Report on Deliverable #10. Restructuring Key MLK-MACC Nursing-Related Departments (Deliverable #10)

Transcription

1 Restructuring Key MLK-MACC Nursing-Related Departments (Deliverable #10) Health Management Associates 1

2 Table of Contents I. Nursing Administration... 3 II. Quality Improvement (QI) and Risk Management.7 III. Utilization Management/Case Management..8 IV. Social Work...9 V. Appendices Position Descriptions: Director of Urgent Care and Patient Flow.11 Registered Nurse 15 Chief Nursing Officer 20 Director, Ambulatory Care Nursing..24 Director of Administrative Nursing Office and Ancillary Nursing Services 27 Director of Nursing 30 Director of Qualify and Performance Improvement..33 Health Management Associates 2

3 Introduction Ambulatory operations in the MACC continue to make the transition from being supported by an inpatient infrastructure to a service model that provides care to outpatients only. While the scope of service for the clinical departments in the MACC have changed over the last 6 months due to decreasing volumes and loss of some providers, the most profound changes have occurred in those departments and services that supported both the MACC and the inpatient hospital. The scopes of service for the following departments have been impacted and will require changes in the services they provide, in their staffing levels, their responsibilities and their reporting structures. The staffing plan for these departments is 196 FTEs. (See detail below). This is compared to the October 31, 2007 HMA Report: MLK Ambulatory Network Staffing Plan, for the same departments or services of 215 FTEs. It will be necessary to implement the recommendations in this report to meet these staffing targets. It will also require strong and effective leadership at the MLK-MACC with ongoing support from DHS to accomplish this change and to continue to provide quality care to all patients. I. Nursing Administration Scope of Service Nursing leadership is currently being led by an interim CNO. (1.0 FTE) This change occurred in December 2007 while the transition from in-patient to only out-patient services was underway. Progress has been made in assessing out-patient competencies on all clinical staff, revising all job descriptions and performance evaluations, and updating policies and procedures to reflect the current clinical services being provided. With the change in nursing executive leadership, the implementation of an Ambulatory Surgery Center and increasing volumes in Urgent Care, a revised structure in nursing administration is necessary. This structure will include five (5.0 FTEs) Assistant Nursing Directors, Administration (ANDA) or Nursing Director Administration (NDA existing title) or Nurse Director ASC reporting to the Interim CNO. The CNO will be responsible for the professional practice of nursing and the provision of nursing care in the MLK-MACC and the Hubert H. Humphrey Community Health Center (HHHCHC.) She will work collaboratively with the CMO to establish and implement standards of care for ambulatory patients. The CNO will also meet regularly and collaborate frequently with the other members of the senior leadership team to assure quality care that is patient centered, safe, efficient, effective, timely and equitable. It will be important for all management and staff to have a very clear understanding of the meaning of patient-centered care. Team work is essential. The CNO will establish clear expectations for administrators and staff, identify opportunities to improve patient care, patient safety, and overall clinical care and hold the nursing leadership team accountable for providing this care. The CNO will meet weekly with the Nursing Administrators. She should also be visible within the MLK-MACC and at HHHCHC, making frequent rounds in all clinical areas. Health Management Associates 3

4 The Nursing Administrators in the MLK-MACC and HHHCHC will report to the CNO and be responsible for providing leadership to the Nurse Managers and/or staff within their areas. They will meet with the Nurse Mangers weekly. The Nurse Managers will work collaboratively with the staff and providers in the primary and specialty clinics, Ambulatory Surgery Center and Urgent Care. The Nurse Managers will hold brief meetings each morning with all staff and providers assigned to the department to clarify schedules and determine any barriers to providing care. Monthly staff meetings will be held to provide a regular forum for ongoing communication between staff and administration and to update all staff on progress on performance improvement indicators and accreditation status, answer any questions, and respond to staff concerns related to the provision of safe care. The Nursing Administration Office under the leadership of one ANDA will be responsible for Clerical Support (5.0 FTEs); Staff Education (3.0 FTEs); Radiology Nursing staff (2.7 FTEs); and Occupational (Employee) Health (1.0 FTE). Clerical support in Nursing Administration should work as a pool sharing the workload and other tasks required to support the CNO, the Nursing Administrators, and Nurse Managers. The current responsibilities for each clerical support person should be assessed to determine any overlap or tasks that are unnecessary in an ambulatory administrative setting. Their job descriptions should be revised to reflect the change in responsibility and should include at least the following: share the workload, and communicate often but especially when needing assistance to meet a deadline or complete a project. Staff education is responsible for competencies for all clinical/licensed staff and a Specialty Area Competency Assessment for Urgent Care; certification and recertification for CPR, ACLS, PALs, Arrhythmia Recognition; classes based on needs Physical Assessment, Pediatrics and Adults; and New Employee Orientation for MACC nursing RN, LVN, CNA, Clerical staff. Occupational (Employee) Health is located at the corner of 120 th and Compton. They provide annual physicals for all employees as well as pre-employment physicals. A Nursing Director, Administration will be responsible for Nursing Informatics (1.0 FTE); Nurse Managers (3.0 FTEs) in Medicine/Medicine Sub-Specialty Clinics; Surgery/Surgery Sub-Specialty Clinics; and Women and Children s Health/Pediatric Specialty Clinics. The nurse managers will be responsible for all clinical staff in the Primary and Specialty clinics (78.2 FTEs). Urgent Care and Patient Flow will be lead by one ANDA. The nurse manager for Urgent Care (1.0 FTE) will report to this position. Urgent Care will be staffed with 35.0 FTEs. This will include one Urgent Care supervisor and one Patient Flow supervisor for each shift; along with Patient Flow and Triage staff. The Nurse Manager in Urgent Care will be responsible for the patient flow function. The fifth Assistant Nursing Director, Administration reporting to the CNO at MLK- MACC will provide leadership at HHHCHC. This position is responsible for Primary Care and Specialty Care; Urgent Care; and Performance Improvement at HHHCHC. There are 116 FTEs in the clinical areas and 4 nurse managers. Health Management Associates 4

