Home Based Primary Care (HBPC) - Registered Nurse (RN)

Full Job Description

The HBPC Outpatient Staff RN delivers competent, evidence-based nursing care to Veterans enrolled in the HBPC Program.

This role involves providing direct patient care and comprehensive care coordination for Veterans in their homes.

The RN will conduct case management activities, assist Veterans in obtaining appropriate nursing resources, and ensure continuity of care across the healthcare continuum.

This position requires daily travel to Veterans' homes. All care is provided in a home setting. Basic Requirements: English Language Proficiency. In accordance with 38 U.S.C.

7403(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English.

Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program.

Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program.

(Reference VA Handbook 5005, Appendix G6); OR In cases of graduates of foreign schools of professional nursing, possession of a current, full, active, and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program.

Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD).

Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia.

Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification.

Grade Determinations: The following Scope, Education and Dimension criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade.

The Dimension requirements (Practice, Veteran/Patient Driven Care, Leadership, Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment: https://apply.usastaffing.gov/ViewQuestionnaire/12886236.

Grade/Level Scope Education Nurse I, Level I Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies.

An Associate Degree (ADN) or Diploma in Nursing, with no additional professional nursing required.

Nurse I, Level II Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex.

An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I, Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required.

Nurse I, Level III Demonstrates proficiency in practice based on conscious and deliberate planning. Self-directed in goal setting for managing complex client situations.

An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2; OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I, Level 2; OR a Master's degree in nursing (MSN) and no additional professional nursing experience; OR a Master's degree in a *related field with a BSN and no additional professional nursing experience.

Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others.

A BSN with 2 years of professional nursing equivalent to Nurse I, Level 3; OR an MSN with one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Doctoral degree in Nursing with no professional nursing experience; OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience.

Nurse III Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting.

MSN and 2 years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Master's degree in *related field with BSN and two years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III.

*Note: Foreign education programs/degrees are not creditable as related degrees. Preferred Experience: BSN preferred.

3 to 5 years nursing experience in case manager, or an equivalent combination of education and experience providing comparable case management knowledge, skills, and abilities, highly preferred.

Experience working effectively as a cohesive member of an interdisciplinary team preferred. Experience in home care case management preferred.

Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

Physical Requirements: This position includes a level of physicality normally associated with duties performed by nurses such as direct patient care, and potentially long periods of walking, standing, sitting, moderate lifting, repeated bending, or kneeling.

Examples may include but are not limited to: Significant amounts of time standing assisting assigned patients Utilization of safe patient handling and mobility protocols Position specific duties/expectations are detailed in the associated competency and should be performed once the competency has been validated.

Other Significant Information: The HBPC RN Care Manager is expected to drive to see Veterans in their home, traveling in and dealing with all kinds of weather elements at various times.

This position requires operation of a government-owned or leased motor vehicle to properly carryout assigned duties.

A valid, state-issued driver's license is required, along with medical clearance by Employee Occupational Health (EOH). The incumbent of this position would be considered an Incidental Driver.

Incidental operators are employees, other than those occupying a position officially classified as a motor vehicle operator, who are required to operate a government-owned/leased motor vehicle to properly carry out their assigned duties.

This position potentially requires flexibility in schedule and assignments. Major Duties:

The incumbent of this position must have a valid, state-issued driver's license.

The HBPC registered nurse, in addition to being a core member of the HBPC interdisciplinary team, functions in the PACT team role as a care manager and is responsible for: Delivering direct nursing care in the home setting.

Developing and coordinating the patient's plan of care to include ongoing assessment and reassessment, care planning, care coordination, monitoring, and evaluating clinical outcomes.

Interacting, coordinating and advocating for the patient/caregiver with other relevant parties across a continuum of care, beyond a single episode of care, ensuring seamless transitions.

Providing individualized education and support to the patient and caregiver to optimize clinical outcomes and support quality of life decisions.

Delegating and supervising the care given to the patient by licensed practical nurses (LPNs) or vocational nurses, and home health technicians, as applicable. Providing intensive care management.

Linking Veterans with resources. Coordinating resources for comprehensive care to avoid duplication of services and streamline staff interaction and services with the Veteran.

Participating in the development of the individual plan of care at interdisciplinary care meetings for assigned panel of patients.

In addition to the listed duties, the HBPC RN Care Manager uses patient information databases to identify at-risk Veterans requiring coordination of care, utilization of and participation of other team member's services, and use of decision support tools (along with critical thinking skills) to triage Veterans with symptom-related complaints.

Furthermore, the HBPC RN Care Manager monitors and tracks consults in collaboration with the HBPC team, assisting in ensuring the Veteran receives the right care, at the right time, in the right place.

VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for performance awards Paid Time Off: Up to 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year) Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Licensure: 1 full and unrestricted license from any US State or territory Work Schedule: Full-time; 730-1600 Telework: Not Available Virtual: This is not a virtual position.

Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized