Registered Nurse (RN) - Public Health
Nash County
Nashville, NC

Public Health Nurse II (Clinical and CAP)

   To provide nursing services to all Nash County Health Department patients following agency policies, procedures and standing orders. Health department programs include Maternal Health, Family Planning, Women's Health, Adult Health, Child Health, Immunization, STD/HIV, Tuberculosis and Communicable Disease.      To provide the nursing portion of the annual multidisciplinary assessments for target patients as required per the most current NC Medicaid Community Alternatives Program for Disabled Adults and Children (CAP/DA and CAP/C) Clinical Coverage policies.         Community Alternative Program for Disabled Adults {CAP/DA) -A Medicaid Home and Community-Based Services (HCBS) Waiver authorized under section191S(c) of the Social Security Act and complies with 42 CFR § 440.180, Home and community-based waiver services. This waiver program provides a cost-effective alternative to institutionalization for a beneficiary, in a specified target population, who is at risk for institutionalization if specialized waiver services were not available. These services allow this targeted individual to remain in or return to a home and community-based setting.        Community Alternative Program for Children (CAP/C) - A Medicaid Home and Community based Services (HCBS) program authorized under section1915(c) of the Social Security Act and complies with 42 CFR § 440.180, Home and Community-based Waiver Services. This waiver program provides a cost-effective alternative to institutionalization for a Medicaid beneficiary who is medically fragile and at risk for institutionalization if home- and community based services approved in the CAP/C waiver were not available. These services allow the beneficiary to remain in or return to a home and community-based setting. This waiver supplements, rather than replaces, the formal and informal services and supports already available to an approved Medicaid beneficiary.     Work Schedule:8:00 a.m. - 5:00 p.m. Monday through Friday. Some duties require working occasional weekends and overnight travel. Employee may have to work emergency shelter or special clinics as necessary. Hours vary depending on the services of the department and the needs of patient.DESCRIPTION OF RESPONSIBILITIES AND DUTIES:  40%       CAP Public Health Nurse     Performs nursing assessments on patient at time of annual reassessments.   Expected total CAP/DA and CAP/C visits to be between 5-20 patients per month but may vary depending on available slots and changes in patient status.   Reviews patient's current medications.   Enters data into EHR (eCap). Documents date RN assessment completed in CAP/DA - CAP/C spreadsheet as notification to patient's CAP Case Manager that visit has been completed.   10% Women's Health Program  Completes an initial or interim medical and psychosocial history. Takes blood pressure and orders appropriate lab tests. Provides education and counseling regarding medical and psychosocial problems identified.   Provides education, counseling, and instructions regarding methods of birth control and method chosen.   Dispenses appropriate medications and/or birth control method according to the Department's Pharmacy Policy and Procedure and Family Planning Policy and Procedures and Standing Orders.   Updates immunizations per Standing Orders.  Initiates referrals for abnormal findings and needs identified.   Documents findings and all activities in the patient's medical record according to the Department's Medical Record Policy.     10%  Prenatal Program  Completes an initial or interim medical and psychosocial history.   Takes blood pressure and orders appropriate lab test per standing orders and guidance from clinician. Provides education and counseling regarding medical and psychosocial problems identified. Provides appropriate education and counseling. Assists physician with exam. Dispenses appropriate medications and/or vitamins and iron according to the Department's Pharmacy Policy and Procedures and Maternity Policy and Procedures.   Initiates referrals for abnormal findings and needs identified.   Documents findings and all activities in the patient's medical record according to the Department's Medical Record Policy and Procedures.       10%  STD/HIV Program  Completes an initial or interim medical and sexual history. Orders appropriate lab tests. Provides education and counseling regarding problems identified.   Dispenses or administers appropriate treatment according to the STD Policy, Procedures, and Standing Orders, and according to the Department's Pharmacy Policy and Procedures.   Updates immunizations per Standing Orders. Provides pre and post-test HIV counseling. Initiates referrals for abnormal findings and needs identified.   Documents findings and all activities in the patient's medical record according to the Department's Medical Record Policy.   Fills in as necessary to receive referrals from other health care facilities. Contacts patients needing medical treatment.  10%   Child Health  Completes an initial or interim medical, psychosocial, and developmental history.   