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RN--Cardiovascular ICU, Unit Based Per Diem, Moses H. Cone Hospital

Job ID: 5658
Facility: Moses Cone Hospital, Cardiovascular ICU
City: Greensboro

Date Posted: 2019-01-11 07:06:02 UTC
2018-11-03 06:08:46 UTC

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Job Description

LOCATION : Moses Cone Hospital, Cardiovascular ICU
CITY : Greensboro

JOB DETAILS :
Exempt: No | FTE: 0.001 (0 hours/week) | Schedule: flexible | 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.

EDUCATION :

Associates - Nursing - Required
Bachelors - Nursing - Preferred
Additional Information:
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.

LICENSURE/CERTIFICATION/REGISTRY/LISTING-REQUIRED :
RN - Registered Nurse licensed in North Carolina or a Compact state.
BLS (CPR) - AHA Health Care Provider BLS

LICENSURE/CERTIFICATION/REGISTRY/LISTING-PREFERRED :
Advanced Cardiovascular Life Support

Pediatric Advanced Life Support
Cone Health is an equal opportunity employer. If you require assistance with our online job submission process, please contact our team at 866-266-3767 to request an accommodation.

Cone HealthPer Diem RN Policy Agreement

PURPOSE:
The intent of this policy is to definethe RN per diem program. This policy applies to non-benefited RN's in approveddepartments in a hospital setting or an acute care hospitalsetting. Per Diem RNs are scheduled to supplement and support regularlyscheduled employees to meet patient needs.

DEFINITIONS:
Per Diem employment is defined as .001FTE.

POLICY:
ConeHealth, in support of effective staffing levels to ensure safety and qualitypatient care, allows hiring Registered Nurse per diem staff. Nurses serving inthese positions will follow an established set of procedures and guidelines,which define and support the per diem role.

PROCEDURE:
• RNper diem hours are not guaranteed hours.
• Anemployee in a regular full-time or part-time benefited position cannotsimultaneously hold a non-benefited RN per diem position.
• Currentfull-time or part-time employees requesting a status change to RN per diem mustapply to a vacant job requisition (on department or career center site).
• RNper diem employees must complete all Cone Health designated annual requirementsand department requirements. Failure to comply with this policy includingmeeting annual requirements and department worked hour requirements may lead toinitiation of progressive disciplinary action, up to and including separationof employment.
• PerDiem RNs will sign a commitment agreement upon acceptance of position.
• Failureto work within a 90-day period may result in separation of employment from ConeHealth.
Employee SchedulingResponsibilities
• Schedulehours based on department needs AFTER full-time and part-time staff arescheduled.
• NotifySupervisor or Department Director if unable to meet the agreed upon commitment.
• Followdepartment guidelines for submitting schedule. Failure to submit schedulewithin established timeframe will result in a schedule being entered for you bythe leadership team.
• Scheduledhours and any additional hours may be worked off home department ONLY ifall needs in home department are met.
Supervisor / DepartmentDirector Responsibilities
• Reviewthe per diem policy with each employee (internal or external) moving into a perdiem position annually during performance reviews. .
• AllRN per diem hours will be entered in the scheduling system.
• Homedepartment leadership is responsible for ensuring per diem RNs are incompliance with required work hours.
• Overtimefor per diem RNs must be approved by Department Director or designee.
• Consultwith Chief Nursing Officer for employees working greater than 40 hours per weekfor two consecutive pay periods.

Pay / Benefits Practice
• RNper diem employees will be paid at a reduced rate of pay for all non-productivetime.
• RNper diem employees are eligible for shift differential, overtime pay, andholiday pay.
• RNper diem employees are not eligible for weekend differential, mileage reimbursement,incentive, or other bonuses.
• PerDiem RNs who work to the hours to be eligible for medical coverage through theAffordable Care Act (ACA) will no longer be eligible for the per diem RNposition. HR will connect with employees meeting these eligibility levels andalternative FTE changes.
• Payperiod merit lump sums will cease for employees who convert from regularfull-time or part-time status to per diem status.

• Employeesin non-benefited per diem RN positions who receive a flat, hourly rate are noteligible for pay increases.

