The Home Health Visit Nurse works collaboratively with the Home Health RN Care Manager and other disciplines, providing skilled care, education, treatment, and emotional support to patients. Monitors and assesses the care provided while insuring the patient attains and maintains their highest level of functioning. Insures that the Physician and all members of the care team are aware of pertinent changes in the patient’s condition and progress toward goals.  Collaborates with the Home Health RN Care Manager insuring that the established plan of care is appropriate and is implemented and/or modified based on the patient’s responses to treatment.

1. Provides skilled nursing care to an assigned caseload of patients.
2. Monitors the care, treatment, and service provided by other disciplines (SN, PT, OT, ST, MSS, RD, HH Aide) to insure patient receives the care required to improve their health status.
3. Educates patients and their families on proper home health care strategies and procedures.
4. Instructs and supervises the patient and family in the care of the patient and maintenance of a healthy environment for the patient.
5. Evaluates, and revises the plan of care in collaboration with the Home Health RN Care Manager as appropriate, based on patients identified needs and progress toward goals.
6. Reviews the plan of care of assigned patients to insure that the physician orders are being followed and that the patient receives the care required to achieve established goals.
7. Performs skilled assessments and documents findings in the OASIS accurately and timely.
8. Measures wounds weekly.
9. Maintains an accurate and current list of each patient’s medications.
10. Communicates regularly with the Home Health RN Care Manager regarding patients, progress toward goals, barriers to care and outcomes.
11. Establishes positive working relationship with physicians and physician’s office staff and keeps them informed of patient’s problems and progress towards goals as appropriate.
12. Assess patient’s outcomes and offer suggestions on ways to improve outcome scores.
13. Participates in the performance improvement plan and process to ensure positive patient outcomes
14. Actively participates in IDT meetings.
15. Participates in on-call rotation
16. Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
17. Performs compliance requirements as outlined in the Employee Handbook
18. Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
19. Requires use of electronic mail, time and attendance software, learning management software and intranet.
20. Must adhere to all DCH Health System policies and procedures.
21. All other duties as assigned.

Registered Nurse with a current Alabama license.  Prefer 1 year of recent home health or acute care nursing experience or a combination of both.  Prefer experience in home health care. Prefer extensive clinical knowledge and experience in the care of patients with multiple and complex diagnoses, disease processes and care needs. High speed internet when working from home. Must  be able to read, write legibly, speak, and comprehend English. Must have current BLS certification or be able to obtain within 60 days of employment and before first independent patient visit.

WORKING CONDITIONS

Is able to lift 50 pounds, turn and position patients weighing over 200 pounds.  Ability to stand, walk, kneel, sit, crouch or stoop with good balance for extended periods of time.  Must be able to maneuver over a variety of uneven surfaces including fields, grass, ditches, gravel, concrete, wood, vinyl, or carpet.  Good manual finger dexterity.  Must have good communication skills.  Must be licensed and insured to operate a motor vehicle.  Must have tolerance in a variety of environments to include the presence of pets and infestation.

Physical presence onsite is essential.  Hearing and vision must be normal or corrected to within normal range.  Able to perform the duties with or without reasonable accommodation.