REGISTERED NURSE II

JOB SUMMARY:

Meets all eligibility requirements of a Registered Nurse I.Works under the supervision of the Director. The Registered Nurse II assesses, plans, implements, evaluates, and supervises individualized care in a patient care area according to departmental policies and procedures and Nurse Practice Act. She/he will individualize patient care based upon the age appropriate and developmental needs and will accept responsibility for the direction of coworkers in the implementation of the plan of care. Collaborates with physicians, patient/families and members of the health care team in delivering a plan of care. Utilizes positive communication skills. May be required to work on other nursing units according to distribution of staff and patients. Should be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his/her unit. Performs other duties as assigned.

 JOB DUTIES:
1. Completes nursing assessment of patient, and documents appropriately into patient record.
2. Develops a plan of care based upon the assessment of patient, age appropriate and developmental needs of the patient.
3. Collaborates with physicians and other health team members in developing a plan of care.
4. Provides, delegates, and coordinates the plan of care.
5. Initiates, manages, and participates in discharge planning.
6. Initiates, manages, and participates in patient/family teaching.
7. Demonstrates implementation skills in accordance with Policies and Procedures.
8. Evaluates and updates patient’s response to plan of care.
9. Maintains professional standards by participating in inservices, committees, and performance improvement activities, etc.
10. Facilitates physiological, psychosocial, and spiritual care of the patient.
11. Utilizes positive communication skills to effect conflict resolution and team work.
12. Contributes to cost effective patient care by monitoring use of time, equipment, and supplies.
13. Complies with safety policies and procedures in order to provide a safe environment for employees, patients, and visitors.
14. Demonstrates necessary flexibility in regard to changes in Hospital or unit activities. 15. Should be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patient served on his/her unit.
16. Acts as preceptor and charge nurse as assigned.
17. Actively participate in achieving departmental goals.
18. Performs other duties as assigned.

PERFORMANCE CRITERIA: QUALITY OF WORK QUALITY: 

• Effectively applies the nursing process to plan and manage patient care, including meeting teaching and continuum of care needs.  
• Accurately performs an initial patient assessment, including a complete history and physical examination, and accurately performs ongoing patient assessment. 
• Nursing practice is consistent with all requirements of the house wide and department specific competencies. 
• Effectively delegates to and monitors the activities of support staff, and intervenes as needed by providing education and redirecting their activities as appropriate.  Completes an admission patient/family learning needs assessment (language, education level, previous knowledge and experience, who must learn, preferred learning style).  Informs patient of his/her role in providing accurate information and asking questions regarding diagnosis and treatments. 
• Ensures that all newly admitted patients are oriented to their physical environment, hospital routine, and answers any questions from patient/family. 
• As part of the interdisciplinary care plan, develops an education plan, utilizing appropriate resources. Symptom and pain management is addressed. 
• Evidence of appropriate patient/family education includes:

1. Teaching performed (content), recorded on the education screen
2. Resources/instructional strategies utilized, recorded on the education screen
3. Patient/family understanding and participation, recorded on the education screen
4. Patient/family progress toward meeting teaching goals, recorded on the patient care plan

5. A plan to address unmet teaching needs, recorded on the patient care plan  Acknowledges accountability for the accurate and timely processing of medication orders as well as administration of medications, understanding their therapeutic action, correct route of administration, side effects and contraindications, appropriate monitoring of laboratory/other data as it applies to the medication, and the emergency response to adverse drug reactions and the documentation to reflect and support nursing action. 

• Complies with all critical elements of the Medication Use Policy and Procedure as evidenced by:

1. Accepting verbal orders for medications in emergency situations or during procedures only when the physician is not able to write the order.
2. Reading back all telephone orders to the ordering physician, and records “RBV” next to the order to indicate that the order was read back and verified for accuracy.
3. Adhering to the approved abbreviations list, including adherence to the “do not use” abbreviation list.
4. Verifying correct order entry for new medication orders prior to administering the medication or by the end of the shift by checking the original physician order with the order entered onto the Pyxis medication list for the patient, and for patients with an existing MAR, the handwritten entry.
5. Administering medications by taking the MAR and medication to the patient’s room, and using at least two patient identifiers prior to administering the medication(s).
6. Adhering to standardized time of administration unless the physician orders the medication at specific times and/or there is a clinical indication to vary from the standardized times of administration.
7. Adhering to the Independent Double Check process for high alert medications.
8. Educating patients about medication safety as well as providing medication specific patient education as required.
9. Adhering to all requirements for narcotics wastage. 

Patient care practice conforms with the hospital’s established guidelines and preventative elements for infection control observed by:
1. Utilization of Standard Precautions for all patients.
2. Barrier use to protect self from potential exposures to blood and body fluid.
3. Annual fit testing for N-95 respirator.
4. Differentiation between medical waste and biohazardous waste streams.
5. Utilizes prescribed barriers, signage, and patient education for each of the four transmission based isolation categories.
6. Complies with the Hand hygiene guidelines.
7. Documents patient skin testing for TB in the medical record.

