Become familiar with the facility's administrative structure as introduced in the pre-training orientation session • Report to the charge nurse all accidents/incidents (even of an unknown source) you observe on the shift they occur. • Report all changes in the resident's condition to the Nurse Supervisor/Charge Nurse as soon as practical. • Answer phone (especially during mealtimes) • Assist with errand of residents/staff • Assist with secretarial tasks at the nursing station (making copies, filing, etc.) as requested • Straighten resident closets/drawers - label resident belongings. Complete personal belonging form • Maintain orderly/clean resident rooms and common areas (utility rooms, showers, resident bathrooms, day rooms, break room, etc.) • Follow established policies concerning exposure to blood/body fluids • Ensure that residents who are unable to call for help are checked frequently • Answer call bells promptly & report needs to CNA/Nurse • Make rounds assisting residents by opening/closing blinds, straightening blankets, making sure call bells are within reach, etc. • Turn all medications found in the resident's room/possession over to the Nurse Supervisor/Charge Nurse • Watch for and report any change in room temperature, ventilation, lighting, etc. • Transport residents to & from meals/activities/outdoors/etc. • Provide residents with Reality Orientations as instructed • Pass linen. Make unoccupied beds. Put extra covers on beds. • Use the wristband or photo card file to identify residents before serving meals, etc., as necessary • Clean feeder tables, wheelchairs, bedside/over bed tables, urinals, bedpans, refrigerators, microwaves, etc. • Place supplies/briefs in resident rooms/ common areas/ Unpack and stock supply room when deliveries arrive. • Replace trash can liners in wastebaskets • Inform the Nurse Supervisor/Charge Nurse of any changes in the resident's condition so that appropriate information can be entered into the resident's care plan. • Pass snacks/trays to residents (To include passing protective clothing covers, opening milk cartons, refiling drinks, cutting food, etc.) Return trays to dietary. NEVER FEED THE RESIDENTS • Assist residents with identifying food arrangements (i.e., informing residents with sight problems of food that is on his/her tray, where it is located, if it is hot/cold, etc.) • Serve between meal and bedtime snacks as instructed • Keep residents' water pitchers clean and filled with fresh water (on each shift), and within easy reach of resident • Collect and redistribute water pitchers for weekly cleaning by dietary • Check rooms for food articles (i.e., food in proper containers, unauthorized food items, etc.) • Learn and be aware of code system identifying specials needs of residents • Ensure the resident's room is ready for receiving the resident (i.e., bed is made, name tags up, admission kit available, etc.) • Greet residents and escort them to their room • Introduce resident to his/her roommate, if any, and other residents and personnel as appropriate • Inventory and mark the president's personal possessions as instructed • Store resident's clothing • Assist residents with packing their personal possessions when they are being transferred to a new room, or when being discharged • Transport residents to new rooms or to the receiving area • Perform all assigned tasks in accordance with our established policies and procedures, and as instructed by your supervisors • Follow work assignments, and/or work schedules in completing and performing your assigned tasks • Cooperate with inter-departmental personnel, as well as other facility personnel to ensure that nursing services can be adequately maintained to meet the needs of the residents • Create and maintain an atmosphere of warmth, personal interest and positive emphasis, as well as a calm environment throughout the unit and shift • Report defective equipment to Nurse Supervisor/Charge Nurse • Inform the Nurse Supervisor/Charge Nurse of your equipment and supply needs • Report occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals in accordance with the facility's policies and procedures governing accidents and incidents • Maintain the confidentiality of all resident care information • Ensure that you treat all residents fairly and with kindness, dignity, and respect • Knock before entering the resident's room • Report all grievances and complaints made by the resident to the Nurse Supervisor/Charge Nurse • Report all allegations of resident abuse and/or misappropriation of resident property • Honor the resident's refusal of assistance. Report such refusal to your supervisor • Attend and participate in scheduled training and educational classes • Attend and participate in scheduled orientation programs and activities • Attend and participate in annual OSHA and CDC in-service training programs for hazard communication, TB Management, and bloodborne pathogens standard • Participate in appropriate in-service training programs prior to performing tasks that involve potential exposure to blood/body fluids • Wash hands before and after performing any service for the resident • Keep the nurses' call system within reach of the resident • Immediately notify the Nurse Supervisor/Charge Nurse of any resident leaving/missing from the facility • Follow establish safety precautions in performance of all duties • Keep residents' personal possessions off the floor and properly stored • Keep floors dry. Report spills immediately. Take care of minor clean-ups • Keep excess supplies and equipment off the floor. Store in designated areas • Wash wheelchairs, walkers, etc., as instructed • Clean, disinfect, and return all resident care equipment to its designated storage area after each use • Perform routine housekeeping duties (i.e., clean bedrails, overbed table, nightstand, etc., that relate to nursing care procedures) • Before leaving work area for breaks, or at the end of the workday, store all tools, equipment, and supplies • Report all hazardous conditions and equipment to the Nurse Supervisor/Charge Nurse immediately. • Report all safety violations • Follow established smoking regulations, Report all violations • Report any communicable or infectious disease to the Director of Nursing Services/or to the Infectious Control Coordinator • Report missing/illegible labels and MSDSs to your supervisor • Use only the equipment you have been trained to use • Operate all equipment in a safe manner • Use only the equipment and supplies necessary to do the job. Do not be wasteful • Report defective equipment to the Nurse Supervisor/Charge Nurse • Inform the Nurse Supervisor/Charge Nurse of your equipment and supply needs Supervisory Requirements This position has no supervisor responsibilities Qualification Education and/or Experience Must possess, as a minimum, an 8th grade education. 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 managers and employees. Mathematical Skills Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Certificates, Licenses, Registrations To perform this job successfully, an individual must be proficient in the Microsoft Suite products. 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. The employee must occasionally lift and/or move up to 25 pounds. Prolonged use of a desktop or laptop computer. While performing the duties of this job, the employee is regularly required to sit, stand, walk and talk, read or hear. Frequent use of all office related equipment to include; copier/scanner/fax, telephone, and calculator 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 low to moderate. Additional Information Note: Nothing in this job specification restricts management's right to assign or reassign duties and responsibilities to this job at any time. Critical features of this job are described under various headings above. They may be subject to change at any time due to reasonable accommodation or other reasons. The above statements are strictly intended to describe the general nature and level of the work being performed. They are not intended to be construed as a complete list of all responsibilities, duties, and skills required of employees in this position.

