IDENTIFICATION Department Northwest Territories Health and Social Services Authority Position Title Registered Nurse, Acute Care/Emergency Position Number(s) Community Division/Region(s) 67-4198 Fort Smith Health/Fort Smith PURPOSE OF THE POSITION The Registered Nurse, Acute Care/Emergency provides nursing care to paediatric and adult patients that ranges from emergency care to palliative care in both inpatient and outpatient settings in accordance with established standards of nursing practice for Registered Nurses and the philosophy and objectives of the Northwest Territories Health and Social Services Authority (NTHSSA) to ensure that patient's physical, emotional, psychosocial, spiritual, educational and daily living needs are met. SCOPE Located within the Fort Smith Health Centre (FSHC), the Registered Nurse, Acute Care/Emergency (RN) reports directly to the Clinical Leader, Acute Care/Emergency and provides culturally sensitive care to patients of all ages within the 4 bed Emergency Department as well as the 6 bed Acute Care inpatient unit. During any and all shifts there are 2 RNs on duty to care for both inpatients and outpatients. During every shift one RN will be designated as Responsible (Charge Nurse) for the overall nursing care of all patients within the Acute Care/Emergency setting. The Responsibility Nurse will act in the absence of the Clinical Leader to make decisions appropriate to the RNs scope of practice and skill level. Every RN will be required to act as Responsibility Nurse. The RN is a member of the nursing team and responds to actual or potential health problems, plans and performs interventions and evaluates patient outcomes with the intention of maintaining or regaining patient health. The RN provides direct nursing care to patients ranging from pediatric to geriatric, non-urgent to critically ill or requiring resuscitation where the outcomes are often unpredictable and patients may be unstable. Patients presenting to the FSHC may be discharged from the Emergency Department, admitted to an Acute Care August 1, 2016 GNWT Job Description Page 1 of 7
inpatient bed, or may be transferred to an alternate facility depending on the nature of the presenting illness or injury. The RN acts as a patient advocate and facilitates communication between the patient, family, and other health care professionals. This will result in a holistic approach to planning, organizing, teaching, and relationship development that will best meet the needs of the patient. In addition, the RN may be required to assist the physician with both invasive and non-invasive procedures required to save a patient's life. There is always a physician on call and available to the RNs but the physician is not always present in the facility afterhours or on weekends. As such, the RN may be required to use independent nursing interventions and approved medical directives to begin treatment of a patient before the physician arrives. These proactive steps may include but are not limited to IV initiation, ECG completion, cardiac monitoring, oxygen therapy, and some medication administration. The RN is also responsible for answering and dispatching ambulance calls. There is a dedicated ambulance phone at the Acute Care desk from which calls for ambulance assistance are received. It is the duty of the RN to receive the call, complete the call sheet, and dispatch the ambulance. The duties of the position are carried out in accordance with the standards, guidelines, and scope of professional nursing practice, the policies and procedures of the Northwest Territories Health and Social Services Authority, and Accreditation Canada Standards and Required Operational Practices. RESPONSIBILITIES 1. Provide direct nursing care to a wide variety of adult and pediatric patients requiring medical treatment ranging from non-urgent to emergent/resuscitation in both an inpatient and outpatient setting using the nursing process and in accordance with the standards, guidelines, and scope of profession nursing practice. The RN assesses, plans, implements, documents and evaluates care to ensure a coordinated holistic approach which best meets the needs of the patient, Assists patients to achieve their optimum level of health in situations of normal health, illness, injury, or through the process of dying, Advocates the dignity and self-respect of patients, Promotes the autonomy of patients and helps them to express their health needs and values to obtain appropriate information and services, Safeguards the trust of patients that information learned in the context of a professional relationship is shared outside the health care team only with the patients permission or as legally required, Applies and promotes principles of equity and fairness to assist patients in receiving unbiased treatment and a share of health services and resources proportionate to their needs, and Acts in a manner consistent with their professional code of ethics, responsibilities and standards of practice. August 1, 2016 GNWT Job Description Page 2 of 7
2. Facilitates, implements and modifies patients and family education/teaching based on the needs of the patients Uses a holistic approach to facilitate individual learning of patients and their families upon admission, transfer, or discharge in relation to patient illness or injury (i.e. selfcare, health promotion, etc.) Assesses the patient for physical and psychological needs, their knowledge of their health, disease process and learning needs. Researches, develops, revises and evaluates on an ongoing basis, educational resources necessary to support patients Coordinates the admission, transfer, or discharge of patients. This includes explaining and ensuring that patients understand the admission or discharge plan. 3. As Responsibility Nurse, assumes accountability for the standard of care delivered toward determining and achieving patient care goals Makes decisions necessary to promote change and ultimate outcome of goal attainment for the patient. Communicates with other members of the health care team regarding the patient's health care to provide continuity of care and promotes collaborative efforts directed toward quality patient care. Triage or delegate the responsibility for triaging patients to the other RN on duty. Direct and supervise the functions of others who provide support. Ensuring adequate staffing levels during all shifts (i.e. calling in appropriate relief staff). Coordinates the activities of critical situations/incidents within the Acute Care/Emergency units. Identifies and understands role in disaster responses and Universal Emergency Codes and is aware of the FSHC's safety plans (Fire Safety, Code Orange, etc.). 4. Promotes excellence in nursing practice and advocates for clinical environments that have the organizational and resource allocations necessary for the application of best practices, and for safe, competent and ethical nursing care Provides coaching and leadership to peers, students, and other members of the health care team to develop skill levels necessary to achieve the standard of care. Shows initiative to remain current and up-to-date with best nursing practice through attendance at in-services and trainings, personal reading, participation in mock demonstration, and use of PDI. Collaborates with nursing colleagues and other members of the health care team to advocate health care environments that are conducive to ethical practice and to the health and well-being of patients and others in the setting Maintains an organized and efficient workspace by ensuring nightly, weekly, and as requires stock checks (crash carts, IV trays, blanket warmer, emergency rooms, etc.) are completed and areas are stocked with necessary supplies for safe and complete patient care Orientates new employees to unit specific programs and mandate Participates in committees, task forces, and research projects as related to the FSHC August 1, 2016 GNWT Job Description Page 3 of 7
Work with RN colleagues and other members of the health care team in revising and developing policies and procedures for the acute care/er unit. 5. Provides emergency nursing services to the general public experiencing health issues or crisis Takes a lead role in disaster responses with the Acute Care/Emergency unit Responds and provides triage and emergency nursing care Applies the Canadian Triage Acuity Scale (CTAS) to all patients presenting to emergency Mobilizes resources and provides care in adherence to clinical guidelines for emergency response Initiates emergency call and dispatches ambulance services as needed When there are only two RNs in the facility, there will be a RN on call for emergency situations, higher than usual acuity, or for staff replacement including providing constant observation for patients when required. The RN will be scheduled three to four on call shifts per month. WORKING CONDITIONS (Working Conditions identify the unusual and unavoidable, externally imposed conditions under which the work must be performed and which create hardship for the incumbent.) Physical Demands Between 25% and 50% of the incumbents day will be spent lifting, moving, and supporting patients. Lifting of and physical support of patients within the Acute Care/ER units may be done on an individual basis or with the aid of one or two co-workers. In addition, the incumbent will be required to bend and stand in awkward positions while performing patient assessments, care, or when assisting with procedures. As a result of the generally fast paced environment of the ER setting, the RN may spend significant amounts of time walking or rushing from room to room in order to provide patient care. This may cause substantial levels of fatigue and physical stress. Environmental Conditions During the shift (100% of time) the incumbent will have significant levels of exposure to communicable diseases, blood (i.e., trauma patients with bleeding wounds who require cleaning and dressing of wounds), bodily fluids (emesis or discharge from wounds or orifices), and hazardous materials (sharps, cytotoxic medication, toxic cleaning and sterilization solutions) that can result in significant health risks to the incumbent. Sensory Demands The incumbent will be required to use the combined senses of touch, sight, smell, and hearing during ongoing triage, assessment, and continuous observation of patients within the Emergency Unit and Acute Care. August 1, 2016 GNWT Job Description Page 4 of 7
