Hospital In Home - Registered Nurse Care Coordinator

Full Job Description

Hospital in Home (HiH) offers intensive time limited home care to Veterans with acute and/or complex medical conditions such as Heart Failure, Community Acquired Pneumonia, Cellulitis, Chronic Obstructive Pulmonary Disease (COPD) or other conditions amenable to safe and effective management in the home setting.

The HiH RN Care Coordinator reports directly to the Nurse Manager HBPC/Telehealth. 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/12928925.

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.

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

Physical Requirements: Heavy Lifting (45 lbs and over); Straight Pulling, Pushing, Walking, Standing, Repeated bending (8 - 12 hours); Reaching above shoulder; Use of fingers; Both hands and legs required; Ability for rapid mental and muscular coordination simultaneously; Near vision correctable at 13" to 16" to Jaeger 1 to 4; Far vision correctable in one eye to 20/20 and 20/40 in the other; Both eyes required; Depth perception; Ability to distinguish basic colors and shades of colors; Hearing (aid permitted); Emotional/Mental stability; Keyboarding and reading computer screen (8-12 hours intermittently over scheduled shift).

Major Duties:

The VASD HiH Registered Nurse Care Coordinator assumes the following roles and responsibilities: 1. Manages, plans, schedules, and coordinates acute home nursing care for an assigned panel of Veterans.

2.

Works effectively with patients, families, or significant others, and with professional and supportive personnel within the home, the community, and inpatient/ ambulatory care services in support of the Veteran plan of care.

3. Attends, leads, and contributes to daily interdisciplinary care plan huddles. 4. Develops effective nursing care plan and interventions to meet care goals in the home. Coaches other team members. 5.

Applies nursing standards to reduce infections, promote Veteran and Staff safety including appropriate screening before visits, wearing appropriate PPE, cleaning reusable equipment, and disposing of medical waste in the home care environment.

6. Operates point-of-care testing devices, performs venipuncture, collects other specimens as ordered or according to standardized procedures, and safely transports within nursing scope of practice. 7.

Provides IV therapy including peripheral IV insertion, medication administration and infusion, and insertion site care. 8.

Performs comprehensive nursing medication review, in-home medication administration, and fills patient medication/pill organizers as prescribed. 9. Provides comprehensive patient education.

Assesses Veteran/Caregiver ability to manage self-care in the home environment; develops appropriate teaching plans for medication management, symptom identification, progression, and appropriate actions; care of medical devices; performs appropriate procedures.

Utilizes Motivational Interviewing and TEACH principles and monitors progress toward goals/outcomes. 10. Plans for discharge on admission to the program.

Monitors patient/caregiver progress towards mutually identified goals and outcomes, coordinates supportive in-home and clinic services, and ensures hand-off to receiving service, clinic, or program for successful transition of care.

Coaches other team members. 11. Provides nursing leadership in HIH performance improvement initiatives. 12.

Maintains knowledge of clinical telehealth options to facilitate care coordination and communication including VVC/VCM, Clinical Video Telehealth, and Remote Patient Monitoring. 13.

Participates in mission for education of nursing students and medical interns/ residents as a preceptor, presenter, and/or mentor. 14.

Follows procedures and policies for care and maintenance of government vehicles. 15. Other duties as assigned. Preferred Experience: 1. BSN and 3 years full time employment as an RN. 2.

One year recent practice experience working with complex patient population in home care environment. 3. One year recent acute/critical care or emergency nursing experience. 4.

Proficient in clinical skills such as venipuncture, IV insertion, IV medications/infusions. 5. Experience working in an autonomous role. 6.

Contributions to performance improvement or evidence-based activities in nursing practice. 7.

Ability to use different technology and communication mediums such as computers, laptops, phones, software programs and apps to communicate effectively with Veterans , Caregivers, internal and external specialties/agencies.

VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for performance awards Paid Time Off: 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: 0800-1630, Day tours with weekend rotations Virtual: This is not a virtual position