Job Code 1520

CASS REGIONAL MEDICAL CENTER

Job/Position Description

Employee Name: ______________________________________

Department Name: Emergency

Title: Emergency Department RN

EEOC Classification: Professional/Non-Exempt

Date: _______________________________

PART ONE: Dimension and Description

Primary Purpose: To provide quality patient care following the standards using the nursing process in order to maintain a safe environment, to provide patient and family education, and to provide proper documentation for billing.

Formal Policy-Setting Responsibilities: Formally responsible for making recommendations regarding policies associated with the job’s purpose and essential responsibilities.

Routine Decision Making: Triages patients, performs nursing process and determines all aspects of nursing care; administers medications and treatments appropriately.

Formal Supervisory Responsibility: No formal supervisory responsibility.

Required Knowledge: Nursing process; critical care; medications and treatments; growth and development; disease processes; anatomy and physiology.

Required Skills and Ability: Good communication skills; auscultation, palpation and IV skills; time management skills; ability to utilize and interpret emergency equipment.

Unusual Working Conditions: Risk of blood, body fluid contamination. Risk for injury from aggressive, combative or disoriented patients.

Education and Certification/ Registration Required for the Position: Two to four-year RN degree; current licensure in the state of Missouri; ACLS/BLS/PALS/TNCC required, one year of critical care or Emergency experience preferred. Eight (8) CE’s specific to trauma and approved by the trauma medical director and four (4) CE’s specific to stroke and approved by the stroke medical director are required by this position on an annual basis as directed by the department manager. This position requires annual completion of NIH stroke certification.

Population Specific Competencies: Recognizes the importance that diversity/cultural beliefs have when delivering care to the populations served at Cass Regional.

Age Specific Competencies: Provides care to neonates (birth to 6 weeks), infants (6 weeks-2 year), children (2 yr-12 yrs); adolescent patients between 12 to 18 years of age; adult patients between 18 to 64 years; and geriatric patients 65 years and older.

PART TWO: Essential Responsibilities and Tasks

A. Performs the assessment phase of the nursing process. (25% of time)

1. Performs immediate bedding (as resources allow) and triages all patients upon arrival to the emergency department.

2. Performs a patient assessment that includes all pertinent patient history, assessment of body systems and other screenings on arrival to the exam room.

3. Documents patient assessments and re-assessments completely during ER stay.

4. Utilizes only approved abbreviations when documenting in patients chart.

5. Assesses data relative to age/population specific needs for every patient, upon arrival.

6. Assesses abnormal patient findings throughout emergency department stay.

7. Assesses patient/family's learning needs on admission.

8. Demonstrates ability to communicate effectively with patients that are impaired due to alcohol, drugs or experiencing psychiatric issues.

9. Completes appropriate pain assessment on admission.

10. Completes all aspects of the medication reconciliation process by completing an accurate and complete list of patient’s current medication.

11. Encourages patients to stay for treatment rather than leave prior to the medical screening exam or against medical advice.

12. Communicates in a non-judgmental, friendly manner with guests at all times.

13. Consistently uses AIDET when communicating with patients, family members, etc.

B. Performs the planning phase of the nursing process. (20% of time)

1. Formulates a plan of care with the physician based on the patient assessment on admission that addresses all problem areas.

2. Adapts plan of care with physician as patient's condition changes.

3. Collaborates with ancillary departments to facilitate the plan of care after the physician writes orders.

4. Denotes and documents significant changes in the patient’s condition during ED stay.

5. Interprets significance of abnormal patient findings after assessing patient on admission and as condition changes.

6. Notifies Charge Nurse of need for increased number and level of personnel in the event of increased census or patient acuity.

7. Supports the principles of the Patient Experience culture.

8. Participates in the budget process by bringing suggestions to the manager for needed equipment, supplies and resources.

C. Performs the implementation phase of the nursing process. (15% of time)

1. Implements patient care during the emergency department stay.

2. Documents and reports significant abnormal patient findings to the physician immediately.

3. Is proficient at locating, caring for and utilizing emergency department equipment, supplies, etc.

4. Acts rapidly, effectively and manages self and others during emergency situations.

5. Administers IV's and medications as ordered by physician according to hospital policy on every patient.

6. Validates the presence of an order on the chart prior to giving any medications.

7. Scans patient’s wristband and medications according to hospital policy. Documents the administration of all medications on the patient’s MAR immediately after administration.

