Summary:
Under general supervision, delivers care to patients utilizing the nursing process of assessment, planning, intervention, implementation, and evaluation, in accordance with established protocol and / or as ordered by the emergency room physician. Works in cooperative effort with physician and other members of clinical staff to ensure effective patient care delivery and achievement of desired patient outcomes. Effectively interact with patient and significant others, while maintaining the standard of professional nursing. Provides care for patients presenting with various types of illnesses and/or injuries requiring emergency attention and must be able to recognize and effectively treat life-threatening conditions.
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:
FACILITY OPERATIONS
Clinical
- Provides direct and individualized nursing care to patients based on the application of scientific nursing principles. In addition to general nursing care, responsibilities include (but are not limited to):
- Collects information regarding chief complaint and / or current symptoms, as well as a detailed patient history, and documents findings in the patient medical record. Reports findings to the healthcare provider.
- Consults and coordinates with health care team members to assess, plan, implement and evaluate patient care plans.
- Performs triage and assessments, while considering both physical and psychosocial elements
- Manages basic life support needs and stabilizes patients until the attending physician is available, based upon nursing standards and protocol.
- Initiates corrective action whenever information from monitoring equipment shows adverse symptomatology.
- Documents nursing care as appropriate in the patient medical record.
- Works directly under physicians, assisting them during exams, procedures, diagnostic testing and treatments.
- Prepares and administers medications as ordered by the physician, (oral, subcutaneous, intravenous / infusion, intramuscular) and records administration and such other relative data in the medical record. Reports adverse reactions to medications or treatments in accordance with the policy regarding the administration of medications by a licensed registered nurse
- Provides IV infusion / therapy in accordance with physician orders, performs 12-lead EKG, venipuncture and IV initiation, blood draws, cardiac and pulse oximetery monitoring, applies oxygen using the appropriate delivery system, administers nebulized treatments.
- Assists physician with management of critical patients
- Assists physician with procedures including but not limited to laceration repair (any complexity), any procedure requiring moderate sedation, Incision and Drainage (I &D), cardiac arrest, intubation, chest tube insertion, foreign body removal (any part of the body), live birth or spontaneous aborted fetus and tissue, records time of death and birth, assists Administration in reporting death in the emergency room as needed
- Keeps accurate records of procedures, including moderate sedation flow sheet, CPR/Code Blue flow sheets/record
- Maintains and makes appropriate and correct entries into applicable clinical logs and records as required by facility policy and procedure.
- Cleans and bandages wounds, applies splints.
- Reviews discharge instructions with the patient and, as needed, provides patient education and training including wound care, crutch training, use of nebulizers or inhalers, and other types of training.
- Reviews all discharge instructions with patient and take vital signs prior to discharge to ensure patient is stable and records results in the patient medical record.
- Provides basic, bedside nursing care.
- Assists administration in maintaining proper / par-level supplies and appropriate medical equipment to care for patients.
- Reports any suspected abuse to the appropriate agencies.
- Initiates patient education plan, as prescribed by physician. Teaches patients and significant others how to manage their illness/injury, by explaining: discharge instructions, post-treatment home care needs, diet/nutrition/exercise programs, self administration of medication and rehabilitation, as well as provides referrals to other healthcare professionals for follow-up treatment.
- Displays professionalism while completing multiple urgent tasks in a timely manner.
- Records all care information concisely, accurately and completely, in a timely manner, in the appropriate format and on the appropriate forms.
- Performs other position-related duties as assigned, depending on assignment setting.
- Reports safety violations, work injuries, or work hazards to administration.
- Accounts for on hand narcotics amounts at each shift change in the presence of a qualified healthcare professional, i.e., RN, physician and records narcotic count into appropriate log.
- Logs medication inventory and removal of medications for administration as required by pharmacy policy and ensures security of the pharmacy during shift.
- Provides proper shift change communication report to proper relief and remains on shift until properly relieved by employee of equal licensure or certification.