5 The Nurse Mangers will take over the staffing and scheduling of their areas with clerical support from Nursing Administration if needed. No nurse manager has a span of control greater than 41.0 FTEs. The two managers that have a greater span of control than the others (Urgent Care with 35.0 FTEs and ASC with 41.0 FTEs) have charge nurses within their department staffing. Other than Urgent Care all staff are scheduled Monday to Friday with variations in the schedule only for sick time, vacation, and education. This will eliminate the need for a separate staffing office. The primary and specialty clinics should not need a charge nurse on a full time basis. They could assign one of the RNs on duty to be in charge however that nurse would still have clinic responsibilities. The managers will be accountable for everything that occurs in their department. In their absence one of the other Nurse Managers should be asked to cover the clinic and the Nursing Administrator should plan to be available on the unit a part of each day that the Nurse Manager is away. Goals Nursing leadership should establish key priorities (included in job descriptions) for all of nursing administration under the leadership of the CNO. The following should be considered: Prepare for Joint Commission Accreditation. Establish indicators based on the Joint Commission Ambulatory Standards. Assign responsibility in each department to collaborate with the Department of Quality Improvement and Risk to monitor these indicators and communicate outcomes to staff and providers. Set clear expectations for staff and hold staff accountable. Support staff during transition period. Implement a culture where patient-centered care is the top priority. Assist all staff in maintaining competencies. Recommendations Staffing for Nursing Administration (FTEs) Current HMA 10/31/07 o Management Positions 10.0* 10.0 o Clerical positions o Primary and Specialty Clinics o Urgent Care (based on 35,000 visits) o ASC 41.0** 41.0 o Staff Education 3.0 NA o Radiology o Occupational Health o Nursing Informatics 1.0 NA * includes 1.0 HHHCHC ANDA **Will be further assessed when HMA finalizes implementation plan for ASC in March NA = Not applicable; no recommendation make in 10/31/07. Health Management Associates 5

6 Consider one Occupational (Employee) Health Department for MLK and HHHCHC. Provide service 2.5 days per week at each location. Relocate in proximity with Human Resource Department so clerical staff can be shared. Transfer function of move management currently done by Nursing Administration staff to Facility Management. Revise their job descriptions to include regular communication with nursing leadership on all potential moves. Information Technology department should provide technological support to Nursing Informatics. Collaborate with disciplines to identify relevant system issues that may cause delays in patient care or services. Analyze and make recommendations for Information system to resolve the problem. Finance should be required to assist nursing leadership with budget preparation and monitoring of equipment ordering so that RNs are not required to provide this function in administration but have the information they need to make decisions in a timely manner. Procurement (in collaboration with Finance) should monitor equipment, supplies and unit environmental standardization. Participate with nursing administration in contract renewal, equipment evaluation, and distribution of equipment to areas after review by Bio-Med for compliance with regulatory standards. Patient flow and Case Management should collaborate to provide support needed for transferring patients out of Urgent Care and the MACC. Clerical support staff in Nursing Administration should function as a pool and share the workload while having specific responsibilities to achieve on their own. For example: support the CNO, support the ANDAs, support the Nurse Managers. Perhaps there is capacity in Administration to increase the pool available. Nurse Managers should take over staffing of their areas so that there is not a need for a separate staffing office. Consider potential strategies/relationships with HHHCHC. Assess roles of Patient Flow, Triage, and Case Management. Determine synergies and areas where they could work collaboratively in Urgent Care. (See Case Management below). Remove barriers to successful implementation of the staffing plan. Health Management Associates 6

