Registered Nurse (RN) - Nurse Resident
Central Health
Austin, TX

Registered Nurse (RN) Residency

Overview The RN Resident is expected to complete the 6-month Nurse Residency Program (NRP). The RN Resident is a proactive member of an interprofessional team of licensed and unlicensed caregivers who ensure that patients receive individualized, high-quality, safe patient care. The Nurse Resident collaboratively assists as an active member of the multidisciplinary team to provide therapeutic patient and family-centered care. As a member of the care team, it is expected that the individual upholds the voice of the patient, system policies, and procedures while supporting service excellence goals. During the first five months, residents will rotate through our clinical settings including multi-specialty clinics, Transitions of Care, Respite Care, Case Management, Care at Home, Clinical Navigation, and our Medical Respite settings to gain valuable experience in caring for our patient population. In addition to clinical rotations, residents will enhance their skills through educational sessions, mentoring, and competency validation. After five months, the RN Resident will transition into their permanent position in which they are hired within Central Health, supported by a preceptor. Our nurses are committed to providing a collaborative environment to provide the safest and highest quality of care for our patients. Our team of Registered Nurses models a commitment to the organization's vision/mission/values to support an unparalleled patient experience and positive clinical outcomes. This position aligns with Central Health's deep commitment to advancing health equity and improving health disparities in our community. Paid 6-month Residency Positions, will transition to home department after completion of the residency Specify each nursing department listed in JD Specify positions for new grads, and those up to 2 years' experience February 10, 2025 start date Responsibilities Essential Functions: Nursing Core Essential Responsibilities: * Collaborates with the patient's care team including the primary care team, specialists, home care, hospital team, and any others involved with the patient's care to optimize clinical outcomes. * Serves as an advocate, providing direction and support to the patient and family. Educates patient and family members on diagnosis, treatments, procedures, and medications. * Perform clinical duties as assigned and competency validated and in accordance with Standing Delegation Orders. * Participates in daily/weekly patient care huddles/case conferences. * Enhance the patient experience by practicing AIDET during each patient interaction. * Enhances the patient's experience by addressing and resolving patient issues in a timely manner. * Acts as a resource to Medical Assistants, Community Health Workers, and other clinical team members. * Serve as a preceptor for new clinical team members and students. * May Assist in the development of departmental protocols, policies, and procedures. * Participates in continuous quality improvement projects in order to better serve the patient, family and healthcare system to improve the quality of service provided. * Attend staff meetings and education offerings both in person and via teleconference/online as required. * Supports organizational initiatives to promote and maintain a strong positive workplace culture. * Ensure all tasks provided and associated with patient care, patient administrative processes and related duties comply with all regulatory and accreditation standards, and Central Health Standard Operating Procedures, Policies and Procedures. * Adheres to state board of nursing and state nurse practice act requirements and to other governing agency regulations. * Perform other duties as assigned. Multi-Disciplinary Ambulatory Clinic Essential Responsibilities: * Oversees assigned team, including but not limited to, assisting with establishing work assignments and overseeing flow of unit along with identifying staffing needs. * Evaluates the physical, social, and emotional needs of patients and their families to help them navigate specialty care services. * Enhance the patient experience by supporting Provider teams with in-basket management, refilling medications, and triaging patients in a timely manner following established protocols. * To ensure efficient patient flow and avoid delays in care, may support Provider teams by assisting with procedures, distributing medications and treatments, rooming, and dismissing patients consistent with the standardized workflows. * Completes daily/weekly quality assurance checklists to include delegation of tasks as appropriate to staff (Rider report, class D, McKesson, CLIA, AED, equipment checks, etc.) * Assists with oversight of health center equipment needs, infection control standards, and CLIA regulations, vaccine management, compliance with Standing Delegation Orders, and emergency protocols. * Assists with supply management by ensuring Provider teams maintain requisite supplies needed to deliver timely patient care, identify trends, and anticipate needed supplies. Transitions of Care Clinical Advocate Essential Responsibilities: * Coordinates with hospital Case Management/Care Coordination teams regarding readmission prevention and assists with the identification of patients at high risk for readmission. Proactive collaboration to facilitate discharge teaching for readmitted/high risk patients prior to or at discharge. * Performs handoffs (hospital to aftercare), medication reconciliation and education reinforcement. * Performs the planning, implementation and evaluation of service delivery, patient experience, and care management activities post hospital discharge. * Develops patient-centered discharge plan and communicate discharge plans and patient education needs with physician and care team members. Reviews discharge instructions with patients, identifies patient needs and supports patient/family education regarding chronic disease management, * In collaboration with patient, arranges post-discharge follow up appointment with primary care physician and communicates important updates with