up chain of command Clinical Nurse Manager/Nurse Manager/House Nurse Coordinator pertinent information
• The performance of other nursing acts which are authorized or limited by the board, and which are consistent either with American Nursing’s Association Standards of Practice or with Standards of Practice established by nationally accepted organizations of registered nurses.
• Coordinates clients’ meals and transportation as requested or in absence of Unit Clerk.
• Arrives at work on time and when scheduled and prepares to start patient pickup/delivery runs on schedule as specified by supervisor.
• Maintains work area in a clean and safe manner.
• Drives van as needed for patients requiring transportation to and from program appointments and/or rides in the van with the driver.
• Assists patient(s) on and off the van following hospital and program fall policy and procedure.
• Drives van as requested, greets all passengers in friendly, courteous and helpful manner.
• Responds to passenger requests conforming to procedure guidelines, listens politely and attentively to all requests answering, when appropriate, or communicating the request to supervisor/designee for direction.
• Opens doors and physically assists all passengers on and off the vehicle.
• Stresses the need for and enforces utilization of passenger seat belts for passenger safety.
• Other duties, as assigned.
Minimum Education
• Associate’s degree in nursing
Minimum Work Experience
• 1 year of psychiatric nursing experience preferred
Required Licenses/Certifications
• Registered Nurse
• Basic Life Support Certification, First Aid Certification and Hospital preferred de-escalation training. All certifications can be provided on the job.
Required Skills, Knowledge and Abilities
Ability to work collaboratively.
Mastery of problem solving and decision making skills.
Strong organizational and time-management skills, with the ability to manage a caseload and meet deadlines.
Ability to maintain confidentiality and uphold client privacy in accordance with legal and ethical standards.
Ability to consider the relative costs and benefits of potential actions to choose the most appropriate one.
Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.
Knowledge of phases of care transitions, local community resources and networks.
Master of digital literacy skills.
Demonstrate a willingness to learn and an interest in acquiring new skills.
Proficient in administering and monitoring psychiatric medications, including long-acting injectables, while observing for efficacy and adverse reactions, as applicable.
Proficient with medical and psychological terminology.
Ability to communicate effectively and document information accurately.
Ability to communicate in English, both orally and written.
Must be well organized and function well under stressful conditions.
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