Overview

The RN hospice liaison is a professional nurse who works for the within the hospitals and community agencies, physician practices and other referral sources to assist the patient and family to learn about hospice services and facilitate a referral/admission to the hospice program. They assess the patient for hospice eligibility and for the appropriateness for the different levels of care ( GIP, Respite , Routine Home Care) They collaborate regularly with Physicians, Hospital Care coordinators , Emergency Room staff, business office staff and other vendors who provide services to hospice patients i.e. DME, Pharmacy, Therapists. They ensure a smooth transition to the location where the patient will begin to receive hospice care ( home, IPU, SNF, ALF, PCH) and coordinate with the hospice intake office to schedule the Admission. The framework for practice is steered by the WellStar Professional Practice Model, 5-Star Nursing and evidence based practice and research. RN competencies are derived from these models and supported by the WellStar Core Competencies.

It is expected that all RN Clinical Nurses are licensed, knowledgeable and uphold the practice of nursing as outlined by the Georgia Professional Nurse Practice Act and implements the Scope of nursing as outlined by the Georgia Professional Nurse Practice Act and implements the Scope Practice and Code of Ethics Standards put forth by the American Nurses Association. As a member of the patient services team, it is expected that the individual upholds the voice of the patient, department and system policies and procedures while supporting service excellence goals.

Responsibilities

Core Responsibilites and Essential Functions

Introduces hospice care and services to the Patient and family
* Evaluates their goals for care and readiness to accept a palliative approach to care
* Reviews the Medical record for evidence of disease progression and decline
* Assesses the patients current condition and identifies needs
* Discusses their advance directives related to desire for hydration and nutrition, antibiotics, code status etc.
* Determines if a caregiver has been identified and who has the legal authority to consent for the patient when appropriate.

Collaborates with physicians/NPs regarding the hospice assessment and referral and their assessment findings
* Obtains an order to admit to hospice ,identifies with the physician the hospice related and non- related diagnosis, decides on the Level of Care upon admission to hospice
* Obtains a verbal certification from the attending physician who the patient has selected
* Obtains admitting orders, reviews the medication profile

Coordinates the hospice admission with the hospice intake office and makes arrangements for discharge from the hospital
* Orders medication, equipment and supplies to sustain care ensuring they arrive prior to the patient?s arrival in the home setting.
* When requested assist with the consent for Care and other legal documents
* Makes a Copy of the DNR for the transport to another location,
* Arranges for transportation

Educates the referral sources and hospital staff about hospice care and services and models the holistic approach to care including the family and caregivers in the decision making regarding end of life care.
* Supports the patient and family in their anticipatory grief regarding the transition to hospice care.
* Affirms their right to choose and be included in the Plan of Care.
* Respects their religious and cultural differences in regard to end of life care, and decision making process.

Educates the patient and family about the Reimbursement for hospice care and informs them of their financial responsibilities surrounding care.

Required for All Jobs

Performs other duties as assigned

Complies with all WellStar Health System policies, standards of work, and code of conduct.

Qualifications

Required Minimum Education

Graduate of an accredited/approved school of nursing Required and

Baccalaureate degree in nursing Preferred

Required Minimum Experience

minimum 2 years of acute care experience as an RN Preferred

Required Minimum Skills

Ability to read write and speak the English language, optimize the use of technology to support clinical care and holds basic computer skills;

Strong interpersonal, collaborative skills along with customer service skills required;

Ability to function in a fast paced environment and respond to emergencies in using a decisive, composed and respectful manner;

Possess excellent time management skills; practices nursing using evidence and analytical skills along with possessing strong critical thinking skills.

Work collaboratively as a member of an interdisciplinary team.

Required Minimum License(s) and Certification(s)

Reg Nurse (Single State) 1.00 Required 1.00

RN - Multi-state Compact 1.00 Required 1.00

Basic Life Support 2.00 Required 2.00

Georgia Driver's License 3.00 Required 3.00

Private Vehicle insurance 4.00 Required 4.00

Additional Licenses and Certifications