Hospice & Palliative Care Public Health Nurse ( Job Number: 169792 )
Kaiser Permanente - Portland, OR

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***This position is required to float to various locations throughout the service area. ***

The self-directed Hospice and Palliative Care Public Health Nurse (HPCPHN) provides skilled nursing assessment, planning and coordination/care management across settings to patients in a private home, adult foster home, residential/assisted living care, intermediate care, skilled nursing facility, inpatient hospice facilities and hospital settings in order to maximize the comfort and health of patients and families consistent with hospice philosophy and CCS policies and procedures.

Essential Functions

• Assume initial responsibility for assessing patient/family needs and consulting with attending physician, Hospice and Palliative Care Physician (HPCP) , other IDT staff members or other appropriate community or facility contacts as indicated by patient location and needs at the time of the assessment and care provision
• Obtain data on physical, psycho/social, emotional and spiritual factors that may influence patient/family health status and incorporate that data into the plan of care
• Facilitate advanced illness and/or end of life discussion with patient and family members to assist with choice of hospice or palliative care
• Determine patient appropriateness for palliative care or hospice services (including hospice level of care and care site) in consultation with the HPCP
• Case Management: assume primary responsibility for a patient/family caseload that includes the assessing, planning, implementing and evaluating phases of the nursing process; including scheduling visits to reflect patient care needs in order to maintain continuity of the plan of care; and advocate for patient and family
• Participate as an active member of the IDT to coordinate information and services to update the plan of care
• Maintain up to date patient records so that problems, plans, actions and goals are accurately and clearly stated and changes are reflected as they occur in accordance with CCS policies and procedures
• Instruct primary caregivers, family members, employed caregivers and facility staff to provide hospice specific care as indicated.
• Attend weekly case conferences and actively participate in discussion of patient needs and care planning
• Coordinate hospice care across settings to achieve smooth transitions of care and assure compliance with the hospice plan of care through communication and documentation for family members, caregivers, facility staff as appropriate
• Supervise and document Hospice Aide care delivery every two weeks
• Provide phone triage and support to patients/families as needed and requested

• Assure professional competency through maintaining state-of-the-art skills and knowledge consistent with state and Medicare regulations, Joint Commission accreditation standards, applicable nurse practice acts and agency policies
• Participate in CCS and KP orientation and in service training for professional staff as well as agency and community programs as requested to promote professional growth and understanding of hospice and palliative care
• Demonstrate familiarity with policies of the agency and rules and regulations of state and federal bodies which aid in determining policies
• Participates in department quality management/improvement activities; including but not limited to clinical record review, occurrence reporting, focused studies, process and outcome measurement, peer review, continuous quality improvement projects
• Partner in defining and achieving agency productivity standards


Basic Qualifications

• One year medical-surgical nursing experience in an acute care setting
• Baccalaureate degree in nursing or commensurate knowledge and experience (Commensurate knowledge and experience may include recent experience in areas of care coordination, case management, community health, and public health). Licensed in Oregon and Washington. Requires license in primary state, (Oregon or Washington) prior to first day of employment. Application for licensure in secondary state must be made within six (6) weeks of start date. Licenses in both states required within six (6) 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
• Note: This position requires a reliable automobile to travel to and from patient homes. Able to perform complete physical, psychosocial, spiritual assessments
• Able to operate stethoscope and sphygmomanometer
• Keyboarding or typing skills
• Able to learn to operate a laptop computer to perform clinical documentation
• Working knowledge of concise, yet thorough clinical documentation of patient assessments and care
• Effective problem solving, written and verbal communication and organizational and time management skills required to accomplish case management responsibilities within allocated time frames
• Note: This position requires completion of a typing test 20 wpm

Preferred Qualifications

• Operational knowledge of computerized clinical documentation and office application systems including the use of laptop/notebook computers
• Working knowledge of the managed care industry
• Knowledge of Medicare regulations/requirements
• Excellent time management, problem solving and customer service skills
• Excellent written and verbal communication skills
• Able to work autonomously and manage patient caseload
• Experience working as a member of an interdisciplinary team
• Knowledgeable of the care for the chronically ill and frail elderly
• Working knowledge of Hospice and palliative care for the terminally ill patient. Pediatrics
• Oncology/hospice
• Hospice care and the dying process
• Peripheral and central line IV management
• Able to perform venipuncture and IV insertion
• Able to operate multiple IV pumps
• Certification in Hospice and Palliative Care Nursing

Salary Range:

$33.10 - $47.60

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