Overview The LVN collects and documents patient data; assists in the development of a collaborative, individualized patient care plan. Provides nursing care based on clear and established priorities. Evaluates the patient’s response to the plan of care and the attainment of the patient care plan goals.
Responsibilities
Assessment: Collects and documents patient data The LVN will assist the RN in the nursing assessment of each patient by: Interviewing patient/family and completing a history documentation. Documenting signs and symptoms that indicate actual and potential problems. Incorporating information in the written assessment from patient/family and members of the health care team. Assessing safety of the patient care environment. Documenting patient/family teaching needs in the patient care plan. Assist in the development of a collaborative, individualized patient care plan Documents patient problems and goals requiring intervention, including teaching needs and discharge planning. Provides continuity of care by communicating the plan of care and diagnostic data to the RN. Involves family members and other health care team members in the development of the plan of care as able and appropriate.
Implementation
- Provides nursing care based on clear and established priorities Implements the delegated portion of the medical care plan. Initiates referrals to other members of the health care team and appropriate health care agencies to meet specific learning and care needs of the patient and their significant others. Records and reports all interventions clearly and accurately in the designated manner to the appropriate persons. Explains test, procedures, medications and disease process to patients and families in order to alleviate anxiety. Documents teaching provided and response to same in the medical record. Evaluation Evaluates the patient's response to the plan of care and the attainment of the patient care plan goals. Collaborates with other disciplines to evaluate the attainment of the patient care goals. Assist the revision of the care plan to meet the patient's changing needs. Professional conducts/growth and development Accepts new responsibilities. Sets realistic and measurable goals for own development based on personal, peer and manager's assessment of strengths and learning needs. Achieves goals on a timely basis. Recognizes professional responsibility as extending beyond patient's assignment to include goals established for the unit and Department of Nursing. Upholds established quality standards in overall job performance. Maintains current knowledge of and complies with unit and departmental policies and clinical procedures. Presents cost-effective ideas whenever appropriate to improve systems and procedures. Consistently manages workload to avoid overtime. Consistently arrives on time. Does not exceed sick time allowance, as established by hospital policy. Completes time-cards according to policy and procedure. Maintains professional attire, including visible ID. Demonstrates professional commitment to patients and nursing staff. Teaches and assist the nursing personnel for whom he/she is responsible and orients new personnel. Maintains flexibility in relation to patient assignment, shift assignment or work schedule. Uses established systems to document reportable occurrences. Complies with all safety and infection control standards. Guest/Interdepartmental Relations Participates in report and patient care conferences as assigned. Acknowledges request. Promptly and cordially offers assistance. Listens to the ideas opinions and feelings of others. Expresses and accepts constructive feedback, with a focus on positive outcomes. Participates in one-to-one and group discussions to resolve conflicts that inhibit effective working relationships. Interacts with other departments for problem resolution and quality patient care. Recognizes and intervenes appropriately in stressful situations that may arise with patients, families, and health care team members. Maintains a quiet, therapeutic environment in the immediate patient care areas, including the nursing station. Communicates any changes in orders to team members. Makes rounds to assigned patients, anticipates patient's needs, and answers/responds to patient call lights or paging promptly. Performance Improvement Consistently strives to understand, anticipate and meet the needs, expectations and satisfaction levels of patients and other "customers". Errors, inefficiencies and inaccuracies are brought to management's attention with suggestions for improvement. Demonstrates knowledge of each step of the QI process and participates in the formation and implementation of a quality improvement plan. Participates as a team member in assigned corrective actions teams (CATS). Identifies and implements methods of controlling cost of generating revenue while providing maximum value to both the patient/customer and the hospital. Maximizes efficiency in all departmental operations. Measures progress against quality goals.
- Knowledge of
- Growth and
- Development
- Neonate: Supports head; provides for maintenance of norothermic body temperature.
Infant
Accurately determines feeding patterns; encourages motor development by providing environment conducive to sitting, crawling or walking.
Toddler
Provides active toys, balls; does not use diaper if toilet trained.
Pre-School: Provides for group play; encourages self care, e.g. tooth brushing, bathing.
School-Age: Encourages continuation of studies; encourages child to participate in decision-making.
Adolescent
- Provides reassurance and help in accepting body image changes; is non-judgmental and accepting in behavior.
- Range of
- Treatment
- Neonate with
- R/O
- Sepsis: Demonstrates knowledge of antibiotics.
- All
- Ages -
- Respiratory
- Distress: Accurately auscultates and documents breath sounds every 4 hours.
- School
- Age and
- Adolescent: Evaluates patient level of pain and provides appropriate intervention in a timely manner.
- All
- Ages: Demonstrates the ability to identify normal physiological parameters of the neonate, infant, toddler, pre-school, school age and adolescent patients including vital signs, intake, output, height and weight. Unit Specific Competencies Restraints IV Pump Medication Administration Respiratory Care Isolation Techniques Blood Glucose Testing Bed Scale Ventilation Management Splint Application Cultural Specific Competencies Exhibits culturally responsive attitude including, flexibility, empathy, and awareness of communication needs.
Qualifications
Minimum Education: Minimum Experience: One year skilled nursing experience required; one year acute care experience preferred. Required Certification/Registration: Current California L.V.N. license, BLS and PALS required.
