EMPLOYMENT STATUS:        Exempt, salaried.
REPORTS TO:                        Clinical Services Manager
SUPERVISES:                        Home Care Aides assigned to specific cases.
WORKS CLOSELY WITH:       Clinical Services Manager, VNA Clinical Staff, including all disciplines, Quality Manager, Intake and Referral Coordinator, Team Assistants, Clinical Review.

SUMMARY OF DUTIES: Provides comprehensive nursing service to individuals and families in the home and community health setting, accepting primary care responsibilities and coordinating with other disciplines and community agencies.   Provides health services to special community groups.

JOB REQUIREMENTS: Baccalaureate degree from an accredited College of Nursing, (one year clinical experience preferred); or graduate of an accredited school of Nursing.  Home care or community health nursing experience preferred.  Licensure as a registered nurse in Iowa.  Car, driver's license and adequate insurance as outlined in the personnel policies.  A physical examination is required, completed at the time of employment with a statement from the physician of the ability of the employee to perform the duties of the job.  Annual TB testing is required.  All offers of employment are conditioned upon the result of a criminal background check conducted by the Iowa Division of Criminal Investigation, as required by law and a negative finding on the Office of Inspector General’s Excluded Provider List.

WORK ENVIRONMENT AND EQUIPMENT:  Work is performed in clients' homes with the employee driving from location to location during the work period.  The locations are throughout Johnson County and within a 50-mile radius of the agency.  This area includes Iowa City, small towns and rural areas.  The driving requirements include in-town and highway driving in good and inclement weather. All professional staff will use laptop computers to document their work in the client homes or at the clinic sites.

SKILLS AND KNOWLEDGE/COGNITIVE DEMANDS:  The employee will demonstrate skill and knowledge in providing professional nursing care for the treatment of acute and chronic illnesses and in the area of wellness and preventive health care.   The employee will demonstrate organizational skills required to manage a minimum of six (6) client appointments and necessary follow-up each day; the employee will demonstrate the ability to communicate effectively in the English language, both orally and in writing.  The employee will demonstrate the ability to maintain and update professional knowledge base and the ability to assimilate and utilize agency information regarding policy and procedure changes.  The employee will demonstrate competence in professional decision-making skills within the parameters of the Nurse Practice Act, including the ability to make appropriate assessments, problem-solve, prioritize, establish Plans of Care and evaluate their effectiveness.    The employee will demonstrate the ability to use technology effectively and appropriately, including client care equipment, laptop computers and communication devices (cell phones, voicemail, and electronic mail).   The employee will perform the duties of the job at clients' homes and /or community sites during employed hours.  The employee will be expected to participate in evening; weekend and holiday visit coverage on a rotating basis.
PHYSICAL DEMANDS:  The duties include performing skilled physical assessments and various skilled nursing activities, such as changing dressings, providing medication via IVs and injections, drawing blood, assisting with personal cares, exercises/ambulation, auscultation of lung and bowel sounds, etc.  The duties also include the use of equipment for client care, such as oxygen equipment, suctioning, medication dispensers, laboratory screening meters, and IV pumps. This position requires knowledge of the use of laptop computers, and cell phones for documentation and communication.   These duties require fine motor coordination/dexterity, the ability to grasp, vision with or without corrective aids adequate for fine motor tasks, client assessment, and driving.  The job requires the physical demands of occasional lifting greater than 50 lbs., reaching, pushing, walking, going up and down stairs, driving, etc., with or without the use of assistive/adaptive devices.

ESSENTIAL DUTIES:  To be performed satisfactorily with or without reasonable accommodation.  The following duties are normal for this position.  While this list is intended to be an accurate reflection of the job, it is not to be construed as exclusive or all-inclusive.  Other duties may be required and assigned by the employer.

1.    Provides comprehensive nursing services to individuals and families in the home or community setting which include:
•    Assessment
•    Problem identification
•    Goal setting
•    Plan appropriate nursing interventions for clients or multi-problem families requiring skilled or health promotion care or intervention.
•    Evaluate effectiveness of plans

2.    Provides comprehensive case management skills that include:
•    Accepts primary care responsibilities
•    Coordinates services of all disciplines
•    Manages the care of a caseload or group of clients efficiently and effectively
•    Uses the nursing process and reports appropriately to the Clinical Services Managers, Quality Manager, physicians, etc.  
•    Complies with agency policies on frequency of home visits to meet individual and family health needs.

