Director of Nursing

Purpose of Your Job Position

The primary purpose of your job is to plan, organize, develop and direct the overall operation of the Nursing Services Department in accordance with the Nurse Practice Act, Standards of Practice, and all current federal, state & local standards, guidelines, and regulations that govern our facility, and as may be directed by the Administrator and the Medical Director, to ensure that the highest quality care is maintained at all times.

Delegation of Authority

As the Director of Nursing, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. In the absence of the Medical Director, you are charged with carrying out the resident care policies established by this facility.

Job Functions

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 you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position.

Duties and Responsibilities

Administrative Functions

Plan, develop, organize, implement, evaluate, and direct the nursing services department, as well as its programs and activities, in accordance with the Nurse Practice Act, Standards of Nursing Practice, and all current rules, regulation, and guidelines that govern the long-term care facility.

Develop, maintain, and periodically update written policies and procedures that govern the day-to-day functions of the nursing services department.

Maintain a reference library of written nursing material (i.e., PDR's, Federal and State Regulations, etc.) that will assist the nursing service department in meeting the day-to day needs of the resident.

Develop, maintain, and periodically update the Nursing Service Procedures Manual and nursing service objectives and philosophies.

Develop and implement a nursing service organization structure.

Make written and oral reports/recommendations to the Administrator, as necessary/required, concerning the operation of the nursing service department.

Develop, maintain, and periodically update written job descriptions for each level of nursing personnel in accordance with the Americans with Disabilities Act, OSHA, and other pertinent laws and regulations.

Develop methods for coordination of nursing services with other resident services to ensure the continuity of the resident's total regimen of care.

Develop, implement, and maintain an ongoing quality assurance program for the nursing services department.

Develop, implement, and maintain an ongoing quality assurance/performance improvement program for the nursing services department

Participate in facility surveys (inspections) made by authorized government agencies.

Assist the Quality Assessment & Assurance Committee in developing and implementing appropriate plans of action to correct identified deficiencies.

Assist the Infection Preventionist in the establishment and implementation of the Infection Control and Antibiotic Stewardship Programs

Assist in discharge planning for the nursing services portion of the resident's discharge plan.

Perform administrative duties such as completing medical forms, reports, evaluations, studies, charting, etc. as necessary.

Monitor and assist in the coordination of outside; contracted, and/or independent services to meet residents’ needs.

Monitor the quality of the services provided by outside, contracted and/or independent providers. Identify and address any problems identified.

Review and respond to resident, family, and visitor complaints in coordination with other departments.

Ensure the implementation of the Facility’s abuse polices and procedures in the Nursing department.

Assist in the investigation, determination, and development of corrective action, if necessary, for Adverse Incidents.

Assist in investigation of abuse, neglect, mistreatment and misappropriation of resident belongings in coordination with other departments. Ensure that events are tracked for patterns and assist in the development of plans of action to prevent re-occurrence.

Assist the Consultant Pharmacist in developing, maintaining, implementing, and periodically updating written policies and procedures for the administration, storage, and control of medications and supplies.

Participate in regularly scheduled reviews of the discharge plans.

Committee Functions

Serve on, participate in, and attend various committees of the facility (i.e., Infection Control, Policy Advisory, Safety, Quality Assurance & Assessment, QAPI, etc.) as required, and as appointed by the Administrator.

Serves on the Compliance and Ethics Committee

Provide written and/or oral reports of the nursing services programs and activities as required, or as may be directed by such committee(s).

Participate in the Antibiotic Stewardship Program.

Attend and participate in weekly PPS meetings.

Schedule, attend, and participate in developing the agenda for Care Plan Meetings as necessary.

Evaluate and implement recommendations from established committees as they may pertain to nursing services.

Personnel Functions

Determine the staffing needs of the nursing service department necessary to meet the total nursing needs of the residents.

Recommend the number and level of nursing personnel to be employed.

Assist the Administrator and/or HR Director in the recruitment and selection of nursing service personnel.

Ensure that all nursing assistants are enrolled in or have graduated from an approved training program, if applicable.

Ensure a sufficient number of licensed practical and/or registered nurses are available for each shift to ensure that quality care is maintained and staffing regulations are met..

Assign a sufficient number of certified nursing assistants are available for each shift to ensure that routine nursing care is provided to meet the daily nursing care needs of each resident and to ensure compliance with staffing regulations.

Ensure that all nurse aide trainees are 1:1nder the direct supervision of a licensed nurse.

