Pre-Admission Testing Nurse (LVN)

Position Purpose: The Pre-Admission Testing (PAT) Nurse is responsible for assessing, planning, implementing, and coordinating patient care from admission to discharge. The PAT Nurse is responsible for the achievement of patient outcomes through implementation of critical pathways and in accordance with the mission, vision, and values of the facility. The PAT Nurse works within the Pre-Op/PACU department and is responsible for coordinating patient preparation for procedures for patients of all ages (pediatric, adult, and geriatric). The Nurse communicates with referral sources, patients and physician offices to assure the appropriate preoperative testing and patient education are complete in accordance with physician orders and in compliance with the philosophy and protocols of Pasteur Plaza Surgery Center, standards of practice and regulations of governing agencies.

Position Reports to: Pre-Op/PACU Manager

Degree of Supervision Provided to Position:

Medium, must be self-directed and works under direction of the Administrator.

Education, Experience, and Licensure:

Graduate of an Accredited School of Nursing. At least one year of nursing experience required which should include Pre-Op and PACU preferred. Previous outpatient surgery center and pre-admission experience preferred. Current state licensure to practice. Successful completion of Basic Life Support (BLS)/Basic Cardiac Life Support (BCLS) within 90 days of employment or documentation of current BLS/BCLS certification.

Internal Relationships (Works Closely With):

As a representative of Pasteur Plaza Surgery Center, all comments, attitudes, actions, and behaviors have a direct effect on the Facility’s image and perceptions of quality service. Interaction with patients, families, physicians, referral sources, affiliating schools, visitors, volunteers, co-workers, supervisors, vendors, etc. must be in a manner that is friendly, supportive, courteous, respectful, cooperative, and professional. This behavior should promote an atmosphere of teamwork, which is congruent with Facility standards and guidelines to promote positive relations.

Job Requirements:

G. Skills and Abilities:

1. Ability to correlate clinical data with patient’s medical and nursing care.

2. Ability to set priorities.

3. Ability to provide direction to others that is clear, concise and promotes efficiency throughout the clinical areas of the facility.

4. Ability to communicate well with patients, families, teammates, physicians, other members of the healthcare team, etc.

5. Is courteous, understanding and sympathetic toward patients, physicians and others.

6. Ability to set priorities and work independently.

7. Warm, friendly personality with a commitment to treat patients with compassion and respect.

8. Ability to interact in a positive manner and to communicate well with patients, families, co-workers, physicians, supervisor and other facility teammates.

9. Recognizes legal and policy limits of individual practice.

H. Clinical Quality:

1. Assesses, plans, evaluates and ensures the implementation of the patient’s care to achieve identified outcomes and delivers safe patient care according to facility policy and procedure.

2. Evaluates the patients’ past medical history and surgical plan using the Outpatient Surgery Admission Index and the PAT Anesthesia Protocols and obtains Anesthesia approval when necessary. Prepares charts at the minimum 2 days in advance with one week being the goal.

3. Implements appropriate standards of care based on assessment data and patient’s own goals. Goals are mutually set with the patient and family.

4. Interviews pre-operative patients to gather necessary data to assist for admission planning, pre-admission screening and teaching.

5. Ensures provision of patient care daily in an organized and timely manner.

6. Adheres to all facility policies and procedures when providing patient care.

7. Utilizes nursing care standards when planning and implementing patient care.

8. Assesses learning needs according to patient’s level of understanding and readiness to learn.

9. Assumes an active role in the provision of quality nursing care for patients receiving care. Continues to develop the role of pre-admission nurse role in outpatient setting adhering to clinical guideline practices.

10. Utilizes specialized nursing knowledge, nursing process and discriminative judgment while giving direct or indirect care.

11. Assumes pre-op and PACU duties as described in those job duties.

12. Demonstrates ability to make decisions concerning facility-based problems.

13. Participates in team conferences on assigned patients.

14. Demonstrates continued competence in assessing, treating, and caring for individuals based upon age-specific needs utilizing a developmental perspective.

15. Demonstrates appropriate knowledge and competence of designated skills identified for position.

16. Displays an understanding of each patient’s cognitive, physical, emotional, and chronological maturity in the assessments, treatment, and care undertaken based on age-specific criteria.

