Palliative Care Nurse Practitioner

Affinity Care of Virginia -

Job Description Summary

The Nurse Practitioner is a registered professional nurse with advanced graduate education and clinical training who provides comprehensive palliative and advanced disease management services in compliance with the state Nurse Practice Act and under the supervision of a collaborating physician. Works in collaboration with patient’s Primary Care Provider to provide compassionate care to patients with serious or life limiting illness in need of palliative care support. Patient care will be provided in the community setting and through telehealth. Under the direction of the medical director, the nurse practitioner uses the nursing process to assess, review medication, diagnose, plan, provide and evaluate care. Actively determine patient prognosis, provide and educate patient on the disease progression, assist with advanced directives and address issues of grief to patients and caregivers.

Essential Job Functions/Responsibilities

Patient Care

1. Provides medical care, palliates and manages advanced illness in compliance with the state Nurse Practice Act under the supervision of a collaborating physician in the community.
2. Reviews history & performs physical examinations, by evaluating the patient's medical condition and health history, ordering and interpreting results from laboratory and diagnostic tests or procedures, diagnosing health conditions and documents the findings in the patient's medical record.
3. Manages chronic and complex conditions through collaboration with the patient and their care team by developing an individualized plan of care, prescribing medications and / or treatments, obtaining consultations or making referrals and coordinating with other community care services.
4. Educates patient and caregivers regarding medications, side effects, treatment, illness progression, diet and nutrition, medical adherence and crisis anticipation and prevention.
5. Educate and provide assistance to patient and caregiver(s) in understanding and completing advanced directives based on the patient’s goals and wishes.
6. Facilitate clarification of patient and caregiver goals of care to support development of a comprehensive care plan.
7. Implements interventions to support the patient with chronic conditions to decrease the recurring hospitalizations. Monitors the effectiveness of interventions.
8. Facilitates patient transitions between health care settings.
9. Assures that patient receives appropriate measures to control symptoms, through collaboration with interdisciplinary team members.
10. Reviews and develops protocols for treatment and proposes options for interventions based on the literature in collaboration with the collaborating physician.
11. Consults the collaborating physician when the patient's plan of care is outside standardized practice and protocols.

Communication

1. Communicates and collaborates with the interdisciplinary group to create, review and revise the patient's plan of care.
2. Consults with the patient's primary care provider, the advanced disease management medical director and other healthcare practitioners regarding the patient's ongoing care needs and medical management related to the patient's chronic and complex condition.
3. Communicates with other community health practitioners to coordinate the plan of care.
4. Attends and participates in interdisciplinary group meetings.
5. Completes, maintains and submits accurate and relevant clinical notes, physical examination notes, assessment visit notes, medical orders, collaboration notes and other documentation in the medical record.
6. Educates/counsels patients, families, and/or caregivers as to preventative care, medical problems, psychological problems, and spiritual problems in conjunction with the interdisciplinary team to meet the total needs of patients.
7. Provides and maintains a safe environment for the patient.
8. Assists the patient and family / caregiver and other team members in providing continuity of care.
9. Works in cooperation with the patient, family / caregiver and interdisciplinary group to identify the goals of care and meet the care needs of the patient and family / caregiver.
10. Serves as a nursing resource for consultation and educations to members of the interdisciplinary team and other healthcare practitioners in the community.
11. Establishes, builds and nurtures relationships with staff and community referral sources to facilitate program growth.

Additional Duties

1. Maintains knowledge of and compliance with current Medicare/Medicaid, state/federal rules and regulations for professional (palliative care, advanced disease management, transitional and chronic care) services
2. Ensures compliance with the Medicare conditions of participation and other state regulations govern the provision of healthcare.
3. Complies with all Health Insurance Portability and Accountability Act (HIPAA) requirements in accordance with federal, state and organizational policies.
4. Participates in organizational monitoring of the quality of medical services and quality improvement initiatives.
5. Assumes responsibility for personal growth. Develops, maintains and upgrades professional knowledge and practice skills through attendance at seminars, conferences and participation in continuing education and in-service classes.
6. Fulfills the obligation of requested and/or accepted assignments.
7. Demonstrate knowledge in communication and counseling patient/family in dealing with life limiting and end-of-life issues

Position Qualifications

1. Graduation from an accredited School of Nursing.
2. Completion of an accredited Nurse Practitioner Program which conforms with the Board’s educational standards.
3. Current nursing licensure in State and CPR certification.
4. Master's degree with a minimum of one (1) year Nurse Practitioner experience and a minimum of one (1) year hospice or palliative care experience.
5. Accreditation from an approved certifying body for advanced practice nursing as required by State.
6. Certification in a specialist area preferred; (e.g. Hospice and Palliative Nursing (CHPN), Pediatrics or Geriatrics)
7. Able to perform duties autonomously, schedule and meet workload expectations. Provide leadership for the care team, to ensure that the patient’s care plan and interventions are met.
8. Identify and report to leadership immediately any concerns or issues, that places the team, patient or caregiver at risk.
9. Excellent observation, verbal and written communication skills, problem solving skills, mathematical skills; nursing skills per competency checklist.
10. Prolonged or considerable walking or standing. Able to lift, position and / or transfer patients. Able to lift supplies and equipment. Considerable reaching, stooping, bending, kneeling and/or crouching. Visual acuity and hearing to perform required nursing skills.
11. Travel between care sites is mandatory. Must be a licensed driver with an automobile that is insured in accordance with state/or organization requirements and is in good working order.