The Home Health RN is responsible for completing individualized patient assessments, supports and document to the established care plans based on assessment/history findings, delivers patient-centered care that is culturally appropriate, evaluates patient’s response to care, and reports to the Case Coordinator RN as needed. The Home Health RN is accountable to deliver care and supporting the established plan of care. The Home Health RN collaborates and communicates with the Case Coordinator RN and with the interdisciplinary team to ensure that all assessment findings are known by the team.
1. Performs comprehensive subjective and objective assessment of the patient status that includes physical, psychosocial, and environmental parameters in home and assisted living settings.
2. Ensures compliance with federal/state regulations governing home health care services by following policy and procedure consistent with agency standards.
3. Familiarizes self with each patient’s individualized plan of care that incorporates analysis of assessment data including the patient’s self-stated goals; directs and participates in delivery of professional services to home care patients.
4. Provides skilled interventions identified by the case manager to achieve realistic outcomes within a specified time period and patient- centered goals.
5. Communicates and collaborates with interdisciplinary team progress/lack of progress toward outcomes.
6. Assures thorough and accurate documentation of all clinical data from admission through discharge, including, but not limited to, OASIS, HCFA 485, physician's orders, skilled nursing visits and changes in conditions.
7. Consistently demonstrates competency with technical nursing skills according to the legal scope of practice.
8. Implements teaching specific to patient and family needs and evaluates and communicates any changes that are needed.
9. Ensures the maintenance and confidentiality of patient records.
10. Submits documentation timely and per agency policy.
11. Documents on laptops or tablets at point of care as outlined in policies/procedures
12. Maintains productivity standards as established by Compass Care.
13. Rotates into after-hours call or weekend visits.
Education: Associate’s degree in Nursing required.
Experience: One year acute care or nursing home experience preferred.
License/Certification/Registration: Washington State (DOH) Registered Nurse licensure required. Valid driver’s license and proof of automobile insurance required. Car for travel to and from home visits during shift required.