Registered Nurse: Critical Care

Job Summary:

Essential Duties and Responsibilities

• Supports and promotes the mission and values of Covenant Health Ministry.
• Renders professional nursing care to patients within an assigned unit of the hospital, in support of medical care as directed by medical staff and pursuant to objectives and policies of the hospital
• Compliant in completion of all unit specific competencies and requirements required to care for critically ill patients within the department during orientation period onboarding and annually as assigned.
• Involved in quality improvement planning and processes for the area of practice 
• Clinical documentation and care plans completed comprehensively for all patients assigned in a timely manner within the electronic health record (EHR), including Vital Signs, assessments, care plans, and information related to any change in condition.
• Knowledge and understanding of responsibilities during down-time
• Responds quickly to all patient monitoring alarms
• Provides emotional support for patients and families during difficult situations
• Collect specimens as ordered and in the order required per policy, labeling and sending to the lab in a timely manner
• Engages and participates in unit or organizational committees and councils.
• Ability to analyze patient assessments and data, communicate findings, document and implement actions timely and accurately
• Pursues personal growth and development through continuous learning opportunities within and outside of the organization.
• Seeks feedback and accepts constructive criticism regarding practice and takes actions as appropriate.
• Practice reflects knowledge of current practice standards (ANA, NH Nurse Practice Act, Specialty standards).
• Communicates patient information appropriate for continuity and safe care through hand offs, walking rounds, and physician/provider interaction.
• Provides a safe and secure environment for patients, visitors, and staff by following established procedures and protocols
• Implements resources and initiatives that are in place or in process to improve patient safety.
• Works within guidelines of Just Culture Environment to promote error reporting and adoption of safe practices.
• Assures issues are addressed through appropriate use of the chain of command
• Completes hourly rounding in collaboration with LNAs (Licensed Nursing Assistant) on all assigned patients
• Identifies and assists in correction of patient care safety issues.
• Builds respectful relationships through early and pro-active identification of concerns, compliments, or suggestions
• Collaborates unit to unit and shift to shift for resolution of conflicts and issues in a timely manner
• Consults with nurses in other department/units to draw upon expertise in other clinical areas/specialties.
• Works collaboratively with Providers to complete assessments and perform bedside procedures.
• Displays professional, positive perspective, including when faced with difficult circumstances
• Seeks opportunities to assist all team members
• Actively participates in unit-based shared governance and with the philosophy of the unit and the organization.
• Appropriately delegates aspects of care and unit activities to other nursing personnel
• Provides support and mentors new nurses and other disciplines withing the department through preceptorship and other methods as requested by the department leadership.
• Participates in Peer Review maintaining confidentiality.
• Participates in DNV survey readiness. 
• Demonstrates characteristics of the SPIRIT of St. Joseph Hospital with a commitment to my co-workers and holds peers accountable for the same.
• Follows organizational HIPAA compliance policy.
• Demonstrates fiscal responsibility through complete and accurate timekeeping, as well as patient supply utilization.
• Avoiding unauthorized use of overtime and managing ETO per policy.
• Participates in annual evaluation 360 process as requested.
• Provides quality care by remaining up-to-date on Nurse Sensitive Indicators.
• Responds to emergency situations per department/role requirements such as Code Blue and rapid response team.
• Other duties as consistent with this role.

Emergency Department, additional responsibilities include:

• Triages patients and determines priority of care (ESI level) based on physical, psychological, and social needs including factors influencing patient flow through the system.
• Implement protocol orders associated with approved chief complaints.
• Performs focused assessment related to chief complaints in a timely manner according to established triage guidelines
• Reassess arrived patients after initial triage to ensure no change in condition.
• Provides quality care for patients presenting with acute illness and/or trauma requiring emergent/urgent attention and able to recognize potential life-threatening conditions for early intervention
• Initiates corrective action as appropriate when information from monitoring equipment shows adverse symptomology or patients demonstrate adverse clinical symptoms
• For admitted/boarding patients, complete required documentation per policy
• Engages in initiatives aimed at improving patient throughput