Holiday Requirements:
• Aminimum of one winter and one summer Cone Health recognized 12-hour holidayshift is required.
• Non-exemptemployees scheduled to work on approved holidays in order to care for patients,will receive a holiday premium of 50% of their base hourly rate for allauthorized work hours from 11:00 p.m. the day before the holiday to 11:00p.m. the day of the holiday. See Policy Title: Holidays.

Winter Holidays
Summer Holidays
Thanksgiving Day
Memorial Day
Christmas Day
Independence Day
New Year's Day
Labor Day

Weekend Requirements:
Aminimum of 1 weekend shift per 6-week schedule is required.
• Weekendshifts begin at 3pm on Friday and end Monday at 7am.

Floating andReassignment:
• PerDiem employees are required to float, and are the first to float.
• PerDiem RNs not needed on their home department will be reassigned by theAdministrative Coordinator or designee according to patient care needs.
• PerDiem RNs reassigned within their service line will assume a fullassignment.
• PerDiem RNs reassigned outside of their service line will negotiate a modifiedassignment.

Call Off:
• PerDiem RNs are subject to being called off.
• Ifthe AC or designee has determined a reassigned employee is not needed, thenurse will be called off.
• Orderof call-off hours are as follows: per diem overtime, benefitedstaff overtime, potential overtime, benefited staff volunteers, systemper diem, campus per diem, unit per diem, benefited staff.
Scheduled hours that theemployee is called off or on-call count towards the employee's commitment.

PerDiem Options:

Option
Job Code
Definition
Eligibility Requirements
Schedule
RN per diem
5300
Hired into a direct patient care area outside the acute, inpatient /emergency departments.

Unit Based
RN per diem

5301
Hired into a specific home nursing department.

Minimum of one year of current experience and documented competency in clinical area of work.
(36 hours per 6-week schedule; includes 1 weekend shift).

One winter and one summer holiday.

Campus Based
RN per diem
5302

Hired into a campus-based Flexible Resource department.
Minimum of 2 years of current experience and documented competencies in area of application
System Wide
RN per diem

5303
Hired into a SW Flexible Resource department with day-to-day assignments.

Minimum of 2 years of current experience and documented competencies in area of application
Clinical Instructor/
Faculty
per diem
5304
Hired into a specific home nursing department.

Individualized scheduling plan approved by the Department Director.

MOSES CONE HEALTH SYSTEM

Scopeof Services

2H/ Cardiovascular Intensive Care (CVICU) Unit

1. DepartmentDescription - 2 Heart CVICU is a 26bed patient care department with 26 private, hard-wired monitored beds withtelemetry capability that provides care primarily to cardiovascular/thoracicintensive care patients, 7 days a week, 24 hours a day. The patient rooms are locatedon the perimeter of a rectangular shaped department with 7 nursing stationsaround the department. Supply storage isin between the nursing stations in the center of the department. Each nursingstation contains a patient call system and 3 nurse stations with centralcardiac monitoring system at the center and at each end of the department.

2. Population/ClientsServed - High volume patient populations include those experiencing anacute myocardial infarction (MI) with complications, complex arrhythmias, heartfailure, undergoing Cardiac Surgery, Aortic Abdominal Aneurysm Repair, ThoracicAbdominal Aneurysm Repair, Esophagectomy patients, Thoracotomy, multipletrauma, sepsis, Shock, acute respiratory failure, renal failure, hypertensivecrisis, and CVVH. Low volume populations include head trauma, stroke,pneumonia, drug overdose, diabetic ketoacidosis, GI bleed, and long termventilator patients. The average lengthof stay is 34.71 days based on admissions. Age groups served are adult andgeriatric.

3. ServicesProvided - Nursing care is provided 24 hours a day, 7 days a week by an RNstaff that is supported by ancillary staff of Nurse Technicians and a NursingSecretary. Nursing care includes cardiac and respiratory assessment andmonitoring, pharmacological support to the hemodynamically unstable patient andmedical and nursing interventions to achieve physiologic stability and preventcomplications. Services also include patient education related to the surgicalprocedure, disease process, other procedures, and support services fordiagnostic purposes and rehabilitation.
The medical and nursing directors are responsible for triageof patient admissions. They are supported by and collaborate with the AssistantDirector (AD), Charge Nurse (CN) and RN IV. Triage is determined by usingadmission and discharge criteria approved by the Critical Care Committee.

