Patient Assessment and Care Planning:

• Conduct thorough initial assessments of new residents upon admission, evaluating their medical history, current condition, and specific care needs.
• Collaborate with the interdisciplinary team (doctors, therapists, social workers) to develop and implement individualized care plans that address each resident’s medical, emotional, and psychological needs.
• Continuously assess residents’ conditions and adjust care plans as necessary to reflect changes in health status, medications, or functional abilities.

Medication Management:

• Administer prescribed medications to residents, ensuring correct dosages, timely administration, and proper documentation.
• Monitor residents for medication side effects, allergies, or adverse reactions and notify the healthcare provider when necessary.
• Educate residents and their families about the medications, their purposes, and potential side effects.

Clinical Care and Treatments:

• Provide routine nursing care, such as wound care, catheter care, dressing changes, and managing chronic conditions like diabetes, heart disease, or respiratory issues.
• Assist with activities of daily living (ADLs) as needed, such as bathing, dressing, and feeding residents who are unable to perform these tasks independently.
• Monitor vital signs (blood pressure, pulse, temperature, respiratory rate) and report any significant changes to the physician or care team.
• Manage and monitor residents’ pain levels, ensuring effective pain management strategies are in place.

Resident and Family Education:

• Educate residents and their families about health conditions, treatments, medications, and ways to manage chronic conditions.
• Offer guidance on lifestyle changes, nutrition, mobility, and other self-care practices that promote health and comfort.
• Provide emotional and psychological support to residents and their families, addressing any concerns about care or health status.
• Teach families how to assist with caregiving tasks, such as repositioning, transferring, and helping with physical therapy exercises.

Care Coordination and Advocacy:

• Coordinate and communicate with the broader care team to ensure residents receive comprehensive care across multiple disciplines (e.g., physical therapy, nutrition, social work).
• Advocate for the needs and preferences of residents, ensuring their care plans are followed and that they receive appropriate care in a timely manner.
• Monitor and respond to changes in residents' mental and emotional well-being, ensuring they have access to appropriate mental health resources or counseling if needed.

Documentation and Reporting:

• Maintain accurate, up-to-date records of residents' conditions, treatment plans, and interventions.
• Document all interactions with residents, medication administration, changes in health status, and any concerns or incidents that occur.
• Ensure compliance with all regulatory requirements, including HIPAA standards, by maintaining confidential and thorough documentation.
• Complete assessments, care plan updates, and progress notes in a timely manner to ensure all care is well-documented.

Emergency Response and Crisis Management:

• Respond to medical emergencies, including sudden changes in condition, falls, or adverse reactions to treatments.
• Provide immediate care in emergency situations, such as CPR, first aid, or other life-saving measures, until additional medical support arrives.
• Monitor residents at risk for falls, dehydration, or infections, and implement preventative measures to reduce risks.

Compliance and Quality Assurance:

• Ensure that care provided meets all federal, state, and facility regulations, policies, and standards.
• Participate in quality improvement initiatives to enhance the overall care experience for residents and improve outcomes.
• Ensure that residents' rights, including dignity, privacy, and autonomy, are respected at all times.

Leadership and Staff Supervision:

• Supervise and mentor nursing assistants and other support staff, providing guidance on care tasks and assisting with skill development.
• Assist in delegating tasks and managing shifts to ensure that care delivery is efficient and meets the needs of all residents.
• Participate in staff meetings and contribute to discussions regarding resident care and facility improvements.