- Complete all necessary chart nursing documentation in accordance with policy. Documentation must be legible and in English.
- Performs quality assurance reviews of charts as designated by administration.
- Maintains all required certifications and licenses as required by the 25 TAC §131.45.
- Maintains all clinical proficiencies and annual training as required by facility policy.
- Also performs other clinical services, where qualified and competent which may include but not be limited to the following: Laboratory a. Performs duties as assigned for venous blood draws for blood and body fluid samples. Uses drawn samples to perform and complete such laboratory point of care testing and send out labs as ordered by the on duty physician. b. Reports abnormal lab testing to the health care provider as soon as possible and without delay. c. Posts such completed lab results to the chart. d. May perform or assist with daily/monthly QC’s to ensure proper performance and compliance in the laboratory. e. Fulfills requirement of annual laboratory proficiency testing. f. Reports and documents any diversion from normal lab operations or incidents to the Nurse Director, i.e., exposures, incidents, spills, injuries, etc.
COMPLIANCE
- Maintains confidentiality of patient related issues as outlined by HIPAA and company policies.
- Works in cooperation with other administrative and facility staff to ensure compliance with HIPAA rule and standards as applicable to patient medical records, patient care, and diagnostic testing to include but is not limited to patient medical charts, radiology reads/results and other protected health information (PHI).
- Ensures emergency room and treatment areas operate within the compliance standard with Federal, State and if applicable, accrediting agencies.
- Successfully completes all required competency testing as required for position with the emergency room.
- Shall fully comply with the guidelines set forth in the Infection Control and Prevention Program and any applicable Center for Disease Control (CDC) requirements relative to the operations of the facility.
- Reports all conditions and injury as required by state, federal and local laws including but not limited to reportable diseases, notifiable conditions, animal bites, sexual assaults, abuse, neglect and others as required by law.
- Be required to undergo and successfully complete periodic review and on-site skill / proficiency testing.
- Ensures operation and processes of the emergency room and treatment areas including any applicable standards of care are maintained at the highest possible level in all aspects in the areas of quality assurance, patent and life safety.
RISK MANAGEMENT/QUALITY ASSURANCE
- May assist the Nurse Director in completing or producing various clinical reports.
- Performs medical record quality assurance reviews of nursing notes and documentation for accuracy and completion and reports deficiencies to Nurse Director.
- Ensures all diagnostic test results and other portions of the patient char have been reviewed by the attending physician and then properly reconciled to the patient medical record.
- Assists the Nurse Director in other clinical duties as needed.
- Reports any violations of policies and procedure, including any incidents of over Infection Control, Patient Safety, Safety Violation and Hazards to Administration.
- Works in cooperation with other administrative and facility staff to ensure overall departmental compliance topics and matters directly and indirectly related to quality assurance; risk management and life safety as applied to patient care and employee safety
ENVIRONMENT OF CARE/LIFE SAFETY / PATIENT SAFETY
- Abides by the Safety and Environment of Care policies and procedures of the facility.
- Participates in disaster and fire drills as required by the facility and knows role in the event of evacuation as assigned by administration.
- Uses proper PPE when performing patient care and handling chemicals.
- Adheres and complies with the requirements of the infection control and patient safety programs.
- Ensures operational readiness of the emergency room clinical department as it applies to equipment, materials, supplies, maintenance and repairs. Removes defective equipment and devices from service and makes prepares deficiency report to Nurse Director.
- Takes steps and performs duties to ensure the emergency room nurse station and other clinical areas are clean and free from hazards.
- May complete training and competencies in high level disinfection of semi-critical devices.
- Properly disinfects and stores medical equipment in clean utility areas, ensures medical equipment is connected to critical power when not in use, and in ensures that all equipment is operational and ready at all times.
- Assist in inventorying of supplies and equipment to ensure proper working order and adequate par levels. Reports low par-level of supplies and medications to Nurse Director.