Develop work assignments and schedule shift hours, and/or assist nursing supervisory staff/Nurse Staffing Coordinator in completing and performing such tasks.

Delegate to nursing service supervisory personnel the administrative authority, responsibility, and accountability necessary to perform their assigned duties.

Assist the Human Resource Director in developing performance evaluation schedules, criteria, competency evaluations, and annual reviews for the nursing service department (e.g., RNs, LPNs, CNAs, medication aides, etc.).

Conduct performance evaluations, competency evaluations and reviews of nursing staff and the nursing department.

Make daily rounds of the nursing service department to ensure that all nursing service personnel are performing their work assignments in accordance with acceptable nursing standards.

Monitor absenteeism to ensure that an adequate number of nursing care personnel are on duty at all times. Carry out disciplinary action in accordance with facility policies as necessary.

Develop, maintain, and periodically update the written procedure for ensuring the professional nursing personnel, including private duty nurses, have valid and current licenses are required by this State.

Review and respond to complaints and grievances made or filed by department personnel. Provide complaint/grievance reports to the Administrator as required or as may be necessary.

Ensure that departmental disciplinary action is administered fairly and without regard to race, color, creed, national origin, age, sex, religion, handicap, or marital status.

Assist the Infection Preventionist in establishing a TB management program for employees.

Report occupational exposures to blood, body fluid, infectious materials, and hazardous chemicals in accordance with the facility's policies and procedures governing accident and incidents.

Ensure background checks to include AHCA screenings on Nursing Service personnel are completed in accordance with established procedures.

Ensure that Nursing personnel are not permitted to work or are hired if an AHCA Background Screening determines they are “Not Eligible”. Nursing personnel may not be hired or return to work until such time as the AHCA Background Screening determines they are “Eligible”.

Ensure that any licensed nursing staff who has been found guilty, by a court of law of abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property or who have disciplinary action in effect against his or her professional license by a state licensure body as a result of a finding of abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property are ineligible for hire.

Ensure that all CNAs’ credentials are verified through the State Nurse Aide Registry. Ensure that any CNA who has a finding entered into the State nurse aide registry concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of their property is ineligible for hire.

Ensure that appropriate adverse actions relative to CNA's employment criteria are reported to the State Nurse Aide Registry.

Ensure that any nurse or CNA, who is found to have abused, neglected, mistreated, exploited, or misappropriated resident’s belongings is reported to the Department of Health- Medical Quality Assurance.

Nursing Care Functions

Participate in the interviewing and selection of residents for admission to the facility, including the PASRR screenings.

Provide the Administrator with the information relative to the nursing needs of the resident and to the nursing department's ability to meet those needs.

Inform nursing service personnel of new admissions, their expected time of arrival, room assignment, etc.

Ensure that rooms are ready for new admissions.

Greet newly admitted residents upon admission. Escort them to their rooms as necessary.

Make rounds with physicians as necessary. Schedule physician visits as necessary.

Inform the Medical Director when physician visits are not made in a timely manner or they fail to comply with current regulations and/or facility policies.

Encourage attending physicians to record and sign progress notes, physicians' orders, etc., on a timely basis and in accordance with current regulations. Encourage physicians to utilize the EMR system.

Ensure that direct nursing care be provided by a licensed nurse, a CNA, and/or a nurse aide trainee qualified to perform the procedure.

Review nurses' notes to ensure that they are informative and descriptive of nursing care being provided, that they reflect the resident's response to the care, and that such care is provided in accordance with the resident's wishes.

Schedule daily rounds to observe residents and to determine if nursing needs are being met in accordance with the resident's request.

Monitor medication passes and treatment schedules to ensure that medications are being administered as ordered and that treatments are provided as scheduled.

Provide direct nursing care as necessary.

Authorize the use of restraints when necessary and in accordance with current regulations and our established policies and procedures.

Ensure that residents who are unable to call for help are checked frequently.

Staff Development

Develop and participate in the planning, conducting, and scheduling in-service training classes that provide instructions on "how to do the job," and ensure a well-educated nursing service department.

Develop, implement, and maintain an effective orientation program that orients the new employee to the facility, its policies and procedures, and to his/her job position and duties.

Provide leadership training that includes the administrative and supervisory principles essential for Nurse Supervisors/Charge Nurses.

Encourage Nurse Supervisors/Charge Nurses to attend and participate in outside training programs. Schedule times as appropriate.

