Website Kaiser Permanente
The self-directed Hospice & Palliative Care Public Health Nurse (HPCPHN) provides skilled nursing assessment, planning & coordination/care Mgmt across settings to patients in a private home, adult foster home, residential/assisted living care, intermediate care, skilled nursing facility, inpatient hospice facilities & hospital settings in order to maximize the comfort & health of patients & families consistent w/hospice philosophy & CCS policies & procedures.
- Maintain up to date patient records so that problems, plans, actions & goals are accurately & clearly stated & changes are reflected as they occur in accordance w/CCS policies & procedures.
- Provide adequate emotional & clinical support at the time of death.
- Provide phone triage & support to patients/families as needed & requested.
- Determine patient appropriateness for palliative care or hospice srvs (including hospice level of care & care site) in consultation w/the HPCP.
- Assume initial responsibility for assessing patient/family needs & consulting w/attending physician, Hospice & Palliative Care Physician (HPCP) , other IDT staff members or other appropriate community or facility contacts as indicated by patient location & needs at the time of the assessment & care provision.
- Instruct primary caregivers, family members, employed caregivers & facility staff to provide hospice specific care as indicated.
- Attend weekly case conferences & actively participate in discussion of patient needs & care planning.
- Coordinate hospice care across settings to achieve smooth transitions of care & assure compliance w/the hospice plan of care through communication & documentation for family members, caregivers, facility staff as appropriate.
- Case Mgmt: assume primary responsibility for a patient/family caseload that includes the assessing, planning, implementing & evaluating phases of the nursing process; including scheduling visits to reflect patient care needs in order to maintain continuity of the plan of care; & advocate for patient & family.
- Provide input into the bereavement assessment & plan of care.
- Supervise & document Hospice Aide care delivery every two weeks.
- Participate as an active member of the IDT to coordinate info & srvs to update the plan of care.
- Obtain data on physical, psycho/social, emotional & spiritual factors that may influence patient/family health status & incorporate that data into the plan of care.
- Facilitate advanced illness &/or end of life discussion w/patient & family members to assist w/choice of hospice or palliative care.
- Able to work autonomously and manage patient caseload.
- Knowledge of Medicare regulations/requirements.
- Excellent time management, problem solving and customer service skills.
- Working knowledge of the managed care industry.
- Peripheral and central line IV management.
- Hospice care and the dying process.
- Knowledgeable of the care for the chronically ill and frail elderly.
- Certification in Hospice and Palliative Care Nursing.
- Excellent written and verbal communication skills.
- Working knowledge of Hospice and palliative care for the terminally ill patient.
- Able to operate multiple IV pumps.
- Experience working as a member of an interdisciplinary team.
- Operational knowledge of computerized clinical documentation and office application systems including the use of laptop/notebook computers.
- Able to perform venipuncture and IV insertion.
Company: Kaiser Permanente
Vacancy Type: Full Time
Job Location: Portland, OR, US
Application Deadline: N/A