New Graduate Nurse

Fresenius Medical Care, Fresno

PURPOSE AND SCOPE:Functions as part of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a Staff Registered Nurse, to ensure provision of quality patient care on a daily basis in accordance with FMS policies, procedures, and training. Supports the FMCNA's mission, vision, values, and customer service philosophy. Supports the FMCNA commitment to the Quality Enhancement Program (QEP) and CQI Activities, including those related to patient satisfaction and actively participates in process improvement activities that enhance the likelihood that patients will achieve the FMCNA Quality Enhancement Goals (QEP). Adheres to all requirements of the FMCNA Compliance Program, and FMS patient care and administrative policies. Employees hired into this position will be required to obtain their nursing license and registration within the timeframe outlined in state specific regulations, or within 90 days from hire date, whichever comes sooner.PRINCIPAL DUTIES AND RESPONSIBILITIES:STAFF RELATED:Directs Patient Care Technician's provision of safe and effective delivery of chronic hemodialysis therapy to patients in compliance with standards outlined in the facility policy procedure manuals, as well as regulations set forth by the corporation, state, and federal agencies.Delegates tasks to all direct patient care staff including but not limited to LVN/LPNs, Patient Care Technicians, and Dialysis Assistants.Assesses daily patient care needs and develops appropriate patient care assignments.Routinely monitors patient care staff for appropriate techniques and adherence to facility policy and procedures.Participates in staff training and orientation of new staff as assignedParticipates in all required staff meetings as scheduled.PATIENT RELATED:Education:Ensures educational needs of patients and family are met regarding End Stage Renal Disease (ESRD).Provides ongoing education to patients regarding their renal disease, vascular access and dialysis therapy, and other related health conditions.Discusses with patient, and records education related to diet/fluid and medication compliance.Provides patient specific detailed education regarding adequacy measures where applicable - Online Clearance Monitoring (OLC), Adequacy Monitoring Program (AMP), Urea Kinetic Modeling (UKM).Ensures transplant awareness, modality awareness, and drive catheter reduction.Educates patients regarding laboratory values and the relationship to adequate dialysis therapy, compliance with treatment schedule, medications, and fluid.Dialysis Treatment:Provides safe and effective delivery of care to patients with ESRD.Accurately implements treatment prescriptions including Sodium (Na) modeling prescription, and Ultrafiltration modeling (where appropriate) to ensure stable treatment therapy as indicated.Assesses patients' response to hemodialysis treatment therapy, making appropriate adjustments and modifications to the treatment plan as indicated by the prescribing physician. Communicates problems or concerns to the Team Leader or physician.Identifies and communicates patient related issues to Team Leader or physician.Initiates Initial and Annual Nursing Assessment, and ongoing evaluation and documentation of patient care needs according to FMC Policies and Procedures.Actively participates in the pre evaluation, initiation, monitoring, termination, access homeostasis, and post evaluation of patients receiving hemodialysis treatment therapy according to established FMC procedures.Takes appropriate intervention for changes in patient adequacy status and troubleshooting access flow issues as identified by OLC/AMP yellow lights.Provides, supervises (if applicable), and monitors hemodialysis access care according to established procedures.Implements, administers, monitors, and documents patient's response to prescribed interdialytic transfusions, including appropriate notification of adverse reactions to physician and appropriate blood supplier.Ensures accurate and complete documentation by Patient Care Technician on the Hemodialysis Treatment Sheet. Laboratory-related:Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System.Ensures appropriate preparation of lab requisitions for Spectra or alternate lab.Ensures correct labs tubes are utilized for prescribed lab specimens and that lab draw and processing procedures are performed appropriately for all lab samples.Identifies and ensures appropriate follow-through regarding missed labs and specimens reported to be insufficient according to company policies and procedures.Ensures all specimens are appropriately packaged according to Department of Transportation (DOT) policies and procedures relating to shipment of blood or body fluid specimens and potentially hazardous material.Ensures that all labs are directed and delivered to appropriate labs.Reports alert/panic and abnormal labs results to appropriate physician.Ensures lab results are forwarded to physicians as requested. General duties:Enforces all company approved policies and procedures, as well as regulations set forth by state and federal agencies and departments.Maintains overall shift operation in a safe, efficient, and effective manner.Act as a resource for other staff members.Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and information.Collaborate and communicate with physicians and other members of the healthcare team to interpret, adjust, and coordinate care provided to the patient.Provides assistance as needed to patients regarding prescription refills according to FMCNA Policies.Ensures all physician orders are transcribed and entered into the Medical Information system in a timely manner.Oversees all documentation of patient information.Maintains facility drug list for all required stock medications.Maintains competency with all emergency operational procedures, and initiates CPR and emergency measures in the event of a cardiac and/or respiratory arrest.Ensures verification and availability of adequate emergency equipment.Ensures provision of appropriate vaccinations, immunizations, and annual Tuberculosis (TB) testing.Administers medications as prescribed or in accordance with approved algorithm(s), and documents appropriate medical justification if indicated.Administers PRN medications as prescribed and completes appropriate documentation of assessment of effectiveness.Maintains appropriate recording of controlled substances as required by law.Assists with the coordination of patient transportation if necessary.MAINTENANCE/TECHNICAL:Ensures a clean, safe, and sanitary environment in the dialysis facility treatment area.Ensures competency in the operation of all dialysis-related equipment safely and effectively.Ensures all patient stations, including machines and chairs, are clean and free of blood and placed appropriately.Ensures that all blood spills are immediately addressed according to FMCNA Bloodborne Pathogen Control Policies.MEDICAL RECORDS & DOCUMENTATION:GeneralEnsures all relevant data including physician orders, lab results, vital signs and treatment parameters, and patient status are documented appropriately and entered into Medical Information System.Ensures all appropriate patient related treatment data is entered into the Medical Information System.Ensures all FMCNA policies regarding patient admission, transfer, and discharge are appropriately implemented.Ensures and verify accuracy of Patient Care Technician documentation. DailyReviews and ensures appropriate daily completion of Hemodialysis Treatment Sheets by all patient care staff.Ensures that all appropriate procedures are followed regarding opening and closing procedures, inclusive of monitoring that all staff and patients have safely left the premises.MonthlyInitiates, documents, and completes ongoing Continuous Quality Improvement (CQI) activities including monthly reports.Completes monthly nurses' progress note.Ensures patient medical records are complete with appropriate information, documentation, and identification on each page (Addressograph label is on all chart forms).Reviews transplant status and follows established procedure regarding appropriate action to be taken.Completes patient care plans for new patients within the initial 30 days or any patients deemed unstable requiring monthly patient care plans.Completes any long-term programs that are due. AnnuallyCompletes initial and annual Nursing History and Assessment physical.Ensures completion of Annual Standing Order Review with each physician as required.OTHER: As a condition of continued employment, you are required to obtain and maintain any required credentials or certifications necessary for your position in an active and valid status (including renewal of such credentials or certifications prior to any expiration date). In the event that your credential or certified status changes, you must notify your supervisor immediately.Capable of working in a challenging environment which requires the ability to handle demanding situations, multitasking, and remaining flexible to changing needs.Maintain regular and punctual attendance.Perform other related duties as assigned.Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.PHYSICAL DEMANDS AND WORKING CONDITIONS:The physical demands and 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 position provides direct patient care that regularly involves heavy lifting and moving of patients and assisting with ambulation. Equipment aids and/or coworkers may provide assistance. This position requires frequent, prolonged periods of standing and the employee must be able to bend over. The employee may occasionally be required to move, with assistance, machines and equipment of up to 200 lbs., and may lift chemical and water solutions of up to 30 lbs. up as high as 5 feet.The work environment is characteristic of a health care facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials.Employees are required to take the Ishihara's Color Blindness test as a condition of employment. Note that: Failing theIshihara Test for Color Blindness does not preclude employment. The Company will consider whether reasonable accommodation can be made.SUPERVISION:NoneEDUCATION:Graduate of an accredited School of Nursing.Current appropriate state Temporary Permit.Must meet the practice requirements in the state in which he or she is employed. EXPERIENCE AND REQUIRED SKILLS: 0 - 1 year's related experience.ACKNOWLEDGEMENT:I acknowledge that I have read and accepted this job description. I understand what is expected of me in this position, and I am able to perform the essential functions as outlined with or without reasonable accommodation. Furthermore, I understand that the duties and responsibilities listed in this job description are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position. If I have any questions about duties and responsibilities not specified in this job description that I am asked to perform, I should discuss them with my immediate supervisor or my Human Resources representative.ADDENDUM:Managers in each state must determine if their state regulations permit employees to operate in this capacity, as well as the allowable duties and practice restrictions if permitted. Managers should consult their state-specific regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed-Nurse-50-State-Review-Training-TracksFinal-5-19.pdf. For additional information please contact your Regional Education Coordinator.EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.