Job Description

About NYC Health + Hospitals

NYC Health + Hospitals/Community Care reaches outside the walls of our hospitals and brings health care to patients where they live. With more than 600 dedicated employees, Community Care provides services including home care, community care coordination, and community-based care management to individuals managing chronic health conditions residing in Brooklyn, Manhattan, Queens and The Bronx.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Duties & Responsibilities

PURPOSE OF POSITION

Under the direction of the supervising Assistant Director of Nursing in Community Care, Provides community-based professional nursing care to patients in group and private homes, as well as those without housing across New York City. Diagnoses and treats responses to actual or potential health problems by means of nursing methods and techniques such as case-finding, health teaching, health counseling and the provision of care supportive to and restorative of life and well-being. Assesses, plans, implements, and evaluates the patient’s plan of care. Provides direct skilled nursing care and observes and instructs the patient in their place of residence. May coordinate services of other caregivers.

AREAS OF RESPONSIBILITIES

• Conduct comprehensive health and behavioral assessments, including mental health evaluations, medication management, and physical health status.
• Develop and implement individualized care plans based on patients' medical and behavioral health needs, collaborating with family members, doctors, and therapists.
• Monitor and assist with the administration of psychiatric medications, ensuring proper dosages, educating patients and families about medications, and watching for side effects.
• Provide emotional support, de-escalate behavioral crises, and teach coping mechanisms to patients dealing with conditions such as depression, anxiety, bipolar disorder, or schizophrenia.
• Track patient progress, report on changes in their health or behavior, and modify care plans as necessary. Communicate with healthcare teams to update on the patient's status.
• Educate patients and their families on managing mental health conditions, improving coping skills, and creating routines that promote well-being.
• Work closely with other healthcare professionals, including social workers, therapists, and physicians, to ensure comprehensive patient care.
• Respond to behavioral health crises and provide appropriate interventions, such as de-escalation techniques or emergency referrals.
• Monitor physical health signs such as vital signs, nutrition, and sleep patterns, and provide general nursing care when needed.
• Provides teaching, guidance and direction to allied nursing personnel in rendering patient care. May assist with orientation of new personnel.
• Participates in departmental and interdisciplinary conferences pertaining to policies and procedures affecting nursing practice.
• Participates in development and maintenance of a system of evaluation of nursing care, practices and procedures, including evaluation of nursing personnel.
• Interprets philosophy and objectives of agency and Nursing Department to patients/clients, families and other groups.
• Maintains professional competence through participation in continuing education and other appropriate learning experiences, including agency provided in-service programs.
• Participates in internal/external quality assurance/performance improvement (QA/PI) activities, programs, and training, as required.
• Performs other professional nursing activities and related duties, as delegated by nursing service administration, including clinical record reviews.
• Provides individualized skilled Nursing care to the patients requiring part-time intermittent professional nursing service through the use of the nursing process.
• Provides assessment of patient and develops a plan of treatment and care with ongoing evaluation of patient/family needs for other services.
• Provides professional nursing services as outlined in the patient's plan of treatment and authorized by patient's physician, and provides emergency treatment as needed.
• Records physical, social, psychosocial and environmental needs of the patient. Provide ongoing monitoring of the patient in the home care setting and escalates any clinical changes to the physician or non-physician provider as needed.
• Utilizes input from patient, caregiver, MD and peers to devise a Nursing Care Plan which is feasible within the physical, financial and emotional resources of the patient/caregiver and the Department of Health regulations.
• Evaluates patient's response to plan of care as necessary, consistent with physician's orders.
• Reviews and revises plan of care as necessary, consistent with physician's orders.
• Plans activities necessary for effectuating the timely discharge/transfer of patient, and notifies all appropriate parties including patient's physician.
• Authorize & coordinate all services including nursing, rehab, respiratory therapy, nutritional services, equipment, professional and non-professional staffing and support services.
• Collaborates with case managers and other disciplines regarding the patient’s progress and discharge plans.
• Demonstrates a professional attitude and ethical conduct in compliance with departmental standards.
• Involves the patient and caregiver actively in goal setting.
• Establishes and maintains a cooperative, effective working relationship with the staff, physician and non- physician providers, Case Managers and other hospital personnel, outside vendors, agencies and the community at large.
• Attends weekly to bi-monthly team meetings and participates in case conferences and case load reviews on a weekly to bi-weekly basis.
• When needed completes Physician’s Orders in a timely manner.
• Completes admission paperwork, including OASIS, Physician and Nursing POCs and progress notes within 48 hours of visit encounter.
• Reviews clinical records to ensure compliance with departmental and regulatory standards.
• Obtains written orders for all verbal orders returned.
• Maintain up-to-date patient files with complete records including care plans and re-certifications, reports of all services rendered, progress notes and discharge summaries.
• Writes clean and concise progress notes that reflect the implementation of the plan of care and the patient’s response to that plan of care.
• Competent in knowledge of patient teaching plans and interventions.
• Competent in knowledge of safe administration and teaching medications.
• Demonstrates safety and accuracy in performing treatments and procedures according to the Home Care Department standards of care/practice.
• Competent to complete thorough and accurate nursing assessments.
• Demonstrate competence in skilled nursing interventions.
• Competent in knowledge of documentation requirements for Home Care.
• Participates in case conferences and/or Interdisciplinary Team conferences as needed and as designated by the Clinical Manager.
• Works with other members of the Interdisciplinary Team to develop appropriate interventions in order to achieve clinical and functional goals.
• Participates in the agency’s Quality Assurance Performance Improvement/PIP as assigned.
• Supervises and monitors the care given by home health aides and ensures proper documentation.
• Participates in an interdisciplinary health care team in determining and implementing a comprehensive plan of care.
• Participates in the coordination of other professional and para-professional services in the home and provides supervision as needed and per DOH regulations.
• Provides patient/family/significant other/patient identified representatives with teaching and involves them in assessment activities and goal setting.
• Maintains current, complete, and appropriate documentation in the patient care record. May be required to use computer systems in carrying out these functions.
• Duties include but may not be limited to wound care, including NPWT/VAC, Peg/Trach Care Management, Foley insertion and catheter care management, JP/PleuRx Drain care, administering injections.
• Provides teaching on disease and medication management.
• Obtains photographs for consultation by wound specialists.
• Ability to apply evidence-based practices to the home care setting.
• And other duties as ordered/prescribed.