7 II. Quality Improvement (QI) and Risk Management Scope Director reports to CEO. The department responsibilities include QI and Risk Management. (Also responsible for Utilization Management: see below) There are 7.0 FTEs in the department. 2.0 RNs in QI (one for MLK-MACC and the other for the ASC) and 2.0 RNS in Risk Management. A third RN floats between QI and Risk Management to assist with issues in both departments. This nurse s responsibilities include abstracting data for the Core Measures; new employee orientation; training for the Patient Safety Net (Adverse Event Reporting System); case reviews; and reviewing all data from the Patient Safety Net for MLK and HHHCHC. She is also assigned to special projects, arranges appointments for attorneys, claims account executives, ensures that all attorneys needs are met (charts, diagnostic tests, reports), assists in arranging Round Table Discussions with County Council and DHS, and assists the Risk Management staff. The staff in Risk Management continue to track IP cases from MLK-Harbor Hospital; new IP cases that continue to be filed; follow up on complaints to the Board of Supervisors, patient advocacy office; and perform case reviews when issues are identified in the Patient Safety Net. All issues are discussed with the CMO and CNO. While there is no clerical staff for this department a clerk (1.0 FTE) in risk management performs this function for QI and Risk. Goals The management staff has been in place since May. With the transition to out-patient in August and the new CMO in January the following are priorities: Work closely with CMO to establish a PI team/council and prepare a PI Plan for the MACC. Draft plan is awaiting approval. Prepare for and achieve Joint Commission Accreditation. Develop indicators based on the National Patient Safety Goals (NPSG). Currently working on screening tools for documentation and moderate sedation (used in OMF/Dental). Collect and analyze data from ASC. Collaborate with ASC staff. Establish membership for QI Committee. There is an established Ambulatory Care Meeting that meets monthly where PI could/should be reported. Analyze data provided by individual service/department and report outcomes to CMO and CNO. Recommendations Current HMA 10/31/07 Staffing 7.0 FTE 8.0 FTE Determine appropriate departments to report under QI and Risk Management and revise job description. Consider moving Case Management under nursing administration to strengthen the case management process. Health Management Associates 7

8 Establish PI plan for the MLK-MACC with physician and staff input as soon as possible. Determine membership on QA/PI Committee. Collaborate with HHHCHC on Joint Commission Accreditation. Consider possibility of moving responsibility for Risk Management of inpatient cases to another venue to create a clean break from former inpatient services. III. Utilization Management/Case Management Scope This department is led by an Assistant Nursing Director and reports to the Director of QI and Risk Management. The RNs continue to do Utilization Review and TARs approximately 10 hours per RN each week. They currently have a backlog of 150 cases and this is expected to increase. The clerical staff drive charts to the MediCal field office downtown. The clerical staff also review and process billing documents and are responsible for photocopying charts and preparing for submission to the MediCal field office. One RN is responsible for reviewing all peds clinic visits for CCS eligibility. The UM Nurse Case Manager submits referrals to CCS and is a liaison between CCS Nurse Case Managers, clinic staff, and patients. In addition she is responsible for submitting medical documentation and updates as needed by CCS. RNs spend the other 30 hours per week doing Case Management on patients transferred from MLK-MACC and patients receiving care in the MACC. Their work is not only with patients in the community but also within the MACC. Community work includes: Daily calls to the 8 Impacted Hospitals and to the Metro Care hospitals regarding plans for discharge, and communication with RN caring for the patient regarding potential discharges. They make appointments, fax prescriptions to the MLK-MACC pharmacy, order equipment, and/or arrange for home health. The PRW registers the patients in the MACC system if new to the MACC. One RN works with St. Vincent Hospital. The census there may be 6 15 patients each day. She calls each day for the current census of MLK patients; assists with MediCal applications, as well as tasks noted above. MLK- MACC work includes: Order equipment, IV antibiotics, etc. for patients seen in the clinics. They also meet patients in the clinic as requested by MD or RN. Document visits and information in Affinity; make appointments for services not offered in MLK-MACC; and call Social Work for problem patients or for patients needing special services/placement, e.g., Dialysis, SNF. Goals Devote 100% RN time to Case Management when utilization management is no longer needed. Determine synergies with patient flow function and establish protocols for collaboration to support the clinical staff in the MACC and Urgent Care. Health Management Associates 8

