Job Summary The transitional care nurse works with members of the multidisciplinary team and the patient/caregiver to ensure that an effective and well-informed discharge occurs. The nurse will function as a liaison between the acute setting and sub‑acute levels including home health, nursing home, hospice care, and/or family caregiver. The Transitional care nurse provides continued education post discharge to the patient/family members to promote positive outcomes and ensure understanding of disease, prevention and treatment modalities utilized. The nurse provides resources to the patient/caregiver necessary to meet the specific identified needs of the patient. The nurse collects, inputs and maintains specific data necessary for the completion of specific dashboards which are utilized to enhance and coordinate the needs of the population served. In conjunction with the RN coordinator, the Transition of Care nurse reviews and discusses findings/concerns in relationship to the established plan of care for further evaluation and assistance. The nurse is responsible to complete all NICHE GRN education and continue participating in geriatric nursing education programs to maintain knowledge base. The Transition nurse behaves in a professional manner and consistently demonstrates and promotes the values of respect, honesty, care, and dignity for the patient and all members of the healthcare team. The Transition of Care nurse is committed to the constant pursuit of excellence in improving the health status of the population followed. Minimum Requirements Experience: 3 years clinical experience. Education: Graduated from a Practical Nursing School program. Special Skills: Proficient in English, verbal, written communication, and computer skills. Licensure: Current unrestricted Louisiana LPN license CPR Certification. #J-18808-Ljbffr FMOLHS
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