3.    Provides assessment and care to adults and elderly; performs assessment and care to 
specialty populations under the guidance of agency policies and nurses (pediatric, 
maternity and newborn, wound/ostomy and psychiatric).

4.    Plans and provides health services to special groups as assigned, i.e., Eldercare.

5.    Maintains knowledge of community resources; utilizes appropriately and coordinates services to meet needs of individuals and families.

6.    Promotes optimal independence of clients as feasible while meeting their needs.

7.    Maintains, up-grades nursing knowledge through continuing education programs, review of literature, etc., applicable to home and community health.  Submits documentation of such activities for personnel record.

8.    Maintains current knowledge of agency policy and procedures through attendance at required meetings and by review of written materials provided by agency.  Incorporates changes into daily job activities.

9.    Maintains current CPR and knowledge of expected performance in emergency situations.

10.    Performs client visits according to Plan of Treatment or as client needs dictate.


11.    Reviews admission processes with new clients and communicates basic information about VNA services and policies. 

12.    Establishes effective relationships with clients and families, respecting client rights and involving clients and families in decision making as possible.

13.    Communicates and obtains verbal orders to request additional authorizations of services (based on client needs) from acting physician. 

14.    Provide[s] Clinical Service Manager, intake manager, and billing coordinator with clinical updates as appropriate.

15.    Provides pertinent client geographical, financial, medical and statistical information in a complete, accurate and timely manner as required by the agency.

16.    Completes and generates all necessary documentation accurately within the timelines determined by Medicare and other regulatory body requirements.

Examples of documentation include but are not limited to:
•    OASIS
•    Plan of care
•    Routine visit notes


17.    Participates in evening, weekend and holiday call duties as scheduled and according to agency policies.
18.    Manages and maintains calendar of events to assure punctuality for scheduled visits, meetings, and prompt submission of clinical paperwork. 
19.     Tracks visit frequencies to assure compliance with care plan. 


20.    Assumes responsibility in HCA service:
•    Orientation/training demonstrations
•    Planning services
•    Supervision
•    Evaluation of Aides in the provision of safe, quality care
•    Provides personal cares in absence of HCA staff


21.    Participates as necessary in orientation, instruction, and demonstration of agency services to other staff, students, and visitors, and telephone inquiries regarding agency services.

22.    Provides instruction to other staff members in the application of a specific skill as needed.

23.    Participates in agency group meetings, including in-services, performance improvement activities, staffings and projects as required.

24.    Represents the agency in community activities and meetings as required.


25.    Complies with agency policies regarding maintenance of clinical records and reports.

26.    Complies with agency standards on visit productivity.

27.    Complies with personnel record keeping requirements (e.g. auto insurance documentation, licensure) on a timely basis.


28.    Maintains knowledge of and complies with the Nurse Practice Act.

29.    Complies with agency policies regarding conflict of interest.

30.    Complies with agency policies regarding client rights.

31.    Makes accurate assessments regarding clients’ homebound status, skilled need and payer eligibility and documents appropriately on an ongoing basis.

32.    Complies with agency policies regarding standards of conduct.


33.    Will demonstrate the following in the use of technology:
•     Willingness to learn new procedures and incorporate them into daily activities.
•    Competence in use of client care technology required in carrying out job duties. Will follow agency procedures for use.
•    Competence in use of communication and documentation devices such as laptop computers, cell phones, pagers, etc.
•    Competence in use of agency clinical documentation software to develop physician’s plan of care and interim orders, enter and update medication lists, and document the following: periodic OASIS and nursing assessments, update nursing care plan, nursing visits, and care management activities.


34.    Participates in medical records audits, Medicare surveys, and Joint Commission surveys as needed.

35.    Participates in additional short-term projects, as they arise.

36.    Contributes new ideas to organization.

37.    Performs other duties as necessary, including required participation in VNA emergency/ disaster plans.