patient's primary care provider, as appropriate. * Conducts initial post-discharge outreach to patients within a defined timeline. Performs and documents medication reconciliation during outreach call if applicable. Medical Respite RN Essential Responsibilities: * Contribute as an active member of a collaborative, multidisciplinary team supporting the Respite and Bridge Programs. * Provides nursing support for the service delivery of Respite, Bridge, and Mobile Healthcare Services. May provide care both in a clinic setting and in a mobile setting alongside our community partners. * Works closely with community partners to improve access to care and address health disparities in our community. * Provides comprehensive care to marginalized individuals with complex health needs. * Advocate and support individuals who are experiencing homelessness by facilitating and assisting patients transition to a medical respite facility to rest and recuperate from a medical condition. * Participate in the identification of patient needs for referral to resources that facilitate the continuity of care such as housing and benefits. * May perform appointment registration duties including verifying and entering patient demographic and insurance information in the electronic medical system, collects co‐payments/deductibles, and completes closing, and/or end-of-day processes. * May be required to operate a company vehicle to community-based locations for the provision of health care services. Care at Home Essential Responsibilities: * Completing accurate assessment of discharging needs, coordinating medication and appointments and documentation, reporting to appropriate personnel as indicated and working collaboratively with Advanced Practice Providers, primary care providers, specialists, and community providers. * Medication review against list from discharging provider and/or facility. * Work closely and collaboratively with local hospitals, skilled nursing facilities, community clinics and other programs to review incoming referrals according to inclusion criteria. This will include traveling to do an in person assessment if needed. * Accompany Advanced Practice Provider for home visits and complete intake assessment in Electronic Health Record. * Triage all incoming referral for Care at Home Program and ensure admittance to program as clearly defined in program criteria. * Complete daily/ weekly quality assurance checklists to include delegation of tasks as appropriate to staff. (McKesson, CLIA, etc.) RN Navigator: * Collaborates with the patient's care team including, primary care team, specialists, virtual care, home care, hospital team, and any others involved with the patient's care to optimize clinical outcomes functioning from a call center and hybrid setting. * Reviews clinical progress of patients and coordinates communications to referring, consulting, and primary care physicians. * Coordinates scheduling of appointments as needed. * May assist with the referral process, tracking outcomes of referrals and treatments. * Educates patient and family members on diagnosis, treatments, procedures, and medications in a call center setting. * Supports transitions of care activities with the patient's medical home care management team or the Central Health case management team as indicated to support patients with complex health, social determinants of health (SDOH) and behavioral health needs, or frequent hospital utilization. * May support with review of diagnostic imaging studies, lab values and notifies Provider as appropriate for abnormal findings. * In collaboration with the Nurse Manager, maintains awareness of key performance indicators/metrics and coordinating interventions to prevent avoidable ER visits, hospital admissions and readmissions, etc. Case Management: * Performs comprehensive assessment of medical needs, including but not limited to disease education and medication reconciliation. Assesses the physical, social, and emotional needs of patients and families for optimal health outcomes. * Educates patient and family members on diagnosis, treatments, procedures, medications and healthcare services covered by Central Health. * Develops, collaborates and execute care plan in collaboration with primary care provider teams through Care at Home Model. * Promote adherence with disease specific clinical outcomes by providing each individual with self-management support including disease specific education materials and Care plan and treatment goals including selfmanagement goals. * Responsible for telephonic and/or face to face assessment, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. * Coordinate care and communication between multiple providers, medical, nursing, social, and behavioral health. * Evaluate and modify care plan goals based on patient improvement and resource effectiveness. * Plan and coordinate care daily with all members of Central Health's care team to assure maximum quality and efficiency of care between Eligible Patients, Physicians, Advanced Practice Providers, case management and nursing. Knowledge, Skills and Abilities: * Sound-critical thinking and decision-making skills * High level of skill at building relationships and providing excellent customer and patient care * High degree of knowledge and competency in the practice of nursing and documentation requirements * High level of problem-solving skills to better serve patients and staff * Excellent verbal and written communication skills required * Strong commitment to quality, efficiency, and effectiveness * Skill in fostering and maintaining positive relationship with community partners * Ability to function as a member of a multidisciplinary team * Strong application of Microsoft office and electronic health records Qualifications QUALIFICATIONS: Education: Associate's Degree- Graduation from an accredited school of nursing Work Experience: Less than 1 year or less of RN experience Licenses and Certifications: RN - Registered Nurse - State Licensure and/or Compact State Licensure Unrestricted Registered Nurse License in the State of Texas upon hire. Basic Life Support (BLS)- obtained through approved American Heart Association upon hire