LOCATION : Alamance Regional Medical Center, ARMC-EMERGENCY ROOM
CITY : Burlington
JOB DETAILS :
Exempt: No | FTE: 0.001 (Relief) | Schedule: relief | On Call: NO
JOB SUMMARY :
Assesses, plans, implements, documents, organizes, prioritize, delegates, supervises and coordinates the care of neonatal, pediatric, adolescent, adult, geriatric patients as prescribed within the parameters of the NC Nurse Practice Act and hospital complex.
Associates Nursing Required
Bachelors Nursing Preferred
Graduate of a School of Nursing. BSN required or with approval of the hiring manager, experienced RN's with an AD or Diploma with an active plan to obtain their BSN within four years from date of hire may be considered.
RN - Registered Nurse licensed in North Carolina or a Compact state.
BLS (CPR) - AHA Health Care Provider BLS
Advanced Cardiovascular Life Support
Pediatric Advanced Life Support
MAJOR WORK ACTIVITIES :
Provides nursing care via the nursing process for the development, implementation and evaluation of nursing care. Collects and analyzes patient/significant other data. Completes an admission database and ongoing assessment to include collaboration with patients, significant others and other health care providers. Implements a plan of care for each patient (utilizing clinical pathways where applicable) and individualizes to meet the age specific needs of patients/significant others. Identifies variances and makes adjustments in the plan of care based on evaluation of the plan and effectiveness of nursing interventions. Documents and updates the plan of care, nursing care, nursing interventions and patient response to care, and keeps healthcare team, patients and significant other informed. Contributes to the discharge plan by identifying homecare needs. Recognizes changes in patients' conditions and revises the plan of care appropriately. Demonstrates advanced competencies and critical thinking skills in day to day practice. Identifies and implements educational needs for patients/significant others. 30 %
Establishes a caring and therapeutic nurse/healthcare team/patient/significant other relationships. Recognizes communication barriers, identifies resources and establishes plans to resolve barriers to communication. Demonstrates respect for diversity and cultural differences in patient/significant others related to age, ethnicity, gender, religion, socioeconomics, education, personality, or other unique variable. Formulate individualized plans to address individual needs related to diversity, cultural difference or other unique variables. Advocates for the patient/significant other. Demonstrates skillful responses to customer needs based on particular context of the situation. 25 %
Supports an environment of evidence based practice/research/quality improvement. Demonstrates knowledge of Shared Governance accountabilities and principles, supports DSGC directly as a council member or indirectly by keeping informed of council activities/supporting council decisions, brings forth issues to council. Demonstrates knowledge of how to access reference documents containing policies, procedures, standards, and additional resources. Participates in QI/ Research activities based on role and major work activities as outlined in the research point system guidelines. Demonstrates knowledge of department QI plan. Demonstrates understanding of resource management and implements opportunities. Collects QI data and participates in analysis and action plan development, incorporates changes into practice. Facilitates ongoing activities to meet and adhere to regulatory standards (TJC, DFS, OSHA). 20 %
Supervises other members of the team. Contributes to a supportive and healthy work environment. Holds self and others accountable for complying with policies, procedures and standards. Participates in learning needs assessments. Provides input into and supports the precepting and mentoring process. Delegates appropriate tasks to support staff, ensure completion of delegated tasks and provides feedback as needed. Demonstrates team spirit and collegiality. Supervises select personnel in performance/patient care. 15 %
Demonstrates effective conflict resolution/negotiation skills. Promotes positive, supportive, and professional work environment free of disruptive behavior. Practices, in all professional relationships, with compassion and respect for the inherent dignity, worth and uniqueness of every individual. Follows Chain of Command for assistance with issues related to unresolved/problem-solving and/or conflict resolution. Provides, seeks and receives constructive feedback. Provides peer to peer feedback and seeks mediation as necessary. Promotes effective conflict resolution. 10 %
DEPARTMENT SUMMARY :
SCOPE OF SERVICES
1. Department Description
Emergency services are provided on the Annie Penn (AP), Alamance Regional Medical Center (ARMC), Wesley Long (WL), MedCenter High Point (MCHP) and the Moses Cone Health Campuses. Medical, Nursing and ancillary care is provided for all patient populations presenting with a variety of emergency and non-emergency conditions. In providing this care, the Emergency Departments support the mission of Cone Health to continually improve the healthcare of our patients and our community as the regions' best healthcare system.