9 Work closely with Social Work department in meeting the needs of the patients. Recommendations Current HMA 10/31/07 Staffing 7.0* FTE 13.0 FTE *6.0 RNS Clerical support for CM Consider outsourcing all Utilization Review work related to inpatients at the former MLK-Harbor Medical Center (currently requires 3.0 clerical, 1.0 coder, 1.0 secretary, and 1.0 PRW RN) within the DHS system OR assign 1.5 FTE RNs to Utilization Management full time until the work is completed. Determine number of support staff needed for this function. Assign other 4.5 RNs and 1.0 clerical to Case Management. Move Case Management into Nursing Administration. Assistant Nursing Director and Nurse Manager position currently in Case Management would be eliminated. Case Management could report to existing ANDA or function could be decentralized and assigned to Nurse Managers in each clinical area. Reorganize RN staff to provide consistent 40 hours Case Management in the community and in the MLK MACC. Assign 1.0 RN to the Community case management and the rest to MLK MACC. IV. Social Work Scope Social Work currently reports to the Assistant Administrator. Current staff consists of 1.0 Social Work Supervisor; 1.0 Secretarial support (bi-lingual); 3.0 Social Workers 1.0 ACSW on LOA; 1.0 ACSW for adults; 1.0 LCSW for pediatrics. (5.0 FTEs) They all work 8:00 am - 5:00 pm or as long as needed. Their responsibilities include the following: counseling for domestic violence, child abuse, mental health, personality disorders; responding to MLK-MACC MD calls and requests from MD or RN in Affinity; and making referrals in the community to Department of Public Social Services, Social Security, Unemployment Office, Department of Mental Health, Department of Housing, City shelters, various food banks, etc. Goals Continue to support the provision of patient-centered care. Work collaboratively with case management and patient flow. Recommendations Current HMA 10/31/07 Staffing 5.0 FTE 10.0 FTE Health Management Associates 9

10 Interviews Conducted Sharon Arnwine, Interim CNO Mary Miodovski, RN, Assistant Nursing Director Administration Pauline Rodriguez, Nursing Director Administration MACC Lessie Barber, Assistant Nursing Director Susan Velasco, RN, Director of QI and Risk Management Luz Bag-aw, MSW, LCSW, Social Services Manager Cloteal Young, RN Nursing Instructor Documents Reviewed Martin Luther King Jr. Multi-Service Ambulatory Care Center Nursing Services Organizational Chart MLK-MACC Staff Personnel Staffing as of February 7, 2008 CNO s DRAFT organizational chart for new staffing model MACC Quality Improvement Organizational Chart MLK-MACC Quality Improvement Plan 2007/2008 DRAFT MLK, Jr. MACC Ambulatory Care Nursing Services HMA MLK Ambulatory Network Staffing Plan, October 31, 2007 Job Descriptions Health Management Associates 10

11 Martin Luther King, Jr., Multi-Service Ambulatory Care Center Position Description Employee Name: Lessie Barber Employee Number: Payroll Title: Assistant Nursing Director 1 Functional Title: Director of Urgent Care and Patient Flow Item Number: 5295 A FLSA Status/Bargaining Unit #: Covered / BU# 311 Department/Service Area: Nursing- Administrative Nursing Office Facility Location: KDMC Reporting Level: Chief Nursing Officer Prepared By: Prepared Date: 11/01/07 Approved By: Chief Nursing Officer Approved Date: 07/01/07 Review Date: 11/01/07 Revision Date: 02/27/08 SUMMARY The Assistant Nursing Director (AND) has ultimate authority for specified areas in the organization, specifically Patient Flow and Urgent Care. This AND works independently under the general direction of the Chief Nursing Officer (CNO), with all levels of the MLK Jr. MACC staff and interdisciplinary groups. The AND provides direction for the Patient Flow Management Department to assure appropriate patient flow from discharge to transfer. Collaborating with CEO, CNO, Medical Director, and other staff in implementing and improving processes for patient flow. Assumes the responsibility for overseeing patient movement processes and identifying opportunities to improve. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Participates in shared governance. Participates in quality improvement activities. Functions as a member of the inter-disciplinary health care team. Adheres to the mission, vision, and philosophy of the Ambulatory Center and the Nursing Department. Serves as patient advocate Maintain patient confidentiality. Health Management Associates 11

12 Assist with staff development and education Directs coordination of daily operating practices of transfers Promotes effective communication with and among physicians from different departments, clinical areas, ANO, and registration staff in facilitating patient flow and increasing capacity. Monitor pending transfers within the organization and pending intra-county transfers; maintains a continuous assessment of the patients awaiting transfers to and from beds. Identifies potential problems and take proactive measures to avoid/ minimize problems. Documents and follows through with problem transfers. Works closely with designated physicians and nurse managers in identifying patients who are candidates to be transferred. Liaisons with Registration, DEM, ANO, UR, QM, Environmental Services, and clinical areas/ services. Educates staff on the patient flow process. Collects and analyzes data to identify trends and patterns; prepares statistical reports Conducts formal patient flow studies of outpatient services Collects and analyzes data to identify trends and patterns, prepares and analyzes statistical reports to Departments. Prepare for Joint Commission Accreditation. Establish indicators based on the Joint Commission Ambulatory Standards. Assign responsibility in each department to collaborate with the Department of QI and Risk to monitor these indicators and communicate outcomes to staff and providers. Set clear expectations for staff and hold staff accountable. Support staff during transition period. Implement a culture where patient-centered care is the top priority. Assist all staff in maintaining competencies. Health Management Associates 12