Performs visual acuity and hearing screening and takes blood pressure on children four years and older. Orders appropriate lab work. Counsels parent regarding nutrition, growth and development, medical concerns, immunizations, care of the newborn and older child, etc.   Dispenses or administers medications and immunizations according to the Standing Orders of the Child Health Program and the Pharmacy Policy and Procedures.   Issues prescription according to the Standing Orders of the Child Health Program. Initiates referrals for abnormal findings and needs identified. Documents findings and all activities in the patient's medical record according to the Department's Medical Record Policy.     10%  Adult Health Program  Completes an initial or interim medical and psychosocial history. Takes blood pressure and orders appropriate lab tests. Provides education and counseling regarding problems identified (ex., chronic disease and disease prevention).   Dispenses medications according to the Department's Standing Orders and Pharmacy Policy and Procedures.   Updates immunizations per Standing Orders. Initiates referrals. Documents findings and all activities in the patient's medical record according to the Department's Medical Record Policy.       5%   Communicable Disease/COVID-19/Community Health  Administers immunizations per Standing Orders. Provides education and counseling.  Documents findings in the patient's medical record according to the Department's Medical Record Policy. Participates in disaster services as required.   Assists with department wide community activities, i.e.: community flu/pneumonia programs, COVID-19 vaccine and//or testing clinics, health fairs, etc. Assists other Department staff with school activities; i.e.: immunizations, communicable disease services, etc. Assist with Red Cross disaster sites/shelters as needed Participates in disaster services as required.     5%    Other Duties  Assists with general clinic patients; i.e.: those presenting for pregnancy tests, TB medications, hepatitis B vaccine, blood pressure checks, B12 injections, etc.   Maintains required personnel records (ex., time, travel, and telephone logs).   Attends staff training and other continuing education programs and monthly staff meetings. Helps maintain a safe working environment. Performs other duties as assigned by the supervisor or health director.A considerable knowledge of and skill in the application of nursing theory, practices, principles, and techniques employed in the field of public health and related programs is required and have the ability to apply these principles and practices of public health.   This position requires strong assessment skills and qualifications to perform adult and pediatric physical assessments. Ability to secure the cooperation of clients, to elicit needed information and to maintain effective working relationships; ability to record accurately services rendered and to interpret and explain records, reports, and medical instructions. Requires knowledge of available resources and appropriate referral methods. Requires the ability to plan and coordinate work with others, to deal tactfully with others, and to exercise good judgement in appraising situations and making decisions. Requires working knowledge of current social and economic problems relating to public health.   Accuracy Required in Work:Accuracy is required when determining eligibility for case management services. Accuracy and sound judgement are required in all nursing interventions with patients. Accuracy is required in identifying patient needs through interview and for performing medical and psychosocial assessments, and for documentation, and referral process, as well as following agency policies and procedures.   Consequence of Error:Errors could result in inappropriate or inadequate health services endangering the health and safety of patients. Errors may also precipitate malpractice lawsuits and/or disciplinary action by the North Carolina Board of Nursing resulting in serious ethical, legal and financial consequences. Failure to educate parents on domestic violence resources may have negative impact on client's safety. Failure to report neglect/abuse may become life threatening to the child.   Instructions Provided to Employee:General instructions and guidance provided by Social Work Supervisor, Nursing Supervisor, Health Director, Program Consultants and Medical Consultants on an ongoing basis. Job description delineates responsibilities of position. Program and agency guidelines and protocols are available.  Receives a twelve-week minimum orientation. Attends workshops related to job. In-house updates at monthly staff meetings or by written memo.   Guides. Regulations, Policies and References Used by Employee:North Carolina Nursing Practice Act and Board of Nursing Directives State Program Guidelines and Agreement Addenda for various programs Local Personnel Policies Federal and State Statutes and Rules NC Public Health Children and Youth Branch ACIP Manual NC DHHS Women's Health Branch NC Division of Medical Assistance for Clinical Coverage Policy   Supervision Received by Employee:Nursing duties are supervised by Nurse Supervisor. Will require direct observation and evaluation of statistical program data, reports and record audit findings. Annual performance appraisals at least annually.   