The Emergency Department on the Annie Penn campus is located in Reidsville It consists of 23 beds which includes five Fast Track rooms, two resuscitations rooms and two negative pressure rooms. There is one triage room and a dedicated nurse first area located at registration. There is telemetry capability in 21 rooms plus three portable monitors. A decontamination shower is located near the ambulance entrance with easy access from the outside.
The Wesley Long Campus is located in Greensboro. The Emergency Department at Wesley Long consists of 55 beds; which includes a secured 10 bed all private rooms Behavioral Health area. There are (4) triage rooms, (6) Fast Track rooms, one- (2) bed resuscitation/critical care room and (33) private treatment rooms (which includes an (8) bed Transitional Care Unit). All beds have telemetry/hardwire capability with a capacity to monitor up to 55 patients. A decontamination shower is also located near the ambulance bay with access from the outside and there are three negative pressure rooms
The Emergency Department at MedCenter High Point is a freestanding Emergency Department located in High Point. The treatment area consists of 2 Triage rooms, 12 treatment rooms including an isolation room, and one trauma/critical care room with capability for two beds. All of the beds at MCHP have telemetry/hardwire capability. A Decontamination shower is also located near the ambulance bay with access from the outside. Patients requiring hospital admission are transported to MC, WL or a hospital of patient's choice.
The Emergency Department on the Moses Cone Campus is a designated Level II Trauma Accredited, Chest Pain Accredited, LVAD Accredited, and Stroke Center. It is divided into designated treatment areas: triage, Acute Care Rooms, Trauma, Fast Track, and a pediatric area. Our ED acute care rooms are designed in PODs (A, B, C, D, E, PEDs, Fast Track) based on evidence based care. We have 6 PODs in the adult ED with 61 rooms all telemetry/hardwire capabilities. In POD D, we have 3 designated trauma rooms. One of the trauma rooms serves as a resuscitation room. We have 8 fast track rooms where one room serves as an Ophthalmology/ENT room. We have three negative pressure rooms. There is a 12-bed pediatric area.
The Emergency Department of Alamance Regional Medical Center consists of 58 beds: 26 beds in the major care section; 15 beds in the Flex Care area; 9 beds in the transitional unit; and 8 beds in the secured Behavioral Health area. Hours of operation are 24 hours/day, 7 days a week. ARMC functions as a Level III emergency service and is staffed with at least two Emergency Physicians at all times. Nurse Practitioners and Physician Assistants are utilized and supervised by the Emergency Physicians. There is a daily call schedule of multidisciplinary staff physicians for referrals, admissions, and consultations. The Emergency Department's staff is composed of Registered Nurses, Emergency Department Technicians, and Departmental Secretaries. The department works closely with Alamance County Emergency Medical Services and with regional ground and air ambulance services.
All of the Emergency Departments contain a patient registration area, waiting area, private family consultation area, and a security station. The waiting areas contain: TVs, snack machines, and telephones. There is also a supply of reading and educational material available. All Emergency Departments provide an outside covered entrance area to protect the patients/families during inclement weather.
Lounge and restroom facilities are provided for all staff. The nursing station is located in close proximity to critical treatment areas for visualization. The nursing stations contain computers, manuals, charts and documents to facilitate patient care. On all campuses, patient rooms are equipped with telephones and televisions for use by patients/families. Adult and pediatric emergency carts, monitors and defibrillators are strategically located to provide immediate response to patient needs.
