Job Summary This is a PRN professional position that provides after-hours and/or daytime nursing coverage for pediatric patients in the Transitions Kids Program on assigned weekdays, weekends, holidays, and/or weeknights. This position requires staff to triage phone calls, perform telehealth visits, and make visits to patients’ homes to provide symptom relief and/or support at the time of a patient’s death. This position collaborates with the Transitions Kids Team. All work will be performed in a manner consistent with agency, nursing, and regulatory standards and regulations.

Responsibilities - what you do Provide medical and emotional support for families across the continuum of care, including during times of crisis. Collaborate with the Interdisciplinary Group (IDG) to assess, establish, and support the achievement of patient/family-centered care goals and to coordinate the appropriate utilization of contract services. Conduct a thorough nursing assessment by phone and/or Zoom video call that addresses the patient and/or family’s specific diagnosis/needs/concern/problem. Use professional judgment, in collaboration with the IDG, to individualize the plan of care based on the interdisciplinary team’s assessment of the patient and family’s unique needs and response to care. Work collaboratively with TK Team in achieving patient care goals. Plan, provide, supervise, and document safe, competent, and compassionate care for patients in accordance with physician orders and established policies and procedures. Collaborate with the patient, the patient’s family, facility staff, and the TK team to develop culturally sensitive care plan components. Make appropriate recommendations related to phone/telehealth/in -person assessment in accordance with TK’s policy and procedures. Provide and document appropriate and relevant end of life information and education to families in compliance with current Centers for Medicare and Medicaid Services CMS Conditions of Participation (CoPs). Coordinate with Administrative Team to manage the appropriate use of patients’ medical equipment, supplies, and medications. Delegate tasks and supervises the activities of LPNs and Hospice Aides, as needed. Responsible for following current CoPs as related to Certified Nursing Assistant (CNA) supervision. Provide coverage of after-hours phone calls from patients and families and/or after-hours visits to patient homes when needed and as arranged with supervisor. Contact DME companies, pharmacies, transportation services, and other related community entities involved in care of patient as needed. Professionally manage time, people and technology. Participate in Transitions Kids team meetings at request of TK Program Manager and/or Team Lead. Participate in own professional development by maintaining required competencies, identifying learning needs, and seeking appropriate assistance or educational offerings. Actively participate in the orientation and training of new employees of all disciplines when requested by Program Manager and/or Team Lead. Maintain current training and knowledge of pediatric nursing and pediatric hospice/palliative nursing. Perform other duties as assigned by Transitions Kids Program Manager and/or Team Lead.

Expectations - how you do it TK Core Values are exemplified in all interactions with internal and external customers. Adheres to TL and TK policies, procedures and guidelines. Adheres to CMS and state guidelines and nursing standards of practice. Adheres to NHPCO Ethical Practices and the American Nurses Association’s Code of Ethics.

Requirements - what you need Registered Nurse with current NC license; BSN required. Minimum 2 years recent pediatric clinical experience required. Pediatric hospice, pediatric hospital inpatient, and/or pediatric home health experience or equivalent preferred. Pediatric Hospice and Palliative Care Nurse Certification (CHPPN) preferred. Bilingual preferred, particularly Spanish. Able to forge high-quality, trusting relationships with patients, families, and co-workers. Able to independently seek out resources and to work collaboratively with a team. Able to communicate clearly with patients, families, visitors, IDG team, physicians, facility staff, leadership, and others. Able to educate patients and families regarding Transitions Kids services and roll and to collaborate with patients and families to identify their goals and values that will inform medical decision-making. Experience engaging with patients and families in goals of care conversations and/or completing advance directives preferred. Able to teach patients and families in accordance with the plan of care. Knowledgeable about reimbursement sources, Medicare regulations, licensing laws, and accreditation standards. Competent computer skills with ability to learn new software programs. Current CPR certification. Must have and maintain a valid North Carolina Driver’s License, maintain automobile insurance coverage, and have access to reliable transportation. Must be able to travel to, enter and function in the homes/facility of any patient/family in the service area to assess and provide care to all patients. May be required to lift and/or carry items up to 50 pounds. Must have sensory abilities to complete physical assessment, communicate with patient/family care providers and physician, and to complete the reporting and follow-up documentation responsibilities of the job. Available to staff a minimum of four weeknights OR one weekend per month. Available to work during and/or after office hours, including weekend and holiday commitments as outlined in Employee Information.