REPORTS TO: Clinical Services Manager 
SUPERVISES:  Home Care Aides as related to performance of direct care in patients seen by the Auxiliary Staff Nurse.
WORKS CLOSELY WITH: Intake and Referral Coordinator, Staff Nurses and Therapists, Team Assistant, Clinical Review, Quality Manager.

SUMMARY OF DUTIES:     Responsible for providing home health care to patients during the absence or unavailability of regular staff and during peak referral or visit periods.  Assists in staffing of community health clinics as needed.

EMPLOYMENT STATUS:   Exempt, hourly/Per Visit.

JOB REQUIREMENTS: RN or BSN from an accredited school of nursing and licensed in the State of Iowa.  Home care or community health experience is preferred. Strong assessment skills. Car, driver's license and adequate insurance as outlined in the personnel policies required.  A physical examination completed at the time of employment is required, with a physician's statement of the employee's ability 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 and clinic sites with the employee driving from location to location during the work period. The clients' homes and clinic sites are throughout Johnson County and within a 50 mile radius of the agency.  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 providing nursing care in the area of wellness and preventive health care.  The employee will demonstrate organizational skills required to manage several client appointments and necessary follow-up each day; the employee will be expected to demonstrate good oral and written communication skills.  The employee will perform the duties of the job at the client's home and/or community site during regular office hours.  The employee will also be expected to assist with weekend and evening visits.  The duties include performing various skilled nursing activities, such as changing dressings, providing medication via IVs and injections, drawing blood, assisting with teaching, education and assessment of personal cares or exercises/ambulation, etc.

PHYSICAL/COGNITIVE DEMANDS: The duties include performing various skilled nursing activities such as dressing changes, assisting with personal cares/ambulation, blood draws, etc.   Performance of these duties requires fine motor coordination/ dexterity, the ability to grasp, vision with or without corrective aids adequate for fine motor tasks, patient assessment and driving an automobile.   The job requires the physical demands of occasional lifting of more 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 the 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.

Provides comprehensive home health care to patients and families, including initial assessment/admission process, periodic reassessments (60 day, resumption of care, significant change in condition, transfer, discharge) or follow up visits under a plan of care established by the primary nurse.

Ensures continuity of care for the patient by obtaining all necessary information and equipment prior to visits, contacting physician or other care providers as indicated, and making reports to payer representatives to obtain payment authorization as appropriate.  Reports to the Nurse Manager or primary care provider at end of work session about outstanding contacts and any additional follow up required.

Staffs Community Health Clinics or other community activities throughout the VNA service area as assigned.  This commonly includes, but isn’t limited to:  blood pressure screening, general health assessment and teaching, or provision of treatments such as foot care, immunizations, blood draws or fingerstick glucose or cholesterol.

Assists with evening/weekend home visits, or assumes evening/weekend/holiday call as assigned in absence of call staff.

As part of comprehensive home health care maintains awareness of patient’s need for and use of home care aide services.  Assumes responsibility for supervising Home Care Aides as a part of each visit, and in compliance with the Medicare Conditions of Participation.  This includes establishing/reviewing HCA care plans and the orientation/supervision/evaluation of aides in provision of safe, quality care.  Performs personal cares in absence of HCA staff.

Manages home visit schedule, documentation, and coordination efficiently and effectively.  The standard expectation for visits will be 1 visit for every 1.5 hours of availability.  Variations from the standard (up or down) must be approved by the supervisor.

Keeps Nurse Manager or designee informed of availability to make home visits.  Informs VNA of general availability one month in advance and provides specific availability for the following week by noon each Friday.  Maintains the identified availability until at least 9 AM on each available day.

Follows through with assignments according to availability identified.   Receives tentative assignments after 4:30 PM the prior working day.  Synchronizes computer to obtain assignments and review updated patient information.   Will be contacted by 9 AM on each available day with any schedule additions/changes.    May need to make visits same day as requested at times.  Note:  occasionally patient or employee circumstances change later than 9 AM, requiring an additional request for schedule changes.  These changes are optional, though certainly helpful when possible.

Documents effectively, accurately, and in compliance with the Medicare Conditions of Participation, payer requirements and agency policies and procedures.  Utilizes laptop computer according to agency procedures, completing most documentation in the patient home, synchronizing at the beginning and end of each work day, and completing all documentation within agency time frames.

Provides pertinent patient geographical, financial, medical and statistical information in a complete, accurate and timely manner as required by the agency.  Complies with agency policies regarding maintenance of clinical records and reports.  

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

Participates as necessary in orientation, instruction and demonstration of agency services to staff and students.

Maintains knowledge of community resources; utilizes appropriately and assists in coordination of service to meet needs of individuals and families.

Establishes effective relationships with patients and families, respecting patient rights and involving patients and families in decision making as possible.  Promotes optimal independence of patients as feasible while meeting their needs.

Participates in regular agency inservice and staff meetings, PI activities, staffing and other activities as required, making alternative arrangements to obtain the information in a timely manner if schedule doesn’t permit attendance at specific agency events.  Minimum education requirement:  12 hours documented education hours (may be combination of VNA, other health care agency, and CEU credits) annually including the following required agency topics:  Infection Control, Safety and Chemical Hazards, Confidentiality and Privacy, and Patient Rights/Ethics.

Maintains required competencies for discipline; participates in agency competency evaluation activities.   Maintains current CPR training and knowledge of expected behavior in emergency situations.

Maintains knowledge of and complies with professional licensure requirements and standards, professional ethics and performance standards, and agency personnel policies, ethics and compliance policies.

Meets with Nurse Manager for scheduled supervisor conference at least monthly.

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