Summary Performs a complete pre-assessment of patient by obtaining a clinical history from patient/family. Assures the appropriate pre-admission status was designated. Contacts physician offices prior to the patient being registered to obtain orders and other patient documents. Care given reflects initiative and responsibility indicative of professional expectations. Communication on behalf of the patient reflects the mission, ethics, and goals of the facility, as well as the focus statement of the department. Also provides care in the outpatient services area directed toward meeting both the psychosocial and physical needs of the patient. Assesses, plans, implements, and evaluates the care of patients undergoing invasive procedures in the outpatient surgery department. Communicates with physicians and/or anesthesia providers continuously and as needed about patient condition. Participates in performance improvement and CQI activities.
Provides pre-operative teaching to the patient/family regarding medications, day of surgery, prep, etc. Communicates concerns with patient health history to anesthesia department. Makes decisions reflecting knowledge of facts, knowledge of diseases/surgical conditions, care required and good judgment. Performance reflects knowledge in all areas of care specific to outpatient surgery (i.e., GI, autologous, conscious sedation). Manages and operates equipment safely and correctly. Electronic documentation meets current standards and policies. Organizes and manages nursing activities reflecting consideration for patients' needs and the needs of the facility and staff. Utilizes initiative; strives to maintain steady level of productivity; a self-starter; compatible and supportive; a team player. Knowledge of medications and IV fluids and their correct administration, based on age of the patient and patient's clinical condition. Follows the five medication rights and reduces the potential for medication errors. Ability to perform a head-to-toe preoperative assessment on all patients and reassesses, as needed postoperatively. This includes pediatric, geriatric and the general patient population. Ability to adequately assess and reassess pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management. Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors. Ability to formulate an individualized plan of care, as indicated, and evaluates for effectiveness. Formulates a teaching plan, based on identified patient learning needs, and evaluates effectiveness of learning; family is included in teaching, as appropriate, from preop to discharge. Provides patient with explanation and verbal reassurance consistently. Identifies physical symptoms and changes and takes appropriate action in a timely manner. Knowledge of cardiac monitoring and can identify dysrhythmias. Communicates appropriately and clearly to Outpatient Services Manager, coworkers, and physicians. Consults other departments, as needed and as appropriate, to provide for an interdisciplinary approach to the patient's needs. Demonstrates an ability to be flexible, organized and function under stressful situations. Treats patients and their families with respect and dignity. Practices good guest relationships. Maintains a good working relationship and effective communication both within the department and with other departments for the benefit of the patient. Meets current documentation standards and policies and completes within the shift. EDUCATION AND EXPERIENCE: Graduate of an accredited school of nursing. BSN or current enrollment in a BSN program preferred. Two years nursing experience in an outpatient surgical setting preferred.
OTHER CREDENTIALS / CERTIFICATIONS: Current Registered Nurse licensure in the state of Nebraska. Current ACLS and BLS certification.