Cardiac Cath and Angiography Lab additional responsibilities include:

• Ability to learn complex technologies effectively
• Experience with complex/critical care medication infusions, including titration management
• Enhanced knowledge of anatomy and physiology, especially cardiac
• Experience with emergency cardiac interventions
• Provide in-depth history and medication review (pre-admission testing) of all patients scheduled for procedures to ensure patient safety peri-procedure.  Demonstrates the ability to correctly identify periprocedural safety issues, and report to physician accordingly.
• Demonstrates clinical expertise in creating and maintaining a sterile field.
• Plans and provides equipment and supplies based on procedure and physician needs.
• Participates in on-call assignments and demonstrates flexibility to cover staffing as needed. 
• Ability to be within 30-minute radius when on call.
• Ability to safely administer procedural sedation.  Pass annual sedation examination. Documents sedation according to policies and procedures.
• Maintains safe working environment to include radiation safety/appropriate personal protection attire.
• Demonstrates criteria for arterial and venous sheath removal. RN has working understanding of guidelines provided in physician orders for safe sheath removal when patient has been given blood thinners prior to sheath removal.
• Demonstrates the ability to identify criteria for equipment including Intra-Aortic Balloon Pump (IABP), IMPELLA etc.  Assist MD with set up, insertion and maintenance of equipment as needed.
• Assist with insertion of Flow wire, Opsens and IVUS.  RN must demonstrate contraindications and reversal for IV adenosine infusion.
• Demonstrates a working knowledge of hemodynamic waveforms.  Obtains the ability to monitor arterial waveform during left heart catheterization. Able to identify damping and ventriculization of arterial waveforms.  Able to correctly identify different hemodynamic waveforms during right heart catheterizations. 

Job Requirements

Job Knowledge and Skills

• Basic Dysrhythmia preferred or obtained prior to completion of orientation.
• NIHSS certification preferred or obtained prior to completion of orientation
• Certification in Specialty preferred
• Call shifts required for Cath Lab and Stress Lab.
• CPI training preferred or obtained within 6 months of hire.
• CPI advanced training for the ED and ICU within 6 months of hire.

Education and Experience

• Current New Hampshire RN license required
• Graduate of an approved Nursing program strongly preferred
• 3-5 Years Critical Care Experience preferred for the Cardiac Cath/Angiography Lab
• ASN required, BSN preferred
• BLS required
• ACLS Preferred for all critical care RN roles (excluding the Operating Room and Pre-Admission testing and is required prior to completion of orientation)
• PALS Preferred –
  • Required prior to completion of orientation for Urgent Care, and PACU
  • Required prior to assuming care for critically ill pediatric patient for Emergency Department (may have ENPC in place of PALs)
• TNCC – Preferred – required within 18 months of hire for the Emergency Department
• TCAR – Preferred – required within 1 year of hire for the ICU and PACU.
• Crisis Prevention Institute (CPI) training preferred or obtained prior to completion of orientation
• Membership in a professional organization preferred.

Covenant Health Mission Statement

We are a Catholic health ministry, providing healing and care for the whole person, in service to all in our communities.

Our Core Values:

•Compassion

We show respect, caring and sensitivity towards all, honoring the dignity of each person, especially the poor, vulnerable and suffering.

•Integrity

We promote justice and ethical behavior, and responsibly steward our human, financial and environmental resources.

•Collaboration

We work in partnership, dialogue and shared purpose to create healthy communities.

•Excellence

We deliver all services with the highest level of quality, while seeking creative innovation.

Applicants, employees and former employees are protected from employment discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age (40 or older), disability, and genetic information (including family medical history).

Comp Range:

Rate of pay displayed reflects the beginning of the pay scale.  At the time of an offer, determination of your offer will reflect your skills and experience as it relates to the position.

Our people make the difference. See firsthand what makes our employees and culture shine!