Location: Hartford,CT, USA
Provides primary nursing care to home based care patients as ordered by the physician, and in accordance to the organization's policies and procedures. The RN is responsible for the initial assessment and care plan development in collaboration with the Population Health Case Manager. Provides functional support/supervision to Home Healthcare Aides and LPNs as needed. Provides therapeutic intervention, overall care management and achievement of top decile client outcomes and patient satisfaction.
Accurately assesses patient condition and risk at admission, at required time points, and as needed, utilizing appropriate standardized documentation. Assesses the patient's condition and needs and determines the appropriate level of care.
In collaboration with the physician, Population Health Case Manager, and patient, develops appropriate assessment-based plan of care including: attainable patient goals and services needed to improve and/or stabilize patient's medical condition, functional abilities and promote independence.
Maintains a current working knowledge of applicable Federal, State and local laws and regulations, the Organizational Integrity Program, Code of Ethics, as well as agency policies and procedures and follows Code of Conduct.
Reports changes in patient condition in a timely manner to the physician and/or Population Health Case Manager. Obtains orders for changes in the plan of care to respond to the patient's condition.
Follows orders for treatment and provides services as indicated on the plan of care.
Utilizes and implements appropriate educational tools and pathways per guidelines and/or policy and procedure
Trinity Health Of New England At Home provides compassionate, exceptional care where people are most comfortable: at home. We are the area's most comprehensive home care provider with trusted quality of care. With new strategy, vision and technology, we are growing and shaping the future of healthcare