Community Care Nurse - Weekend

Job Summary:

Within an Interdisciplinary Team (IDT) setting, the Community Care Nurse – Weekend is responsible for promoting and maintaining the health of LIFE Pittsburgh Participants in the community during peak weekend hours.

This position provides in-person clinical assessments, post-hospital discharge follow-up, urgent illness evaluations, and scheduled weekend home visits. The role works collaboratively with the Weekend On-Call Registered Nurse to support high-quality telephonic triage, timely field response, and continuity of care.

This position supports participant safety, reduces unnecessary emergency department utilization, and enhances weekend clinical responsiveness within the community setting.

Essential Functions:

• Demonstrates and reflects a commitment to the mission and core values of LIFE Pittsburgh to support the elderly in maintaining their dignity and independence in the community.

• Conducts post-hospital discharge assessments to ensure safe transition to home and adherence to discharge plans.

• Performs in-home clinical evaluations for acute illness, changes in condition, and urgent participant concerns.

• Completes scheduled weekend home visits as assigned.

• Collaborates closely with the Weekend On-Call RN to determine appropriate course of action following telephonic triage.

• Utilizes strong clinical reasoning and critical thinking to assess participant status and determine necessary interventions.

• Notifies PCP, or IDT members of changes in participant condition, abnormal findings, medication issues, or other significant concerns.

• Coordinates care with hospitals, skilled nursing facilities, EMS, pharmacies, and other contracted providers as appropriate.

• Provides participant and caregiver education regarding medication management, disease processes, safety precautions, and treatment plans.

• Assists in development and implementation of Participant comprehensive assessment and plan of care.

• Documents assessments, interventions, communications, and outcomes thoroughly and accurately in accordance with LIFE Pittsburgh policies and regulatory requirements.

• Supports efforts to reduce avoidable emergency department visits through timely in-person assessment and intervention.

• Provides services promptly, exercises tact, patience, and courtesy at all times and conducts themselves in a professional manner with Participants, families, co-workers and external contacts.

• Proactively maintains compliance with required education, certifications, and organizational training requirements.

Working Conditions:

• Works within the LIFE Pittsburgh Adult Day Health Centers (ADHC), travels to and works in Participant residences, hospitals, nursing home facilities, or other community settings in which the Participant may require support.

• Weekend schedule: Saturday and Sunday, typically 9:00am – 5:00pm (minimum 4 hours per day).

• Awareness that working with LIFE Pittsburgh Participants (in the home or center) involves potential exposure to unpleasant sights and smells, exposure to blood borne pathogens and/or other communicable diseases. Standard/Universal Precautions must be utilized at all times.

Knowledge / Skills / Abilities:

• Ability to obtain and interpret information in terms of the specific needs of the Participant.
• Frequently required to manage many details within a fast-paced environment.
• Possesses knowledge of human anatomy and development of the Participant served.
• Understands the range of treatment needed by the Participant served.
• Strong clinical reasoning and decision-making skills.
• Well-developed organizational and interpersonal skills. Strong written and verbal communication skills are required.
• Ability to multi-task and problem-solve complex situations.
• Must be able to support cognitively impaired seniors and their families in dealing with sensitive issues and facilitate problem-solving.
• Must be flexible and able to adapt quickly to changing clinical situations.
• Ability to work independently in the field while maintaining strong collaboration with the Interdisciplinary Team.
• Ability to work effectively with people from various social and cultural backgrounds.

Required Certification/License:

• Valid PA Registered Nurse License or Licensed Practical Nurse
• Valid CPR certification
• Valid Driver’s License and automobile insurance
• Must have access to a reliable vehicle for travel

Education/Experience:

• Graduate of an accredited school of nursing
• Minimum one (1) year experience working with the frail or elderly population
• Experience working with and relating to the geriatric population and their family members
• Experience in home care, community-based care, or transitional care preferred