Backup TB\CD Nurse

General Statement of Duties

• Primary Purpose of Position:

Essential Duties and Tasks

• 45%Back-UpProgram Coordinator for the TB Program.
  • Covers two offices; Nashville (full time office Monday - Friday, 8:00 AM-5:00 PM), and the Rocky Mount branch office.

• Participates in administrative decisions regarding assessment of program needs and future planning. This includes state contract and future budget needs.

• Reviews and monitors services performed to ensure they meet Health Department, State, and Federal Guidelines.

• Serves as liaison with local physicians, area and regional hospitals, clinical consultant, Health Departments, State and Regional consultant’s staff and other disciplines within the department to assure that patient needs and goals of the programs are met.

• In the absence of the CD/TB Coordinator, this position updates local physicians and hospital infection control nurses of changes in communicable disease laws and public health services related to TB, and CD changes as well. Notifies new physicians of state reporting requirements.

• Coordinates changes in the clinic schedule and staffing changes with the clinical supervisor.

• In collaboration with the CD/TB Coordinator, this position is responsible for maintaining records in accordance with local and state policies.

• Serves as a resource for employees in the absence of the CD/TB Coordinator.

• In collaboration with the CD/TB Nurse, coordinates and assists with TB screening for mass screening on high-risk population groups such as firefighters, rescue personnel, and in industries as needed.

• In collaboration with the CD/TB Coordinator, ensures that staff is provided Mantoux Tuberculin Skin Test (TST) administration, reading and interpretation training to Health Department Medical Staff on hire and reviews with staff as indicated.

• 
  Investigation, Treatment, Follow-up and Clinical
  • In collaboration with CD/TB Coordinator, this position:

• Investigates and provides follow-up of newly identified cases of tuberculosis, (suspect and known cases). Interviews case/family. Identifies risk behaviors, provides education, counseling, and testing. Instructs regarding treatment regimen and identifies side effects of medicine. Schedules appointments as needed. Issues sputum containers with instructions regarding collection. Identifies contacts. Obtains consent for treatment and release of medical records.

• Provides patient follow-up by reviewing records as reports and other information is received. Initiates correspondence between the Department and other medical care providers. Maintains close telephone contact with physician and communicates changes in plan of care to the patient. Advises physician when supervised therapy is indicated due to patient non-compliance. Provides supervised therapy in the clinic or home setting for known cases as needed to ensure that appropriate therapy is completed. In some cases, DOT can be done via video call with patients. Informs nurse supervisor, health director, and physician when a non-compliant patient needs public health law intervention.
• Notifies contacts of need for screening. Obtains history of previous exposure and evaluates relationship to case to determine whether a close or casual contact. Initiates appropriate screening per standing orders and treatment as ordered by physician.

• Completes surveillance forms and required reports in State NC EDDS reporting system.

• Reviews charts to obtain medical reports and x-rays from other medical centers and private physicians needed for current medical status. Assess patient's status and identifies needs. Provides pre and posttest HIV counseling. Obtains interview, follow-up with physician regarding x-ray results, administers skin test, dispenses medications and sputum containers, orders needed lab tests and provides education and counseling. Assists physician with developing a plan of care, and reinforces the physician’s orders to patients, or follows standing orders. Provides education to patients, families, contacts, etc.

• Provides direct patient care in the patient’s home and in the Department’s, clinics as needed/assigned.

• Visits patient while in the hospital, if needed, consults with patient’s physician and starts contact investigation.

• Serves as a member of the Nash County Health Department Epi Team along with the Health Director, Nursing Director, Preparedness Coordinator, Nursing Supervisors, Environmental Health Specialist, Laboratory Technologist, Health Educator, and Management Support personnel. Coordinates outbreak control activities with other disciplines within the agency and with other PHN’s assigned to assist when a communicable disease threatens the community.

