GENERAL SUMMARY:
Under supervision of the Director of Nursing this position is responsible for providing and coordinating nursing care in accordance with established facility policies and procedures; and to assess residents’ care needs and to take appropriate action in compliance with all local, state, and federal regulations and guidelines.

ESSENTIAL JOB FUNCTIONS:

• Perform tasks and assume responsibility for resident care, under the direction of an R.N. as outlined in the law regulating the practice of nursing and rules and regulations of the Maine State Board of Nursing.
• Observe, report and document changes in resident conditions, seeking assessment and guidance as needed from the D.O.N. relative to interventions and care planning. Follow-through with care plan and document outcomes.
• Must be able to assume the role of medication pass as needed and on a rotating basis.
• Participate in the care planning process. Revise and update the care plan to reflect current resident needs.
• Prepare C.N.A. assignments and maintain accountability for care.
• Communicate with staff frequently to assure timely and accurate completion of assignments.
• Provide direct resident care in the event of insufficient C.N.A. staffing.
• Participate in C.N.A. performance evaluations when requested by the D.O.N.
• Assure that nursing department personnel, residents and visitors follow established policies and procedures.
• Complete incident reports pertaining to resident and employee injuries on designated forms, and submit to the D.O.N.
• Notify resident family/responsible party of acute changes, incidents, and transfers to the hospital. Send a completed bed hold policy with the resident when transferred to a hospital.
• Obtain and transcribe physician’s orders. Prepare and administer medications and treatments per M.D. orders (or delegate to the C.N.A.-M.)
• Adhere to nursing standards of practice, facility policies, state, and federal regulations regarding psychopharmacological medication administration.
• Participate in facility’s Quality Assurance Program.
• Participates in orientation of new nursing personnel.
• Assure that stock level of medications, medical supplies and equipment are maintained. Communicate with the ward clerk, who manages ordering inventory for the nursing department.
• Maintain the daily census report.
• Provide nursing report to the on-coming charge nurse in a clear, concise, and timely manner.
• Perform or ensure that the narcotics “count” occurs at the beginning and end of each shift.
• Replace vacancies in staffing to cover callouts. Contact the R.N. on call when difficult or unusual staffing issues arise.
• Contact the RN on-call during weekends if a situation arises that cannot be managed within the L.P.N.’s scope of practice.
• Maintain confidentiality of all RESIDENTS and EMPLOYEES information to assure that all rights are protected.
• Must treat all residents with dignity and respect at all times.
• Must have a clear understanding of resident rights and abuse reporting policies and procedures.
• Must report any actual or suspicion of resident abuse to the department supervisor or other appropriate personnel.
• Responsible for following all facility safety policies and procedures and reporting any safety issues or concerns to the appropriate personnel.
• Must report all incidents and accidents immediately to the department supervisor or other appropriate personnel as required by established policies and procedures.
• Responsible for following all facility infection control policies and procedures.
• Responsible to follow all department policies and procedures.
• Responsible for following all established facility professional and personnel policies and procedures.
• Participate in all in-services and departmental meetings as required.

OTHER DUTIES AND RESPONSIBILITIES:

• Promotes and maintains positive community relations.
• Maintains current knowledge of trends and practices in the field through peer association, attendance at seminars, study, and review of literature.
• Attends all mandatory in-services.
• Reports any workplace safety concerns to Supervisor immediately.
• Performs other related duties as required.

SKILLS/EXPERIENCE/TRAINING REQUIRED:

• High School diploma or the equivalent.
• Completion of a prescribed curriculum in a state accredited program for the preparation of practical nurses, from which program the applicant holds a diploma or certificate.
• Must hold a valid licensed practical nurse license from the State of Maine
• Current Basic Life Support certification
• Must possess the ability to make independent decisions when circumstances warrant.
• Must possess the ability to deal professionally with personnel, residents, families, visitors, government agencies and the general public.

SUPERVISORY RESPONSIBILITY:

• Responsible for the direct supervision of C.N.A and C.N.A-M staff.

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Work is performed primarily in a nursing home environment, which is generally not subject to extremes in temperature, odors, etc.
• Stands, sits and walks most of the working day.
• Must be able to lift, push or pull up to fifty (50) pounds.
• Uses computer keyboards requiring eye/hand coordination and finger dexterity.

The above statements are intended to describe the general nature and level of work being performed by people assigned to do this job. The above is not intended to be an exhaustive list of all responsibilities and duties required.

*External and internal applicants, as well as position incumbents who become disabled as defined under the Americans with Disabilities Act, must be able to perform the essential job functions (as listed) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case by case basis.