Medical leadership is under the direction of the Chief of Emergency Services and Medical Directors for the Moses Cone, Wesley Long, MedCenter High Point, and Annie Penn Campuses. Similarly, nursing leadership is under the direction of the Executive Director of Emergency Services and each Emergency Department has a Nursing Department Director. Medical and Nursing leadership is responsible for maintaining quality improvement programs.
Nursing utilizes the Shared Governance structure (Nursing Administrative Manual) to provide consistent, effective and efficient nursing care. Through this structure, the nursing staff has a direct impact on clinical decisions specific to the department, by participating in various committees: Department Shared Governance Council, Service Shared Governance Council, Clinical Policy and Procedure, and Nursing Executive Council.
The Emergency Department nursing leadership and the Medical Directors approve policies and procedures specific to the department. They are consistent with hospital policies, medical staff rules and regulations, and federal and state regulations (EMTALA). Additionally, Joint Commission rules and regulations guide the provided services.
2. Population/Client Served
Emergency Services provide a comprehensive array of patient care.
Example types of patients frequently seen include: chest pain, respiratory distress, abdominal pain, orthopedic trauma, motor vehicle collisions, surface trauma, behavioral health and general medical complaints. Trauma patients are usually transported and stabilized/treated on the Moses Cone Campus where the dedicated Trauma Program is located. (Refer to Trauma Scope of Service) Specific therapeutic interventions include: airway management, circulatory support, medication administration, cardiac monitoring, splinting and casting, infection control, safety measures and education to patient and family/significant others. All patients are seen regardless of their ability to pay. The population is diverse not only in language, but also in age as patients are seen throughout the continuum of life.
3. Services Provided
The Emergency Departments provide emergency care 24 hours a day 7 days a week. Patients may be self-referred, physician referred, or as directed by employee health. Patients are triaged, according to established triage categorization guidelines. A licensed independent practitioner with appropriate clinical privileges determines the scope of assessment and care for patients in need of emergency care. All patients are medically screened and cleared by a physician or physician extender. Patients may be evaluated and treated by the Emergency Department physician or extender, their private physician, or assigned to physicians participating in an on-call schedule.
• bstetrical patients who present for non-pregnancy related conditions are treated according to their presenting complaints. Appropriate transfer of the OB patient depends on her medical stability and need.
A full service laboratory is available 24 hours a day. Non-routine studies may also be performed at an outside lab. Additionally point-of-care testing is performed by trained personnel.
Diagnostic radiology services are available at all times (refer to Radiologic Scope of Service) to provide routine studies using both fixed and mobile equipment. Angiography of all types, Sonography, Nuclear Scanning, MRI and CT scanning are available as needed.
A variety of other Departments support the Emergency Departments in delivering care: Surgical Services, Endoscopy, Heart and Vascular Center, and multiple Intensive Care Units. These departments are available to treat patients using established criteria for admission/treatment.
Patients are discharged from the department or admitted to the hospital as inpatients. In the event that the patient requires services that are not provided at the presenting facility, provision is made for transfer within or outside the system according to EMTALA guidelines. Emergent stabilizing care is provided until the transfer is complete.
The Emergency Departments are staffed 24 hours a day, 7 days a week. The Emergency Departments are staffed with a medical director, physicians, department director, registered nurses, nursing technicians, emergency medical technicians, unit secretaries/monitor technicians, physician assistants or nurse practitioners, materials management staff and volunteers. Other patient care providers include Flow Managers, Patient Representatives, Respiratory Therapists, Laboratory Technicians, Radiology Technicians, Care Management, Social Work, and Pastoral Care. Specialty consultation is available by members of the medical staff on a 24-hour basis. MICN's, Paramedics, CareLink, and Emergency Department physicians accomplish pre-hospital care and communications.
