DON (Director of Nursing)

Purpose of Your Job Position

The primary purpose of your position is to plan, organize, develop, and direct the overall operation of our Nursing Service Department in accordance with current federal, state, and local standards, guidelines, and regulations that govern our Facility and as may be directed by the Administrator to ensure that the highest degree of quality care is maintained at all times.

Delegation of Authority

As Director of Nursing Services you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties.  You are charged with carrying out the resident care policies established by the Facility. 

Job Function

Every effort has been made to identify the essential functions of this position.  However, it in no way states or implies that these are the only duties you will be required to perform.  The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is an essential function of the position. 

Duties and Responsibilities

Administrative Functions

·         Plan, develop, organize, implement, evaluate, and direct the nursing service department, as well as its programs and activities, in accordance with current rules, regulations, and guidelines that govern the nursing care facilities.

·         Develop, maintain, and periodically update written policies and procedures that govern the day-to-day functions of the nursing service department.

·         Maintain a reference library of written nursing material (i.e., PDR’S, Regulations, Standards of Practice, etc.) that will assist the nursing service department in meeting the day-to-day needs of the resident.

·         Make recommendations for developing, maintaining and periodically updating the Employee Handbook to the Administrator.

·         Develop and implement a nursing service organization structure.

·         Make written and oral reports and recommendations to the Administrator concerning the operation of the nursing service department.

·         Develop methods for coordination of nursing services with other resident services to ensure the continuity of the residents’ total regimen of care.

·         Develop, implement, and maintain an ongoing quality assurance program for the nursing service department.

·         Participate in Facility surveys (inspections) made by authorized government agencies, as necessary or as may be directed.

·         Assist in developing and implementing appropriate plans of action to correct identified deficiencies.

·         Assist the Discharge Planning Coordinator in developing, implementing and periodically updating the written procedures for the Discharge Planning Program.

·         Assist the resident and Discharge Planning Coordinator in planning the nursing services portion of the resident’s discharge plan.

·         Perform administrative duties such as completing medical forms, reports, evaluations, studies, charting, etc., as necessary.

·         Monitor the Facility’s QI, QM, and survey reports.  Assist in developing plans of action to correct potential or identified problem areas.

·         Assist in calculating the number of direct nursing care personnel on duty each shift. Report such information to the Administrator or his/her designee to ensure that accurate staffing information is posted.

Personnel Functions

·         Inform the Nurse Supervisor and/or Unit Manager of staffing needs when assigned personnel fail to report to work.  Recommend overtime for assigned CNAs and other nursing personnel to the Nurse Supervisor or Unit Manager to insure residents’ needs are met.

·         Report absentee call-ins to the Nurse Supervisor and/or Unit Manager.

·         Provide feedback and recommendations for probationary and annual employee performance evaluations for CNAs and other nursing personnel.  Prepare probationary and annual employee performance evaluations for CNAs and other nursing personnel.  Meet with CNAs and other nursing personnel to review performance.

·         Develop work assignments and/or assist in completing and performing such assignments.  Reassign assigned CNAs and other nursing personnel based upon skills and qualifications.

·         Provide leadership, education, counseling, and discipline, when appropriate, to assigned CNAs and other nursing personnel.

·         Make daily rounds of your unit/shift to ensure that assigned CNAs and other nursing personnel are performing their work assignments in accordance with acceptable nursing standards.  Make changes to assignments based upon resident needs and availability of skilled staff.

·         Evaluate daily performance of assigned CNAs and other nursing personnel.  Document any disciplinary issues and report problem areas or disciplinary actions to the Nurse Supervisor and/or Unit Manager.

·         Meet with your assigned CNAs and other nursing personnel, on a regularly scheduled basis, to assist in identifying and correcting problem areas, and/or to improve services.  Assign personnel accordingly to insure quality resident care while allowing personnel to improve in areas where they may be deficient, with appropriate supervision. 

·         Ensure that CNAs, department personnel residents, and visitors follow the department’s established policies and procedures at all times.

·         Resolve personnel disputes and issues within the unit and reassign or remove personnel to insure patient safety. 