Variety and Purpose of Personal Contacts:Requires continuous contact with staff within the Health Department on a daily basis and occasionally requires dealing with clients that are upset or dissatisfied, and with sensitive or volatile situations. Must have good communication and negotiation skills. This position also requires employee to develop and maintain ongoing working relations with other community agencies and service organizations, including physicians and hospitals. Works and interacts closely with the Social Work Supervisor, Nursing Supervisor, Health Director, Regional and State consultants.   Physical Effort:Good physical health and stamina is needed. This position involves office and clinic duties that may include walking, sitting, stooping, bending, lifting, carrying, and other physical efforts. Some travel on rural roads is involved and may be during inclement weather (i.e., rain, extreme heat or cold, etc.). Requires the provision of patient services each day whether through applying direct clinical skills, phone calls, record management, or attending a continuing education workshop.   Work Environment and Conditions: Some work will be conducted in various locations outside of the health department. The CAP/DA and CAP/C visits will be performed in the client's home and occasionally at Long Term Care Facilities. Some clients' homes may be unkempt, unsanitary, and the building structure may be unsafe (i.e., loose boards of floor, dark, etc.). This position falls under Category I of the OSHA guidelines for exposure, meaning tasks will involve exposure to blood, body fluids, or tissue. Employee also attends appropriate seminars and workshops to remain abreast of program changes, updates and available resources. Employee may be exposed to bad weather, hazardous driving conditions, and hazardous social environments. There is a moderate level of stress to be anticipated due to the nature, scope, and complexity of the job functions. Machines, Tools, Instruments, Equipment, and Materials Used:Materials and equipment used mainly includes pens, paper, computer, telephone, automobile, and cellular telephone. Additionally, standard office and audio/visual equipment including: facsimile, photocopier could be used. Medical equipment that may be used include: Otoscope, Stethoscope, BP Cuff, syringes, needles, ophthalmoscope, scales, and stadiometer.   Visual Attention, Mental Concentration, and Manipulative Skills:Concentration is required when listening to parents/caregivers and assessing what they are saying about their child/family member. Close visual attention is required in observing and assessing parental reactions to their child as well as assessing the home environment. Clients/parents may be unable to clearly express concerns.   Communicate with patient and other professionals. Must be able to organize, identify and complete the work process. Document in medical records.   Close visual attention is also a must in the clinic, home setting, office setting, as well as driving.   Safety for Others:The part of the work which requires care to safeguard other people is continuous. Any clues of abuse or neglect must be identified and appropriately referred. Observing the client's and/or child's environment for safety is also essential. Maintaining confidentiality is also required to safeguard others. Complies with health and safety standards to safeguard the wellbeing of all clients and co workers according to state and local guidelines. Must be knowledgeable of safety policies and procedures of the department. Must be knowledgeable of local policies, procedures, and standing orders, and have the nursing expertise to provide appropriate medical care. Must be adequately immunized per Department policy. Adheres to Department's Bloodborne Pathogen Policy.   Dynamics of Work:Changes in policy occur as state guidelines, Medicaid programs, State and local changes in policies and procedures, public demand, trends and numerous other factors are updated and the recommendations are incorporated into local policy. Changes may occur daily due to patients who require unforeseen demands. Changes also occur when recommended by the Department's local medical consultants.   This position requires the employee to be resourceful, versatile, self-motivated, energetic, competent, possess good communication skills, an ability to motivate others, and be able to work with individuals, organizations, and interested groups.REQUIRED MINIMUM TRAINING: Graduation from an accredited school of professional nursing and one year of professional nursing experience   ADDITIONAL TRAINING/EXPERIENCE:  NC Credentialed Public Health Nursing Course (NCCPHN) Introductions to Public Health in North Carolina Online Training Series, Certificate of Public Health Nursing in North Carolina ICS Training 100, 200 and 700 Red Cross Disaster I and 11 CPR Certificate CPR/Defibrillator training HIV counseling and testing program OAE Training Breast exam Assessment Training License or Certification Required by Statute or Regulation:Current license to practice as Registered Nurse in North Carolina by the North Carolina Board of Nursing. Valid North Carolina Driver's License.