• 
  45%Back up to Communicable Disease

• Serves as back up to CD/TB Coordinator and duties may include:

• Assists CD nurse in the investigation and follow-up of suspect and known cases of communicable diseases and their contacts as recommended by the State Communicable Disease Program and as written in local policies, procedures, and standing orders. Schedules lab work. Initiates prophylactic treatment as indicated. Provides education and counseling regarding specific disease, including mode of transmission, incubation period, period of communicability and methods of control. Completes surveillance forms and communicable disease report. Completes required reports in State NC EDDS reporting system.

• Monitors NC EDSS workflow for reports of positive labs of un-reported CD and TB suspected cases and reports withing the appropriate timeframe.

• Works closely with local physicians, healthcare facilities, epidemiologist at the local hospital, medical consultant and staff at the state level to provide adequate follow-up, referrals and treatment (if necessary) based on the Communicable Disease laws and guidelines

• Act as liaison between clients and physicians to assure that clients are receiving proper treatment as well as understanding their treatment plan to assure compliance to it.

• Strive to stay updated in all areas of nursing practice in Communicable Disease by attending workshops, in-services, and reading textbooks and/or periodicals on recent changes and advances in this field.

• 
  5% STD/HIV Program

• Completes an initial or interim medical and sexual history. Orders appropriate lab tests. Provides education and counseling regarding problems identified. Dispenses or administers appropriate treatment according to the STD Policy, Procedures, and Standing Orders, and according to the Department's Pharmacy Policy and Procedures. Provides Pre and Post Test HIV Counseling.

• 2% Women's Preventive Health Program

• Completes an initial or interim medical and psycho-social history. Takes blood pressure and orders appropriate lab tests. Provides education and counseling regarding medical and psycho-social problems identified.Provides education, counseling, and instructions regarding methods of birth control and method chosen. Provides preconceptual counseling when indicated. Assists physician with GYN exam. Dispenses appropriate medications and/or birth control method according to the Department's Women’s Preventive Health Policy, Procedures and Standing Orders and Pharmacy Policy and Procedures.

• 
  2% Prenatal Program

• Completes an initial or interim medical and psycho-social history. Takes blood pressure and orders appropriate lab tests. Provides education and counseling regarding medical and psycho-social problems identified. Assists physician with exam. Dispenses appropriate medications and or vitamins and iron according to the Department's Pharmacy Policy and Procedure and Prenatal Policy, Procedures and Standing Orders. Initiates referrals for abnormal findings and needs identified. Documents findings and all activities in the patient's medical record according to the Department's Medical Record Policy.

• 
  1% Other Duties

• Maintains required personnel records. (ex.: time, travel, and telephone logs). Attends staff training and other continuing education programs and monthly staff meeting. Helps maintain a safe working environment. Participates in disaster services as required. A member of the Preparedness Team and attend regular meetings and assist with planning. Will alternate 24 hours/7 days a week telephone on-call with Nursing Supervisors and Director of Nursing for on call Preparedness coverage. Assists with general clinic patients; i.e.: those presenting for pregnancy tests, TB medications, hepatitis B vaccine, blood pressure checks, B12 injections, etc. Other duties as assigned.

• 
  II.B. OTHER POSITION CHARACTERISTICS:

