Job Code 514
CASS REGIONAL MEDICAL CENTER
Job/Position Description
Employee Name: _______________________________
Department Name: Med/Surg
Title: Med/Surg LPN
EEOC Classification: Professional/Non-Exempt
Date: ______________________________
PART ONE: Dimension and Description
Primary Purpose: To provide prescribed medical treatment to patients, quality nursing care and comfort to patients, while promoting teamwork and to provide proper documentation for billing.
Formal Policy-Setting Responsibilities: Formally responsible for making recommendations regarding policies associated with the job’s purpose and essential responsibilities.
Routine Decision Making: Changes in patient assessment and what observations need to be reported immediately.
Formal Supervisory Responsibility: No formal supervisory responsibility.
Required Knowledge: Knowledge of hospital policies and procedures; knowledge of disease process; medication reaction and interaction; medications and treatments.
Required Skills and Ability: Techniques of nursing care; assessment skills; good communication skills; computer skills and time management skills.
Unusual Working Conditions: Risk of blood, body fluid contamination. Risk for injury from aggressive, combative or disoriented patients.
Education and Certification/ Registration required for the position: Technical or vocational school education with current LPN license in the State of Missouri; BLS required; NIH certification required, PALs preferred.
Age Specific Competencies: May provide care for birth to pediatric (birth-2 yrs.), pediatric/child patients between (2 yrs-12 yrs); adolescent patients between 12 to 18 years of age; adult patients between 18 to 64 years; and geriatric patients 65 years and older.
PART TWO: Essential Responsibilities and Tasks
A. Assists with the implementation phase of the nursing process. (20% of time)
1. Implements patient care through team approach each shift.
2. Documents and reports significant findings to the charge nurse / physician / manager immediately.
3. Is knowledgeable of location, care and operation of medical surgical equipment each shift.
4. Acts rapidly, effectively and manages self and others during emergency situations.
5. Administers medications within scope of care, as ordered, within one hour of time scheduled according to the five rights on every patient.
6. Observes all physician orders each shift.
7. Accurately documents the IV starts, tubing changes and administration of all medications prior to the end of the shift.
8. Ensures all physicians’ orders are reviewed on the EMAR.
9. Accurately and correctly wastes unused portion of controlled substances prior to the end of the shift.
10. Attaches patient's name band, fall risk, allergy band, etc. immediately after patient's arrival and upon bands being removed.
11. Ensures fall protocol is followed on each patient.
12. Utilizing the “AIDET” model, conducts an appropriate introduction, discusses with patient ADL's and plan for the shift and compliments at least one member of the patient care team each shift. Purpose of AIDET directly relates to patient satisfaction scores and performance evaluation
13. Bedside report to be performed each shift with the off-going nurse. Report to include patient/family interaction
14. White boards to be updated during shift change and throughout the shift. To include personalized patient goals and pain control.
B. Assists with performing the assessment phase of the nursing process. (15% of time)
1. Assists with assessing all assigned patients at start of shift.
2. Assists with assessing data relative to age specific needs for every patient at start of shift.
3. Repeats assessment on abnormal patient findings at least once and PRN during shift.
4. Assesses the patient's & family's learning needs every shift.
5. Completes appropriate pain assessment at the start of shift and as needed.
C. Assists with performing the planning phase of the nursing process. (5% of time)
1. Reviews and updates care plan each shift and PRN.
2. Collaborates with interdisciplinary team to facilitate the plan of care after the physician enters orders.
3. Interprets, under the supervision of a registered nurse, the significant abnormal patient findings after assessing the patient and as condition changes.
4. Updates white boards each shift, to include personalized patient goals and pain control.
D. Assists with performing the evaluation phase of the nursing process. (10% of time)
1. Evaluates each assigned patient's response to care each shift and PRN.
E. Provides patient and family education. (15% of time)
1. Provides patient's and/or family's education based on assessments and re-assessments each shift.
2. Uses terminology appropriate to patient/family's knowledge base and age specific needs each shift.
3. Re-assesses patient and family's learning needs and abilities each shift.
4. Documents education provided including subject taught, method of teaching, who was taught and comprehension of information each shift.
5. Provides and documents patient and family follow-up instructions at discharge.
F. Maintains a safe and comfortable unit. (10% of time)
1. Ensures alarms on any assigned areas are audible to alert staff, each shift.
2. Removes malfunctioning equipment from the direct patient care area immediately upon discovering a problem.
3. Completes a requisition for repair and provides to purchaser's mailbox a copy before the end of shift.
4. Completes the job duty list for the unit each month.
5. Utilizes correct patient identification by the hospital approved, two methods, for positive patient identification.
6. Utilizes correct method of bar scanning patient identification bracelets for medication administration via EMAR 95% of the time.
7. Utilizes correct method of bar scanning patient medications or medication administration via EMAR 90% of the time.
8. Provides thorough handoff communication in report using Cass Regional report format on each patient.
G. Demonstrates accountability to the nursing process through documentation. (15% of time)
1. Documents time and date on each physician order.
2. Documents assessments at least every shift and PRN.
3. Documents according to the plan of care at least once per shift.
4. Documents clearly the implementation of specific intervention, including details of methods used, with the time of implementation and evaluation of patient response.
5. Utilizes only approved abbreviations in patient documentation each shift.
6. Documentation follows hospital and departmental policies for frequency and content.
H. Develops and promotes performance improvement initiatives. (10% of time)
1. Plans, develops and evaluates self-objectives, annually.
2. Participates in planning ways to solve problems and make improvements in the medical surgical unit, quarterly, and as needed.