Minimum Qualifications

QUALIFICATIONS FOR THE JOB

CERTIFICATION(S)/LICENSE(S):

A valid New York State license and current registration to practice as a Registered Professional Nurse in New York State; and

Holds, or obtains through facility orientation, a valid and current certification in Basic Life Support (BLS) through the American Heart Association (AHA); and

One (1) year of experience as a registered nurse; and

Ability to travel regularly to patient/client assignments across New York City via public transportation and/or private vehicle; and

Demonstrated commitment to continued professional development.

EDUCATIONAL LEVEL:

A valid New York State license and current registration to practice as a Registered Professional Nurse in New York State; and

• Bachelor’s of Science degree in Nursing or higher (or other nursing degree, as identified by NYS Education Department including Master of Science in Nursing, Doctor of Nursing Practice, Doctor of Philosophy Degree in Nursing or Doctor of Nursing Science) from an accredited college or university, registered with the NYSED; or
• Obtains a Bachelor’s of Science Degree in Nursing or higher, as described in “a” above, within ten (10) years of the date of initial licensure; and

Holds, or obtains through facility orientation, a valid and current certification in Basic Life Support (BLS) through the American Heart Association (AHA); and

One (1) year of experience as a registered nurse; and

Ability to travel regularly to patient/client assignments across New York City via public transportation and/or private vehicle; and

Demonstrated commitment to continued professional development.

Additional Qualifications

EQUIPMENT/MACHINES OPERATED:

• Smart phone
• Laptop Computer
• Desktop Computer
• Multifunction Copier

COMPUTER PROGRAMS/SOFTWARE OPERATED

• Epic H2O Hyperspace
• Epic H2O Remote Client
• Microsoft Office (Outlook, Word, Excel, PowerPoint, Visio, OneNote)

KNOWLEDGEABLE IN :

• Demonstrated knowledge regarding Federal, State and local regulations and JCAHO standards for Home Care.
• Excellent verbal, written, organizational and analytical skills.
• Demonstrated competence as a registered nurse in patient assessments and critical thinking skills.
• Previous experience using various computer software applications: i.e., Outlook, Word, Excel, Access, etc.

How To Apply

If you wish to apply for this position, please apply online by clicking the "Apply for Job" button or forward your resume to [email protected] noting the above Job ID # 117913.

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Loan Forgiveness Programs for eligible employees
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• College tuition discounts and professional development opportunities
• Multiple employee discounts programs

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