Registered Nurse Applicant (Hemodialysis)

Job Description

Job Title: Registered Nurse Applicant (Hemodialysis)

The Registered Nurse Applicant functions as a vital part of the hemodialysis healthcare team, operating under the direction or supervision of a Staff Registered Nurse. This role is crucial for ensuring the daily provision of quality patient care in strict accordance with FMS policies, procedures, and training. The incumbent will uphold FMCNA’s mission, vision, values, and customer service philosophy, actively supporting the FMCNA commitment to the Quality Enhancement Program (QEP) and Continuous Quality Improvement (CQI) Activities, including those focused on patient satisfaction. Active participation in process improvement initiatives aimed at achieving FMCNA Quality Enhancement Goals (QEP) is expected. Adherence to all requirements of the FMCNA Compliance Program and FMS patient care and administrative policies is mandatory. A critical requirement for this position is to obtain a nursing license and registration within the timeframe outlined by state-specific regulations, or within 90 days from the hire date, whichever comes sooner.

Principal Duties and Responsibilities:

Staff Related:

• Directs Patient Care Technicians: Guides Patient Care Technicians in the safe and effective delivery of chronic hemodialysis therapy, ensuring compliance with facility policy procedure manuals and corporate, state, and federal regulations.
• Delegates Tasks: Assigns tasks to all direct patient care staff, including but not limited to LVN/LPNs, Patient Care Technicians, and Dialysis Assistants.
• Assesses Patient Care Needs: Daily evaluation of patient care requirements to develop appropriate patient care assignments.
• Monitors Staff Performance: Routinely observes patient care staff for appropriate techniques and adherence to facility policies and procedures.
• Participates in Training: Engages in staff training and orientation of new personnel as assigned.
• Attends Meetings: Participates in all required staff meetings as scheduled.

Patient Related:

Education:

• ESRD Education: Ensures patients and their families receive comprehensive education regarding End Stage Renal Disease (ESRD).
• Ongoing Patient Education: Provides continuous education to patients on their renal disease, vascular access, dialysis therapy, and related health conditions.
• Compliance Discussion: Discusses and records patient education pertaining to diet/fluid and medication compliance.
• Adequacy Measures Education: Delivers patient-specific detailed education on adequacy measures where applicable, such as Online Clearance Monitoring (OLC), Adequacy Monitoring Program (AMP), and Urea Kinetic Modeling (UKM).
• Modality and Access Awareness: Promotes transplant awareness, modality awareness, and initiatives for catheter reduction.
• Laboratory Value Education: Educates patients on laboratory values and their relationship to adequate dialysis therapy, compliance with treatment schedules, medications, and fluid intake.

Dialysis Treatment:

• Safe Care Delivery: Provides safe and effective delivery of care to patients with ESRD.
• Accurate Treatment Implementation: Precisely implements treatment prescriptions, including Sodium (Na) modeling and Ultrafiltration modeling (where appropriate), to ensure stable treatment therapy.
• Patient Response Assessment: Assesses patients’ response to hemodialysis treatment therapy, making appropriate adjustments and modifications to the treatment plan as indicated by the prescribing physician. Communicates problems or concerns to the Team Leader or physician.
• Issue Identification: Identifies and communicates patient-related issues to the Team Leader or physician.
• Nursing Assessment: Initiates Initial and Annual Nursing Assessments, and conducts ongoing evaluation and documentation of patient care needs according to FMC Policies and Procedures.
• Treatment Cycle Participation: Actively participates in the pre-evaluation, initiation, monitoring, termination, access hemostasis, and post-evaluation of patients receiving hemodialysis treatment therapy following established FMC procedures.
• Adequacy Intervention: Takes appropriate intervention for changes in patient adequacy status and troubleshoots access flow issues identified by OLC/AMP yellow lights.
• Access Care: Provides, supervises (if applicable), and monitors hemodialysis access care according to established procedures.
• Transfusion Management: Implements, administers, monitors, and documents patient’s response to prescribed interdialytic transfusions, including appropriate notification of adverse reactions to the physician and relevant blood supplier.
• Documentation Oversight: Ensures accurate and complete documentation by Patient Care Technicians on the Hemodialysis Treatment Sheet.

Laboratory-related:

• Order Transcription: Reviews, transcribes, and accurately enters physician lab orders into the Medical Information System.
• Requisition Preparation: Ensures appropriate preparation of lab requisitions for Spectra or alternate lab.
• Specimen Collection & Processing: Ensures correct lab tubes are utilized for prescribed lab specimens and that lab draw and processing procedures are performed appropriately for all lab samples.
• Missed Labs Follow-up: Identifies and ensures appropriate follow-through regarding missed labs and specimens reported as insufficient, adhering to company policies and procedures.
• Specimen Packaging: Ensures all specimens are appropriately packaged according to Department of Transportation (DOT) policies and procedures for the shipment of blood/body fluid specimens and potentially hazardous material.
• Lab Delivery: Ensures all labs are directed and delivered to the appropriate laboratories.
• Result Reporting: Reports alert/panic and abnormal lab results to the appropriate physician.
• Physician Lab Forwarding: Ensures lab results are forwarded to physicians as requested.