13 PATIENT AGE & TREATMENT COMPETENCY( ) infant ( X ) Adolescent ( X) Geriatric ( X ) Child ( X ) Adult ( ) Not a patient care position Familiar with, and ability to utilize, the nursing process to assess, plan, implement and evaluate assigned patients relative to their age, development, medical condition and/or diagnosis. Ability to appropriately obtain and interpret information relative to the patient's needs. Knowledge of the expected growth and development of assigned patients. Ability to understand the range of treatment needed by the assigned patient population. SUPERVISORY RESPONSIBILITIES This position guides Registered Nurses, Licensed Vocational Nurses, and Nursing Attendants in the performance of their duties, and makes nursing decision that affect a larger number of patients. This position provides instruction and direction for the unit intermediate clerks and unit institutional helper. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to walk; use hands to finger, handle, or feet; reach with hands and arms; and talk or hear. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move more than 25 pounds. Physical Class Definition: Class"3" Moderate WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. MINIMUM EDUCATION/EXPERIENCE REQUIREMENT Three years experience in clinical nursing and a Bachelor s degree in nursing. A Master s degree in nursing or one year of experience in nursing research or administration will be substitute for one year of the required clinical experience or all the above may be substituted by: two years of experience in nursing administration and a Master s degree in nursing administration. REQUIRED LICENSE/CERTIFICATES Current license to practice as a Registered Nurse issued by the California State Board of Registered Nursing. Current Basic Cardiac Life Support. Health Management Associates 13

14 CONTINUING EDUCATION Thirty (30) hours of continuing education every two (2) years. LANGUAGE SKILLS Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business, correspondence and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. My signature below acknowledges receipt of this position description. Employee signature Date Health Management Associates 14

15 MARTIN LUTHER KING AMBULATORY SURGICAL CENTER Position Description Employee Name: Traci Valdez Employee Number: Payroll Title: Nurse Manager Functional Title: Registered Nurse Item Number: 5286A 86E FLSA Status/Bargaining Unit #: Covered/BU#311 Department/Service Area: Nursing Services Facility Location: MLK-ASC Reporting Level: Clinical Nursing Director Prepared By: Prepared Date: Approved By: Approved Date: Review Date: Revision Date: 02/27/08 SUMMARY The Nurse Manager, under the supervision of the CNO, administrates and organizes an organization unit with the responsibility for planning, selecting and/or devising the methods and procedures utilized by staff ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: (Other duties may be assigned) Adheres to the mission, vision, and philosophy of the Ambulatory Surgical Center. Responsible for assignment of patient care based on staff competency and knowledge of their specific scope of practice; and, based on specific patient care needs. Delegates, directs, and supervises subordinate staff to which patient care duties have been assigned. Clarifies roles and responsibilities as needed. Conducts frequent unit rounds to assess, plan, coordinate, and evaluate the care delivered to the patient. Assures all charts are checked for accuracy. Provides direct patient care. Manages the environment, assuring all patient care areas, as well as the nurse's station, the lounge and closets, are regularly cleaned, and meets quality and Infection Control standards. Functions as a member of the inter-disciplinary healthcare team. Health Management Associates 15

16 Provides primary, comprehensive, and professional nursing care. Performs Environmental Rounds Maintains a customer friendly environment. Assesses and evaluates the behavioral and emotional status of assigned patients. May transport patients within the Ambulatory Surgical Center. Performs life saving therapy as directed by a physician: in the absence of a physician, initiates immediate and appropriate life saving measures. Participates in interdisciplinary Patient/Family Education. Participates in interdisciplinary Care Planning. Administers patient medications including High Alert as ordered by the physician and in accordance with standards of practice. Performs Nursing assessment, physical, behavioral, and emotional status of assigned patients. Monitors and observes assigned patients, documenting medical information in the patient s health record, using charting by exception process. Implement nursing care and physician orders. Serves as patient advocate. Performs and monitors intravenous therapy and venipuncture. Collects laboratory specimen, interprets, and evaluates diagnostic laboratory test results. Prepares event notification. Monitors patient s vital signs and evaluates physical condition of patient. May provide instruction and direction to interdisciplinary professional and ancillary personnel. Assist physician in patient medical examination. Maintain patient confidentiality. Responsible for classification of assigned patients. Prepare for Joint Commission Accreditation. Establish indicators based on the Joint Commission Ambulatory Standards. Assign responsibility in each area to collaborate with the Department of QI and Risk to monitor theseand AORN indicators and communicate outcomes to staff and providers. Set clear expectations for staff and hold staff accountable. Support staff during transition period. Implement a culture where patient-centered care is the top priority. Assist all staff in maintaining competencies. Health Management Associates 16

