Registered Nurse

Job Description

About the Job

Department: Stepdown Intermediate Care 009

Schedule: Day Job

Hospital: Henry Ford Health Genesys

Location: Grand Blanc, Michigan

General Summary

As a Registered Nurse at Henry Ford Health Genesys, you will exercise independent professional judgment and analytical skills, applying the nursing process to deliver a comprehensive range of delegated, interdependent, and independent nursing services to patients.

Within the established framework of the Seven Dimensions of Patient Care and Benner’s Domains of Nursing Practice, you will demonstrate:

• Clinical competence
• Compassion and customer service orientation
• A focus on process and outcomes
• Cost-consciousness

These attributes are crucial when assessing, planning, implementing, and evaluating the nursing care provided to all patients.

Key Responsibilities

Patient Care Coordination & Philosophy

• Coordinate development of a multi-disciplinary plan of care in accordance with Nursing Problem Care Sets (Core Outcomes and Core Intervention Sets) and/or clinical practice guidelines, age-specific requirements, and professional and regulatory requirements to ensure appropriate length of stay, use of resources, and achievement of quality outcomes.
• Provide patient care that reflects a respect for patient’s rights, dignity, values, culture, preferences, and expressed needs.
• Assess patient/family needs for information and education across the continuum, plan and implement patient teaching using a variety of techniques and methods, and evaluate the effectiveness of educational interventions.
• Help to alleviate patient fears and anxiety through skillful application of professional and interpersonal communication.
• Utilize a variety of pharmacologic and non-pharmacologic approaches to ensure patient comfort and relief of pain.
• Involve the patient, family, and significant others in the development of the plan of care.
• Collaborate with patient/family, hospital staff, and community agencies to develop discharge plans that prepare patients for continued care needs.

Assessment & Planning

• Complete an Admission Assessment and shift assessment as required.
• Perform ongoing reassessment as required.
• Assess health status and determine care needs of the patient.
• Complete assessment for Risk Factors, including fall, skin breakdown, VTE, and aspiration. Initiate appropriate initiatives as indicated (e.g., SKINN Bundle, Fall Prevention Plan, SCD).
• Complete Medication Reconciliation upon admission and change in level of care.
• Establish, direct, coordinate, and document the plan of nursing care in conjunction with patient/family.
• Initiate Problems and Outcomes list (plan-of-care) based on medical diagnosis and patient needs.
• Monitor, document, and report patient response to interventions and progress toward outcomes.
• Document nursing interventions (NIC) and progress toward outcomes (NOC); patient education; and evaluation every shift, as required.

Patient Education & Discharge

• Incorporate all elements of Signature Care in daily interactions with the patient:
  • Introduce self and write name on whiteboard.
  • Discuss plan of care with patient/family.
  • Explain medications and treatments, provide teaching as appropriate.
  • Ask if patient needs anything else before leaving the room.
• Educate the patient regarding treatment plan, safety measures, medications, and self-care as indicated. Document education activities on shift assessment flowsheet and plan of care (POC).
• Work with the Case Manager to ensure appropriate referrals are initiated prior to discharge.
• Review discharge plans/instructions with the patient prior to discharge, including signs/symptoms to watch for after leaving the hospital. Ensure appropriate follow-up is arranged.
• Ensure that core measures Discharge Instructions are given to all CHF patients.
• Document patient care according to established documentation guidelines.

Administration of Therapeutic Regimens

• Demonstrate knowledge and skill application of basic nursing procedures (e.g., dressing change, catheterization, NG tube insertion, suctioning).
• Implement/complete medical interventions as ordered. Initiate standing orders appropriately.
• Initiate and/or assist with all patient care activities, including activities of daily living, and provide other services as required for patient comfort, safety, and well-being.
• Assess and initiate interventions to prevent/minimize patient skin breakdown.
• Follow clinical practice guidelines and procedures as written.
• Establish and maintain peripheral IV therapy.
• Obtain body fluid specimens, per procedure.
• Obtain blood specimens if no phlebotomist is assigned to the area.
• Perform blood capillary glucose monitoring.
• Administer the following according to established policies and procedures:
  • Medications
  • IVs
  • Blood products
• Prepare patients for surgery or other invasive procedures according to established guidelines.
• Perform or assist with procedures according to established standards of care and nursing practice.
• Utilize equipment based on manufacturer’s instructions and established nursing procedures. Correctly operate and troubleshoot IV pumps, PCA pumps, epidural pumps, feeding pumps, and patient beds, as applicable.

