Nurse Navigator, Supportive and Palliative Care, Newark, DE

ChristianaCare is currently seeking a full-time Nurse Navigator for our inpatient Supportive and Palliative Care team at ChristianaCare in Newark, DE. In this role, you will navigate and facilitate the care of patients and their families seeking palliative care in collaboration with the multi-disciplinary care team.

Work Schedule

Monday-Friday, 8:00am-4:30pm

No weekends or holidays

Principal Duties and Responsibilities

Coordination of Care

• Assists Palliative Care staff with coordinating referrals from within and outside of Christiana Health Care.
• Completes a review of the patient upon initial encounter and periodically throughout navigation, matching unmet needs with appropriate services.
• Assists with identifying potential and realized barriers to care (e.g., transportation, caregiver support, housing, language, culture, literacy, role disparity, psychosocial, employment, financial, insurance) and facilitates referrals.
• Schedules and/or facilitates scheduling of appointments.
• Triage of family/caregiver phone calls, messages determining disposition of call. Coordinates response with Palliative clinicians based on clinical assessment and communicates treatment plan/recommendations to patient/caregiver.
• Organize inpatient palliative census and daily workload. Evaluate and triage consults by collaboration with the hospital team (bedside nurse, consulting providers).
• Support established inpatients in lieu of Palliative provider consult.
• Collaborates with the outpatient team for seamless transition.
• Provides psychosocial support to and facilitates appropriate referrals for patients, families, and caregivers, especially during periods of high emotional stress and anxiety.
• Supports discussions with patients and caregivers related to goals of care and end of life treatment decisions (hospice). Facilitates scheduling of family/provider meetings.
• Applies basic knowledge of insurance process (e.g., Medicare, Medicaid, third-party payers) and their impact on staging, referrals, and patient care decision toward establishing appropriate referrals, as needed.
• Monitors progress in achieving defined patient specific, clinical outcomes through performance improvement activities and outcomes.
• Manages care flow and navigates multidisciplinary treatment needs (including communication with and coordination of tests, and imaging).

Education

• Assesses patient and family learning needs to identify barriers to education (e.g., literacy, language, cultural influences, comorbidities)
• Utilizes "Teach Back" method for patient education.
• Collaborates with multidisciplinary team to develop patients' clinical treatment plan.
• Educates the patient/family/caregiver: diagnosis, treatment options, medication side-effect management, behavioral disturbance triage and guidance.
• Assists patient/family with appropriate information to make an informed decision.
• Maintain our inpatient patient education resources - (booklets on end-of-life expectations, pamphlets on our team and resources)
• Provide system education to nurses on nursing role in palliative care (by helping inpatient nurses understand how to interact with hospice, and be a nurse providing comfort care and advocating for basic primary palliative care for their patients)

Communication

• Facilitates communication among the Palliative Care team to prevent fragmented or delayed care.

• Acts as a liaison and advocate between the patients, families, caregivers, and health care providers to promote and optimize patient outcomes.
• Empowers patients and families through education and encouragement to self-advocate and communicate their needs.
• Adheres to established regulations concerning patient information and privacy.

Professional Role

• Contributes to Palliative Care program development, implementation, and evaluation within the healthcare system and community.
• Maintains required credentials and participates in learning to stay current with disease specific information and issues related to memory care, insurance, ethical issues.
• Contributes to the knowledge base of the healthcare community and in support of the Palliative Care role through activities such as involvement in professional organizations, presentations, publications, and research.
• Participates in system committees such as magnet, nursing council, safety, cultural competency/diversity, patient education, professional nursing council.
• Is a Mentor for students and other members of the team.

• Works with health improvement team to implement and evaluate new processes of care and patient flow which are determined by the team utilizing pathways, guidelines, and algorithms.
• Supports a culture of safety, respect, and commitment to excellence and inclusivity.

Education and Experience Requirements

• BSN required.
• Masters in nursing preferred.
• RN license or eligible for licensure in the state of Delaware, Pennsylvania, New Jersey, or Maryland
• Three or more years of combined clinical experience in clinical and/or administrative experience in case management, clinical trials, older adult, palliative/hospice care preferred.
• Nursing Cert - Certified Hospice and Palliative Nurse (CHPN) - Hospice & Palliative Credentialing Center within 3 years of hire.

Special Requirements

• RN license or eligible for licensure in the state of Delaware, Pennsylvania, New Jersey, or Maryland
• BLS

Qualified candidates should apply online and include a current resume for consideration.

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EEO Statement: Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.