Triaging patients is a critical function of the RN working in the ER unit and requires the incumbent to make assessments based on not only what they are being told by the patient but also based on what they see, hear, or sense from the patient. Skilled assessment using all senses assists the RN to identify potentially life threatening illness or injury. Mental Demands The incumbent may be exposed to death/dying and other emotionally disturbing experiences such as trauma and critically ill patients. The RN, Acute Care/Emergency is expected to remain calm, controlled, and professional, regardless of the situation, and demonstrate compassionate care to the patient, family, and other members of the health care team. In addition, within the health care setting, there can be a significant loss of control over the work pace with frequent interruptions that may lead to mental fatigue or stress. The Emergency Unit is often the most volatile nursing unit within the hospital with potentially abusive patients, patients under the effects of substances, or patients experiencing mental health crisis. RNs may be subjected to physical or verbal assault by patients in crisis. There is a concern for safety and well-being which may cause increased levels of stress on the incumbent both during and after working hours. The RN, Acute Care/Emergency, is required to be motivated and innovative in the area of continuing education and practice to encourage the professional growth of self and others. KNOWLEDGE, SKILLS AND ABILITIES Advanced knowledge of and an ability to apply standardized nursing processes (assessment, planning, implementation and evaluation) and current nursing practice to ensure that adult/pediatric patients' physical, emotional, psychosocial, spiritual, educational, and daily living needs are met As a wide and all-encompassing range of illnesses/injuries are admitted to the Health Centre, the RN must be up to date with disease processes, treatments, and assessments for a very broad range of patient populations. Ability to educate patients and their families (where applicable) on appropriate self-care methods and techniques. Knowledge of biological, physical, and behavioral sciences in order to recognize, interpret, and prioritize findings, and determine and implement a plan of action based on accepted standards of practice, Knowledge of and ability to network resources within and outside the FSHC (i.e. Social Services, Public Health, medevac teams, etc.), in order to ensure support of patients and their families Ability to operate a desktop computer in order to send and receive electronic mail, access PeopleSoft, use Medipatient and EMR, and conduct research over the internet. August 1, 2016 GNWT Job Description Page 5 of 7
Ability to operate and/or use standard medical equipment (such as: ECG, IV pumps, stretchers, thermometers, sphygmomanometer, blood glucose monitors, suction tubes, pulse oximeter, etc.) Ability to operate and provide advice and assessment using specialized equipment, medications, tools and techniques (including but not limited to ECG, emergency drugs, defibrillator, bear hugger, etc.) Ability to effectively operate non-medical equipment used during the care of patients within the FSHC (these include but are not limited to lifts, wheel chairs, bathing equipment, etc.) Demonstrated commitment to excellence in nursing practice and continuing education Typically, the above qualifications would be attained by: This level of knowledge is commonly acquired through the successful completion of a Baccalaureate Degree in Nursing and at least 2 years of Acute Care nursing experience or one year recent emergency or critical care experience. ADDITIONAL REQUIREMENTS Fort Smith Regional Requirements Within the Fort Smith Region, all Registered Nurses must be registered with the RNANTNU and have successfully completed a criminal records check, Within the Fort Smith Region, all Registered Nurses must be able to acquire within a reasonable time frame and remain current with the following mandatory certifications: Non-Violent Crisis Intervention, Blood Glucose Monitoring, IV Pump Certification, Immunization Certification, WHMIS, BLS for Healthcare Providers, CTAS ACLS, PALS, NRP, Internet and e-mail applications, and Fire safety training, Desirable training and/or certifications include: Mental Health First Aid, TNCC, ENPC, Canadian Nursing Association Certifications, Emergency Nursing Programs, and Critical Care Nursing Programs. August 1, 2016 GNWT Job Description Page 6 of 7
Position Security (check one) No criminal records check required Position of Trust criminal records check required Highly sensitive position requires verification of identity and a criminal records check French language (check one) French required French preferred French not required August 1, 2016 GNWT Job Description Page 7 of 7