Staff Competencies and Skills to Provide Services
Staff have the training, credentials, experience and competencies to provide the care as defined by their job description. Registered Nurses, Emergency Medical Technicians, Respiratory Therapist and Nursing Technicians must have current licensure or certification. They also complete an orientation program specific to their job description, which encompasses some of the following: (refer to orientation pathways for complete description)
• Patients rights and confidentiality
• Age specific guidelines
• Care of the trauma patient (minor to major)
• Care of chest pain patient
• Care of renal patient
• Care of abdominal patient
• Care of the neurology patient
• Care of altered level of conscious patient
• Care of respiratory distress patient
• Care of pediatric patient (trauma, fever, seizure)
• Care of psychiatric patients
• Care of sickle cell patients
• IV initiation and maintenance
• Computer/ Flowsheet Documentation
• Equipment specific to patient care
• ASAP (Epic)
Emergency Medical Technicians/ Nursing Technicians
• Patient rights and confidentiality
• Age specific guidelines
• Anticipating and setting up equipment for various procedures ( suturing, pelvic exam)
• Proper technique for obtaining/sending EKGs
• Collection of lab specimens
• Safe transportation of patients/ wheelchairs/stretchers
• Equipment designated for patient care
• Computer/Flowsheet documentation
• POC training
Nursing Secretary/Monitor Technicians
• Patients rights/confidentiality
• Telephone usage
• Fax machine
• Paging System
• Physician Call system
• ASAP (EPIC)
• Rhythm recognition
• POC training
All direct caregivers must hold current licensure in CPR. It is strongly recommended that Registered Nurses become certified in ACLS, ENPC or PALS, TNCC, CATN, and staff at the Trauma Center is expected to complete TNCC after one year of employment. Emergency Department staff also complete a crisis in resolution training (CPI).
5. Competency/ Education Plan
Each role has a defined orientation pathway or competency validation list that is completed prior to the person taking an independent assignment. This pathway has key competencies that must be demonstrated by direct observation by the individual's preceptor or another experienced staff member. The Department Director determines, with input from the preceptor, educator, and by observation, when orientation is complete.
• n going competency, validated by direct observation and record review, is determined by the Department Director, Assistant Director, Educator, and shift leadership. Competency is also maintained through Skills Fairs, routine review of low volume and problem prone procedures and EKG revalidation.
Competency for the EDs consist of Triage competency (ESI) for RNs; Charge Nurse competency for select RNs; mandatory education for all staff; new staff orientation; Trauma and Stroke education, and EMTALA. It is strongly recommended that Registered Nurses become certified in ACLS, ENPC or PALS, TNCC, CATN, and staff at the Trauma Center is expected to complete TNCC after one year of employment.
CONDITIONS OF EMPLOYMENT :
* Annual flu shot
* Annual TB test (if applicable to your job location)
* Annual HLCs (Healthstream, formerly CBL)-Safety at Work and Corporate Compliance
* Maintain licensure/certification/registry/listing (if applicable to your job)
ABOUT CONE HEALTH :
Cone Health is a state of the art network of facilities providing patients access to the latest developments in medical care from their first moments of life through later years. Our network offers the most breakthrough treatments and technology available in healthcare today. As a teaching hospital, we offer employees the opportunity to become leaders in the industry and continued growth from their first day on. Extraordinary patient care is about being "high-touch" as well as "high-tech". Community service and superior patient care are the cornerstones of our organization, a philosophy that is demonstrated by each and every one of our valued team members. We are proud to be the largest private, not-for-profit employer of choice in the Piedmont, NC area community. Additionally, as one of the region's largest and most comprehensive health networks, Cone Health has more than 100 locations, including six hospitals, three ambulatory care centers, three outpatient surgery centers, four urgent care centers, a retirement community, and more than 100 physician practice sites. Our tagline - "The Network for Exceptional Care" - highlights our commitment to excellence, which is shared by our more than 11,000 employees, 1,300 physicians and 1,200 volunteers.
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