Provide expert care coordination, consultation, education, and advocacy for patients and families.
Perform focused and ongoing nursing assessments independently to guide clinical decision-making, patient care, and performance improvement goals.
Manage patient triage and follow-up through multiple modalities, with telephone triage as a primary function, including symptom calls, Red Calls, portal messages, encounter follow-up, and test result communication.
Support clinic workflows through in-person and remote care, including patient intake, medication reconciliation, nurse visits (in-person/video), and assistance with procedures as needed.
Deliver culturally sensitive, age-appropriate, team-based care that actively incorporates patients and families into care planning and shared decision-making.
Educate patients and families on diagnoses, medications, side effects, and care plans by assessing readiness to learn, developing individualized teaching plans, and adapting approaches to ensure understanding.
Serve as the primary care coordination resource for families, utilizing internal and community resources to ensure continuity of care, address psychosocial or ethical concerns, and support optimal outcomes.
Collaborate closely with the primary medical team, consulting services, case managers, social workers, outside agencies, and families to develop and implement organized care plans for complex patients.
Coordinate program-specific activities and support seamless transitions of care, including hand-offs between inpatient and outpatient settings in collaboration with the LVL complex care navigator.
Document nursing assessments, care, education, and all team, physician, and patient/family communication accurately, efficiently, and in accordance with hospital policies and protocols.
Collaborate effectively with nursing colleagues, physicians, assistive personnel, and interdisciplinary partners; provide functional supervision and delegate tasks appropriately following the 5 Rights of Delegation.
Develop and maintain therapeutic, professional relationships characterized by empathy, clear boundaries, cultural humility, and constructive conflict resolution.
Uphold hospital standards, apply unit policies with ease, and actively participate in quality improvement initiatives.
Demonstrate strong critical thinking, organization, communication, technological proficiency, and the ability to manage multiple interventions simultaneously.
Function with minimal supervision, high motivation, and strong patient advocacy while supporting the Interdisciplinary Pediatric Feeding Program.
Perform additional duties as required to meet departmental and patient care needs.
Perform job functions in alignment with service principles emphasizing innovation, service excellence, teamwork, and high-quality care for patients, families, coworkers, and partners.
Expectations
Demonstrated ability to apply critical thinking and clinical judgment in daily practice, including assessment, planning, intervention, evaluation, and problem-solving.
Demonstrated ability to organize, prioritize, and manage multiple interventions simultaneously.
Demonstrated effective written and verbal communication skills and the ability to collaborate.
Ability to function competently with the electronic medical record and other relevant technological applications.
Additional responsibilities may be assigned based on departmental needs.