17. Appropriately modifies approach to the patient based upon patient age utilizing a developmental perspective.

18. Provides appropriate age-specific interventions related to safety issues.

I. Assessment - Demonstrates appropriate knowledge and competence of designated skills identified for pre-admission nurse.

1. Serves as initial and primary contact for referral sources to direct screening and clearance of patients scheduled for, or potentially to be scheduled for procedures by using the Outpatient Admission criteria and reviews information with Anesthesia if required.

2. Contacts patients preoperatively to gather medical history, relevant social and cultural information, allergy, and medication information.

3. Verifies patient information, surgical site, and planned procedure match what is on the surgery schedule.

4. Reviews all preoperative test results and notifies physicians when results are outside normal limits or incomplete. Lab values, EKG, X-Rays, Prior H&P, Prior documented vital signs, scheduling sheet and physician orders

5. Variations are identified during the preoperative nursing assessment are noted and documented. Notification of surgeon and anesthesia provider must occur and be documented.

6. Identifies relevant emotional, safety and psychological needs of patient and family or significant others.

7. Obtains previous surgical and anesthesia history.

8. Verifies accompanying responsible adult and availability of safe transport home.

9. Assesses ability to understand pre-procedural teaching and discharge plan.

10. Reviews charts for completeness.

J. CARE PLANNING/EDUCATION

1. Works with physician offices and specialty physician to obtain additional testing.

a. Assists in obtaining specialized interpreters

b. Language Line

c. Sign Language Interpreters

2. Communicates with clinical lead if unable to obtain.

3. Arranges appointments for preoperative testing as needed within operating times of available services.

4. Provides education to patients or caregiver. The patient’s discharge sheet is required to be reviewed with the patient and/or caregiver.

a. Provides clear description of perioperative process and completes the One Medical Passport Pre-op instruction form.

b. Instructs on oral intake restrictions and medication schedule as ordered.

c. Instructs patients to bring medications on the day of surgery if the medications have not already been reconciled.

d. Instructs patients that valuables need to be left at home or with family member.

i. Informs the patient that before going to the operating room he/she will have to remove (if indicated by procedure):

ii. Dentures/Partials

iii. Glasses/Contacts

iv. Hairpins/Hairpieces

v. Undergarments

e. Is very knowledgeable of medications and their actions. Educates the patient on which medications they need to take or not take the day of surgery (i.e.: anticoagulants, beta blockers, diabetic meds, heart meds)

f. Explains the need for an adult escort who can drive the patient home.

g. Instructs to wear loose clothing that can be easily removed (i.e. avoiding clothing that pulls on and off over the head).

h. Discuss the type of anesthesia planned and assure patient that anesthesia will evaluate and answer any questions preoperatively.

i. Instructs patient to bathe/shower the evening before of the morning of surgery.

j. Instructs the patient to brush teeth and rinse mouth the morning of surgery. The patient should not swallow the rinse.

k. Inform patient of postoperative care:

i. Vital signs monitored frequently

ii. Activity/Diet Restrictions

iii. Nursing personnel MUST assist with first ambulation

iv. Pain and nausea control

v. Discharge criteria if anticipate same-day discharge.

E. Communicates clearly with physician offices

1. Telephones/emails physician offices for test results not received.

2. Notifies physicians when results are abnormal or incomplete.

3. Calls specialist offices to seek quick appointment times for patients needing additional clearance (i.e. cardiologist, pulmonologist).

4. Communicates clearly with patients or caregiver with arrival time and location.

5. Follows up if patient is canceled. Communicating this to physician offices, scheduler, patient and other staff.

F. TECHNICAL SKILLS

1. Uses office equipment:

a. Computer ( Microsoft Office, One Medical Passport, Patient Trak, Internet, email, S:/Drive, U:/Drive)

b. Printer

c. Fax

d. Telephone

G. DOCUMENTATION

1. Documents in OMP, and on the paper chart appropriately, accurately and timely.

a. Patient medical history, relevant social and cultural information, allergy, and medication information.

b. Education provided to patients, care givers, and family members.