·         Develop and maintain a good working rapport with inter-departmental personnel, as well as other departments within the Facility to ensure that nursing services and activities can be adequately maintained to meet the needs of the residents.

·         Review complaints and grievances made or filed by your assigned CNAs or other nursing personnel.  Make appropriate reports to the Nurse Supervisor and/or Unit Manager as required or as may be necessary.  Follow Facility’s established procedures.

·         Receive or provide the nursing report upon reporting in and ending shift duty hours.

·         Report occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals in accordance with the Facility’s policies and procedures governing accidents and incidents.

Committee Functions

·         Serve on, participate in, and attend various committees of the Facility as appointed by the Administrator.

·         Evaluate and implement recommendations from established committees as they may pertain to nursing services.

·         Assist the Pharmaceutical Services Committee in developing, maintaining, implementing, and periodically updating written policies and procedures for the administration, storage, and control of medications and supplies.

·         Schedule, attend, and participate in developing the agenda for Care Plan Committee meetings as necessary.

·         Participate in regularly scheduled reviews of the Discharge Plans and make such plans available to the Care Plan Committee, as required or as may be necessary.

Personnel Functions                                                                                                                                                            

·         Determine the staffing needs of the nursing service department necessary to meet the total nursing needs of the residents.

·         Supervise and assist scheduling of employees within established state guidelines.

·         Recommend the number and level of nursing personnel to be employed.

·         Assist the Administrator and/or the HR Director in the recruitment and selection of nursing service personnel.

·         Ensure that all nursing assistants are enrolled in or have graduated from an approved training program.

·         Assign a sufficient number of LPNs and RNs for each tour of duty to ensure that quality care is maintained.

·         Assign a sufficient number of CNAs as applicable, for each tour of duty to ensure that routine nursing care is provided to meet the daily nursing care needs of each resident.

·         Ensure that all nurse aide trainees are under the direct supervision of a licensed nurse.

·         Develop work assignments and schedule duty hours, and/or assist nursing supervisory staff in completing and performing such tasks.

·         Delegate to nursing service supervisory personnel the administrative authority, responsibility, and accountability necessary to perform their assigned duties.

·         Complete and/or delegate the completion of all annual reviews for the nursing services department.

·         Monitor absenteeism to ensure that an adequate number of nursing care personnel are on duty at all times.

·         Develop, maintain, and periodically update the written procedure for ensuring that professional nursing personnel, including private duty nurses, have valid and current licenses as required by this State.

·         Review complaints and grievances made or filed by department personnel.

·         Provide complaint and grievance reports to the Administrator, as required or as may be necessary.

·         Ensure that departmental disciplinary action is administered fairly and without regard to race, color, creed, national origin, age, sex, religion, handicap, or marital status in accordance with all applicable state laws.

·         Assist the Infection Control Coordinator in establishing a TB management program for employees.

·         Report occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals in accordance with the Facility’s policies and procedures governing accidents and incidents.

·         Ensure background checks on nursing service personnel in accordance with established procedures.

·         Ensure that all CNAs as applicable, credentials are verified through the State Nurse Aide Registry.

·         Ensure that appropriate adverse personnel actions relative to CNAs as applicable, employment criteria are reported to the State Nurse Aide Registry.

·         Terminate employment of personnel when necessary, documenting and coordinating such actions with the HR Delegate and/or Administrator.

Nursing Care Functions

·         Participate in the interviewing and selection of residents for admission to the Facility, including PASARR screenings.

·         Provide the Administrator with information relative to the nursing needs of the resident and the nursing service department’s ability to meet those needs.

·         Inform nursing service personnel of new admissions, their expected time of arrival, room assignment, etc.

·         Ensure that direct nursing care be provided by LPNs, CNAs, and/or a nurse aide trainee qualified to perform the procedure.

·         Review nurses’ notes to ensure that they are informative and descriptive of the nursing care being provided, that they reflect the resident’s response to the care, and that such care is provided in accordance with the resident’s wishes.

