The Nurse Extern provides a continuation of role development for the upcoming registered nurse. Now shadowing the Registered Nurse, the Extern will begin to develop assessment skills, time management techniques, medication administration, and tasks/skills as delegated by the nurse.

1. The Nurse Extern will perform the following tasks as delegated to do so and under the direct supervision of the Registered Nurse.

• Monitor condition on each assigned patient on admission and on an ongoing basis to include but not limited to the patient’s physical condition, psychological status, social status, spiritual and cultural needs, pain assessment/management, nutritional and functional status, developmental or age related factors, and discharge planning needs.
• Administration of routine medications and related documentation in the patient’s electronic health record.
• Dressing changes – simple bandaging (e.g. steri-strips), wet-to-dry, and/or sterile dressing change
• Maintenance of ostomies
• Peripheral venous phlebotomy for laboratory analysis
• Application of oxygen via nasal cannula
• Insertion/removal of Foley catheter, to exclude suprapubic catheterization
• Initiation and discontinuation of nebulizer treatments to exclude racemic epinephrine administration
• Administration of routine screening tests/immunizations (e.g. flu and TB)
• Provides, and documents patient and/or significant other education based on physical, behavioral, psychological, developmental, and age-related factors, after identifying barriers to learning.
• Participates in coordinating the care planning with patient, family, providers and other disciplines to achieve patient-centered outcomes.
• Applies safety principles when performing care and accurately documents observations, care provided and changes in care plan.
• Participates in team shift reports.
• Assists in performance improvement (PI) activities by assisting with PI measures and supporting and implementing changes necessary for improvement.

1. The Nurse Extern shall NOT be delegated the following nursing activities:

• Administration of PRN medications
• Administer any form of medication through the following routes:
  • Gastric
  • Nasogastric
  • Intravenous
• Suction of and/or replacement of tracheostomy
• Accessing feeding tubes (G or J-tubes)
• Placement of any form of intravenous catheters
• Accessing of any intravenous catheter for initiation or therapies
• Administration of blood or blood products
• Suprapubic catheterization

1. Accurately documents care provided according to policies and procedures.
2. Performs initial and annual competency per job class. Specific ages: adolescent, adult and geriatric as defined by scope of service.

6. Applies safety principles and proper body mechanics in the performance of specific techniques of personal and supportive care, such as ambulation of patients, transferring patients, assisting with normal range of motion and positioning.
7. Participates in economical utilization of supplies and ensures that equipment and nursing units are maintained in a clean, safe manner.
8. Ensures that patients are placed on cardiac monitors as soon as possible. Reports alarms immediately to the nurse caring for the patient.

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
• Performs compliance requirements as outlined in the Employee Handbook
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.
• All other duties as assigned.

Must currently be enrolled in a Registered Nursing program and must have successfully completed coursework in pharmacology, medication administration and fundamentals or has successfully completed a licensed practical nursing program OR has graduated from an accredited RN program but failed the NCLEX exam and is committed to re-taking it within a 3-month timeframe. Current American Heart Association (AHA) Basic Life Support (BLS) Provider training required.  Must be able to read, write legibly, speak, and comprehend English.

Physical:  Physical presence onsite is essential.  Hearing and vision must be normal or corrected within normal range.  Able to perform duties with or without reasonable accommodation. Ability to tolerate prolonged periods of standing and walking.  Ability to lift and carry 50 pounds with frequent lifting and/or carrying of objects weighing up to 25 pounds.  Is able to push stretcher/wheelchair with average adult patient.  Is able to do frequent stooping and on occasion crouching, crawling or kneeling.  Ability to reach reasonable distances in any direction.  Ability to run in emergency situations.  Must be able to move fingers in a coordinated manner.  Must have ability to feel and perceive temperature, texture, shape and size with fingertips. 

Environmental:  Includes exposure to human body fluids, disease, infection, lab chemicals and hazard materials and/or cleaning solutions.  Requires wearing common protective or safety equipment.

Psychological:  Includes receiving delegation, working with team members, addressing conflict, and communicating with all types of personalities.