JOB KNOWLEDGE: 

• Successfully completes required house wide competencies within the required time frame. 
• Successfully completes department specific competencies within the required time frame. 
• Possesses the critical thinking skills needed to apply the nursing process to plan and manage patient care including:

- Knowledge required to individualize the patient’s plan of care based on the diagnosis and/or condition/needs.
- knowledge required for evaluating and reassessing the patient’s condition and plan of care on an ongoing basis. 

• Possesses a working knowledge of the Chain of Command Policy, including when and how the policy applies. 
• Possesses age-specific knowledge and skills required to complete an admission patient/family learning needs assessment. 
• Possesses the knowledge and skills required to develop an education plan based on the patient/family learning needs assessment. 
• Possesses the knowledge and skills required to safely manage all aspects of medication use processes including receiving telephone orders, transcribing and verifying new orders, administering medications, monitoring the effects, and reporting errors or other adverse events.

DEPENDABILITY: 

• Assumes responsibility for own actions, including followup and completion of tasks in an effective and timely manner. 
• Fulfills departmental and hospital responsibilities including:

1. Attending staff meetings as appropriate
2. Reading all meeting minutes and posted communications
3. Participating in departmental performance improvement activities
4. Attending all hospital and department specific required inservices
5. Maintaining an active role in problem solving and resolution

PERFORMANCE CRITERIA: PRODUCTIVITY/USE OF TIME:
INITIATIVE: 

• Demonstrates motivation and ambition on the job. 
• Adapts to and supports change. 
• Independently seeks unassigned work without impacting quality. 
• Is flexible. 
• Questions old methods and offers suggestions for improvement of procedures.

 JUDGEMENT: 

• Integrates data to diagnosis as evidenced by appropriate care guidelines selected, based on diagnosis. 
• Recognizes and responds appropriately and timely to changes in patient condition.  Notifies the physician, charge nurse, nursing supervisor, AHN, department director, or other members of the healthcare team as patient condition warrants. 
• Appropriately implements the chain of command procedure as described in the Chain of Command Policy within a time frame appropriate to the incident. 
• Individualizes the patient’s plan of care based on the diagnosis and/or condition/needs, utilizing age specific and cultural considerations. 
• Evaluates and reassesses the patient’s condition and plan of care on an ongoing basis.  Uses logical and sound decisions in choosing a particular course of action. 
• Knows when to refer conflicts or issues to manager.

PRODUCTIVITY: 

• Prioritizes workload in order to utilize resources to effectively prioritize patient care tasks so that the assignment is completed within the required time frame. 
• Uses appropriate delegation skills to manage clinical assignment in an organized, efficient manner using human and other resources.

ATTENDANCE:
Assumes responsibility for attendance and punctuality in order to promote the efficient operation of the Hospital and essential components of solid employee performance. Poor attendance and tardiness disrupt productivity and make it difficult to function effectively. Each employee shall be responsible for being present at the correct time each day. (See Attendance APM for further details.)

PERFORMANCE CRITERIA: INTERPERSONAL RELATIONS/ TEAMWORK WORKING RELATIONSHIPS: 

• Demonstrates habits of reliability and follow though. 
• Resolves open issues independent of supervision. 
• Serves as a collaborative member of the health care team acting in a manner that is cooperative in order to affect positive patient outcomes. 
• Demonstrates an open and approachable attitude with patients/families, peers and physicians. 
• Demonstrates consensus building skills with the ability to respect personal, professional, and/or cultural differences. 
• Willing to compromise individual needs/desires for the betterment of the work group and/or patient care needs. 
• Willing to negotiate respectfully with staff during handoff in order to meet patient care needs.

COMMUNICATION: 

• Possesses the knowledge and skills required to document the following:

1. Initial patient assessment, including complete history and physical examination
2. Ongoing patient assessment
3. Admission patient/family learning needs assessment
4. Individualized patient/family education plan, based on identified needs
5. Processes related to medication use including receiving telephone orders, transcribing/verification, administration and monitoring, and reporting errors/adverse events. 

• Documentation is legible. 
• Initial admission history is documented within the required time frame, as defined by unit specific practice standards including:

1. Patient history, diagnosis, height and weight are recorded in the appropriate queries. 2. All pain assessment queries are complete. If pain was present prior to admission, the nursing record documents a description of the pain and how the patient managed it.
3. All functional screen queries are complete.
4. All nutritional screen queries are complete.
5. Medication, food and other allergies are noted.
6. All queries in the advance directive section are complete.
7. All queries in the system history sections are complete (respiratory, cardiovascular, GI/GU, skin).
8. All psychosocial section queries are complete.
9. All education assessment queries are complete.
10. All medications are listed including disposition of any brought to hospital, if applicable. 