17 In addition to the essential duties and responsibilities delineated in the staff nurse job description the Perioperative Services/ Nurse Manager Nurse will consistently perform the duties of a circulating nurse, including but not limited to, the following: Successfully meets the basic competencies for an operating room R.N. Verifies physician privileges Completion of surgical checklist Verification of operative consent, informed consent, blood consent as appropriate, history and physical, labs, X-rays, and correct side/ site/ patient/ procedure Ensures adherence to count policy and procedure Documentation of intraoperative care plan Provides assistance to anesthesiologist within RN scope of practice Knowledge of equipment and safe practice in utilizing surgery equipment Provides safe environment for patient and team members, including, but not necessarily limited to, medications, laser, radiation, and electrosurgical practices Documentation of narcotics and resolution of narcotic discrepancies Documentation of implants and use of laser Requests assistance when needed and is knowledgeable about when to escalate in order to provide appropriate care to the patients. Crash cart checks Code responses per ASC policy and procedure Documentation of event notifications in Patient Safety Net System Handles specimens and documents according to policy and procedure Provides report on patient from shift to shift, upon patient transfer, and when change in patient condition warrants report Follows up with changes in condition of patients Provides coverage for breaks Participates in patient flow activities Oversight of patient chart Crash cart and refrigerator checks Assures unit cleanliness Assures medication room is clean and checks for outdates of medication Participates in clinical pertinence follow up Checks all alarms and monitors on unit Oversees unit activities for daily operations for efficient patient flow Health Management Associates 17

18 Oversees scheduling process to ensure staffing ratios are met Coordinates, facilitates, and manages change efforts Participates in and assists in coordination of educational programs for staff development Provide leadership and participates in collection, analysis of data, and presentation of information for Performance Improvement Monitors for on-going compliance to policies and procedures and regulatory requirements Performs conflict resolution utilizing interpersonal and communication skills with clients, colleagues, and peers Mentors and coaches others to improve performance, enhance skills, and develop career options PATIENT AGE & TREATMENT COMPETENCY ( ) Infant ( x ) Adolescent ( x ) Geriatric ( x ) Child ( x ) Adult ( ) Other (No age specific category) Familiarity with, and ability to utilize, the nursing process to assess, plan, implement and evaluate assigned patient care relative to patient age, developmental stage, medical condition and/or diagnosis. Ability to appropriately obtain and interpret information relative to the patient s needs. Knowledge of the expected growth and development of assigned patients, ability to understand the range of treatment needed by the assigned patient population. SUPERVISORY RESPONSIBILITIES Provides unit supervision on a daily basis to all staff assigned. PHYSICAL DEMANDS While performing the duties of this job, the employee is frequently required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stoop, kneel, or crouch. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, and ability to adjust focus. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical Class Definition: Class 3 Moderate. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable Health Management Associates 18

19 accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. MINIMUM EDUCATION/EXPERIENCE REQUIREMENT A Master degree in Nursing and/or Health Care Administration, BLS REQUIRED LICENSE/CERTIFICATES Current license to practice as a Registered Nurse issued by the California State Board of Registered Nursing. CONTINUING EDUCATION Thirty (30) hours of continuing education every two (2) years. LANGUAGE SKILLS Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from physicians, managers, clients, customers, and the general public. My signature below acknowledges receipt of this position description. Employee Name: Date: Health Management Associates 19

20 MLK-MACC Ambulatory Services Budget Title: Chief Nursing Officer Pages: 3 Attachments: Functional Title: Chief Nursing Officer Salary Grade: Job Code: Approved by: Senior Management Approved by: Administrator Effective Date: The MLK Ambulatory Services mission is to deliver integrated health services with dignity and respect regardless of a patient s ability to pay; to foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies which promote and protect the physical, mental and social well being of the people of Los Angeles County. Written by: POSITION SUMMARY: The Chief Nursing Officer (CNO) is an executive with extensive clinical and senior leadership experience in ambulatory care. Is skilled in teambuilding, change implementation and quality improvement. Focused on staff competence, clinical quality and patient safety. Recognized as an effective team leader with strong mentoring capabilities. Responsible for the professional practice of nursing and the provision of nursing care in the Multi-specialty Ambulatory Care Center (MACC), Dollarhide Community Health Center and Hubert Humphrey Comprehensive Health Center (HHCHC). Member of the Senior leadership team. Participates in strategy planning, budget preparation, and performance improvement. PRIMARY CUSTOMERS SERVED: Nursing Director, Administration, Assitant Nursing Directors, Administration; and Nurse Director ASC for MLK-MACC, Urgent Care, ASC, HHHCHC, Dollarhide CHC; providers; patients. REPORTS TO: CEO QUALIFICATIONS: Health Management Associates 20

21 Experience Minimum 5 years experience in ambulatory care. Licensure and Certification Licensed as a Registered Nurse in the state of California Valid CA driver s license Education Masters Degree in Nursing, Health Care Administration, Nursing Administration, or Public Health or related field required. Age Specific Criteria: Not applicable Environmental, Physical and Functional Requirements Frequent clinic rounds, meeting attendance, travel between MACC, Dollarhide and HHCHC Cultural Competence Must have cultural and linguistic skills appropriate for level of interaction with Department of Health Services, regulatory bodies, senior leadership, physicians, staff and community. Review Date: Revise Date: MLK Ambulatory Services Budget Title: Budget Code: Functional Title: SKILLS Knowledge of nursing practice guidelines; nursing standards of care and the standards for professional nursing practice in the OP setting; state laws; and accreditation standards for ambulatory services. Knowledge and ability to build structure, systems, and processes for the delivery of quality patient care services throughout all of ambulatory services. Ability to problem-solve and provide workable solutions in a timely manner. Health Management Associates 21

