DIRECTOR OF NURSING

 
POSITION: 
The Director of Nursing assumes full time administrative authority, responsibility and accountability for the delivery of nursing services in the facility. Manages facility employees in the provision of care and services according to professional standards of nursing practice, consistent with facility philosophy of care and county, state and federal laws and regulations. Develops and implements policy and procedures consistent with current law and best nursing practices.  In collaboration with the Administrator, allocates department resources in an efficient and economic manner to enable each resident to attain or maintain the highest practicable physical, mental, and psycho-social well-being. Collaborates with other departments, professionals, consultants, and organizations, including government agencies and advocacy groups, to develop support and coordination of resident care, related administrative functions and to represent the interests of the facility. 
 
REPORTING: 
This position is responsible to the Administrator.   
 
FLSA STATUS:      Exempt 

ESSENTIAL JOB FUNCTIONS: 

Assist in the development and maintain nursing policies and procedures that reflect current standards of nursing practice and facility philosophy of care consistent with county, state and federal laws and regulations, as applicable. 
Communicate and interpret policies and procedures to nursing staff.  Monitor practice for effective implementation 
Review 24 hour report from every unit daily to ensure timely, effective responses to significant changes in condition, transfers, discharges, or use of physical or chemical restraints, unexplained injuries, potential abuse or neglect, medication errors, loss of resident property, any evidence or resident or family dissatisfaction.  Gather and analyze facts, assess situations, develop and implement appropriate actions to investigate, to notify appropriate parties, to resolve issues and to record facts properly.  Keep Administrator informed of findings and results 
Communicate directly with residents, families, medical staff, nursing staff, interdisciplinary team members and Department Heads to coordinate care and services, improve organization and implementation of plans of care, to maintain quality of care, quality of life and a homelike environment for all residents 
Establish and implements infection control program designed to provide a safe, sanitary and comfortable environment and to prevent the development and transmission of disease and infection.  Review infection control surveillance reports to identify trends and to develop effective actions to control and prevent infections in the facility.  Include infection control information and statistics in Quality Assessment and Assurance Committee report 
Monitor the provision of care and services to residents on all shifts and evaluates regulatory compliance efforts through daily rounds to observe care on units, to review records and to interview staff members, residents, families and other interested parties.  Evaluate the findings of compliance rounds conducted by designated facility staff on a daily basis.  Design, implement and evaluate actions to continuously improve quality 
Participate in monthly Medicare Triple Check to ensure Medicare Part A and Part B are billed accurately with charges captured in a timely manner for all allowable costs and that the facility has acquired the clinical documentation to support charges for services to Medicare be in compliance under the Medicare program and in accordance with the Medicare Triple Check Compliance Monitoring Policy, Procedure and Guidelines. 
Conduct quality assessment and assurance activities, including regulatory compliance rounds, in all departments to monitor performance and to continuously improve quality.  Develop program to gather and analyze data for trends and to institute actions to resolve problems promptly 
Evaluate effectiveness of actions.  Participate as member of Quality Assessment and Assurance Committee with the Medical Director and at least three other facility staff members.  Report and make recommendations to Quality Assessment and Assurance Committee 
Supervise development of in-service education programs designed to equip nursing staff with sufficient knowledge and skills to provide nursing and nursing related services to each resident to attain or maintain the highest practicable physical, mental and psycho social well-being and to perform the essential functions of their jobs satisfactorily 
Assist Administrator in preparation for long term care survey.  Actively participate in long term care survey process by instructing staff in matters of conduct and disclosure, maintaining a presence at all times surveyors are on-site and directing the timely collection of information required by the survey team.  Demonstrate concern for identified problems and undertake corrective action while survey is in progress if appropriate.  Gather and present supplemental documentation to avoid potential deficiencies.  Collaborate with Administrator to develop responses to survey report as needed 
Collaborate with physicians, consultants, facility agencies and institutions to improve quality of services and to resolve identified problems 
Consult with Administrator daily about resident status, census, budget, and personnel and other relevant issues 
Participate in the development of the nursing department budget.  Provide relevant financial information to Administrator regarding department financial needs and status 
Over all responsibility for the Admission process:  Review and approve admissions, be aware of acuity needs of current residents and impact of admissions, monitor staffing needs/abilities  in relationship to admissions 
Develop and maintain a good working relationship with hospital discharge planners to facilitate admissions and maintain census 
Over all responsibility for the Medicare/PPS program:  Determine eligibility for coverage, monitor and approve admissions, case management (utilization review), timely response to requests for billing related information from Fiscal Intermediary and Service Center A/R department, maintain close working relationship with Rehab Department personnel, monitor daily documentation, monitor the MDS assessment process in relationship to A/R process, establish guidelines for management of acuity (staffing needs), and provide resident and family education regarding benefits (as needed) of the Medicare/PPS program to maintain the integrity of the Medicare Program 
Develop staffing plans that assure sufficient numbers of qualified, competent nursing staff to meet direct care needs, conduct assessments as required, develop plans of care, evaluate residents’ responses to interventions and document clinical records effectively in compliance with county, state and federal laws and regulations, as applicable. Recommend number and type of nursing personnel necessary to provide care and to maintain compliance with facility mission and regulations 
Hire and retain qualified competent nursing staff to provide nursing and nursing related services to attain or maintain the highest practicable physical, mental and psycho social well-being of each resident.  Conduct interviews, provide regular performance reviews, take appropriate job actions, review job actions taken by subordinates to assure that staff meet qualification and performance standards and can perform all essential functions of the job 
Ensure 24 hour availability as nursing administration resource by providing on-call and telephone access or designating an alternative, qualified nursing staff member to do so 
Maintain current skills and knowledge through continuing education.  Apply information to job responsibilities 
JOB FUNCTIONS: 