·         Ensure that residents who are unable to call for help are checked frequently.

Staff Development

·         Develop and participate in the planning, conducting, and scheduling of timely in-service training classes that provide instructions on “how to do the job,” and ensure a well-educated nursing service department.

·         Develop, implement, and maintain an effective orientation program that orients the new employee to the department, its policies and procedures, and to his/her job position and duties.

·         Provide leadership training that includes the administrative and supervisory principles essential for Nurse Supervisors, LPNs, or RNs.

·         Encourage the nursing supervisory staff to attend and participate in outside training programs. Schedule times as appropriate.

·         Assist the Administrator in developing and revising the nursing assistant training curriculum used by the Facility. Submit to state agency for approval as required.

·         Assist in developing annual Facility in-service training programs (e.g., OSHA, TB, HIPAA, Abuse Prevention, Safety, Infection Control, etc.).

·         Assist in developing advance directive in-service training programs for the staff and community.

·         Assist support services in developing, implementing, and conducting in-service training programs that relate to the nursing service department.

·         Assist in the development of in-service training programs for the nursing staff.  Ensure that these programs meet the continuing education requirements that allow licensed personnel (e.g., RNs, LPNs, CNAs as applicable, etc.) to keep their licenses on an active status.

·         Attend and participate in continuing educational programs designed to keep you abreast of changes in your profession, as well as to maintain your license on a current status.

Safety and Sanitation

·         Assist in developing safety standards for the nursing service department.

·         Ensure that the department’s policy and procedure manuals identify safety precautions and equipment to use when performing tasks that could result in bodily injury.

·         Assist the Infection Control Coordinator in identifying, evaluating, and classifying routine and job-related functions to ensure that tasks in which potential exposure to blood or body fluids are properly identified and recorded.

·         Ensure that all personnel performing tasks that involve potential exposure to blood or body fluids participate in appropriate in-service training programs prior to performing such tasks.

·         Ensure that adequate supplies of personal protective equipment are on hand and are readily available to personnel who perform procedures that involve exposure to blood or body fluids.

·         Monitor nursing service personnel to ensure that they are following established safety regulations in the use of equipment and supplies.

·         Ensure that nursing service work areas (i.e., nurses’ stations, medicine preparation rooms, etc.) are maintained in a clean and sanitary manner.

·         Ensure that all resident care rooms, treatment areas, etc., are maintained in a clean, safe, and sanitary manner.

·         Ensure that all nursing service personnel follow established departmental policies and procedures, including appropriate dress codes.

·         Ensure that nursing service personnel participate in and conduct all fire safety and disaster preparedness drills in a safe and professional manner.

·         Assist the Infection Control Committee in the development, implementation, and revising of written aseptic and isolation techniques.

·         Develop, implement and maintain a program for monitoring communicable and/or infectious diseases, including TB, among the residents and personnel.

·         Ensure that nursing service personnel follow established infection control procedures when isolation precautions become necessary.

·         Develop, implement, and maintain a procedure for reporting hazardous conditions or equipment.

·         Ensure that personnel wear and/or use safety equipment and supplies when lifting or moving residents.

·         Report missing and illegible labels and MSDSs to the safety officer or other designated person.

Equipment and Supply Functions

·         Recommend to the Administrator the equipment and supply needs of the department.

·         Ensure that a stock level of medications, medical supplies, equipment, etc., is maintained on premises at all times to adequately meet the needs of the resident.

·         Develop and implement procedures that ensure nursing service supplies are used in an efficient manner to avoid waste.

·         Ensure that personal protective equipment used in the handling of infectious materials are available and easily accessible to nursing service personnel.

·         Ensure that appropriate MSDSs are on file for hazardous chemicals used in the nursing service department.

Care Plan and Assessment Functions

·         Assist in the development of preliminary and comprehensive assessments of the nursing needs of each resident.

·         Develop a written plan of care (preliminary and comprehensive) for each resident that identifies the problems or needs of the resident, indicates the care to be given, goals to be accomplished, and which professional service is responsible for each element of care.