• Participates in rounds and/or accesses other members of the health care team to meet patient’s needs. 
• Uses fundamental tools essential for effective communication and interaction (active listening, assertiveness, and collaborative problem solving) to effectively communicate with:

1. Patients and families
2. Other staff members in department
3. Other members of the health care team, including physicians
4. Other departments 

• Participates objectively in the peer review evaluation process. 
• Provides accurate and objective feedback, in a professional, respectful and timely manner. 
• Receives peer feedback in a respectful and professional manner. 
• Effectively manages conflict with:

1. Peers
2. Patients/families
3. Staff in own department
4. Other members of the health care team, including physicians 5. Staff in other departments

PERFORMANCE CRITERIA: PROFESSIONAL ACCOUNTABILITY:
SAFETY: 
Follows safe work practices, takes an active interest in preventing injury or illness and promoting a safe and healthful environment for self and others, and complies with Hospital and governmental safety regulations concerning, but not limited to, the following:
1. Safety Manual
2. Universal Precautions/Infection Control Plan
3. Fire Safety Plan (Code Red)
4. Emergency Preparedness Plan
5. Patient and Employee Instrument and Equipment Guidelines
6. Hazard Communication Program (MSDS sheets, etc.)
7. Employee Injury & Illness Prevention Program (including proper body mechanics)
8. Security Programs- Facility Access Plan Page 7 Salinas Valley Memorial Healthcare System Registered Nurse II (RNII) Infant Security Plan Parking and Traffic Regulations Computer Access
9. Back Injury Prevention Program
10. Medical Emergency Plan (Code Blue)
11. General Safety Rules and Regulations
12. Employee Injury/Exposure Reporting 

• Demonstrates an understanding and assumes responsibility for safety issues as it relates to their work and that of their colleagues. 
• Demonstrates an understanding of patient safety goals as defined by accrediting/regulatory bodies, and integrates patient safety practices when caring for patients.

PROFESSIONAL DEVELOPMENT: 

• Furthers professional growth by obtaining knowledge in area of expertise, and applies new knowledge to the clinical setting in order to improve patient care. 
• Demonstrates understanding of the five independent roles of the professional nurse, and practice reflects understanding of the roles:

1. Identifies patterns of human responses to actual or potential health problems.
2. Assesses health status.
3. Selects, performs, manages and evaluates nursing actions.
4. Provides health counseling/teaching.
5. Teaches, administers, supervises, delegates and evaluates nursing practice.  Understands and utilizes performance improvement concepts, including the organization’s Performance Improvement Plan and structured problem solving model.  Identifies operational issues and offers suggestions for improvements that will increase the effectiveness of the department or improve patient care, utilizing performance improvement concepts and structure when necessary. 
Participates in hospital wide performance improvement teams, hospital committees, and/or task forces. 
Assumes role of the Charge Nurse as assigned.
COMPLIANCE:
Promotes the Hospital’s mission to deliver healthcare with a spirit of caring for the community at large in keeping with the theme of “Neighbors Who Care”.
Assumes personal responsibility to comply with all Federal, State and local laws governing business conduct; conducts business in an ethical and trustworthy manner; and displays the qualities and characteristics of a professional at all times when dealing with patients, visitors, physicians, volunteers and fellow employees.

POPULATION – SPECIFIC CARE: Demonstrates the knowledge and skills necessary to provide care appropriate to the populations served. This includes demonstrating knowledge of the principles of caring for the following, but not limited to, geriatric, pediatric, developmentally-challenged, special needs and physically-challenged, and various diagnoses, interventions, procedures and operations performed for patients served.

JOB SPECIFICATIONS:
1. Licensure: Current California RN license. Current BLS/Healthcare Provider status as per American Heart Association standards. * See unit specific certification requirements below.
2. Experience: Minimum of one (1) year Clinical Registered Nurse experience preferred in specialty areas. Must have successfully completed SVMH Pharmacology test.
3. Essential Technical/Motor Skills: Precise hand/eye coordination and finger dexterity is necessary to administer medications, start IV, performs procedures and other direct patient care activities.
4. Interpersonal Skills: Ability to relate cooperatively and constructively with patients, families, significant others, co-workers, physicians, and other staff members.
5. Essential Physical Requirements: See attached “Physical Requirements Sheet”
6. Essential Mental Abilities: Ability to prioritize and perform critical thinking process to include, but not limited to: (respiratory, cardio-pulmonary, neuro and psychosocial), to formulate a plan of care based upon the assessment and to evaluate the patient’s reaction to the plan of care.
7. Essential Sensory Requirements: Must be able to hear, see, verbally communicate and have tactile sense. 8. Performance Improvement: Assumes active role in the department’s Continuous Performance Improvement Program. Develops, implements and assesses Continuous Performance Improvement efforts as assigned.

Salary Range: $63.92 - $94.31
Company Description:

Kindred Communications is boutique direct-hire placement headhunting firm with a focus on diversity and inclusion tech placement. We strive to diversify the workforce once placement at a time.