Licensed Practical Nurse - Full Time

SUMMARY:

Provide nursing care within the scope of licensure for assigned individuals according to established nursing standards and in accordance to DIDD and DOH Policy and Procedures with utmost professionalism.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.

1. Provide healthcare supports as prescribed by treating physicians.
2. Interpret and Implement Individualized Health Care Plans. Implementation may involve bowel and bladder tracking, monitoring and documenting input and output, seizure tracking, blood pressure monitoring, urostomy care, tracheotomy care, routine injections, etc.)  
3. Assist in the ADL process to ensure the safety and integrity of the individual (e.g., bathing, dressing, oral hygiene, toileting, feeding, etc.)
4. Administer medications, identify and report medication effectiveness, identify and report adverse side effects, maintain medication counts for controlled drugs.
5. Interpret and Implement Medical Crisis Plans. Report the need for revisions to the Agency RN.
6. Ensures that medical equipment is kept clean and serviceable.
7. Maintains an accurate inventory of healthcare supplies. Reports discrepancies in inventory to Agency RN.
8. Documents care and education provided to the individual served.
9. Documents orders followed and medical interventions in the form of a detailed nursing summary.
10. Assists with shadowing and/or training, mentoring, and reviewing plans with any new staff to the home.
11. Other duties as may be assigned.

Program and Service Coordination:

1. Attend and actively participate in Annual ISP and COS Meetings.
2. Complete the Physical Status Review (PSR) and Healthcare Oversight Form 90 days prior to the ISP effective date.  
3. Maintain a current and accurate Health Passport. In the absence of medication changes, the Health Passport will be updated at least quarterly.
4. Review Therapy Evaluations and Clinical Monthly Reviews to ensure appropriate implementation of therapy plans.  
5. Maintain current competency-based training for all therapy plans.
6. Accompany individual to all doctor appointments and keep Nursing Department abreast of any changes to the health care plan.
7. Maintain consumer records in accordance with DIDD Operations Manual.
8. Ensure that required paperwork such as Medical Encounter Forms, Medication Logs, and Medication Variances are submitted to the Nursing Department in a timely fashion.

Medication Administration Records

1. Review MAR’s prior to implementation. Initial every medication on the MAR as verification that the medication indicated is consistent to the PCP order.  
2. Ensure MAR’s adequately reflect all critical elements as outlined by DIDD ie., individual’s name, effective month, start/stop dates, prescribing diagnosis for each medication listed, accumulative diagnosis, allergies, Name of PCP/Nurse Practitioner.
3. Obtain specific parameters for all PRN medications prior to implementation.
4. Verify that all new orders are transcribed (entered on the MAR) in accordance with the Medical Encounter Form AND the script. Any and all discrepancies will be addressed via letter and/or fax to the prescribing physician by the end of the 1st business day.
5. Ensure that MAR Travel Books include the following documents: accurate and complete MAR, corresponding scripts, Medication Profiles, and Medication Count Sheets.

Medication Variances

1. During the shift, it is expected that medication variances will be detected, documented, and reported immediately, to include evidence of PCP/NP notification (with the exception of signature omissions).
2. Ensure all Medication Variances are on file, in the office, no later than the 5th of the month for the previous month.

Referrals/Follow-Up

1. Review all Medical Encounter Forms upon submission to the office to ensure timely and adequate follow-up to referrals.  
2. Verify all MD referrals to confirm timely scheduling. If not already scheduled, LPN will notify the Agency RN to coordinate resolution.
3. Ensure that all ordered procedures (ie., EEG, X-Rays, Fasting Lab Work, etc.) are scheduled according to the order. If not already scheduled, LPN will notify Agency RN to coordinate resolution 
4. Request and obtain test and lab results within 1 week of the procedure.
5. Document all medical appointments on Medical Calendars. Notify Agency RN if an appointment warrants rescheduling.  
6. Ensure that individuals served are not seeing 2 physicians with the same specialty, unless one is clearly documented as a second opinion.

Therapy Services

1. LPN will stay abreast of Therapy Plans that would place the individual at risk of harm if not implemented i.e., Dining Plan, Gait Plan, and/or Bathing Plan  
2. LPN will inspect assistive devices (i.e., wheelchair, shower bench, grab bars, raised toilet seat, etc.) to ensure equipment is safe and sanitary.

Psychotropic Medications

1. Prior to psychiatric visits, LPN will review necessary documents prior to psychiatric appointments (i.e., Sleep Records, Intake Records, Output (if applicable), Weight History, # of Reportable Incidents, etc.) to avoid unwarranted medication adjustments. 
2. Ensure that all psychotropic medications have a current and valid consent.
3. Ensure that the Psychotropic Consent clearly captures strength and route for every psychotropic medication indicated.
4. Ensure that the Psychotropic Consent is completed by the Psychiatrist or his/her Nurse Practitioner and NOT by agency staff.
5. Obtain verbal consent from the individual’s legal representative PRIOR TO administration. It is expected that written consent by the legal representative will be obtained within 14 working days.
6. If the individual does not have a legal representative, the LPN will obtain written consent by the individual immediately.
7. Complete and Submit HRC Medication Review Form to the Agency RN for follow through.   
8. LPN will NOT administer PRN psychotropic medications without obtaining prior approval by Agency RN or have a written and approved Medical Crisis Plan.  

Health Care Oversight

1. Any individual with a history of or current seizure diagnosis will have a seizure record in their chart. This includes Seizure Tracking Forms and an Accumulative Seizure Log.
2. If an individual experiences an increase in seizure activity or experiences seizure activity after an extended lapse in seizure activity, it is expected that the LPN will notify the Agency RN to ensure timely and appropriate notification to the neurologist or the PCP, if the individual is currently not being followed/monitored by a neurologist.
3. If an individual is on a stool softener for constipation, the LPN will ensure that a Daily BM Tracking Form is maintained and adequately recorded.
4. If an individual is on a physician prescribed diet, the LPN will ensure that Daily Intake Records are maintained and entries are consistent to the order.
5. The LPN will review the Monthly RN Oversight Form prior to placement in the individuals Medical Chart and keep the Agency RN abreast of resolutions.  
6. The LPN will demonstrate the ability to interpret and implement Medical Crisis Plans for individuals on his/her caseload. (i.e., CHF, HTN, Diabetes, etc.)
7. The LPN will report a monthly weight loss or weight gain of 10 pounds or more to the Agency RN for appropriate MD advisement.
8. The LPN will notify the Agency RN if individual served experiences an increase in falls. In the interim, it is expected that a Fall Tracking Form will be implemented to track the frequency of falls.  

EDUCATIONAL REQUIREMENTS:

Must possess a current license, in good standing, as a practical nurse issued from the State of Tennessee, or issuing state must be part of the Nursing Compact acceptable to the State of Tennessee.

SPECIAL REQUIREMENTS:

• Proof of Education
• Proof of Licensure
• Current and Valid Driver’s License
• Satisfactory Abuse and Neglect Registry Check
• Satisfactory Criminal Records Report
• TB Test
• CPR and 1st Aid Certification
• Successful Completion of DIDD Core Training

Supervisory and Management:

This position reports directly to the Agency RN and has NO supervisory responsibilities. However, if the LPN observes or suspects substandard performance by another LPN, it will be his/her responsibility to report it the Agency RN.  

PHYSICAL DEMANDS:

The physical demands described here are representative of those which must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear. The employee frequently is required to stand, walk, sit, and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up 50 pounds.