LPN - Hospice (Part-Time)

Participates with the Health Care Team in delivering quality and customer focused care to patients in a manner which reflects Kaiser Permanente's organizational and nursing mission, vision and values. Provides nursing and administrative support to clinicians and other health care team members to offer a variety of health care services to patients. Clinical duties involve both direct (in person) and indirect (via phone or on-line) patient care activities requiring both simple to complex nursing knowledge and skills. As appropriate to the LPN's scope of practice, the LPN is expected to have competent focused/limited nursing assessment and triage skills on routine or self-limiting health conditions, critical thinking, communication, problem-solving and decision-making skills in order to meet patient needs and contribute to a positive care experience and work environment. Performs clinical tasks and procedures under the direction of a clinician, within the scope of the LPN's professional training and individual competency. Works under the clinical supervision of the clinician or registered nurse and under the general direction of the designated supervisor.

Essential Functions:

Clinical Tasks: These job tasks provide patient care and are to be performed competently, consistently, accurately and according to established regional/departmental clinical protocols, policies and procedures and standards. They are:

* Prepares and organizes patient's office visit for known reason/procedure by ensuring that all appropriate tests, clinical information (e.g. diagnostic test results, consultation reports, outside reports, etc.) and order entries are ready for clinician review prior to appointment time.

* Performs focused/limited nursing assessment and triage on routine or self-limiting medical conditions as directed by RN/clinician. . Recognizes when to defer to and/or assist with comprehensive assessment for complex medical conditions by RN/clinician.

* Utilizes standardized tools (e.g. PST, health maintenance alerts) to identify and address health maintenance/care gaps with patient and alerts clinician on those that require his/her attention.

* Recognizes signs and symptoms of common and routine medical conditions/illnesses, abnormal versus new/existing and implements planned nursing and medical interventions as delegated by RN/clinician.

* Contributes to the development, implementation or modification of the individualized patient's plan of care under the direction of the RN/clinician.

* Prepares patient for actual visit/procedure prior to clinician's exam during rooming-in process.

* Assures exam/procedure room contains appropriate supplies, equipment, forms and educational materials are available and ready for use during visit/procedure. Checks equipment are in safe working order and cleans room after use.

* Provides health teaching/education or advice on routine or self-limiting medical conditions, procedures, tests, surgeries, self-injections, etc. Utilizes standardized tools to determine patient's level of engagement in self-care as directed by RN.

* Uses KP HealthConnect and other information systems to document all pertinent data and outcomes of nursing care according to standardized procedures and policies such as and not limited to the use of SBAR, SOAP or APIE, KP HealthConnect smarttools, etc. Updates demographic/historical clinical data gathered in electronic medical record.

* Clinical Procedures:

* Performs diagnostic tests, therapies and procedures within scope of practice competently and with maintenance of proficiency according to: a) specific department standards on core clinical tasks (see department's list of core skills); b) application of knowledge and skills appropriate to developmental age of patient; and c) established policies such as and not limited to patient safety, aseptic and sterile techniques and infection control. Examples of categories of clinical tasks are:

* Screening tests - e.g. vital signs, vision, hearing, developmental, LOPS, pain, etc.

* Diagnostic tests - e.g. urine dips and drug, spirometry/PFT, bladder scan, O2 saturation rate, allergy skin testing, treadmill assist, etc.

* Medication administration via oral, topical, otic, rectal, vaginal, IM, SubQ, intradermal, IV (includes insertion & d/c of peripheral line, use of pump), ophthalmic, bladder, inhalation and nasal routes

* Wound care - e.g. routine and complex dressing changes, staple/suture removal, ostomy, drains management, etc.

* Therapies - e.g. photo, laser, foot care, etc.

* Application and/or removal of orthopedic appliances and other devices - e.g. splints, slings, orthotics, cast, crutch management, anti-embolic stockings measurement, procedural safety restraints, etc.

* Tube insertions/care - e.g. urinary catheterization, NG tube, suctioning, tracheotomy, etc.

* Minor surgical procedures assist - e.g. biopsies, excisions, insertion of devices, D&C, etc.

* Medical procedures assist - e.g. PAP, colonoscopies, sigmoidoscopies, colposcopies, joint aspirations, lumbar puncture, etc.

* Lab specimens collection and labeling - e.g. nasopharyngeal, wound, throat, etc.

* Irrigations - e.g. eye, ear, bladder, wound

* Instrument/equipment set-up, cleaning and processing (sterile and non-sterile) - e.g. scopes, cryogun, O2 tank, procedural trays, etc.

* Ambulate/transfer of patient using lift equipment

* Other procedures outlined in the core skills checklist as attached. Utilizes standardized tools to determine patient's level of engagement in self-care as directed by RN.

