Registered Nurse - Inpatient, Emergency Center

FUNCTION
To provide and coordinate all patient services in an ambulatory setting including routine clinic visits, medical observation, and acute intervention for emergency services in collaboration with all the multi-disciplinary teams at MDACC to achieve quality patient outcomes.

SCOPE
Performs described function in a dynamic, high-volume patient care environment requiring interaction with all members of a multi-disciplinary team and with other departments and Disease Site Centers throughout MDACC. Position requires a combination of sitting, standing and walking. Position will require the use of a keyboard, entering information into a computer and visually obtaining information from a video monitor. Ability to communicate, both written and orally to staff and others in a clear and understandable manner.

ESSENTIAL FUNCTIONS
?Adheres to the Nurse Practice Act of State of Texas, MDACC, and Emergency Center (EC) policies and procedures.
?Maintains a highly professional and positive attitude regardless of work load and stress level.
?Functions as triage nurse or charge nurse only when delegated by Nurse Manager or designee.
?Notifies appropriate physician when patient has a significant change of status.
?Communicates effectively with other staff members regarding patient status.
?Administers drugs (routine and emergency) with proper knowledge, using PHDI for experimental drug information, and observing the 5 RIGHTS.
Right Patient
Right Medicine
Right Dose
Right Route
Right Time
?Follows chain of command when dealing with adverse situations among peers or others.
?Always acts as a patient advocate by seeking the patient's highest good. If additional intervention is needed or if unable to contact primary physician, follow the chain of command for the service or seek medical assistance from the Emergency Center physician.
?Legibly documents all patient interactions on the EC Nurses log.
?Notify appropriate resources for patient/situations requiring in-depth clinical management.
?Responsible for taking all initial vital signs and monitoring subsequent vital sings by unlicensed personnel.
?Responsible for obtaining all blood specimens (venous and arterial) and form central lines on all patients in the Emergency Center.
?Demonstrates appropriate care in compliance with nursing standards, and use of facilities and resources assigned.
?Demonstrates clinical expertise to carry out nursing duties required by the Emergency Center
?All nurses will manage telephone triage calls from all patients by following established protocols and contacting the appropriate physician and convey the information to the triage nurse.
?Assist in unit efficiency by answering the phones and patient call lights when appropriate or necessary.
?Performs procedures in a safe, efficient and cost effective manner.
?Promotes quality of care, improvement of service, professional nursing practice, cooperation, commitment and efficiency.
?Assures continuity of care in collaboration with other disciplines through education, coordination of services, and use of critical paths.
?Provides supervision and assistance to unlicensed personnel and nursing students.
?Identifies self-development needs and seeks assistance in meting these needs.
?Receive multiple phone calls from internal and external customers in courteous and friendly manner.
?Participates in unit CQI activities and staff evaluations.
?Participates in actions to achieve goals, objectives and operational plans of the Emergency Center.
?Acts on behalf of patients to ensure care that is safe and appropriate with consideration for values, diversity and human rights.
?Participates in meetings, committee efforts and task forces as encouraged by the Patient Care Manager.
?Utilizes time in an efficient manner by completing assigned duties. Demonstrates initiative and seeks out additional tasks.
?Responsible for resolution of narcotic discrepancies occurring in PYXIS.
?Ensures that all emergency equipment is charged and functioning.


FUNCTIONS AND RESPONSIBILITIES OF CHARGE NURSE
1.Facilitate efficient workflow of the entire Emergency Center area.
a.Determine patient-physician/primary nurse assignment.
b.Communicate with triage nurse re: activity, acuity level and room availability.
c.Receives patient orders from physicians and notifies primary nurse to ensure timely implementation of orders.
d.Facilitate timely lab/diagnostic results and intervenes for resolution if necessary.
e.Monitor room assignment to facilitate safe and timely transfer of patients.
f.Coordinate transfer of acutely ill patients to the intensive care units and other facilities.
g.Make decision regarding patient flow between pods to create necessary bed space for patients needing emergent care.
h.Provide assistance to USC teamleader.
i.Assign breaktime; reassign patients at change of shift Note: 0630am; 1430; 1830; 2230.
j.Reassign patients of morning shift RNs to midshift RNs
k.Monitor personnel accountability/needs in the area and communicate with Nurse Manager when additional personnel needed.
l.Assign EC code team/first responder to internal emergencies.

Checklist: YES NO
a. MD Documentation
b. RN Documentation
c. RN Charges
d. MD Charges
e. Survey
f. Arm Band
g. Old chart if available

FUNCTIONS AND RESPONSIBILITIES OF TRIAGE NURSE

1.Determine the severity of illness and injury
a.Perform an abbreviated triage ' obtain vital signs, chief complaint, pertinent past medical history, signs and symptoms.
b.Acuity categorization and decision based on acuity classification.
c.Periodically reevaluate/reassess waiting patients as indicated.
2.Provide appropriate support to stabilize clinical and non-clinical care
a.Initiate collaboration with social worker, case manager, translator, etc, as necessary.
b.Complete medical record and variance report on patients who leave prior to treatment.
c.Receive initial communication regarding internal/external disaster or emergencies.
d.Receive information regarding new patients, hospital transfers, etc
3.Provide clinical and non-clinical information to other EC health care givers
a.Initiate flow of patient and paper work to treatment area.
b.Communicate with other care centers as necessary.
c.Collaborate with referral office on self-referred patients.
d.Inform primary physician of patient arrival per service preference (i.e., Gyn surgery)
4.Provide the first and best opportunity for customer service to patients and family
a.Serve as the first professional customer service representative of the institution to patients who come through the EC.
b.Monitor waiting area and inform patients and families regarding waiting time.
c.Collaborate with charge nurse (CN) and primary nurse in informing family members regarding patient status.

MARGINAL FUNCTIONS:
?Assist with transporting all ICU patients to X-ray or ICU. Assists with transport patient to the floor or ancillary departments if necessary.
?Assist with housekeeping duties such as bed cleaning/making, or cleaning equipment (BSC, refrigerator, IMED pumps).
?Monitor supplies to maintain adequate stock in on the unit.
?Performs any other tasks or duties assigned by management.

QUALITIES

Demonstrates a service attitude by:
?Identify new ways to provide better service to supervisor, peers, external employees, visitors, etc.
?Maintains a pleasant demeanor.
?Following up to make sure that the problem is solved.Desired Qualifications:EDUCATION
Required:Graduation from an Accredited School of Nursing.
Preferred:BSN

EXPERIENCE
Required:One year of nursing experience or BSN degree.

Preferred:BSN degree with 1-year oncology experience or ER/ICU experience.

LICENSURE/CERTIFICATION
Required:Current professional nursing license (RN) by the Board of Nurse Examiners for the State of Texas or Board Eligible if new graduate.
CPR ' Re-certified annually
Basic Dysrhythmia Course

Preferred:ACLS

WORKING CONDITIONS
This position requires the individual to work in a noisy, fast paced, high volume oncology emergency environment with a wide range of institutional staff and patients and have the ability to concentrate, organize, prioritize and execute multiple tasks at one time.
Requires walking, bending, stooping, kneeling, and reaching below the waist and above the shoulder and working in awkward positions and lifting 30 to 50 pounds.