Director of Nursing

PURPOSE OF THE JOB

The primary purpose of this position is to plan, organize, develop, control and direct the overall operation of our Nursing Service Department in accordance with current federal, state, and local standards, guidelines, and regulations that govern the facility, and as may be directed by the Administrator and the Medical Director, to ensure that the highest level of quality care is maintained at all times.

Every effort has been made to identify the essential functions of this position. However, it in no way states or implies that these are the only duties the incumbent must perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or an essential function of the position.

SAFETY FACTORS:

Risk Potential to Blood/Body Fluids:

Category I: Tasks in this category involve exposure to blood, body fluids, or tissues, and require the use of personal protective equipment.

Category II: Tasks in this category involve no exposure to blood, body fluids, and/or tissues, but employment may require performing unplanned category I tasks.

Category III: these tasks require no exposure to blood, body fluids, and/or tissues, and category I tasks are not a condition of employment.

ESSENTIAL JOB FUNCTIONS & RESPONSIBILITIES:

Administrative:

• Plan, develop, organize, implement, evaluate, and direct the nursing service department, as well as its programs and activities, in accordance with current rules, regulations, and guidelines that govern the long-term care facility.
• Develop, maintain, and periodically update written policies, procedures, objectives and philosophies that govern the day-to-day functions of the nursing service department. Implement regional or corporate policies and procedures as they are distributed.
• Maintain a reference library of written nursing material (i.e., PDR's, Federal and State Regulations, etc.) to assist nursing staff in meeting the day-to-day needs of residents.
• Develop and implement a nursing service organization structure.
• Make written and oral reports/recommendations regarding the operation of the department.
• Coordinate nursing services with other resident services and departments to ensure continuity of residents' total regimen of care.
• Develop, implement, and maintain an ongoing quality assurance program for the nursing service department. Ensure that monthly or quarterly quality assurance activities occur and are documented.
• Participate in facility surveys and audits made by authorized government agencies. Participate in or direct the development and implementation of correction plans
• Working with the Business Development team, review all referrals for admission, in accordance with the “Green Yellow Red” policy, to assure that the needs of the individual resident can be met by the nursing department. Recommend denials when appropriate.
• Assist the Discharge Planning Coordinator in developing, implementing and periodically updating the written procedures for the Discharge Planning Program. Review discharge plans and make them available to the Care Plan Committee.
• Assist in developing and maintaining positive working relationships with facility medical staff, hospitals, managed care providers and community organizations.
• Perform administrative duties such as completing medical forms, reports, evaluations, studies, charting, etc., as necessary.
• Serve on, participate in, and attend various facility committees (i.e., Infection Control, Policy Advisory, Pharmaceutical, Budget, Medicare, PPS, Quality Assessment and Assurance, etc.) as required, and as appointed by the Administrator. Assist committees with development, maintenance, and implementation of policies and procedures when requested.
• Participates in community health matters or projects as appropriate.

Budget and Planning:

• Develop and implement the nursing budget with the advice and approval of the facility administrator. Manage the nursing budget on a day-to-day basis to ensure that appropriate staffing expense and quality levels are maintained.
• Keep abreast of economic conditions/situations, and recommend to the Administrator adjustments in nursing services that ensure the continued ability to provide quality care.
• Recommend to the Administrator the equipment and supply needs of the nursing service department/residents.
• Working with the Central Supply clerk/designee, assure that appropriate type and quantity of supplies are available to meet the needs of the department and residents

Human Resources:

• In collaboration with the Administrator, Operations Director, Human Resource Manager, and Chief Operating Officer, determine the staffing needs of the nursing service department. Recommend the number and level of nursing personnel to be employed.
• Participate in recruiting and selecting nursing staff members with the advice and assistance of the Human Resource Manager. Delegate this responsibility to subordinate supervisors as appropriate.
• Ensure that a sufficient number of licensed practical and/or registered nurses and CNAs/STNAs are scheduled and working during all shifts. Develop work assignments and schedule duty hours, and/or assist nursing supervisory staff in completing and performing such tasks. Monitor absenteeism to ensure that an adequate number of nursing care personnel are on duty at all times.
• Ensure that all nurse aide trainees are directly supervision by a licensed nurse.
• Delegate the administrative authority, responsibility, and accountability necessary to perform their assigned duties to nursing service supervisory staff.
• Assist the Human Resource Manager in developing performance evaluation schedules, criteria, and annual reviews for the nursing service staff.
• Make at least two daily rounds to ensure that all nursing service personnel are performing their work assignments in accordance with acceptable nursing standards.
• Ensure that professional nursing personnel, including private duty nurses, have valid and current state licenses.
• Review complaints and grievances made or filed by nursing department personnel and assure resolution to the extent possible.
• Ensure that disciplinary action is administered fairly and without regard to protected class.
• Assist the Infection Control Coordinator in establishing a TB and influenza management program for employees/residents.
• Assure that an annual TB risk assessment is completed as required by the State of Ohio/CDC
• Assure that an Infection Control Surveillance program is in place with monthly trends and analysis; recommendations as necessary
• Report occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals in accordance with the facility's policies and procedures governing accidents and incidents.
• Report any activity by licensed staff that is prohibited by law or regulation to the appropriate government entity.
• Ensure that accurate job descriptions are maintained for each nursing position. Collaborate with Human Resources on updating descriptions in accordance with the ADA, OSHA, and other pertinent laws and regulations.
• Ensure that nursing staff members follow established departmental policies and procedures, including the dress code.

Nursing Care:

• Assure that nursing care is provided to all residents in accordance with the Plan of Care; physician orders and resident rights are maintained
• Assure that the company policies and procedures and practices are implemented related to the ongoing assessment and planning; coordination of care; ongoing evaluation and monitoring. (PDSA)
• Monitor department performance in relation to key indicator benchmarks for falls, unplanned wt. loss, restraints, pain management, pressure ulcers and psychotropic meds etc.
• Work with the Administrator to assure that the QAPI process is fully implemented to assure successful survey results; developing on going monitoring of the POCs from the previous 3 year Survey history/Casper report
• Coordinate with MDS the management of Quality Measures
• Participate in the interviewing and admission of residents for admission to the facility.
• Provide the Administrator with information relative to resident nursing needs and the nursing department's ability to meet those needs.
• Develop and maintain systems that inform nursing staff of new admissions. Greet newly admitted residents upon admission. Escort to room as necessary.
• Ensure that physician visits are scheduled and make rounds with physicians as necessary. Monitor attending physicians’ adherence to requirements to record and sign progress notes, orders, etc., on a timely basis and in accordance with current regulations.
• Ensure that qualified staff members provide nursing procedures.
• Conduct daily rounds to observe residents and determine if nursing needs are being met in accordance with the resident's request.
• Assure that the Electronic Medical Record documentation is maintained in accordance with professional standards

Staff Development

• Monitor the planning, conducting, and scheduling of timely in-service training classes to improve the skills and abilities of nursing staff members. Ensure that these programs meet the continuing education requirements that allow licensed personnel (e.g., RNs, LPNs, CNAs/STNAs, etc.) to keep their licenses on an active status; in accordance with state and federal regulations.
• Monitor an effective orientation program that familiarizes new employees to the facility, its policies and procedures, and to the position and its duties and responsibilities.
• Provide leadership training that includes the administrative and supervisory principles essential for Nurse Supervisors/Charge Nurses. Encourage supervisory staff to attend and participate in outside training programs.
• Collaborate with other managers and supervisors with providing in-service programs that relate to the nursing staff.
• Attend and participate in continuing educational programs to stay current on changes in the nursing profession and to maintain current licensure.
• Conduct monthly nurse meeting for all three shifts.

Safety and Sanitation

• Collaborate with the Safety Officer in developing safety standards for the nursing staff.
• Assist the designated Infection Control Coordinator in identifying, evaluating, and classifying routine and job-related functions to ensure that tasks in which potential exposure to blood/body fluids are properly identified and recorded and that policies and procedures address safety standards.
• Monitor all nursing service work areas, resident care rooms and treatment areas to ensure that they are maintained in a clean and sanitary manner. Collaborate with housekeeping and maintenance department staff to remedy any deficiencies.