- May performs monthly inventory of medication and crash carts to ensure all medications and supplies are intact and current. Removes expired medications and orders replacement, removes any supplies with broken seals or otherwise compromised packaging and replaces the items. Properly stores or disposes of expired medications and supplies in accordance with policy.
OTHER ESSENTIAL DUTIES AND JOB RESPONSIBILITIES
- Must be adaptable to varying working conditions that may change with or without advance notice.
- Attends monthly staff meetings, in-services and/or department meetings as required by the facility. Must attend 80% of all mandatory meetings within a one (1) year period of time. Notice of absence from any mandatory meeting must be submitted to the Nurse Director.
- Must be able to work efficiently with various levels of management, vendors, a diverse workforce and patients from various demographic backgrounds.
- May be required to travel at the discretion of the Governing Board. May be required to drive personal or company provided vehicles; and/or travel by airplane as needed.
- Abides by company policies and procedures and complies with all applicable State, Federal and local laws, requirements of all Federal and State regulatory agencies and requirements of any applicable accreditation agencies.
- Takes reasonable measures to ensure that overtime is minimized.
- In order to ensure that department is fully operational, performs department operation duties daily and as needed.
- Ensures that the emergency room clinical department operates within compliance with applicable policies; state, local and federal laws; applicable codes, licensing requirements; ordinances, etc.
- Routinely participates in various activities reinforcing reasonable and sound work activities that supports the goals of the company by performing various assigned tasks.
- Demonstrates the ability to exercise sound judgment; apply effective written and oral communication techniques with all business contacts to include but not limited to employees, vendors, other members of administration, patients, physicians and the general public.
- In conjunction with the other administrative and other designated clinical staff, is engaged in work productivity in the freestanding emergency room.
- Maintains confidentiality of patient and employee related issues.
- Treat all patients, visitors, and staff members fairly and with respect.
- Upholds and enforces patient rights.
- Regular attendance and compliance with attendance standards is required.
- Takes care to perform duties and task which operate within the budget set forth by the Governing Board.
- Position is subject to require overtime. Such position may include being required to work extended hours during the week, weekends, and holidays and during periods in which a state of emergency has been declared. Competencies
To perform this job successfully, an individual should demonstrate the following competencies:
Analytical - Synthesizes complex or diverse information. Problem Solving - Identifies and resolves problems in a timely manner; Works well in group problem solving situations; Uses reason even when dealing with emotional topics. Technical Skills - Objectively assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others. Patient/Customer Service - Manages difficult or emotional patient/customer situations; responds promptly to patient needs; solicits patient feedback in an attempt to achieve an optimum level of patient care. Interpersonal Skills - Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to the ideas of others; and is willing to try new solutions and options. Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens for and seeks proper clarification; responds well to questions asked; demonstrates excellent group presentation skills; participates in meetings and enrichment discussions Written Communication - Writes clearly and informatively; edits work for spelling and grammar; varies writing style to meet appropriate needs; presents numerical data effectively and legibly; and is able to read and interpret written information. Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to the views of others; gives and welcomes feedback; contributes to building a positive team spirit; puts the success of the team above his/her own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed. Leadership - Exhibits confidence in self and others; Inspires and motivates others to perform well; effectively influences actions and opinions of others; Accepts feedback from others; Gives appropriate recognition to others. Quality - Looks for ways to improve and promote quality; demonstrates accuracy, excellence and attention to detail. Diversity - Demonstrates knowledge of EEO policy; shows respect and sensitivity for cultural differences; respectfully helps to educate others on the value of diversity; promotes a harassment-free environment. Leadership - Exhibits confidence in self and others; Inspires and motivates others to perform well; effectively influences actions and opinions of others; Accepts feedback from others; Gives appropriate recognition to others. Ethics - Treats people with respect; Keeps commitments; inspires the trust of others; Works with integrity and ethically; Upholds organizational values. Organizational Support - Follows policies and procedures; completes administrative tasks correctly and in a timely manner; supports the goals and values of the organization; benefits organization through outside activities and representation of the company; supports affirmative action and respects diversity. Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths & weaknesses. Judgment - Displays willingness to make decisions; exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process. Motivation - Sets and achieves challenging goals; demonstrates persistence and overcomes obstacles; measures self against standard of excellence. Planning/Organizing - Prioritizes and plans work activities; uses time efficiently Professionalism - Approaches others in a tactful manner; works well under pressure; treats others with respect and consideration regardless of their status or position; accepts responsibility for his/her own actions. Quality - Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality and excellence. Quantity - Meets productivity standards; completes work in timely manner; strives to increase productivity; works efficiently. Safety and Security - Observes safety and security procedures; Determines appropriate action beyond guidelines; Reports potentially unsafe conditions; Uses equipment and materials properly. Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events. Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time. Dependability - Follows instructions, responds positively to management direction; takes responsibility for own actions; commits to long hours of work when necessary to reach team and/or company goals. Initiative - Volunteers readily; undertakes self-development activities; seeks increased responsibilities; takes independent actions and calculated risks; looks for and takes advantage of opportunities for growth, improvement and/or achievement; asks for and offers help when needed. Innovation: Displays original thinking and creativity; Meets challenges with resourcefulness; Generates suggestions for improving work; Develops innovative approaches and ideas; Presents ideas and information in a manner that gets others' attention. Qualifications/Education: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Graduate of an accredited school/college of nursing; Certificates in Advanced Cardiovascular Life Support (ACLS) and Pediatric Cardiovascular Life Support (PALS) required. Emergency Nursing Pediatric Course (ENPC) may be accepted if as approved by the Governing Board. Current Healthcare Provider (BLS) or Professional Rescuer CPR certification
- Current registered nurse licensure in good standing in the State of Texas
- Minimum 1-year RN emergency room experience, necessary to meet established quality standards
- Knowledge of accepted infection control measures and patient safety
- Experience in documenting patient findings in an electronic health record and assist in other ER duties as needed
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Position, the employee is regularly required when operating or moving equipment, preparing a patient for treatment or administering care to:
- Stand and walk for periods ranging from 6 to 12 hours at a time
- Ability to push, pull, feel, bend, lean and stoop without hindrance;
- Full range of body motion
- Use hands and fingers, handle, or feel; reach with hands and arms
- Sit, climb or balance
- Stoop, kneel, crouch, or crawl
- Talk and hear
While performing the duties of this Position, the employee is occasionally required to:
- Sit for short or extended intervals as required.
While performing the duties of this Position, the employee is frequently required to:
- Lift and/or move in a push or pull manner more than 50 pounds occasionally to reposition a human whether seated,
- laying on a bed or leaning against an object.
- Pushing, pulling carrying or lifting objects such as medical equipment or supplies up to 30 pounds as necessary.
Specific vision acuity abilities required by this job include:
- Close vision
- Distance vision
- Color vision
- Peripheral vision
- Depth perception and ability to adjust focus.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently exposed to infectious and communicable diseases, toxic substances, ionizing radiation, equipment with risk of electronical shock, medicinal preparations and other conditions common in a hospital setting or conditions that have the potential of being physically, emotionally, and/or psychologically harmful. The employee is occasionally exposed to fumes or airborne particles; toxic or caustic chemicals and risk of radiation. The noise level in the work environment is usually moderate. Work Schedule: The facility operates 24/7 with regular consistent work schedules of 36 hours or more per week for full-time; schedules will vary to include evenings, nights and weekends. Must possess the ability to work all shifts including day, evening, weekends, and holiday hours. Reports to work on time and as scheduled, completes work within designated time. PRN employees are expected to work at least two shifts per month to maintain PRN status.