* Uses KP HealthConnect and other information systems to document all pertinent data and outcomes of nursing care according to standardized procedures and policies such as and not limited to the use of SBAR, SOAP or APIE, KP HealthConnect smarttools, etc. Updates demographic/historical clinical data gathered in electronic medical record.

* Clinical Procedures:

* Performs diagnostic tests, therapies and procedures within scope of practice competently and with maintenance of proficiency according to: a) specific department standards on core clinical tasks (see department's list of core skills); b) application of knowledge and skills appropriate to developmental age of patient; and c) established policies such as and not limited to patient safety, aseptic and sterile techniques and infection control. Examples of categories of clinical tasks are:

* Screening tests - e.g. vital signs, vision, hearing, developmental, LOPS, pain, etc.

* Diagnostic tests - e.g. urine dips and drug, spirometry/PFT, bladder scan, O2 saturation rate, allergy skin testing, treadmill assist, etc.

* Medication administration via oral, topical, otic, rectal, vaginal, IM, SubQ, intradermal, IV (includes insertion & d/c of peripheral line, use of pump), ophthalmic, bladder, inhalation and nasal routes

* Wound care - e.g. routine and complex dressing changes, staple/suture removal, ostomy, drains management, etc.

* Therapies - e.g. photo, laser, foot care, etc.

* Application and/or removal of orthopedic appliances and other devices - e.g. splints, slings, orthotics, cast, crutch management, anti-embolic stockings measurement, procedural safety restraints, etc.

* Tube insertions/care - e.g. urinary catheterization, NG tube, suctioning, tracheotomy, etc.

* Minor surgical procedures assist - e.g. biopsies, excisions, insertion of devices, D&C, etc.

* Medical procedures assist - e.g. PAP, colonoscopies, sigmoidoscopies, colposcopies, joint aspirations, lumbar puncture, etc.

* Lab specimens collection and labeling - e.g. nasopharyngeal, wound, throat, etc.

* Irrigations - e.g. eye, ear, bladder, wound

* Instrument/equipment set-up, cleaning and processing (sterile and non-sterile) - e.g. scopes, cryogun, O2 tank, procedural trays, etc.

* Ambulate/transfer of patient using lift equipment

* Other procedures outlined in the core skills checklist as attached. Practice Management Activities: These job tasks are primarily "indirect patient care" (i.e. non face-to-face) to be performed competently, accurately and consistently according to established regional/departmental clinical protocols, policies and procedures and standards. They are:

* Maintains and adjusts clinician's patient schedule for efficient patient that facilitate appointed visits and overbooks.

* Answers and responds to in-coming messages/requests via telephone, mail or kp.org from patient or other department(s) by collecting and communicating pertinent data requiring clinician's review and input. Responds to messages on routine medical concerns that can be addressed by giving advice or health instructions

* Facilitates and completes follow-up duties on patient's plan of care as directed by clinician to include but not limited to: processing of prescriptions and forms; reminder of screening/diagnostic tests that are due; scheduling/staging of procedures, tests, referrals, and/or return appointments; and obtaining and inputting patient data to monitor progress into the electronic medical record

* Assists in coordinating patient care to support patient with complex health needs in navigating easily through the health care system as directed by clinician/RN.

* Sorts and prioritizes mail containing patient and/or clinical information requiring clinician's review and attention.

* Provides population-based care outreach activities to include health maintenance screening as directed by clinician

Practice Management Activities: These job tasks are primarily "indirect patient care" (i.e. non face-to-face) to be performed competently, accurately and consistently according to established regional/departmental clinical protocols, policies and procedures and standards. They are:

* Maintains and adjusts clinician's patient schedule for efficient patient that facilitate appointed visits and overbooks.

* Answers and responds to in-coming messages/requests via telephone, mail or kp.org from patient or other department(s) by collecting and communicating pertinent data requiring clinician's review and input. Responds to messages on routine medical concerns that can be addressed by giving advice or health instructions

* Facilitates and completes follow-up duties on patient's plan of care as directed by clinician to include but not limited to: processing of prescriptions and forms; reminder of screening/diagnostic tests that are due; scheduling/staging of procedures, tests, referrals, and/or return appointments; and obtaining and inputting patient data to monitor progress into the electronic medical record

* Assists in coordinating patient care to support patient with complex health needs in navigating easily through the health care system as directed by clinician/RN.

* Sorts and prioritizes mail containing patient and/or clinical information requiring clinician's review and attention.

* Provides population-based care outreach activities to include health maintenance screening as directed by clinician Teamwork, Leadership and Professional Development Activities:

* Performs appropriate daily activities to start workflow in work area per team agreements and procedures.