4. StaffingPlan/Ratios - The availability of staff to provide services

Registered Nurses, Nursing Technicians, and NursingSecretary. Registered Nurses, NursingTechnicians are scheduled 7 days a week, 24 hours a day and Nursing Secretaryare scheduled 7 days a week, 16 hours a day. Patient assignments are based uponpatient acuity and staff skill. We budget for a ratio of 1.72 patients per RN24 hours a day. The goal is two Nursing Technician each shift and one NursingSecretary from 0700 to 2330 each day.

Staff are scheduled for 6-week periods and distributed basedupon anticipated daily census, shift census, and staff experience.

Staff competenciesand skills to provide services
(* Indicates key competencies)
RN
• Current Licensure
• Current CPR
• Current ACLS
• Life Safety, Fire safety, InfectionControl, and general safety to meet OSHA, state and facility requirements;Corporate Compliance
• Basic and Advance EKG*
• 12 Lead ECG interpretation
• Cardiac assessment
• Hemodynamic Monitoring of ArterialLines and Central Venous Lines and Swan Ganz catheters with cardiac output andwedge measurements
• Cardiac Output measurement,pulmonary wedge pressures and the manipulation of cardiac invasive catheters*
• Defibrillation and Cardioversion*
• Medical emergency/Code/Resuscitation care
• Cardiac and Emergency Pharmacologyknowledge
• Management of Pacemakers forepicacardial and transvenous pacing*
• Care and management of acute coronary syndrome toinclude chest pain, MI, and post PCI
• Arterial and venous sheath removal
• Post cardiac arrest therapeutichypothermia care
• Pericardial drain care
• Aquapheresis therapy
• IV management and titration ofmedications
• Vasoactive Drip titration*
• Cardiac and Respiratory assessmentand intervention skills
• Administration of oxygen deliverysystems including Bipap, mechanical ventilation, and oscillator*
• Ventilator management*
• Pulmonary management to includechest tubes, pleurex drain, and trach care
• Maintenance of and Discontinuationof Thoracotomy Tubes*
• Stroke ( Identification, care, andmanagement)
• IV Conscious Sedation*
• Discontinuation of Central VenousLines*
• Discontinuation of Arterial Lines*
• IABP therapy*
• Obtaining blood from an existingarterial line/ central line*
• CRRT ( Continuous Renal ReplacementTherapy)
• LVAD Therapy*
• CentriMag Therapy*
• ECMO (Extracorporeal membraneoxygenation)
• Impella 2.5, CP, and 5.0 Therapy*

5. Competency/EducationPlan - Orientation/Initial Competency - Each role has a defined orientationpathway or competency validation list that is completed prior to the persontaking an independent assignment. Key competencies are validated by directobservation by the individual preceptor or experienced staff. The DepartmentDirector determines, with input from the preceptor(s) and by observation, whenthe orientation is complete.

Ongoing Competency - Staff member's ongoing competency toprovide care on CVICU is determined by direct observation and record review bythe Department Director, Assistant Director, Educators, and Shift Leadership.Competency is maintained by skills fairs, routine reviews of low volume andproblem-prone procedures, and EKG revalidation.

ACLS is required for all RNs working in the followingdepartments across the MCHS: PACU, outpatient surgery, adult critical care,step-down, telemetry departments in which standing emergency orders areutilized, maternity admissions unit, emergency departments, and Endoscopy. ACLSis required for family practice and internal medicine residents, Carelinkstaff, Administrative Coordinators, Cardiac cath lab techs and cardiac rehabRNs.
1. ACLScertification completed within 12 months of hire date
2. Recertification isrequired every two years

Education Plan
• Joint Commission Compliance
• Magnet Recertification
• Real-time huddle updates
• Hemodynamic Monitoring within thefirst 12 months
• Policy and Procedure updates
• Ongoing pharmacological updates onnew medications
• Inservices to assist staff in bettermeeting patient expectations
• Academic presentations
• EKG Revalidation (on-going for RNsand NS-MTs)
• Ventilator management class withinthe first 12 months
• Specialty education programs, i.e.Impulse, Transitions

Recommended Classes after the first 6 to 24 months:
• IABP class
• TNCC
• CVVH class
• VAD
• CentriMag
• Impella

• ECMO

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