Assist the Administrator in developing and revising the nursing assistant training curriculum used by the facility. Submit to state agency for approval as required and applicable.

Assist or develop annual OSHA and CDC in-service training programs for hazard communication, TB management, and bloodbome pathogens standards and infection control.

Assist or develop advance directive in-service training programs for the staff.

Assist support services in developing, implementing; and conducting in-service training programs that relate to the nursing service department.

Assist or develop in-service training programs for the nursing staff. Ensure that these programs meet the continuing education requirements which allow licensed personnel (e.g., RNs, LPNs, CNAs, etc.) to keep their licenses on an active status.

Attend and participate in continuing educational programs designed to keep you abreast of changes in your profession, as well as to maintain your license on a current status.

Assist the Infection Preventionist in the development of a TB management program.

Safety and Sanitation

Assist the Safety Officer in developing safety standards for the nursing service department.

Ensure that the department's policy and procedure manuals identify safety precautions and equipment to use when performing tasks that could result in bodily injury.

Assist the Infection Preventionist in identifying, evaluating, and classifying routine and job related functions to ensure that tasks in which there are potential exposure to blood/body fluids are properly identified and recorded.

Ensure that all personnel performing tasks that involve potential exposure to blood/body fluids participate in appropriate in-service training programs prior to performing such tasks.

Ensure that adequate supplies of personal protective equipment are on hand and are readily available to personnel who perform procedures that involve exposure to blood or body fluids.

Monitor nursing service personnel to ensure that they are following established safety regulations in the use of equipment and supplies.

Ensure that nursing service work areas (i.e., nurses' stations, medicine preparations rooms, etc.) are maintained in a clean and sanitary manner.

Ensure that all resident rooms, treatment areas, etc., are maintained in a clean, safe, and sanitary manner.

Ensure that all nursing service personnel follow established departmental policies and procedures, including appropriate dress codes.

Ensure that nursing service personnel participate in and conduct all fire safety and disaster preparedness drills in a safe and professional manner.

Assist the Infection Control Committee in the development, implementation, and revising of written aseptic and isolation techniques.

Develop, implement, and maintain a program for monitoring communicable and/or infectious diseases, including TB, among the residents and personnel.

Ensure that nursing service personnel follow established infection control procedures when isolation precautions become necessary.

Ensure that nursing service personnel follow established infection control procedures.

Develop, implement and maintain a procedure for reporting hazardous conditions or equipment.

Ensure that personnel wear and/or use safety equipment and supplies (e.g., back brace, mechanical lifts, etc.) when lifting or moving residents.

Report missing/illegible labels and MSDSs to the safety officer or other designated person.

Equipment and Supply Functions

Recommend to the Administrator the equipment and supply needs of the department.

Ensure that an adequate stock level of medications, medical supplies, equipment, etc., is maintained on premises at all times to adequately meet the need of the resident.

Assist the Maintenance Director in developing a preventive maintenance program for maintaining the nursing department's equipment and supplies in a safe and operable manner.

Develop and implement procedures for the safe operation of all nursing service equipment.

Ensure that only trained and authorized personnel operate the department's equipment. Ensure that all personnel operate nursing service equipment in a safe manner.

Develop and implement procedures that ensure nursing service supplies are used in an efficient manner to avoid waste.

Ensure that appropriate MSDSs are on file for hazardous chemicals used in the nursing service department.

Care Plan and Assessment Functions

Assist in the development of preliminary and comprehensive assessments of the nursing needs of each resident.

Develop a written plan of care (preliminary and comprehensive) for each resident that identifies the problems, needs, resident choice and advance directives, if any, of the resident, indicates the care to be given, goals to be accomplished, and which professional service is responsible for each element of care. Encourage the resident and his/her family to participate in the development and review of the resident's plan of care.

Assist the Resident Assessment/Care Plan Coordinator in the scheduling of care plans and assessments to be presented and discussed at each meeting.

Ensure that all personnel involved in providing care to the resident are aware of the resident's care plan.

Ensure that nursing personnel refer to the resident's care plan prior to administering daily care to the resident.

Review nurses' notes to determine if 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 and revise care plans and assessments as necessary, but at least quarterly, annually and when a significant change has occurred. Develop and maintain a good rapport with all services involved with the care plan to ensure that a team effort is achieved in developing the resident's comprehensive plan of care.

Ensure that medical and nursing care is administered in accordance with the resident's wishes, including the implementation of advance directives.