2. Receives and maintains accurate records of preoperative testing.

3. Documents communication with physician offices.

4. Completes occurrence reports with:

a. All patient unusual incidents

b. Patient / significant other falls

c. Medication / IV errors

d. Visitor or employee injuries

e. Lost equipment or belongings

f. All reports of events to security

H. Teamwork/Accountability/Integrity:

1. Utilizes time effectively.

2. Follows established facility policies and procedures for attendance.

3. Maintains attendance according to guidelines and policy established by facility.

4. Adheres to tardiness policy.

5. Provides notification for unscheduled absences or tardiness in accordance with established departmental procedures as noted by supervisor.

6. Requests scheduled time off according to procedure as noted by supervisor.

I. Continuous Improvement:

1. Maintains and evaluates own clinical expertise and clinical practice.

2. Attends 75% of unit-based staff meetings and demonstrates review of minutes for any meetings missed.

3. Provides in-services as requested by management

4. Participates in scheduled performance appraisals and demonstrates dedication to ongoing performance improvement.

5. Ensures completion of pre-admission documentation maintaining 90% or greater compliance.

6. Responsibly demonstrates and the importance of continuing education to the performance of facility responsibilities and growth in profession.

7. Maintains and displays appropriate knowledge of professional developments through printed material or other sources.

8. Attends professional training seminars when appropriate for job development and shares information with other Teammates.

9. Attends and participates in all applicable facility training and development workshops scheduled by the facility

10. Maintains work area and equipment in an organized and clean manner

11. Maintains dress and appearance according to standards as observed by management

12. Maintains up-to-date knowledge of job description, role, and responsibilities through continuing education activities

13. Maintains certification requirements and submits required evidence of certification to facility management for teammate file.

14. Strives to be professional, courteous, helpful and cooperative.

15. Performs all other duties as assigned by management

J. Compliance:

Upholds and practices the principles and policies of the PPSC Compliance program. Demonstrates the safe operation of equipment and machinery and follows procedures for reporting and correcting an unsafe situation.

1. Communicates patient information to assure confidentiality and continuity of care.

2. Documents all patient information according to established standards of care, policies and procedures.

3. Provides hand-off reports to other teammates that are accurate, concise and pertinent to the patient’s condition and response to care.

4. Provides pertinent patient information to the physician, family, teammates and other members of the multidisciplinary team.

5. Discusses patient information with other health team members in an appropriate environment.

6. Documents patient’s/significant other’s response to teaching interventions.

7. Interacts with all patients, families, visitors and fellow employees in a mature, responsible manner to ensure a positive and professional facility environment.

8. Displays a caring and responsive attitude and conducts all activities respecting patient, family and employee rights and expectations.

9. Maintains confidentiality of all facility and patient information as required by facility policy.

10. Fosters a positive and professional facility environment by interacting with all persons in a considerate, helpful and courteous manner and by participating as a team member.

11. Diffuses/resolves conflict by appropriately communicating with those involved.

12. Accepts constructive criticism and give suggestions in a professional manner.

13. Considers age specific needs in communication.

14. Maintains dress and appearance according to standards as observed by management.

15. Demonstrates the safe operation of equipment and machinery and follows procedures for reporting and correcting an unsafe situation.

K. Financial Skill:

1. Completes appropriate financial management responsibilities.

2. Provides input re: equipment needs/supply needs.

3. Completes patient charges in accordance with facility procedure.

4. Demonstrates sound cost containment techniques.

Participates in periodic inventory count as assigned by management

ENVIRONMENTAL CONDITIONS: Indoors in climate-controlled environment. Patient care environment with potential exposure to unpleasant odors, to blood and body fluids which may carry infection, to infectious disease, and to chemical and electrical hazards. Occasional exposure to outdoor climate.

PHYSICAL REQUIREMENTS: Good visual acuity, accurate color vision. Require pushing, pulling and essentially utilizing a full range of body movement. Ability to stand, walk, stoop, kneel, crouch and/or crawl. Ability to reach, grasp, use fine finger movement and feel fine sensation. Ability to speak and hear.

MACHINES/EQUIPMENT USED: Clinical equipment used for patient care, i.e., suction machine, patient diagnostic equipment, patient monitoring equipment, office equipment: computer, Xerox machine, addressograph.