* Demonstrates flexibility and ability to reprioritize workflow to handle urgent/emergent demands of the team effectively.

* Responds and assists with medical emergencies as directed by clinician/RN.

* Serve as a clinic resource for other team members and assists with mentoring, coaching or training peers

* Reports errors, near misses or other hazards in a timely manner per established procedures.

* Obtains instruction, supervision and consultation as necessary before implementing new or unfamiliar procedures or techniques which are within his/her scope of practice.

* Completes annual competency assessments and trainings by meeting organizational standards and expectations.

* Demonstrates and maintains clinical knowledge and skills related to department's clinical area and contributes new ideas to assist team in achieving departmental/regional quality and service goals/initiatives.

* Other duties as assigned consistent with job description.

Teamwork, Leadership and Professional Development Activities:

* Performs appropriate daily activities to start workflow in work area per team agreements and procedures.

* Demonstrates flexibility and ability to reprioritize workflow to handle urgent/emergent demands of the team effectively.

* Responds and assists with medical emergencies as directed by clinician/RN.

* Serve as a clinic resource for other team members and assists with mentoring, coaching or training peers

* Reports errors, near misses or other hazards in a timely manner per established procedures.

* Obtains instruction, supervision and consultation as necessary before implementing new or unfamiliar procedures or techniques which are within his/her scope of practice.

* Completes annual competency assessments and trainings by meeting organizational standards and expectations.

* Demonstrates and maintains clinical knowledge and skills related to department's clinical area and contributes new ideas to assist team in achieving departmental/regional quality and service goals/initiatives.

* Other duties as assigned consistent with job description.

$21.49-$28.34

Basic Qualifications:

Experience

* Triage/phone experience.

* One year experience as a licensed practical nurse in home care or the acute care setting (preferably medical/surgical). Will consider other experience with ability to demonstrate critical thinking and clinical skills.

Education

* Graduate of Accredited School of Nursing.

License, Certification, Registration

* LPN license in Oregon. Application for Washington LPN license completed by start date, and obtained within three months of hire.

* Valid driver's license.

* Basic Life Support CPR card for Health Care Provider. Valid card must be obtained prior to patient contact and within two weeks of hire.

Additional Requirements:

* Demonstrated clinical nursing skills

* Demonstrated interpersonal and customer service skills (Assessment required for external candidates)

* Demonstrated communication (written and oral) skills

* Demonstrated literacy in using computers and keyboarding

* Skills in problem-solving, setting priorities and using good judgment for decisions

* Ability to work independently and efficiently under pressure

Patient care and coordination of home care services

* Under direct and indirect supervision of the RN:

* Provides regular telephone advice/problem-solving for patients/caregivers following the established plan of care

* Facilitates scheduling for follow up visits and procedures related to all advice calls.

* Completes morning follow up to after-hours advice calls for patient needs.

* Evaluates clinical implications of services ordered, patient/caregiver ability to manage self-care, requirements for clinical monitoring, patient stability, patient behavior that could impact a safe plan of care, and other factors that could impact safety and efficacy of admission care plan.

* Participates in the development and coordination of a comprehensive admission plan of care that incorporates an understanding of patient-specific benefits and eligibility requirements in collaboration with care team, outpatient resources, and referring physician.

* Discusses and collaborates with referral source, access or advice RNs, home care team members, physician, discharge coordinator, and manager regarding complex discharges, unsafe discharge plans, and inappropriate referrals.

* Serves as a liaison between referring and program physicians, patients/families, department supervisors, managers, and CCS staff to ensure timely patient care.

* Processes clinical aspects of referrals and assists with coordination of referrals out for CCS, Salem, Longview, and when programs are at capacity or require referral outsourcing.

* Develops and maintains expert level of knowledge and skills related to agency policy, state practice acts, applicable state and federal regulations, utilization management, and qualifications for H/HBPC services

* Ensure regulatory and compliance standards are met in collaboration with others in the inter-disciplinary health care team.

Preferred Qualifications:

* 2 years nursing experience in assigned department's clinical area (e.g. Pediatrics, FP/IM, OB/Gyn, Surgery, Allergy, Dermatology, Urology, etc.) within an ambulatory care setting.

* Four years' experience as a licensed practical nurse in the acute care setting, medical/surgical setting.

* One year working in a hospice, palliative care or home care program.

* IV therapy experience or recent certification

* Familiarity in documenting in an electronic medical record system

* Current working knowledge and clinical skills in providing routine care, education and advice in assigned department's clinical area OR successful completion of appropriate competencies for assigned primary/specialty care department.