Implements nursing plan of care at the direction of the registered nurse. Provides home-based patient care based on physician orders and the established nursing plan of care. Reports any change in patient status to the Home Health RN and documents as appropriate. Collaborates with Home Health RN and multidisciplinary treatment team to individualize each patient's treatment needs in order to achieve defined goals for improved patient outcomes. Conducts patient psychosocial assessments to explore the physical, psychological and social aspects of the patient and their conditions, obtains history, and elicits an accurate description of psychosocial needs in order to inform care team. Contributes to developing discharge plans, identifying the post-discharge needs of the patient and target appropriate resources for follow-up care, in collaboration with the patient, family and care team. Documents patient care information and ensures timely and accurate completion of patient care records in accordance with policies and procedures. Participates in the education of patients and their caregivers about extended care facilities, home health agencies, and other resources as appropriate to transition patients along the continuum of care. Qualifications include Associate's Degree or Diploma from Accredited Licensed Practical Nurse Program, 3 Years Acute Care or Long-Term Care Experience, Licensed Practical Nurse (LPN) State Licensing Board, CPR certification, Driver's License, and Auto Insurance. Travel up to 75% is required.
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