RN Emergency Room (ER)

PERMANENT PLACEMENT NEED (NOT TRAVEL/TEMPORARY)

DEPARTMENT: EMERGENCY ROOM
DEPARTMENT CODE: 8310
FACILITY CODE: 080
POSITIONS SUPERVISED: NONE
FLSA STATUS: Non- Exempt

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SERVICE EXCELLENCE STANDARDS

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Treats everyone as a guest by making a good first impression, anticipating needs and displaying service recovery skills.
Demonstrates professionalism and excellence by looking professional, being accountable for actions and delivering excellence in our everyday work.
Practices teamwork by participating in decision making and process improvement, communicating effectively and focusing on the problem/issue, not the person.

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POSITION SUMMARY

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Reporting to the Director of Emergency Room Services or the Nurse Manager of Emergency Room Services, the Registered Nurse has shift (8 or 12 hour) accountability for the promotion, maintenance, and restoration of health of patients from neonatal to geriatric which are assigned to his/her care. The RN must utilize specialized knowledge and skills in the application of nursing process skills to effect managed care. Able to provide competent care for patients throughout the life span, from infancy through geriatric.

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ESSENTIAL JOB DUTIES AND RESPONSIBILITIES 1. GENERAL ORGANIZATIONAL RESPONSIBILITIES:

• Treats everyone with dignity and respect and encourages collaborative relationships with collegues, community providers, patients and family members. Consistently identifies ways to improve customer service and feedback while reducing customer/patient complaints.
• Regularly attends department meetings, Town Hall meetings and staff recognition events as appropriate. Actively participates in department and hospital committees.
• Assures timely compliance with job requirements which may include, annual FIT Testing, TB, Flu Vaccination, LMS, licensure and certification renewals.
• Identifies own educational needs and seeks appropriate learning experience.
• Adheres to facility and department attendance requirements.
• Keeps work area clean, organized and clutter free. Notifies housekeeping/EVS as appropriate.
• Ensures department has equipment and supplies necessary to provide consistent quality and service delivery.
• Reports any unsafe situations or safety hazards immediately. Labels and removes any malfunctioning equipment from service and notifies Engineering.
• Participates in Emergency Preparedness Drills. Demonstrates through practice drills and upon request understanding of his/her role in the event of an emergency or disaster.

2. COMMUNICATON / WORKING RELATIONSHIPS:

Interacts with patients, families, guests, medical staff, and peers in a professional and timely manner.
Communicates effectively with the care team.
Follows the chain of command and escalates issues or concerns appropriately.
Utilizes effective interpersonal skills; ability to communicate with and contribute to the total health care needs of the patient and assist family members.
Communicates and coordinates patient requirements with ancillary departments.
Answers and routes incoming calls in an appropriate manner and takes messages when possible.
Refrains from all unprofessional discussions and remains positive at all times.
Respects patient privacy and confidentiatlity, following all HIPAA laws.
5. POSITION SPECIFIC RESPONSIBILITIES:

1. POPULATION SPECIFIC STANDARDS
Neonate/Infant Birth to 12 months
Adolescent 12 18 years
Adult 19 70
Geriatric 71 years and beyond
2. ASSESSMENT
Performs initial assessment appropriate to the patient s clinical presentation/diagnosis, care setting, age development level, psychosocial, cultural and religious orientation and completes documentation per unit standards.
Performs shift assessments and completes documentation per unit standards, including pain assessment and reassessment.
Demonstrates accountability for ongoing awareness for the status of assigned patients. Collects and documents data appropriate to the patient s condition.
Reassesses the patient s care needs and modifies the plan of care as necessary.
Assesses discharge planning needs for each patient upon admission, including referrals to Social Services, and other community resources.
3. PLANNING
Identifies patient problems based on assessment findings and develops an individualized plan of care, including the patient/family.
Prioritizes and coordinates the plan of care with healthcare team members.
Communicates pertinent data to the physician and modifies the plan of care as needed.
Documents response to the plan of care in the medical record.
Reviews the plan of care every shift and modifies as needed.
4. IMPLEMENTATION
Implements identified interventions for each guideline of care from the individualized plan of care.
Demonstrates the ability to effectively communicate patient care needs to all members of the multidisciplinary health care team.
Takes responsibility for educating patients/families and documents education/training within the medical record every shift. Ensures education is:
Appropriate to the patient s age, learning needs, level of understanding, and readiness to learn. Reinforces utilization of the teach back method.
Provides appropriate emotional support and offers assistance to the patient/family.
5. EVALUATION
Analyzes data collected, weighs alternatives, and acts appropriately.
Revises and updates the Plan of Care as evidenced by documentation.
Evaluates the patient s/family response to teaching and revises the individualized plan of care.
6. CRITICAL THINKING SKILLS
Practices effective problem identification/resolution skills as a method of sound decision-making.
Consistently makes sound judgements based on strong assessment skills, keeps appropriate healthcare team members informed of patient change/acuity in condition.
Identifies patients needing emergency interventions. Knowledgeable of code carts, including daily check, contents and equipment.
Demonstrates proficiency in crisis and emergency situations. Prioritizes multiple interventions and changes priorities based on new assessment data.
Precepts and mentors new employees/students ensuring a positive orientation/experience. f. Effectively delegates tasks to appropriate health care team members.
Follows department guidelines, policies and procedures to provide safe patient care.
Identifies systems/processes that may negatively impact patient/family outcomes and provides suggestions to improve care delivery.
Demonstrates sound judgment and effective decision making in following the nursing process.
Triages/priorities based on new assessment data.
Accountable for own conduct and independent decisions made in the course of job performance.
Participates in unit activities designed for improvement of services.
7. CORE COMPETENCIES
Follows the five rights of medication administration and maintains transcription accuracy.
Follows hospital policy for Medication Administration, Pain Assessment and Reassessment for patient safety.
Assumes responsibility for maintaining a high level of clinical expertise, using evidenced-based standards, national benchmarks to promote change within the department.
Maintains required certifications.
Supports other clinical areas in times of increased census and patient care need based on competency validation.
Provides concise and meaningful reports to fellow workers and physicians.
8. UNIT SPECIFIC COMPETENCIES
Assessment: Completes a thorough history/assessment on all age groups per policy. Assess patient changes in care, acuity, and needs and reports changes to charge nurse/physician. Identifies those that are at risk for falls, decrease in skin integrity, etc.
Planning: Observes, identifies, and collects data to identify nursing care needs of the patient. Pediatric/geriatric patients with their individual needs and aging process are reflected in the plan. Psychosocial needs of the patient/family and significant others are part of the plan. Involves all disciplines as needed. Initiates comprehensive care plan following full assessment.
Implementation: Provides quality nursing care based on patients' needs and plan of care. Supervises the care given by other nursing personnel. Performs procedures safely to the pediatric/geriatric patient taking into consideration their limitations due to advanced age.
Patient Education: Plans and documents patient and/or significant others' education needs and documents intervention and patients'/significant others' understanding in nursing notes and/or education flow sheet. Utilizes individualized teaching techniques when necessary in working with patients experiencing sensory or learning deficits.
Discharge planning includes appropriate referrals and assistance.
Medication Administration: Demonstrates safe and accurate administration and documentation of medication.
Safety administers medications to the pediatric/geriatric patient taking into consideration their decrease in absorption, swallowing ability, and the appropriate site, amount and dosage of medication ordered.
Follows correct procedures for obtaining, identifying, and administering blood and blood products.
Evaluation and Documentation: Documentation reflects the plan of care and the implementation of physician order. Discharge assessment and instructions are completed and signed by the patient/significant other. Any unusual occurrence is documented on the incident trending report.
Demonstrates knowledge of emergency intervention associated with patients' disease state. Exhibits knowledge of basic technical skills required to implement safe nursing care and health promotion of the patient as demonstrated through practices: Gastric Lavage, Peritoneal lavage, chest tube insertion, CVP insertion/reading, wound care, visual acuity (peds/adults), cardioversion (peds/adults), splints/immobilization, blood glucose monitoring, placement/monitoring of cardiac rhythms, maintenance of IV lines.
Demonstrates proficiency in the use of equipment.
Orients new personnel/registry staff to the unit.
Responsibilities to the Medical Staff: Communicates significant changes in patient conditions and abnormal diagnostic data requiring medical attention. Accurately transcribes, interprets, and carries out physicians' orders.
Responsibilities as a Charge Nurse: Upholds the standards of patient care in a safe, efficient, and cost efficient manner. Submits written documentation (SOC - Incident Report) when applicable. Participates in Q.I. Shows flexibility in hours to reflect census and acuity. Assigns nursing to patients per acuity and qualifications. Completes daily routine of the unit i.e., assignment sheet.
Participates in unit meetings at least 50% of the time; reads and initials staff meeting minutes.
Provides concise and meaningful reports to team members and physicians.
Demonstrates knowledge of emergency intervention associated with patients' disease state. Exhibits knowledge of advanced technical skills required to implement safe nursing care and health promotion of the patient as demonstrated through practices: Chest tube insertion/thoracentesis, defibrillation/cardioversion (peds/adults),external pacing, tracheostomy/cricothyrotomy, emergency childbirth/care of newborn, sexual assault (care/referrals), domestic violence (care/referrals), thrombolytic therapy, antivenom administration, intraosseous site/care of.
Functions as a sitter for safety and observation of patients when needed

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JOB QUALIFICATIONS

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EDUCATION/TRAINING/ EXPERIENCE:

• One year experience in Emergency Services preferred.
• Basic arrhythmia or experience reflecting knowledge of Critical Care preferred.

CERTIFICATIONS/LICENSES:

• Current license as a Registered Nurse in the State of California.
• Current Basic Life Support (BLS) through the American Heart Association required.
• Current Advanced Cardiac Life Support (ACLS) Certification through the American Heart Association required.
• Current Pediatric Life Support (PALS) Certification through the American Heart Association required within 90 days of hire.
• NIH Stroke Scale Certification within 90 days of hire required.
• Assaultive Behavior Management training required within 90 days from date of hire.

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ESSENTIAL KNOWLEDGE, SKILLS AND ABILITIES

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COMMUNICATION SKILLS: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, regulatory or accreditation requirements. Ability to effectively present information and respond to questions from managers, clients, customers, and the general public.
MATHEMATICAL SKILLS: Basic to Intermediate Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Ability to calculate figures and percentages.
REASONING ABILITY: Intermediate to High Skills: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
OTHER SKILLS AND ABILITIES:

• Demonstrates knowledge and ensures compliance with the Nurse Practice Act, The Joint Commission and Title 22 standards and guidelines.
• Demonstrates compliance with hospital policies and procedures at all times.
• Demonstrates strong leadership, organization, communication and interpersonal skills.
• Demonstrates ability to relate to clinical personnel and medical staff, as well as ability to interact well with the public.
• Demonstrates proficiency in Cerner.
• Must have knowledge of PC and applications.