8. Accurately and correctly wastes unused portions of controlled substances prior to the end of the shift.

9. Implements and documents appropriate interventions to treat patient’s pain while in the ED.

10. Performs narcotic count according to hospital policy.

11. Performs frequent rounding on patients registered for ED care and continually assesses patient needs

12. Is organized, utilizes critical thinking skills and multi-tasks when delivering patient care

13. Keeps patients and families informed when waiting in the Emergency Department. Responds to patient concerns when expectations are not met in attempt for service recovery.

14. Reviews take-home instructions with patient at discharge to include new medications started by the ED, name and number of a physician for purposes of follow up medical care, etc.

15. Explains/teaches patient in a manner the patient can understand by speaking slowly, allow time for questions and assesses understanding prior to discharge.

16. Consistently (95% of time) insures all medications are removed from the Pyxis based on hospital policy. Performs overrides only when emergent patient care needs necessitate (no more than 5% of time).

17. Notifies physician immediately of any positive screening questions.

18. Communicates all pertinent data regarding patient’s condition including fall risks during hand-off, on every patient.

19. Attends 90% of department meetings.

20. Takes initiative to attend mandatory classes (i.e. Safety); also maintains current BLS, PALS, TNCC and ACLS and completes competencies on time without prompting from the manager.

21. Consistently supports the hospital’s EMR initiatives and implements all changes needed to maintain compliance with Meaningful use, etc.

D. Performs the evaluation phase of the nursing process. (20% of time)

1. Evaluates patient care and documents evaluation at discharge or any time patient’s condition changes.

2. Evaluates pain according to hospital policy but specifically on admission and at discharge.

3. Assists manager in completing yearly performance evaluation by contributing information on Tech evaluations.

4. Assists manager in formulating action plans in response to the Employee Engagement survey, Joint Commission, State surveys, etc. whenever requested by Manager.

5. Assists manager in formulating unit goals and actively implements know methodologies to accomplish these goals every year.

E. Provides patient and family education. (5% of time)

1. Determines patient and family's learning needs and abilities throughout emergency department stay.

2. Uses terminology appropriate to patient/family's knowledge base and age specific needs.

3. Provides and documents patient and/or family's education based on assessments and re-assessments of learning needs throughout emergency department stay.

4. Provides and documents patient and family follow-up instructions at discharge.

F. Maintains a safe and comfortable unit. (5% of time)

1. Removes malfunctioning equipment from the unit immediately upon discovering problem.

2. Completes requisitions for repair on malfunctioning equipment by the end of the shift.

3. Stocks supplies in the department every shift.

4. As assigned checks Code Blue carts (pediatric and adult) and appropriately stocks, each shift.

5. Refrains from taking verbal orders except during emergent situations.

6. Participates in the performance improvement process by assisting with planning, data collection, interpretation of data and implementation of needed changes based on results of PI.

G. Provides and verifies patient charges. (5% of time)

1. Charges patient correctly for supplies at the time of use.

2. Participates in performing daily charge reviews to capture appropriate ED level, supply and procedural charges.

H. Other duties as assigned (5% of time)

ESSENTIAL PHYSICAL REQUIREMENTS

TYPE OF WORK (Check One)

Sedentary Work: Lifting 10# maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Jobs are sedentary; if walking and standing are required only occasionally.

Light Work: Lifting 20# maximum with frequent lifting and/or carrying of objects weighing up to 10#. Even though the weight lifted may be only a negligible amount, a job is in this category when it requires walking or standing to a significant degree or pushing and pulling of arms and/or leg controls.

Medium Work: Lifting 100# maximum with frequent lifting and/or carrying of objects weighing up to 25#.

Heavy Work: Lifting 100# maximum with frequent lifting and/or carrying of objects weighing up to 50#.

x Very Heavy Lifting: Lifting objects in excess of 100# with frequent lifting and/or carrying of objects weighing 50# or more.

