Maxmed Healthcare Looking for Registered Nurse – Critical Care Nurse (Telehealth) at Remote, CA Full Time

Registered Nurses – Critical Care Nurse (Telehealth)

(VIRTUAL TELEHEALTH NURSING – NO BEDSIDE CARE)

Onsite at Naval Medical Center, San Diego, CA.

 Work Location and hours: Naval Medical Center San Diego, Building 1, Fourth Floor, Tele-Critical Care Unit Shift are 8, 10, or 12 hour day and night schedules to cover a 24/7/365 watch standing requirement. Shifts will be assigned by the Tele-Critical Care Unit Scheduling Officer or his/her representative. The specific schedule for each two-week period will be provided six (6) weeks in advance. Rotating or Static Shifts beginning and ending at the below listed times, 7 days per week; 12 hour day shift: 0545-1815, 12 hour night shift: 1745-0615, 8 hour day shift: 0545-1415 or 0945-1815, 8 hour night shift: 1745-0215 or 2145-0615

Job Duties:

• Provide virtual comprehensive nursing care monitoring and consultation to on-site medical staff caring for acute and/or chronically ill adults to geriatric patient populations with complex and critical medical-surgical conditions while meeting established standards of care, and delivering care within the principles of the Nursing Process.
• Collect, document, analyze, and interpret physiological, hemodynamic, and laboratory results important to patient treatment regimens and ongoing assessments. Report any abnormal or pertinent findings to on-site medical providers, charge nurses and supervisors as appropriate. Contribute to medical examinations of patients by observing, recognizing, recording, and reporting changes in patient conditions, symptoms, reactions to medications, and responses to treatment modalities to on-site care personnel.
• Virtually perform all nursing care procedures consistent with the command’s nursing procedure manual and unit specific policies.
• Collect and analyze patient and family data for the purpose of assessment, diagnosis, and collaboration of case management between medical providers, the patient, and their family.
• Efficiently assemble focused assessments of physiological, psychological, and medical record data.
• Use critical thinking skills in diagnosing clinical problems and consult with on-site care providers on potential interventions. Assist on-site care providers in re­evaluating prior diagnoses and care plans at appropriate intervals in accordance with the individual patient’s expected outcome.
• Prioritize and report clinical observations accurately and in a timely manner.
• Use clinical decision support tools in determining evidence-based practices for clinical problems.
• Develop potential resolutions to routine, urgent, and emergent patient problems appropriately by demonstrating effective decision-making. Work closely with on-site care personnel to ensure resolution. Advocate needs and wishes of patients and family with regard to health care.
• Formulate and present succinct and comprehensive assessments of real or potential problems to the Duty Intensivist.
• Provide consultation on clinical patient problems in a timely manner; communicate unresolved issues to the Duty Intensivist.
• Provide consultation on emerging clinical problems by:
  • Direct observation via teleconferencing
  • Proactive surveillance of adverse physiological trends
  • Assurance of appropriate prophylactic strategies based on Intensivist’s order
  • Patient chart review
  • Appropriate reaction and follow through to medical and biotelemetry alerts and alarms
• Remain proficient in personal ICU knowledge of pathophysiology, pharmacology, hemodynamics, bedside technology and nursing care.
• Remain proficient in early warning scores and tools and all associated programs within the organization to enhance efficiency in assessment and documentation.
• Consult with members of the internal and external Tele-ICU team and bedside ICU interdisciplinary teams to ensure safe and error-free care during routine care and emergent conditions.
• Comply with best practices and other care directives that the hospital has endorsed in response to Performance Improvement initiatives.
• Report clinical, administrative, or technical problems that result in medical errors, near misses, unsafe care, or suboptimal communication between the Tele-ICU staff and ICU staff through the Patient Safety Report system and Chain-of-Command in accordance with pertinent policies and procedures.
• Maintain patient confidentiality.
• Virtually assist on-site care personnel in the administration of all medications, immunizations, blood, and blood products, as prescribed by a Licensed Independent Practitioner (LIP) and in compliance with Naval Medical Center San Diego (NMCSD) guidelines, policies and instructions.
• Ensure the accurate handling of medications and controlled substances to include their proper labeling, storage, administration, and wasting, as well as the proper documentation of all actions in accordance with the NMCSD guidelines, policies and instructions.
• Utilize knowledge of pharmacology and intravenous therapy to closely monitor expected responses and potential side-effects. Documents all actions, and reports observations directly to the on-site care personnel.
• Consult with on-site care personnel on the administration of potent vasoactive medications, intravenous (IV) push medications, arterial blood gas sampling, central line maintenance, and care of respiratory compromised and critically ill patients with complex health impairments.
• Identify life threatening conditions and consult with on-site care personnel on potential treatment plans utilizing current appropriate algorithms and other approved protocols. During patient care emergencies, provide appropriate support to ancillary personnel upon request.
• Virtually perform nursing care specific to the unique needs of families suffering a bereavement loss.
• Consult with bedside staff in the evaluation for the presence of pain.
• Identify patient/family/significant other needs for health teaching and notify the bedside nurse as needed.
• Assess educational needs of patients and families and provide instructions on procedures and treatments as needed.
• Consult with the multidisciplinary team to ensure proper coordination of patient care and education.
• Consult on patient readiness for transfer or discharge and assist in the preparation of all required documentation, and provide follow-up information to the patient and/or family when requested.
• Identify and attempt to defuse escalating patient situations to minimize the use of physical restraints in accordance with NMCSD guidelines, policies, and instructions by providing recommendations for alternative plans of care.
• Ensure the safe and effective operation of patient care equipment. This includes the safe practice of nursing care, proper handling of hazardous materials, and maintenance of physical security.
• Virtually monitor, operate and troubleshoot highly specialized equipment to include, but not limited to, electronic arterial pressure sensors, cardiac/respiratory monitoring systems, infusion pumps, patient controlled analgesia pumps, various types of mechanical ventilators, end tidal 02/C02 devices, and central venous and arterial catheters. Collaborate with other ancillary support departments when troubleshooting problems with specialty equipment.
• Maintain nursing practice by reviewing literature and/or attending seminars, programs, or workshops for continuing education.
• Upon Government request, provide basic and advanced level classes on the unit and participates in command education and training programs. Apply computer skills in the provision of care, physiological monitoring, and documentation.
• Participate in Continuous Improvement initiatives by identifying problems, collecting data, developing a plan of action, assessing results, and providing recommendations. Participate in evidence based projects and research that impact nursing practice and collect relevant data to support activities.
• Responsible for reading and responding to all pertinent email routinely on scheduled shift worked.
• Participate in staff meetings.
• Submit scheduled and worked hours accurately according to VMC-IP guidelines, policies, and instructions.
• Complete and adhere to all required unit and command training prior to expiration date. Articulate the role and functions of the tele-ICU clearly and professionally to visiting guests.
• Assist in the maintenance of the care environment.