General Duties:

• Policy Enforcement: Enforces all company-approved policies and procedures, as well as regulations set forth by state and federal agencies and departments.
• Shift Operations: Maintains overall shift operation in a safe, efficient, and effective manner.
• Resource for Staff: Acts as a resource for other staff members.
• Clinical Manager Collaboration: Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and information.
• Healthcare Team Collaboration: Collaborates and communicates with physicians and other members of the healthcare team to interpret, adjust, and coordinate patient care.
• Prescription Refills: Provides assistance as needed to patients regarding prescription refills according to FMCNA Policies.
• Physician Order Entry: Ensures all physician orders are transcribed and entered into the Medical Information system in a timely manner.
• Documentation Oversight: Oversees all patient information documentation.
• Drug List Maintenance: Maintains the facility drug list for all required stock medications.
• Emergency Preparedness: Maintains competency with all emergency operational procedures and initiates CPR and emergency measures in the event of a cardiac and/or respiratory arrest.
• Emergency Equipment: Ensures verification and availability of adequate emergency equipment.
• Vaccinations & TB Testing: Ensures provision of appropriate vaccinations, immunizations, and annual Tuberculosis (TB) testing.
• Medication Administration: Administers medications as prescribed or in accordance with approved algorithm(s), documenting appropriate medical justification if indicated.
• PRN Medication Management: Administers PRN medications as prescribed and completes appropriate documentation of assessment of effectiveness.
• Controlled Substances: Maintains appropriate recording of controlled substances as required by law.
• Transportation Coordination: Assists with the coordination of patient transportation if necessary.

Maintenance/Technical:

• Clean Environment: Ensures a clean, safe, and sanitary environment in the dialysis facility treatment area.
• Equipment Competency: Ensures competency in the safe and effective operation of all dialysis-related equipment.
• Station Cleanliness: Ensures all patient stations, including machines and chairs, are clean, free of blood, and appropriately positioned.
• Blood Spill Protocol: Ensures that all blood spills are immediately addressed according to FMCNA Bloodborne Pathogen Control Policies.

Medical Records & Documentation:

General:

• Data Documentation: Ensures all relevant data, including physician orders, lab results, vital signs and treatment parameters, and patient status, are documented appropriately and entered into the Medical Information System.
• Treatment Data Entry: Ensures all appropriate patient-related treatment data is entered into the Medical Information System.
• Admission/Transfer/Discharge: Ensures all FMCNA policies regarding patient admission, transfer, and discharge are appropriately implemented.
• PST Documentation Verification: Ensures and verifies the accuracy of Patient Care Technician documentation.

Daily:

• Hemodialysis Treatment Sheets: Reviews and ensures appropriate daily completion of Hemodialysis Treatment Sheets by all patient care staff.
• Opening/Closing Procedures: Ensures that all appropriate procedures are followed regarding opening and closing, including monitoring that all staff and patients have safely left the premises.

Monthly:

• CQI Activities: Initiates, documents, and completes ongoing Continuous Quality Improvement (CQI) activities, including monthly reports.
• Nurses’ Progress Note: Completes monthly nurses’ progress note.
• Medical Record Completeness: Ensures patient medical records are complete with appropriate information, documentation, and identification on each page (Addressograph label is on all chart forms).
• Transplant Status Review: Reviews transplant status and follows established procedures regarding appropriate action to be taken.
• Patient Care Plans: Completes patient care plans for new patients within the initial 30 days or for any patients deemed unstable requiring monthly patient care plans.
• Long-Term Programs: Completes any long-term programs that are due.

Annually:

• Nursing History and Assessment: Completes initial and annual Nursing History and Assessment physicals.
• Standing Order Review: Ensures completion of Annual Standing Order Review with each physician as required.

Other:

• Credential Maintenance: As a condition of continued employment, you are required to obtain and maintain any required credentials or certifications necessary for your position in an active and valid status (including renewal prior to any expiration date). Any change in credential or certified status must be immediately reported to your supervisor.
• Challenging Environment: Capable of working in a challenging environment that demands handling difficult situations, multitasking, and remaining flexible to changing needs.
• Attendance: Maintains regular and punctual attendance.
• Assigned Duties: Performs other related duties as assigned.

Additional responsibilities may include focusing on one or more departments or locations. See applicable addendum for department or location-specific functions.

Physical Demands and Working Conditions:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This position provides direct patient care that regularly involves heavy lifting and moving of patients and assisting with ambulation. Equipment aids and/or coworkers may provide assistance. This position requires frequent, prolonged periods of standing, and the employee must be able to bend over. The employee may occasionally be required to move, with assistance, machines and equipment of up to 200 lbs., and may lift chemical and water solutions of up to 30 lbs. up as high as 5 feet. The work environment is characteristic of a healthcare facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials. Employees are required to take the Ishihara’s Color Blindness test as a condition of employment. Note that failing the Ishihara Test for Color Blindness does not preclude employment; the Company will consider whether reasonable accommodation can be made.

Supervision:

None.

Education and Required Credentials:

• Graduated from an accredited nursing program within the past 12 months.

Experience and Skills:

• Required to obtain nursing license and registration within the timeline defined by state regulations, or within 90 days of hire, whichever occurs first.
• Current appropriate state Temporary Permit.
• Must meet the practice requirements in the state in which he or she is employed.

EOE, disability/veterans