PHYSICAL DEMANDS (Check those which apply)

x Lifting: Raising or lowering an object from one level to another (includes upward pulling).

x Carrying: Transporting an object, usually holding it in hands or arms or on the shoulders.

x Pushing: Exerting force upon an object so that the object moves away from the force (including slapping, striking, kicking, and treadle actions).

x Pulling: Exerting force upon an object so that the object moves toward the force (includes jerking).

Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, ropes, and the like, using the feet and the legs and/or hands and arms.

Balancing: Maintaining body equilibrium to prevent falling when walking, standing, crouching, or running on a narrow, slippery, or erratically moving surfaces; or maintaining body equilibrium when performing gymnastic feats.

x Hearing: Ability to determine audible communication.

x Stooping: Bending the body downward and forward by bending the spine at the waist.

x Kneeling: Bending the legs at the knees to come to rest on the knee or knees.

x Crouching: Bending the body downward and forward by bending the legs and spine.

x Crawling: Moving about on the hands and knees or hands and feet.

x Reaching: Extending the hands and arms in any direction.

x Handling: Seizing, holding, grasping, turning, or otherwise working with the hand or hands (fingering not involved).

x Fingering: Picking, pinching, or otherwise working with the fingers primarily (rather than with the whole hand or arms as in handling).

x Repetitive Motions: Substantial movements (motions) of the wrist, hands, and/or fingers.

x Feeling: Perceiving such attributes of objects and materials as size, shape, temperature, or texture by means of receptors in the skin, particularly those of the finger tips.

x Speaking: Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

x Seeing: Obtaining impressions through the eyes of the shape, size, distance, motion, color or other characteristics of objects.

Including Major Visual Functions

x Acuity, far - clarity of vision at 20 feet or more.

x Acuity, near - clarity of vision at 20 inches or less.

x Depth perception - ability to judge distance and space relationships so as to see objects where and as they actually are.

x Field of vision - area seen up and down or to the right or left while eyes are fixed.

x Accommodations - adjustment of the lens of the eye to bring an object into sharp focus.

x Color vision- the ability to identify and distinguish colors.

WORKING CONDITIONS (Check those which apply)

x Inside: Worker spends approximately 75% or more of time inside.

Outside: Worker spends approximately 75% or more time outside.

In/Outside: Activities occur inside or outside in approximately equal amounts.

Extremes of Cold: Temperature sufficiently low to cause marked bodily discomfort unless worker is provided with exceptional protection.

Extremes of Heat: Temperature sufficiently high to cause marked bodily discomfort unless worker is provided with exceptional protection.

Temperature Changes: Variations in temperature which are sufficiently marked and abrupt to cause noticeable bodily reactions.

x Wet: Contact with water or other liquids.

Humid: Atmospheric condition with moisture content sufficiently high to cause marked bodily discomfort.

Noise and Vibration: Sufficient noise, either constant or intermittent to cause marked distraction or possible injury to the sense of hearing and /or sufficient vibration (production of an oscillating movement or strain on the body or its extremities from repeated motion or shock) to cause bodily harm if endured day after day.

x Hazards: Situations in which the individual is exposed to the definite risk of the bodily injury.

Fumes: Smoky or vaporous exhalations, usually odorous, thrown off as the result of combustion or chemical reaction.

Odor: Noxious smells, either toxic dust, fumes, gases, vapors, mists or liquids which cause general or localized disabling conditions as a result of inhalation or action to the skin.

x Toxic Conditions: Exposure to toxic dust, fumes, gases, vapors. Mists or liquids which cause general or localized disabling conditions as a result of inhalations or action to the skin.

Infectious Disease: Risk of exposure to biohazardous materials, blood, body fluid contamination.

Dust: Air filled with small particles of any kind, such as textiles dust, flour, wool, leather, feathers, etc., and inorganic dust including silica and asbestos, which make the workplace unpleasant or are the source of occupational disease.

Poor Ventilation: Insufficient movement of air causing a feeling of suffocation; or exposure to drafts.

Identify and describe any additional physical demands or unusual working conditions that were not previously covered. _______________________________________________________

BLS, PALS, ACLS, TNCC, and NIH Stroke Scale