- Assess the overall status of the resident, documenting all identified medical needs in the medical record with a plan for treatment and/or resolution.
- Monitor the residents' activity and provide nursing care in accordance with physician orders, care plans, local, state and federal regulations as well as established facility protocol.
- Coordinate, prepare for and assist with new admissions, transfers and discharges.
- Communicate with residents, family members, other disciplines and health care professionals regarding the status of the resident.
- Take and record vital signs.
- Administer medications and treatments and document accordingly.
- Schedule job assignments and duties for C.N.A., ensuring adequate supervision by providing guidance, education and performance accountability.
- Take report at the beginning of the shift in order to receive an update on the residents under your care and ensure that report is completed in a timely and appropriate manner on each resident, with documentation reflecting as such. This process shall be a primary focus at the start of each shift to ensure that resident needs are addressed promptly and accurately.
- Be observant for changes in a resident's condition and notify the Supervisor (if applicable), physician, administrative on-call staff and family.
- Visit all residents at various times during your shift.
- Supervise and assist with the feeding of residents and administer the tube feedings.
- Order medications from the pharmacy, as indicated, in a timely and accurate manner. Administrative staff shall be notified of any barrier that causes a delay in appropriately processing orders timely and accurately.
- Carry out all physician orders, including making out lab slips, x-ray requests and M.A.R.
- Provide routine nursing documentation as per established facility protocol.
- Prepare residents for going on pass.
- Answer the telephone properly, and in a timely manner, using respectful tones and professional responses.
- Complete Incident/Accident Reports on all residents, employees and visitors as the need arises.
- Leave the nurses' station and medication cart clean and well stocked for the on-coming shift.
- Count controlled drugs at the beginning and end of the shift.
- Report occupational exposure in accordance with established facility protocol for processing Workers Compensations claims accurately and timely. During off hours, ensure that Administrative staff are notified immediately of all Workers Compensation incidents that occur.
- Be knowledgeable about and promote resident rights.
- Prevents abuse, neglect and exploitation of the elderly.
- Promote a safe, clean environment in which the residents may live.
- Check the 24-Hour Report daily in order to be aware of changes in the residents' conditions and/or plans of treatment and accurately complete daily required chart checks, as prescribed by the Director of Nursing.
- Assist with M.D.S.+ and Total Care Plan meetings, as indicated.
- Any other duties and responsibilities, as requested by the Director of Nursing.
- Become a participating facility team member with the residents as first priority.
- Hold/handle
- Lift
- Carry
- Reach – at and below shoulder height
- Push/pull
- Grasp and handle – pens, paperwork and small equipment
- Sit, stand and walk
- Twist, bend, stoop, kneel, and squat
- Fine hand motor coordination
- Ability to read and write legibly
- Ability to comprehend and follow instructions
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Description
Job Description
Job DescriptionDescription:To provide nursing care to the residents as prescribed by the physician and in accordance with established facility protocol, local, state and federal regulations. To lead and/or direct C.N.A. in the delivery of direct resident care.
Accountability: R.N. Supervisor, Assistant Director of Nursing, Director of Nursing
DUTIES AND RESPONSIBILITIES:
PHYSICAL REQUIREMENTS:
COGNITIVE AND SENSORY REQUIREMENTS:
Talking: Communicating with residents, families, physicians, visitors and staff in a manner that is professional and easily understood. Providing appropriate information, using good judgement related to the shared information. Making individuals aware of circumstances in a positive and non-threatening manner
Hearing: Taking instructions the Administrator, To respond to resident complaints and requests, To respond appropriately to disaster instructions and pages
Sight: For performing job effectively and correctly
Smell: For accurate detection and maintenance of facility odors
Touch: In order to detect changes in temperature
LICENSURE REQUIREMENTS:
Must be a Registered Nurse (R.N.) currently licensed and in good standing with the Board of Nursing in the State of Arkansas.
SUMMARY OF OCCUPATIONAL EXPOSURE:
Tasks and procedures performed by the employee involve risks classified by C.D.C. as
Category I. (Direct contact with blood or other bodily fluids to which universal precautions apply.)
OTHER CONSIDERATIONS AND REQUIREMENTS:
Must be able to tolerate a high pace as typical for a nursing facility. Must be able to take and give instructions well and enjoy working with the elderly. Although employee is required to sit for prolonged periods of time, he/she must also be able to tolerate prolonged standing and walking.