22 COMPETENCIES AND KEY ELEMENTS Competency Analytical Assessment; Human Resources; Budgeting/Financial Accounting; Resources Management; Cultural Competence; Strategic Planning; Conflict Management; Statistical Analysis; Communication; Community Health Partnering; Quality Improvement; Multidisciplinary Interventions Key Elements 1. Monitors development of nursing competencies for all levels of nursing staff in ambulatory services. 2. Establishes standards of care for all patients with emphasis on patient safety and quality. 3. Coordinates nurse staffing, competencies and job duties. 4. Works collaboratively with Chief Medical Officer on standards of care for ambulatory patients. 5. Work collaboratively with Director of Operations on personnel issues related to nursing staff and impact on ambulatory operations. 6. Collaborates with Director of Professional Services in provision of ancillary services that support ambulatory care. 7. Provides clear performance expectations to lead nurses and holds them accountable for meeting goals 8. Prepare for Joint Commission Accreditation. 9. Establish indicators based on the Joint Commission Ambulatory Standards. 10. Assign responsibility in each department to collaborate with the Department of QI and Risk to monitor these indicators and communicate outcomes to staff and providers. 11. Set clear expectations for staff and hold staff accountable. 12. Support staff during transition period. 13. Implement a culture where patient-centered care is the top priority. 14. Assist all staff in maintaining competencies. All job requirements listed indicate the minimum level of knowledge, skills, and/or ability deemed necessary to perform the job proficiently. This job description is not to be construed as an exhaustive statement of duties, responsibilities or requirement Health Management Associates 22

23 Job Description Summary Minimum Qualifications Preferred Qualifications Skills, knowledge, abilities. Knowledge of nursing practice guidelines; nursing standards of care and the standards for professional nursing practice in the OP setting; state laws; and accreditation standards for ambulatory services. Knowledge and ability to build structure, systems, and processes for the delivery of quality patient care services throughout all of ambulatory services. Education, Experience Masters Degree in Nursing, Health Care Administration, Nursing Administration, or Public Health or related field. Minimum 5 years experience in ambulatory care. License, Certification Licensed as a Registered Nurse in the state of California Special job characteristics requiring accommodations. Frequent clinic rounds, meeting attendance, travel between MACC and HHHCHC. Flexible work hours based on clinic operations. Health Management Associates 23

24 Martin Luther King, Jr. Multi-Service Ambulatory Care Center Position Description Employee Name: Pauline Rodriguez Employee Number: Payroll Title: Nursing Director, Administration Functional Title: Director, Ambulatory Care Nursing Services Item Number: 5296A FLSA Status/Bargaining Unit #: Exempt Department/Service Area: Nursing Facility Location: MLK Jr. MACC Reporting Level: Chief Nursing Officer SUMMARY The Nursing Director, Ambulatory Care Services is responsible for the management and operations of the Martin Luther King, Jr. Multi Service Ambulatory Care Center Nursing Service. This position is responsible for planning, organizing, budgeting, directing and controlling the accomplishment of both short and long-term objectives consistent with the MLK MACC management plan. The NDA provides oversight and maintains the automated nursing staffing office system (ANSOS), Nursing Order Management System (Affinity), Patient System Network (PSN), Physician Privileges (CATUS), Automated Triage Emergency System(ATEEM) and Learning Management System (LMS) in collaboration with IT Department. Develops and generates management reports for each system. ESSENTIAL DUTIES AND RESPONSIBILITIES: Provides direction to the Ambulatory Care Primary and Specialty Nursing Service. Reviews day-to-day nursing activities including reports of clinic productivity and quality performance measures. Establishes and monitors performance of overall goals, objectives, policies, and standards for the nursing service. Coordinates and defends budget and manpower requests for the Ambulatory Care Nursing Service of the MACC and monitors performance against approved budget. Participates in formulating policy, procedure and standards for the organization and nursing service. Delegates assignments to Nurse Managers, Clinical Nurse Specialists, and other key personnel to develop specific measurable goals for each area of nursing care. Participates in strategic planning for the organization, and is responsible for strategic planning in the Department of Nursing. Health Management Associates 24