• 
  Accuracy Required in Work:Must have a broad base of nursing knowledge with expertise in communicable diseases, their identification, mode of transmission, and control. Requires extreme accuracy when gathering data in disease surveillance and implementation of control measures.
• Consequence of Error:Error could result in inadequate follow-up and further spread of disease-causing unnecessary mass exposure/disease and increased morbidity/mortality. Community protection against communicable diseases is one of the primary duties of our agency and professional management of crisis is expected by our medical society and public.
• Instructions Provided to Employee:The Nursing Supervisor serves as a resource person for this employee and assists occasionally when questions arise. This employee independently prioritizes her work and is held responsible for completion of job responsibilities according to established standards.
• Guides, Regulations, Policies and References Used by Employee:
• State of North Carolina Communicable Disease Laws and Rules
• Control of Communicable Disease in Manual
• Report of the Committee of Infectious Disease
• CDC ACIP Manual
• North Carolina Tuberculosis Program Guidelines
• North Carolina Communicable Disease Manual
• NCHD Communicable Disease/Tuberculosis Policy, Procedures and Standing Orders
• Supervision Received by Employee: Work is reviewed annually by the State Tuberculosis Program Nursing Consultant. Policies, procedures, standing orders, and records are reviewed quarterly by the Quality Assurance Committee within the agency. Work is also observed occasionally by the Nursing Supervisor while in progress. Written performance appraisals are done per Agency Policy.
• Variety and Purpose of Personal Contacts: A cooperative effort is essential in the control of communicable disease. Essential people include: other agency personnel (nurses, health educators, sanitarians, lab technologists, and management support), hospital communicable disease nurses, physicians, the media, and the public. Education of the public to prevent unnecessary alarm and to ensure cooperation is an important element. Enforcing treatment and other control measures on uncooperative cases is often a difficult and sensitive problem.
• Physical Effort: Daily, this employee must be able to perform nursing duties. This may be in a clinical or office setting or it may be necessary to drive to local hospitals, businesses, private homes, or community sites to fulfill the job responsibilities.
• Work Environment and Conditions: As described above, this employee is frequently on the road. Under certain weather conditions, this can be hazardous. Employee is also exposed to potentially harmful acts from others when employee visits in patients' homes. Home visits are done with a team of two if the nurse feels this is indicated. Occasionally the local sheriff's department serves as escort.
• Machines, Tools, Instruments, Equipment and Materials Used:
  • Computer/Copy/Fax/Cell PhoneScales
  • Blood pressure cuff/stethoscopeNeedle and syringe
  • ThermometerOSHA equipment
  • Alcohol swabsN95 Mask
  • OtoscopeAutomobile
• Visual Attention, Mental Concentration and Manipulative Skills:
  • Must be able to identify, organize, and complete the work process. Document on medical record. Administer medications. Communicate with other professionals.
• Safety for Others: Must be proficient at administering screening tests and initiating treatment. Procedures must be followed and Standing Orders are used to ensure appropriate follow-up of communicable diseases. Follows the Agency’s Bloodborne Pathogens Policy. Immunized per Agency Policy.

Knowledges, Skills and Abilities

Considerable knowledge of and skill in the application of nursing theory, practices, principles, and techniques employed in the field of public health and related programs; general knowledge of and ability to apply the principles and practices of public health; working knowledge of current social and economic problems relating to public health; working knowledge of available resources and organizations, and appropriate referral methods.

Desirable Education and Experience

Graduation from a four-year college or university with a B.S. in Nursing which includes a Public Health Nursing rotation and two years of Public Health nursing experience; or a Master’s in Public Health and graduation from a school of professional nursing and two years of professional nursing experience; or graduation from a school of professional nursing and three years of professional nursing experience including two years of Public Health nursing experience; or an equivalent combination of training and experience.

• NC Credentialed Public Health Nursing Course (NCCPHN)
• Introductions to Public Health in North Carolina Online Training Series
  • Certificate of Public Health Nursing in North Carolina
• State approved Orientation and Training Programs in: TB, Communicable Disease and
  • Immunizations
  • “Introduction to Communicable Disease Surveillance and Investigation in N.C.”
  • “N.C. Introduction to Tuberculosis Management Course”
• Red Cross Disaster I and II Training
• ICS Training 100, 200, 300, 400, 700, 800
• CPR Certification
• CPR/Defibrillator training
• HIV counseling and testing program Nash County Policies, Procedures, and Standing Orders
• Maternal Child Health Manual
• Nash County Health Department Personnel Policies
• ICD-10 Code Book

• Current license to practice as Registered Nurse in North Carolina by the N. C. Board of Nursing.
• Valid North Carolina Driver's License.