Summary Responsible and accountable for all elements of the nursing process when providing and/or supervising direct patient care. Assumes responsibility for the coordination of care focused on patient education, self-management, and customer satisfaction throughout the continuum of care. Administers medications and procedures per established policies and guidelines. Influences care outcomes by collaborating with members of the interdisciplinary team. Responsibilities Core elements of performance include knowledge and active participation in the unit/program level quality improvement process and initiatives as well as customer service programs. The Primary Care RNCM works with the Primary Care and Specialty Services to develop and implement comprehensive patient care for adult/geriatric patient population assessing, planning, implementing and evaluating activities and programs. The RN/Care Manager: Provides support to providers daily: coordinating dual care with community and other VA facilities: ensuring all needed records, tests and other information is available to provider at time of appointment to allow provider to focus on treatment plan and Veteran questions in an appropriate and timely manner. Responsible for PACT coordination, including panel management, triage of patients, patient education, monitoring of patient progress toward predetermined goals and timely follow-up. Utilizes and follows Primary Care Nurse Protocols and clinic process SOPs to improve efficiency and care delivery. Works closely with other VA Medical Centers and community facilities to remove obstacles that would impede the Veteran from utilizing the service of those medical centers not available to our facility. Participates in clinic for setting patient goals of care as part of the interdisciplinary team. Utilizes the nursing process in managing, developing, implementing, and evaluating each patient's individual plan in collaboration with the interdisciplinary care team to attain specific clinical outcomes in outpatient clinic settings. Participates in clinic for setting patient goals of care as part of the interdisciplinary team. Participates in activities which meet the performance standards contract for the Medical Center. Participates in the development and implementation of recommended policies and procedures as related to Care Management and/or designated clinical area. Provides for the educational needs of the healthcare team regarding Care Management and/or topics specific to Primary Care. Maintains and upgrades own knowledge base and skills regarding Care Management and/or specific clinical areas and applies this knowledge to nursing practice. Participates in clinic research/EBP within designated area and/or related to Care Management. Establishes effective networking relationships with peers and professionals within the community as related to Care Management. Receives alerts for reassigned new patients to Primary Care, assist with ordering and coordinating appropriate tests, obtaining outside reports and communications with specialty and local medical doctors to expedite patient appointments. Uses Clinical Reminders model and VISTA reports to manage, coordinate and optimize the care for Veterans. Collaborates with clinic staff to ensure patients are given timely appointments and expedite new patient consults. Follow up with patients monitoring and ensuring adherence to treatment plans, intervene in accordance with prescribes clinical guidelines and provide reports on all cases. Documents all patient interaction in the electronic medical record timely following the Patient Records Policy and Primary Care PACT Telephone Care Guide. Provides clinic care and care management to Veterans in Primary Care clinics. Delegates to PACT Team care members and extended primary care members in accordance with Nurse Practice Act. Triages and applies a collaborative team approach in identifying, analyzing, and resolving care problems for scheduled and unscheduled encounters (via phone or face to face) within Primary Care, and Specialty. Communicates and collaborates with the interdisciplinary team to develop and coordinate the treatment plan for Veterans in the outpatient setting. Facilitates and leads HRO clinic huddles with clinic staff. Serves as a resource for other team members and participates in planning for program improvements at the local level. Participate in nontraditional care methods such as telephone, VA Video Connect (WC), - online communication via secure messaging, Shared medical and Group medical appointments. Each Primary Care PACT is set up based on volume/size and interdisciplinary team members assigned within the service. The above scope is included but not limited to each service. Expectations and Scopes change continually based on service, volume, team members, National Directives/Mandates, etc. to meet the need of the Veteran. VA offers a comprehensive total rewards package: VA Nurse Total Rewards Work Schedule: Monday-Friday, Day Shift (may include occasional evenings). Telework: Yes. Ad-Hoc, as determined by the agency policy Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required Requirements Conditions of Employment U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA. Selective Service Registration is required for males born after 12/31/1959. You may be required to serve a probationary period. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Must pass pre-employment physical examination. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). Qualifications Basic Requirements: English Language Proficiency. In accordance with 38 U.S.C. 7403(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program. (Reference VA Handbook 5005, Appendix G6); OR In cases of graduates of foreign schools of professional nursing, possession of a current, full, active, and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program. Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD). Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia. Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification. Preferred Experience: BSN or Higher preferred Grade Determinations: The following Scope, Education and Dimension criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade. The Dimension requirements (Practice, Veteran/Patient Driven Care, Leadership, Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment: https://apply.usastaffing.gov/ViewQuestionnaire/12820395. Grade/Level Scope Education Nurse I, Level I Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies. An Associate Degree (ADN) or Diploma in Nursing, with no additional professional nursing required. Nurse I, Level II Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex. An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I, Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required. Nurse I, Level III Demonstrates proficiency in practice based on conscious and deliberate planning. Self-directed in goal setting for managing complex client situations. An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2; OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I, Level 2; OR a Master's degree in nursing (MSN) and no additional professional nursing experience; OR a Master's degree in a related field with a BSN and no additional professional nursing experience. Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others. A BSN with 2 years of professional nursing equivalent to Nurse I, Level 3; OR an MSN with one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Master's degree in a related field with a BSN and one year of specialized nursing experience equivalent to Nurse I, Level 3; OR a Doctoral degree in Nursing with no professional nursing experience; OR a Doctoral degree in a related field with a BSN with no additional professional nursing experience. Nurse III Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting. MSN and 2 years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Master's degree in related field with BSN and two years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III; OR a Doctoral degree in a related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III. Note: Foreign education programs/degrees are not creditable as related degrees. Reference: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-6 Nurse Qualification Standard. This can be found in the local Human Resources Office. Physical Requirements: Walking, bending, stooping, and some lifting in the direct care of patients. There may also be extended periods of sitting. This position also requires that the staff member be able to wear a lead apron for an extended period of time. Education IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html. Additional Information The William S. Middleton Memorial Veterans Hospital is committed to fostering and sustaining an environment which celebrates diversity, provides equitable opportunities for employment and promotion, and supports inclusiveness in our culture. Together, we strive to create and maintain working and learning environments that promote professional growth and teamwork, and are inclusive, equitable and welcoming. We embrace our differences as individuals and unite as a team toward a common goal: to serve our nation's Veterans. This job opportunity announcement may be used to fill additional vacancies. This position is in the Excepted Service and does not confer competitive status. VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority. If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement. Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.