3. Participates in implementing planned changes and activities to improve the medical surgical unit quarterly, and as needed.
4. Evaluates planned changes and activities to improve the medical surgical unit, quarterly, and as needed.
5. Participates on hospital/ unit teams: 3- 2 or more teams, 2- 1 team, 1- no participation on teams.
6. Attends unit staff meetings 3 = greater than 6 meetings annually, 2 = 4-5 annually, 1 = less than 4 annually.
ESSENTIAL PHYSICAL REQUIREMENTS
TYPE OF WORK (Check One)
Sedentary Work: Lifting 10# maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Jobs are sedentary; if walking and standing are required only occasionally.
Light Work: Lifting 20# maximum with frequent lifting and/or carrying of objects weighing up to 10#. Even though the weight lifted may be only a negligible amount, a job is in this category when it requires walking or standing to a significant degree or
Medium Work: Lifting 100# maximum with frequent lifting and/or carrying of objects weighing up to 25#.
x Heavy Work: Lifting 100# maximum with frequent lifting and/or carrying of objects weighing up to 50#.
Very Heavy Lifting: Lifting objects in excess of 100# with frequent lifting and/or carrying of objects weighing 50# or more.
PHYSICAL DEMANDS (Check those which apply)
x Lifting: Raising or lowering an object from one level to another (includes upward pulling).
x Carrying: Transporting an object, usually holding it in hands or arms or on the shoulders.
x Pushing: Exerting force upon an object so that the object moves away from the force (including slapping, striking, kicking, and treadle actions).
x Pulling: Exerting force upon an object so that the object moves toward the force (includes jerking).
Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, ropes, and the like, using the feet and the legs and/or hands and arms.
Balancing: Maintaining body equilibrium to prevent falling when walking, standing, crouching, or running on a narrow, slippery, or erratically moving surfaces; or maintaining body equilibrium when performing gymnastic feats.
x Hearing: Ability to determine audible communication.
x Stooping: Bending the body downward and forward by bending the spine at the waist.
x Kneeling: Bending the legs at the knees to come to rest on the knee or knees.
x Crouching: Bending the body downward and forward by bending the legs and spine.
Crawling: Moving about on the hands and knees or hands and feet.
x Reaching: Extending the hands and arms in any direction.
x Handling: Seizing, holding, grasping, turning, or otherwise working with the hand or hands (fingering not involved).
x Fingering: Picking, pinching, or otherwise working with the fingers primarily (rather than with the whole hand or arms as in handling).
x Repetitive Motions: Substantial movements (motions) of the wrist, hands, and/or fingers.
x Feeling: Perceiving such attributes of objects and materials as size, shape, temperature, or texture by means of receptors in the skin, particularly those of the finger tips.
x Speaking: Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
x Seeing: Obtaining impressions through the eyes of the shape, size, distance, motion, color or other characteristics of objects.
Including Major Visual Functions
x Acuity, far - clarity of vision at 20 feet or more.
x Acuity, near - clarity of vision at 20 inches or less.
x Depth perception - ability to judge distance and space relationships so as to see objects where and as they actually are.
x Field of vision - area seen up and down or to the right or left while eyes are fixed.
x Accommodations - adjustment of the lens of the eye to bring an object into sharp focus.
x Color vision- the ability to identify and distinguish colors.
WORKING CONDITIONS (Check those which apply)
x Inside: Worker spends approximately 75% or more of time inside.
Outside: Worker spends approximately 75% or more time outside.
In/Outside: Activities occur inside or outside in approximately equal amounts.
Extremes of Cold: Temperature sufficiently low to cause marked bodily discomfort unless worker is provided with exceptional protection.
Extremes of Heat: Temperature sufficiently high to cause marked bodily discomfort unless worker is provided with exceptional protection.
Temperature Changes: Variations in temperature which are sufficiently marked and abrupt to cause noticeable bodily reactions.
x Wet: Contact with water or other liquids.
Humid: Atmospheric condition with moisture content sufficiently high to cause marked bodily discomfort.
Noise and Vibration: Sufficient noise, either constant or intermittent to cause marked distraction or possible injury to the sense of hearing and /or sufficient vibration (production of an oscillating movement or strain on the body or its extremities from repeated motion or shock) to cause bodily harm if endured day after day.
x Hazards: Situations in which the individual is exposed to the definite risk of the bodily injury.
Fumes: Smoky or vaporous exhalations, usually odorous, thrown off as the result of combustion or chemical reaction.
Odor: Noxious smells, either toxic dust, fumes, gases, vapors, mists or liquids which cause general or localized disabling conditions as a result of inhalation or action to the skin.
Toxic Conditions: Exposure to toxic dust, fumes, gases, vapors. Mists or liquids which cause general or localized disabling conditions as a result of inhalations or action to the skin.
x Infectious Disease: Risk of exposure to biohazard us materials, blood, body fluid contamination.
Dust: Air filled with small particles of any kind, such as textiles dust, flour, wool, leather, feathers, etc., and inorganic dust including silica and asbestos, which make the workplace unpleasant or are the source of occupational disease.
Poor Ventilation: Insufficient movement of air causing a feeling of suffocation; or exposure to drafts.
Identify and describe any additional physical demands or unusual working conditions that were not previously covered. ___________________________________________________