Demonstrate knowledge of, and respect for, the rights, dignity and individuality of each resident in all interactions   
Demonstrate competency in the protection and promotion of resident rights.  Able to act as role model for facility staff 
Appreciates the importance of maintaining confidentiality of resident and facility information 
Demonstrate honesty and integrity at all times in the care and use of resident and facility property 
Current knowledge of county, state, federal laws and regulations, as applicable, that apply to practice of nursing in long term care 
Ability to provide nursing leadership to Administrator, Medical Director, Department Heads and governing Body to formulate operational strategies and achieve facility objectives within planned budgets and schedules.  Provide direction to nursing staff to execute tasks necessary to implement operational objectives 
Working knowledge and ability to apply standards of professional nursing practice in job situations.  Able to assist in the development of nursing policies and procedures that reflect current clinical practice, professional standards and facility philosophy of care.  Able to establish criteria to assure that services provided meet established standards of quality 
Sufficient knowledge of clinical practice, regulations and principles of adult education to supervise the continuing education and training of nursing personnel 
Working knowledge of reimbursement sources (ie. Medicare, Medicaid, HMO, Private, Hospice) and  the relationship to the Admission Process 
Working knowledge of the admission criteria and coverage guidelines for the various payor sources 
Working knowledge of the RAI (MDS) assessment process 
Demonstrate satisfactory level of interpersonal skill to interact with facility administration, community and government agencies, interdisciplinary staff 
Able to understand and to follow written/and or verbal directions.  Able to express self adequately in oral and/or written communications.  Able to communicate effectively with staff members, other professional staff, consultants and residents in interdisciplinary care setting and to government agencies 
Sufficient knowledge of personnel policies and ability to perform personnel functions including interviewing prospective staff members, conducting performance evaluations and carrying out disciplinary actions when appropriate.  Able to apply personnel policies to facts concerning job actions without regard to race, sex, age, national origin, religion or disability 
Able to coordinate Quality Assessment and Assurance activities with Medical Director, Administrator, Department Heads and direct care staff 
Carry out duties in accord with the facility mission and philosophy 
Working knowledge of HIPAA Regulations and appreciates the importance of maintaining confidentiality of resident and facility information 
Knowledge of emergency and disaster procedures of facility.  Able to locate nearest exit, to understand and respond to written or oral instruction in case of emergency.  Sufficient mobility, and strength to move freely through the building, to assure resident safety at all times and to assist, transfer or otherwise move residents of facility out of danger in case of emergency 
Demonstrate respect for co—workers and respond to needs of residents by complying with facility policies on attendance and punctuality and dress code.  Able to arrive and to begin work on time and to respond to facility needs 24 hours a day, 7 days a week through on-call availability or delegation 
Working knowledge and ability to comply with facility policies and procedures for workplace safety including infection control procedures, application of universal precautions for blood borne pathogens, use of personal protective equipment and handling of hazardous materials 
Demonstrate ability to prioritize responsibilities and complete projects within allotted time 
Able to respond to change productively and to handle additional projects as delegated 
Able to perform essential functions of Charge Nurse, if needed, when facility has average daily census of 60 or fewer residents 
Able to carry out the essential functions of this job (with or without reasonable accommodation) without posing specific, current risk of substantial harm to health and safety of self and others 
Other duties as assigned  
PHYSICAL CAPACITIES:   (With or Without the Aid of Mechanical Devices) 

Must be able to move intermittently throughout the workday. 
Must be able to see and hear or use prosthetics that will enable these senses to function adequately to ensure that the requirements of this position can be fully met. 
Must meet the general health requirements set forth by the policies of this facility which includes an annual TB screening and physical examination.  
Must be able to sit for extended periods of time. 
Must be able to lift and carry up to 25 pounds.   
Must be able to cope with the mental and emotional stress of the position. 
 
ENVIRONMENTAL CONDITIONS:      
Inside work, normal temperatures, some noise, occasional fumes/odors, chemical exposure and potential exposure to bloodborne pathogens. 
 
This job cannot be performed without exposure to the stresses associated with an intimate, 24 hour skilled care environment that delivers care and services primarily to disabled and cognitively impaired residents in an aging population.  Examples of these stresses include, but are not limited to: emergency health or safety response, weekend and holiday duty, unusual or impaired behavior by residents, family reactions to having a loved one in a nursing home, death and dying, oversight of state surveyors, ombudsmen and federal officials, presence of consultants and attorneys, and variable involvement of medical staff. 
 

QUALIFICATIONS/REQUIREMENTS: 
Education:       
    Graduate of an accredited school of nursing  
License:       
    Current, active license as a Registered Nurse 

Work Experience:     

• 3 years professional nursing experience in long term care setting 
• 1 year administrative experience in nursing service administration or comparable management experience 

Language Skills: 

• Must be able to read, analyze, and interpret common scientific and technical information, and to be easily understood through verbal communication in the English language.   

Mathematical Skills: 

• Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. 
• Ability to perform these operations using units of weight measurement, and volume. 

Communication Skills: 

• Must have exceptional communication and customer service skills, and be empathetic.   
• Ability to effectively communicate with patients, families, responsible parties, staff and outside resources and agencies.