·         Assist the Resident Assessment and Care Plan Coordinator in the scheduling of care plans and assessments to be presented and discussed at each committee meeting.

·         Ensure that all personnel involved in providing care to the resident are aware of the resident’s care plan. Ensure that nursing personnel refer to the resident’s care plan prior to administering daily care to the resident.

·         Review nurses’ notes to determine if the care plan is being followed.

·         Assist in planning, scheduling, and revising the MDS, including the implementation of RAPs and Triggers.

·         Ensure that resident assessment information is transmitted on a timely basis.

·         Review and revise care plans and assessments as necessary, but at least quarterly.

Budget and Planning Functions

·         Prepare and plan the nursing service department’s budget and submit to the Administrator for his/her review, recommendations, and/or approval.

·         Keep abreast of economic conditions or situations, and recommend to the Administrator adjustments in nursing services that ensure the continued ability to provide quality care.

·         Recommend to the Administrator the equipment and supply needs of the nursing service department.

Resident Rights

·         Review complaints and grievances made by the resident and make a written or oral report to the Administrator. Follow Facility’s established procedures.

·         Maintain a written record of the resident’s complaints and/or grievances that indicates the action taken to resolve the complaint and the current status of the complaint.

·         Report all allegations of resident abuse and/or misappropriation of resident property.

·         Must adhere to all HIPAA requirements.

Working Conditions

·         Works in office area(s) as well as throughout the nursing service area (i.e., drug rooms, nurses’ stations, resident rooms, etc.).

·         Is involved with physicians, residents, personnel, visitors, government agencies or personnel, etc., under all conditions and circumstances.

·         Works beyond normal working hours and on weekends and holidays when necessary.  On call 24 hours per day, 7 days per week.

·         Is subject to call back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.).

·         Attends and participates in continuing educational programs.

Education

·         Must possess valid unencumbered, RN State License.  Nursing degree from an accredited college or university preferred.

Experience

·         Must have, as a minimum, three (3) years of experience as a supervisor in a hospital, nursing care Facility, or other related health care Facility.

Specific Requirements

·         Must possess a current, unencumbered, active license to practice as a Registered Nurse in this state.

·         Must demonstrate the knowledge and skills necessary to provide care appropriate to the age-related needs of the residents served.

·         Must be able to read, write, speak, and understand the English language.

·         Must be a supportive team member, contribute to and be an example of team work and team concept.

·         Must possess the ability to make independent decisions when circumstances warrant such action.

·         Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to nursing care facilities.

·         Must possess leadership and supervisory ability and the willingness to work harmoniously with and supervise other personnel.

·         Must be willing to seek out new methods and principles and be willing to incorporate them into existing nursing practices.

Physical and Sensory Requirements

(With or Without a Reasonable Accommodation)

·         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 may include a medical and physical examination.

·         Must be able to relate to and work with the ill, disabled, elderly, emotionally upset, and at times hostile people within the Facility.

·         May be necessary to assist in the evacuation of residents during emergency situations.

·         Based on the Occupational Safety and Health Administration's Guidelines for Nursing Homes Ergonomics for the Prevention of Musculoskeletal Disorders and the American Conference Governmental Industrial Hygienists' Threshold Limit Values for Lifting the Facility has identified that this job may require the lifting of residents, equipment, or other objects.  Accordingly, this job may require a minimum of 5 pounds and a maximum of 45 pounds lifting, periodically and or as needed.

Acknowledgment

I have read this job description and fully understand that the requirements set forth therein have been determined to be essential to this position.  I hereby accept the position of Director of Nursing Services and agree to perform the tasks outlined in this job description in a safe manner and in accordance with the Facility's established procedures.  I understand that as a result of my employment, I may be exposed to blood, body fluids, infectious diseases, air contaminants (including tobacco smoke), and hazardous chemicals and that the Facility will provide to me instructions on how to prevent and control such exposures.  I further understand that I may also be exposed to the Hepatitis B Virus and that the Facility will make available to me, free of charge, the hepatitis B vaccination.  I also understand I may not release or disclose protected health or Facility information without proper authorization.