Registered Nurse - Patient Aligned Care Team - Outpatient

Department of Veterans Affairs

The Registered Nurse (RN) is responsible and accountable for all elements of the nursing process when providing and/or supervising direct patient care. Assesses, plans, implements, and evaluates care based on age-specific components. The RN assumes responsibility for the coordination of care focused on patient education, self-management, and customer satisfaction throughout the continuum of care.

• This Registered Nurse (RN) provides direct Veteran care and care coordination, as it pertains, to Veterans and their care within the Primary Care Department. Manages assigned panel(s), utilizes registries, and ensures appropriate evaluation and access is provided to patient panels. This nurse provides health promotion, health education and coaching on wellness, disease prevention, and chronic care management. The nurse will assist in directing the provision of nursing education, orientation, competencies and providing quality improvement and outcomes utilization. Demonstrates leadership in delivering and improving holistic, primary care through collaborative strategies with others. Evaluates practice in an ongoing process, based on best evidence. Partners with others to effect change and produce optimal outcomes. Supports colleagues through knowledge sharing to provide safe, quality outpatient nursing care. Duties include but are not limited to: Using the nursing process and evidence-based practice to collaborate with the Teamlet and larger interdisciplinary team (family/caregiver, internal and community-based services) in developing a patient-driven, holistic care plan for life. Providing patient and family health education focused on self-management, prevention, and wellness in alignment with the patient's goals. Following the patient's personalized health care plan as designated by the patient and the Patient Aligned Care Team (PACT). Demonstrating advanced clinical knowledge in assessing, planning, implementing, documenting, and evaluating care for a designated patient population across the continuum of care. Triaging and applying a collaborative team approach to identify, analyze, and resolve patient care concerns. Working collaboratively to support the day-to-day mission and operational flow of the clinic. Providing patient care in coordination with the interdisciplinary team. Serving as a clinical resource expert to staff and team members. Functioning as an educator for both patients and clinical team members. Acting as a systems coordinator by monitoring patient progress, evaluating clinical pathways, analyzing variations, and initiating appropriate interventions to ensure optimal and timely patient outcomes. Reviewing Message Manager and assisting the team in addressing and completing pending alerts and communications throughout the tour of duty to facilitate timely care and meet caller needs. VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for performance awards Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year) Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Licensure: 1 full and unrestricted license from any US State or territory Work Schedule: Monday - Friday; 8am-430pm. Telework: Not Authorized Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized

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