Budget and Planning Functions

Prepare and plan the nursing service department's budget and submit to the Administrator for review, recommendation, and/or approval.

Keep abreast of economic conditions/situation, 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.

Resident Rights

Maintain the confidentiality of all resident information.

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 nursing service personnel knock before entering the resident's room.

Ensure that all nursing service personnel are knowledgeable of the residents' responsibilities and rights including the right to refuse treatment.

Review complaints and grievances made by the resident and make a written report to the Grievance Coordinator or designee indicating what action(s) were taken to resolve the complaint or grievance. Follow facility's established procedures.

Maintain a written record of the resident's complaints and/or grievance that indicates the action taken to resolve the complaint and the current status of the complaint. Follow facility's established procedures

Ensure that appropriate notices are received by the resident before his/her room or roommate is changed.

Report and investigate all allegations of resident abuse, neglect, mistreatment, and/or misappropriation of resident property.

Ensure that nursing staff personnel honor the resident's refusal of treatment request and advanced directives. Ensure that such requests are in accordance with the facility's policies governing advance directives.

Ensure that the facility's policies and procedures governing advance directive are reviewed with the resident and/or representative.

Assist the Infection Preventionist in developing and implementing a resident TB management program.

Working Conditions

Works in office areas as well as throughout the entire facility (i.e., drug rooms, nurses' station, resident rooms, etc.).

Moves intermittently during work hours.

Is subject to frequent interruptions.

Is involved with residents, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances.

Is subject to hostile and emotionally upset residents, family members, personnel, and visitors.

Communicates with the medical staff, nursing personnel, and other department supervisors.

Works beyond normal working hours, weekends and holidays and on other shift/positions as necessary.

On call 24 hours per day, 7 days per week.

Is subject to call-back during emergency conditions (e.g. severe weather, evacuation, post-disaster, etc.).

Is involved in community, civic health matters, and projects as appropriate.

Attends and participates in continual educational programs.

Is subject to injury from falls, bums from equipment, odors, assaults from hostile residents, etc. throughout the work day, as well as reactions from dust, disinfectants, tobacco smoke, and other air contaminants.

Is subject to exposure to infectious waste, diseases, conditions, etc., including TB and the AIDS and Hepatitis B viruses.

May be subject to the handling of and exposure to hazardous chemicals.

Maintains a liaison with the residents, their families, support departments, etc., to adequately plan for the resident' needs.

Education Requirements

Must possess, as a minimum, a Nursing Degree from an accredited college or university.

Experience

Must have, as a minimum, five (5) year(s) of experience as a supervisor in a hospital, long- term care facility, or other related health care facility.

Must have, as a minimum, two (2) years training experience in rehabilitative and restorative nursing practices.

Specific Requirements

Must posses a current, unencumbered, active license to practice as a Registered Nurse in this state.

Must possess and maintain an “Eligible” ACHA Background Screening status.

Knowledge of laws, rules, regulations, and guidelines pertaining to Long Term Care Facilities.

Knowledge of ADA and OSHA laws and regulations.

Knowledge of HIPAA and HITECH Laws and regulations.

Knowledge of the Nurse Practice Act and other laws, rules and regulations governing nursing practice.

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 possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public.

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 and supervise other personnel.

Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc. that are necessary for providing quality care.

Must have patience, tact, a cheerful disposition and enthusiasm, as well as the willingness to handle difficult residents and situations.

Must be willing to seek out new methods and principles and be willing to incorporate them into existing nursing practices.

Must be able to relate information concerning a resident's condition.

Must not pose a direct threat to the health or safety of other individuals in the workplace.

Physical and Sensory Requirements

(With or Without the Aid of Mechanical Devices)

Must be able to move intermittently throughout the work day.

Must be able to speak and write the English language in an understandable manner.

Must be able to cope with the mental and emotional stress of the position.

Must possess sight/hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of the position can be fully met.

Must function independently, have flexibility, personal integrity, and the ability to work effectively with residents, personnel, and support agencies.

Must meet the general health requirements set forth by the policies of this facility which include a medical and physical examination.

Must be able to relate to and work with ill, disabled, elderly, emotionally upset, and at times hostile people within the facility.

Must be able to push, pull, move, and/or lift a minimum of 35 pounds to a minimum

height of 5 feet and be able to push, pull, move, and/or carry such weight a

minimum distance of 450 feet.

May be necessary to assist in the evacuation of residents during emergency situations.