25 Participates as a member of the Ambulatory Care management team to review current operations, recommend appropriate action in meeting existing needs and resolving specific problems, and to advise on the establishment of long- and short-term goals and objectives and priorities. Interprets and communicates organizational policies, procedures and priorities internally and to various agencies in the community. Administers general personnel management matters and actions, including selection and appointment of designated senior nursing positions. Ensures overall adherence to licensure and regulatory standards. Directs the provision of appropriate continuing education programs for all categories of staff. Actively participates in MACC committees and Ambulatory Care Services committees; may represent the facility on external meetings and committees. Prepare for Joint Commission Accreditation. Establish indicators based on the Joint Commission Ambulatory Standards. Assign responsibility in each department to collaborate with the Department of QI and Risk to monitor these indicators and communicate outcomes to staff and providers. Set clear expectations for staff and hold staff accountable. Support staff during transition period. Implement a culture where patient-centered care is the top priority. Assist all staff in maintaining competencies. May perform other duties as assigned. PATIENT AGE & TREATMENT COMPETENCY ( ) Geriatric ( ) Adult ( X ) Other (Non-direct patient care) ( ) infant ( ) child ( ) adolescent This position requires special training and expert professional and technical skills in the area of Ambulatory Care and Quality Management/Performance Improvement: consultative and training skills to make this expertise available to other professional and technical nursing personnel; analytical skills to adapt their expertise to the needs of the area or facility to which they are assigned. Leadership skills and ability to assess, plan, organize, implement and evaluate systems and processes to identify and improve organizational performance. Health Management Associates 25

26 SUPERVISORY RESPONSIBILITIES This position may supervise one or more staff at the level of Assistant Nursing Director, Administration; Nurse Manager, Clinical Nurse Specialists, and Management support staff. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stoop, kneel, or crouch. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, and ability to adjust focus. Physical Class Definition: Class "3" Moderate WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. MINIMUM EDUCATION/EXPERIENCE REQUIREMENT A Bachelor's degree in nursing, from an accredited School of Nursing. Master s degree in nursing or a BSN with a Master s degree in Administration or related field. Four years recent experience in management of nursing operations or operational programs. REQUIRED LICENSE/CERTIFICATES Current license to practice as a Registered Nurse issued by the California State Board of Registered Nursing. CONTINUING EDUCATION Thirty (30) hours of continuing education every two (2) years. LANGUAGE SKILLS Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations, and technical reports. Ability to write reports, business, correspondence and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. My signature below acknowledges receipt of this position description. Employee signature Date Health Management Associates 26

27 MARTIN LUTHER KING MULTI-SERVICE AMBULATORY CARE CENTET Position Description Employee Name: Employee Number: Payroll Title: Functional Title: Item Number: FLSA Status/Bargaining Unit #: Department/Service Area: Facility Location: Reporting Level: Mary Lee Miodovski Asst. Nursing Director, Admin. Director of Administrative Nursing Office and Ancillary Nursing Service 5295A Nursing Services MLK-MACC Chief Nursing Officer SUMMARY ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Reports directly to the Chief Nursing Officer regarding all matters of the organization, work and related matters that involve areas of responsibility Provides leadership and oversight to the day to day operations of the following units; i.e. Occupational Health Services, Ambulatory Surgical Center, Interventional Radiology, Nursing Education, Administrative Nursing Office and Liaison to Nurse Recruiting Participates with the Chief Nursing Office and various nursing units in defining annual goals and objectives Participates in the formulation of the budget of nursing department with emphasis on assigned responsible areas Supports Nursing Services in the development of the annual personnel budget proposal for Nursing Services Provide oversight to payroll and credentialing for all nursing staff Coordinates tracking of all credentials including nursing licensure Facilitates the professional development and competencies of all nursing staff Facilitates interdepartmental problem-solving Completes responsibilities, tasks, and relationships with other disciplines of the MACC in order to effectively work together Communicates clearly all responsibilities, expectations and tasks to areas of responsibility Monitors and control costs Health Management Associates 27

28 Takes appropriate corrective action as necessary in regards to employees or expenses, either through disciplinary processes (policies, procedures and nursing standards) or through the management of costs Collaborates with Managers to ensure minimal staffing to each unit Participates as Personnel Liaison and Hearing Officer for Nursing Administration in employee personnel issues. Maintain all non-contract nursing files. Provides workload statistics Collaborates with Nursing Leadership and Educators in the development of the Nursing Educational programs; i.e.: competencies, and other specialties in-services that are unique to the multi-service ambulatory center. Generates expenditure reports including any significant deviations to the Chief Nursing Officer..Assure compliance with regulatory and state guidelines relevant to employees health and surveillance Prepare for Joint Commission Accreditation. Establish indicators based on the Joint Commission Ambulatory Standards. Assign responsibility in each department to collaborate with the Department of QI and Risk to monitor these indicators and communicate outcomes to staff and providers. Set clear expectations for staff and hold staff accountable. Support staff during transition period. Implement a culture where patient-centered care is the top priority. Assist all staff in maintaining competencies. MANAGEMENT RESPONSIBILITIES This position supervises employees in non direct patient care areas. Carries out supervisor responsibilities in accordance with the organization s policies and applicable laws. Responsibilities include interviewing and training employees; planning, assigning, and directing work; appraising performance; addressing complaints and resolving problems. PHYSICAL DEMANDS The physical demands described her are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical Class Definition: Class 2" Light WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable Health Management Associates 28