Provides normalized, therapeutic and preventative nursing care to clients in a given assignment at Beechwood within the scope of the Pennsylvania Professional Nursing Law and in accordance with licensing standards and Woods Services Policies and Procedures.
Assesses client’s health status on admission, when health needs indicate and on discharge.
Refers clients to campus nurse/physicians when further assessment indicated. Differentiates between the need for emergency care or the need for physician follow-up.
Assists physicians with rounds in units and clinics as necessary.
Attends psychotropic medication reviews and actively participates.
Prepares and administers medications as ordered by Woods/Beechwood’s physicians in accordance with Woods’ Medications Procedures. Receives verbal orders as necessary from Woods/Beechwood’s physicians/dentists.
Evaluates therapeutic effectiveness of medication with pertinent data and reports any observed side effects or relevant laboratory values to Woods/Beechwood’s physicians.
Reviews medication sheets and quarterly physician order sheets from pharmacy and makes corrections as necessary, communicating with pharmacy.
Administers immunizations as required.
Documents all relevant information according to Woods/Beechwood’s Medication Procedure Manual on MAR sheets, physicians’ orders and nurses’ notes.
Assists clients with the self-administration of medication goals as indicated by the SAM assessment and RSP.
Accurately administers and documents treatments as ordered by Woods/Beechwood’s physicians.
Instructs, supervises, and insures documentation of any treatment in which direct care staff may be involved.
Documents assessments in the medical chart and on all appropriate reports, forms, graphs, etc.
Documents the health needs of specific clients in residential logs on a daily basis, where applicable.
Prepares assessments for annual physical examinations, GYN, neurological reviews, RSP, consults on and off campus, and completes hospital and emergency room transfer sheets.
Completes division of paperwork form and is responsible for same.
Relays pertinent health concerns (i.e. seizures, elevated temperatures, unusual behavior, rashes) to the campus nurse as necessary and on a daily basis at the end of the shift.
Coordinates appointments with Health Services for clients.
Participates in the Interdisciplinary Team process, as necessary, functioning as an integral member of the team. Documents monthly progress on identified goals.
Coordinates lab work.
Notifies family/guardians/agencies/Residential Manager/Administrative Managers/Supervisors of health issues as necessary. Contacts families/guardians/agencies for non-routine testing, consultations after clarifying insurance/funding.
Other communication needs as assigned.
Participates in continuing education relevant to the area of nursing.
Obtains inservice training as required by Beechwood standards and relevant legal and nursing regulations.
Obtains CPR certification yearly, First Aid certification every three years, and other mandatory inservices.
Conducts inservices as a resource person regarding health issues for other staff persons.
Provides health teaching to clients as necessary.
Attends nurses’ meetings/inservices and serves on committees when requested.
Assumes responsibilities as assigned after complete orientation.
Covers units other than scheduled assignment when necessary.
Assists with emergencies.
Maintains medical equipment in units, assesses functioning of emergency equipment monthly and after use, and reports any malfunctioning equipment immediately.
Assists in orientation of new nursing employees.
Performs other duties as assigned.
Current RN licensure as required by Beechwood NeuroRehab standards and relevant nursing regulations and state law.
Current driver’s license
Current CPR certification or completion of course within six months
Must be able to lift/transfer a minimum of 50 pounds.
One year’s experience in direct nursing care preferred
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