RN/LPN

Essential Functions Provides the highest quality of patient care to facility residents/patients.

Documents care performed and observations of resident status in the clinical record promptly by utilizing standard clinical documentation guidelines as required by the facility, and local, state and federal rules and regulations.

Communicates with resident’s physician.

Completes all nursing documentation: assessments, orders, progress notes, flowsheets, consents, and any assigned tasks and ensures that said documentation accurately reflects services required by the resident and provided to the residents.

Participates in medication management to promote optimal safety and effectiveness for residents by: Administering medications as ordered, including next scheduled dose following admission/readmission.

Notifies Supervisor of medications not available; Preparing, administering and documenting medications as prescribed; Observing and reporting resident responses to medication; Identifying and promptly communicating adverse drug reactions; Initiating enteral or parenteral therapy as ordered; Maintaining narcotic records accurately; Ordering or arranging for ordering of pharmaceuticals; Notifying physicians of automatic stop order; and/or Completing recapitulated physician orders review, as assigned.

Assists with or institutes emergency measures for sudden adverse developments with residents.