Agency nurse Offres d'emploi - Moncton, NB

JOB SUMMARY

The Extra Mural Program Liaison Nurse is a key member of the interdisciplinary team. The Liaison Nurse coordinates care between hospitals, community and home on a local and provincial basis, in accordance with the philosophy, objectives and policies of the EMP. The Liaison Nurse fulfills this responsibility by leading transitional care planning between hospital, community and home, reducing inappropriate admission to hospital by leading EMP centred care planning between hospital, community and home, coordinating EMP clinical services; informing and educating hospital personnel and community partner’s of both scope and the limitations of the EMP, engaging patients and caregivers in care planning; providing information to patients and their caregivers regarding EMP and assisting with short term equipment needs within the scope of the EMP. The Liaison Nurse’s role in planning for EMP clinical services is essential for safe, effective and timely coordination of care enabling the patient’s needs to be met in the right place at the right time, by the right provider.

As an employee of EMP, the Liaisons are accountable to our patients and families and co-workers by participating in and supporting safety related initiatives as well as acting in a manner that fosters a culture of learning. Safety for patients, caregivers, and workplace are kept the priority.

ROLE AND RESPONSIBILITIES

• Coordinate EMP care planning with patients, caregivers and healthcare team, including physicians and nurse practitioners, to facilitate transition between hospital, community and home.
• Identify current EMP patients who are admitted to hospital and provide written or verbal information to the hospital regarding these patients. Dissemination of EMP Transfer of Care information is essential in the continuity of patient care across the continuum. Upon discharge, help facilitate an efficient, safe and coordinated transition back to community with the appropriate mechanisms in place. Effective transfer of information from and to EMP is a vital link in the circle of care.
• Provide EMP Units with updates on hospitalized EMP patients to help determine appropriateness of discharge from EMP services.
• Identify and assess appropriate patients for admission to EMP. Assess patient needs, existing or potential formal and informal supports and screen for safety in the home environment to foster a safe transition.
• Ensure referrals contain all relevant medical information, that clear orders are written, and advise which EMP team members should be involved to meet the established needs upon discharge.
• Screen EMP patients for appropriate Personal Support Services (acute, palliative, or Rehab and Reablement) prior to transition back to the community. Consult with EMP Service Delivery units regarding these required home supports (including potential interim services for those patients awaiting Long Term Care Assessment).
• Provide pertinent discharge information to the EMP patient and caregiver; identify patient goals of care and potential caregiver burden; introduce and foster the philosophy of self-management leading to discharge from EMP once independent in their care.
• Lead and participate in patient care conferences to help coordinate services and share information related to discharge of known and potential EMP patients.
• Attend patient rounds on a regular basis and bed utilization round as resources permit or as required.
• Maintain effective working relationships with physicians and nurse practitioners, hospital unit managers and staff, community agencies and partners.
• Communicate with Department of Social Development regarding EMP patients when necessary.
• Promote and communicate the goals of the EMP and disseminate information to hospital, community partner’s and EMP Interdisciplinary Health Care Team.
• Collaborate with Patient Care Teams (hospital and EMP) to facilitate safe transition of the patient from hospital to community, or from one regional hospital to a community hospital if home is soon to be achieved goal.
• Actively participate in the operations of the local EMP Service Delivery Unit through involvement in patient care reviews, continuous quality improvement activities, staff conferences, orientation and other relevant programs or projects.
• Such other functions as may be assigned by the EMP Director or Manager, which are consistent with the role of the Liaison Nurse.
• Orientation / education of new physicians / nurse practitioners regarding the EMP referral process and transitions in care.

REQUIRED QUALIFICATIONS AND OTHER JOB REQUIREMENTS :