 Knowledge Required:

• Knowledge of advanced nursing specialty concepts including principles and practices to independently perform nursing assignments that require expanded training and experience.
• Knowledge of the pharmacological indications, dosages, delivery modes, desired actions, side effects and incompatibilities of therapeutic agents associated with the inpatient population.
• Skill to observe and note changes in patient conditions using specialized monitoring devices and diagnostic test results, while maintaining awareness of expected responses to prescribed therapies.
• Knowledge to develop individualized, comprehensive nursing plans of care to meet the specialized needs of the inpatient population with consideration of physical, emotional, social, and cultural factors Knowledge to act decisively and appropriately during clinical emergencies and establish priorities in routine and stressful situations. Evidence of ability to cope well with change. Provide basic technological support and escalate unresolved issues in a timely manner per unit standards.
• Skill to communicate effectively verbally, in writing and via Video Teleconference and/or Web-based real-time conferencing (WebRTC) technology.
• Skill to develop and maintain good interpersonal, interdepartmental, inter-facility and “on screen” relations.
• Skill to act as a patient advocate and customer service representative.
• Knowledge of patient’s rights and Advanced Directives.
• Knowledge of and skill to counsel patients and families regarding changes in lifestyle and assistance available from community agencies.
• Knowledge of the command’s Mission and Vision and how the position effectively contributes to their support.
• Knowledge of infection control guidelines and proper procedures for handling, storage, and disposal of infectious waste.
• Knowledge of the information management systems utilized for clinical documentation and data retrieval.