Monitoring Patient Responses & Responding to Changing Patient Situations

• Regularly review work in progress to ensure that treatments, medications, and tests ordered are expeditiously carried out and documented.
• Review patient medical record/reports and confer with physicians regarding treatment plans. Routinely check the chart for new orders.
• Monitor patient physiologic parameters including vital signs, lab work, I&O, blood glucose; recognize and report meaningful changes and intervene appropriately. Document interventions accordingly.
• Monitor presence and intensity of patient’s pain on admission, after pain-producing events, with each new report of pain, and routinely at regular intervals.
• Inform the patient about pain relief and pain relief measures; administer pain medication or alternative interventions as indicated; include pain management resources in the discharge plan/instructions.
• Recognize acute changes in respiratory status (dyspnea, cyanosis, tachypnea, respiratory depression, airway obstruction) and respond appropriately with direct intervention and physician/SWAT notification.
• Recognize acute changes in neurologic status/decreased LOC and respond appropriately with direct intervention and physician/SWAT notification.
• Recognize acute changes in cardiac status (tachycardia, chest pain) and respond appropriately with direct intervention and physician/SWAT notification.
• Recognize acute changes in urinary output and respond appropriately with direct action and physician notification.
• Utilize SBAR tool or other standardized approach to data collection and information sharing when notifying the physician of patient changes/concerns.
• Respond appropriately to life-threatening emergencies through initiation of CPR, assembly of emergency equipment, and immediate interventions (as allowable and indicated).
• Perform emergency equipment checks.
• Provide appropriate support/summon appropriate resources for families in crisis/grieving process.

Ensuring Quality of Health Care Practices

• Communicate with other professionals/departments and physician staff to ensure appropriate progress of patients through the system.
• Monitor individual patient length of stay (LOS); notify case manager and nurse manager of potential LOS/discharge issues.
• Identify ethical issues related to patient care (including issues related to advanced directives) and initiate steps for resolution.
• Demonstrate adherence to patient confidentiality requirements.
• Communicate with patients and families cordially, diplomatically, and respectfully.
• Act to resolve customer concerns/complaints immediately; report complaints that cannot be immediately resolved to the Patient Care Director, Clinical Manager, or House Supervisor.
• Promote a physically safe environment for the patient, including the use and documentation of restraints according to policy.
• Utilize universal precautions for all patients.
• Make cost-effective use of supplies and resources.
• Assist in evaluating new products, procedures, and nursing practices.
• Support organizational, nursing department, and unit strategic goals and activities; participate in department and unit-based council/staff activities meetings.
• Support and actively participate in Nursing Department and unit-specific quality monitoring and quality improvement activities.
• Participate in teaching/mentoring of student nurses and orientees.
• Evaluate own performance utilizing input from peers, co-workers, managers, physicians, and customers, and develop a plan for continual improvement (Does not include formal peer review).
• Complete yearly safety and unit-specific education requirements (GLI).

Organizational and Work Role

• Provide input on appropriate patient care assignments, taking into consideration patient condition and the knowledge/experience/workload of staff.
• Provide direction and leadership to other staff by:
  • Clearly communicating expectations/responsibilities to team members.
  • Observing patients and work in progress periodically throughout the shift.
  • Communicating with team members about work to be completed/problems encountered.
  • Assisting team members with patient care activities as needed.
  • Assisting other “teams” as the situation requires.
• Use the 4 Ps (patient, pertinent issues, picture, plan) to give appropriate and pertinent information at change-of-shift and/or transfer.
• Participate in the creation and maintenance of a healthy work environment by:
  • Treating co-workers with respect.
  • Communicating to co-workers with respect; resolving conflicts and/or negative feelings promptly, privately, and appropriately.
  • Taking responsibility for personal actions, behaviors, and attitudes and not displacing anger or frustration onto co-workers, patients, or families.
  • Communicating appropriate patient care issues/concerns to the nurse manager.
• Respond appropriately to changes in unit workloads, patient census, and/or staffing levels.
• Possess interpersonal skills necessary to interact with patients/families, other nursing staff members, physicians, and other hospital personnel.
• Ability to concentrate and pay close attention to detail when planning and performing professional nursing care, resolving patient care problems, and dealing with patients and families; often during stressful situations.
• Ability to walk or stand continuously and frequently lift and position patients.

Working Conditions

Normal patient care environment with moderate exposure to excessive noise, dust, temperature, etc. Frequent exposure to communicable diseases, hazardous substances, and moderately adverse working conditions due to performance of patient care activities.

Orientation Requirements

This position, aside from the above requirements, will require approximately three (3) to nine (9) months on-the-job experience in order to acquire and effectively apply knowledge of unit and departmental policies, procedures, and standards for patient care and professional nursing practice.

The above is intended to describe the general nature and level of work performed by people assigned to this classification. It is not to be construed as an exhaustive statement of duties, responsibilities or qualifications for the people so classified, nor is it intended to limit or modify in any way, the right of any supervisor to assign, direct, and control the work of employees under their supervision. The most recently dated job description on file in the Human Resources Department will be considered the official job description.

Education/Experience Requirements

• Licensed Registered Nurse credentialed from the Michigan Board of Nursing obtained within 2 Months (60 days) of hire date or job transfer date required.
• Certified BLS Provider specializing in Basic Life Support credentialed from the American Heart Association (AHA) obtained within 3 Months (90 days) of hire date or job transfer date required. Or Certified Instructor.
• Education: Requires a graduate of an approved professional (RN) nursing program.
• No additional preferences.

Additional Information

• Organization: Henry Ford Health Genesys Hospital
• Department: Stepdown Intermediate Care 009
• Shift: Day Job
• Union Code: MIGRA Teamsters RN Local 332