Care Plan and Assessment Functions

• Develop, implement and maintain a care plan process and system that addresses the assessment and individualized needs of residents using an interdisciplinary process
• Ensure that all personnel involved in providing care to the resident are aware of the resident's care plan. Ensure that nursing staff members refer to the resident's care plan prior to administering daily care. Review nursing notes to ensure that the care plan is being followed.
• Assist the Resident Assessment/Care Plan Coordinator in planning, scheduling, and revising the MDS, including the implementation of RAPs and Triggers.
• Review care plans and assessments as necessary, but no less than quarterly.
• Develop and maintain a good rapport with all services involved with the care plan to ensure that the plan of care reflects a team effort.
• Ensure that medical and nursing care plans are administered in accordance with the resident's wishes, including the implementation of advance directives.

Resident Rights

• Monitor nursing care to ensure that all residents are treated fairly, and with kindness, dignity, and respect.
• Ensure that all nursing care is provided in privacy and that nursing staff members guard patient privacy.
• Ensure that all nursing service personnel are knowledgeable of the residents' responsibilities and rights, including the right to refuse treatment. Ensure that nursing staff members honor the resident's refusal of treatment request, and that such requests are in accordance with the facility's policies governing advance directives, including review with the resident and/or representative.
• Review complaints and grievances made by residents and report what action(s) were taken to resolve the complaint or grievance to the Administrator. Maintain written records of resident complaints and/or grievances that document actions taken to resolve the complaint.
• Report to the appropriate authorities and investigate all allegations of resident abuse and/or misappropriation of resident property immediately as determined by policy and procedure; in accordance with state and federal regulations.

Working Conditions

• Works in office areas and throughout the nursing service area (i.e., drug rooms, nurses' stations, resident rooms, etc.). Moves intermittently during working hours.
• Subject to frequent interruptions.
• Subject to hostile and emotionally upset residents, family members, personnel, and visitors under all conditions and circumstances.
• Works beyond normal working hours and on weekends and holidays when necessary. On call 24 hours per day, 7 days per week.
• Subject to injury from falls, equipment burns, odors, etc., throughout the workday, as well as potential reactions from dust, disinfectants, and air contaminants.
• Subject to exposure to infectious waste, diseases, conditions, etc., including TB and the AIDS and Hepatitis B viruses.
• May handle or be exposed to hazardous chemicals.

Education Requirements

• Must possess a Nursing Degree from an accredited school.

Experience

• At least three years experience in nursing administration, including supervision, preferably in a long-term care setting. Knowledgeable about regulations and standards established by Medicare, Medicaid (PA) and state and city government.

Specific Requirements

• Must possess a current, unencumbered, active state license as a Registered Nurse.
• Must be able to read, write, speak, and understand the English language.
• Must possess the ability to make independent decisions when circumstances warrant such action.
• Must be able to relate to and work tactfully with ill, disabled, elderly, emotionally upset, or hostile people. Must have patience, tact, enthusiasm, and the willingness to handle difficult people and situations.
• Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to long-term care.
• Must possess leadership and supervisory ability and the willingness to work harmoniously with other managers and employees.
• Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., necessary for providing quality care.
• Must be able to function independently, and have the flexibility, personal integrity, and ability to work effectively with residents, staff, and support agencies.
• Must be open to change and willing to seek out new methods and principles and incorporate them into existing nursing and administrative practices.

Physical and Sensory Requirements (with or without the aid of mechanical devices)

• Must be able to move intermittently throughout the workday.
• Must be able to cope with mental and emotional stress.
• Must be able to see and hear or use prosthetics that will enable these senses to function adequately to ensure that the requirements of this position can be fully met.
• Must meet the general health requirements set forth by the policies of this facility that include a medical and physical examination.
• Must be able to push, pull, move, and/or lift a minimum of 25 pounds.
• Must be able to assist with emergency evacuation of residents.