Within the RN scope of practice as defined by the Oregon State Board of Nursing, applies the nursing process to the care of patients. Teaches patients and significant others. Documents patient care in the medical record. Collaborates with the interdisciplinary team to effectively coordinate overall care of the patient.

PRINCIPLE DUTIES AND RESPONSIBILITIES

(Essential job requirements listed in bold)

• Assesses patients, as appropriate to the scope of care the nurse will provide. Assessments may include: physical, psychosocial, learning needs and barriers, needs related to age/culture, discharge planning.

• Establishes nursing diagnoses based on results of assessments and in collaboration with the interdisciplinary team

• Plans care according to identified diagnoses and needs. Updates plan of care as appropriate

• Implements/performs individualized care, based on nursing care plan and the nurse’s role with the patient. This care may include but not be limited to:

• Assisting with activities of daily living, including fall risk management and safe patient handling

• Medication administration

• Skin assessment/wound care

• Pain management

• Operation/manipulation of biomedical and other patient care and testing equipment, including but not limited to infusion pumps, patient transfer equipment, cardiopulmonary monitors, invasive catheters and drains, thermoregulation devices, measurement devices, medication dispensing cabinets, external therapeutic devices

• Assisting the physician and other licensed, independent practitioners with invasive and noninvasive procedures

• Teaching patients and their families about current illness, medical tests, medication, general healthcare, illness and disease prevention, and wellness promotion

• Providing appropriate assignment, supervision, and direction to unlicensed assistive personnel in order to ensure optimum patient care

• Providing interdisciplinary coordination and facilitation of overall care

• Documents patient assessments, interventions, care, and teaching in the electronic medical record. Documents in paper format, as necessary. Documentation is complete, concise, timely, and legible.

• Evaluates care provided, communicates patient status and results of care to the interdisciplinary team

• Other duties as assigned