Palliative Care Navigator-RN

GENERAL SUMMARY:

Plays a key role in supporting the clinical care for patients referred for palliative care consultation. Includes working with the interdisciplinary palliative care consult team of physicians, advanced practice nurses, medical learners, chaplains and social workers to deliver excellent patient and family care. Supports the team in achieving clinical standards across the continuum of hospital, clinic and community settings, coordinates resources and provides palliative nursing care.

PRINCIPAL JOB FUNCTIONS:

*Commits to the mission, vision, beliefs and consistently demonstrates our core values.

*Collaborates with other healthcare professionals, including post-acute facilities and providers, to develop a plan and facilitate referrals to address needs and barriers.

*Facilitates the coordination of patient care services to assure timeliness and excellence in patient care including coordination of services, treatment and communication among the medical team.

*Facilitates development, implementation and adherence to clinical and evidence-based guidelines, as appropriate, to ensure optimal clinical outcomes.

*Identifies and addresses barriers to timely and appropriate diagnosis and treatment, connects patients with the appropriate healthcare and community resources.

*Builds therapeutic and trusting relationships with patients, families and caregivers through effective communication and listening skills.

*Provides anticipatory guidance, education and psychosocial support throughout the care continuum.

*Communicates with patients throughout the continuum of care via face-to-face, telephonic, electronic, etc. as appropriate.

*Maintains patient records accurately, completely, timely and confidentially according to procedures. Documents patient encounters and provided services.

*Serves as an expert level care navigator and RN resource and provides assistance to the care team.

*Assists in the identification and reporting of quality issues, and contributes to the performance improvement plan to assess and improve the quality and efficiency of the program including, but not limited to quality assessment, recommendations for program improvement and patient outcomes measures.

*Exhibits behaviors and actions which create a high level of patient/customer satisfaction, which contributes to positive patient/customer relations and which reflect respect for the patient's/customer's rights, needs and confidentiality.

*Ensures all patient care is provided in accordance with regulatory and safety requirements which may include Joint Commission, OSHA, state and federal regulations.

*Utilizes nursing judgement and complex assessment and critical thinking skills at level of licensure to provide comprehensive care and support to patients.

*Utilizes nursing process to perform care navigator tasks and provide highest quality care to patients.

*Establishes and coordinates workflows and participates in best practice initiatives.

*Guides LPN Care Navigators in care of complex patients.

ADDITIONAL JOB FUNCTIONS :

Coordinates patient and provider flow:

* Participates in developing structures and functions to support the palliative care team's assignments and volumes

* Prepares morning census accounting for patient changes and daily staffing

* Attends MDR and contributes to patient discussions as appropriate

* Creatively manages resources and staffing to triage consults and manage day to day clinical needs by facilitating communication with palliative care team members and referring providers or ancillary services

* Implements triage parameters to meet immediate needs and facilitates an interdisciplinary approach to palliative care

* Assists team members in coordinating services provided by palliative care and other health care team members

* Provides clinical care within the RN scope of practice, documents assessments and reports moderate to distressing symptoms to palliative physicians/APPs

* Participates in advance care planning discussions with patients and families and completes documentation (advance directives)

* Communicates updated plans of care to referring providers and unit clinical teams and ensures follow-through

Functions as a resource for patient care units and patient care staff regarding palliative care
• Identifies learning needs of patient care staff and communicates these to nursing and program leadership
• Provides education to patients and their families about palliative care, advance care planning, services available
• Provides education to hospital staff as requested
• Identifies and communicates opportunities for quality improvement to program leadership
• Sees the big picture and uses systems thinking to understand the unintended consequences of decisions.
• Sets appropriate priorities among competing demands.
• Uses available information technology to support day-to-day work operations.

Focuses on the patient/family experience
• Understands & sets and example of exemplary customer service.
• Continuously builds customer understanding by listening to customers.
• Anticipates customer needs, including those with different cultural needs and desires.
• Takes action to meet and exceed the needs of all customer groups.
• Continuously implements strategies to improve customer satisfaction.

EDUCATION AND EXPERIENCE:

Current Registered Nurse licensure from the State of Nebraska or approved compact state of residence as defined by the Nebraska Nurse Practice Act required. BSN required; in lieu of BSN, ten (10) years of nursing experience are required. Masters of Nursing preferred. Minimum of three (3) years recent clinical experience in the area of assigned specialty (Oncology, Orthopedics, other). Hospice or Palliative care experience is strongly preferred.

OTHER CREDENTIALS / CERTIFICATIONS:

Basic Life Support (CPR) certification required. Bryan Health recognizes the American Heart Association (for healthcare professionals), American Red Cross (for healthcare professionals) and the Military Training Network.

Applicable Specialty Certification from an approved credentialing body in the area of practice preferred and required within 18 months.