The Transitional Care Coordination Nurse is a registered nurse who utilizes the nursing process to assess, coordinate, facilitate and deliver nursing care to Medicine and Hospitalist Service patients throughout the Central California VA System.

Duties

The Registered Nurse -Transitional Care Coordination utilizes critical thinking skills and the nursing process to provide the highest level of nursing care for eligible Veterans inpatient and post hospital setting. Nursing services provided in the Transitional clinic include in person, VVC and/or telephone advice: assessment of scheduled and non-scheduled patient problems for acuity and appropriate referral: coordination of care with other VA facilities and the patients primary care provider; patient and family education; assessment of effectiveness of prescribed medications and medication compliance; ongoing patient assessment and follow up care per provider orders; and psychosocial support. Duties include but are not limited to: Provides patient care in keeping with department of medicine standards with attention to physical, emotional, social, spiritual, cultural and age specific needs while preserving personal dignity and autonomy. Demonstrates safe expert knowledge and care relevant to respective nursing care and the ability to apply current theory to practice. Demonstrates highly skilled organizational critical thinking skills to function effectively in a leadership role requiring application of problem solving skills at the unit or program level. Utilizes team approaches to identify, analyze and resolve problems. Uses sound judgement in assessing, planning, implementing, documenting and evaluating age specific patient care using the nursing process. Performs care coordination and care management of complex patient categories to minimize re-hospitalization. Review and evaluation and interpretation of labs, imaging, procedures, clinical visit notes, consults, as well as review of specialty wait times to develop a plan of care with the veteran. Guides and directs others on the interdisciplinary team, in order to facilitate needed care of the veteran. Utilizes the nursing process to assess, coordinate, and facilitate care to patients throughout the continuum. Implementing educational plans to meet the service's needs of patients; Educates patient,family and/or caregivers in regard to treatment and/or procedures. 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 ( 8:00AM- 4:30PM) Telework: Ad-hoc Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required

Requirements

Qualifications

Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. English Language Proficiency. In accordance with 38 U.S.C. 7402(d), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. Graduate of a school of professional nursing approved by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE). The approving official may authorize a waiver of the requirement for ACEN or CCNE accreditation of any degree in nursing provided the college or university has regional accreditation from an accrediting body recognized by the Department of Education at the time of the candidate's graduation and the composite qualifications of the applicant warrant such consideration. In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing. OR The completion of coursework equivalent to a nursing degree in a MSN Bridge Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. Students should submit the certificate of professional nursing to sit for the NCLEX to the VA along with a copy of the MSN transcript. (Reference VA Handbook 5005, Appendix G6) OR In cases of graduates of foreign schools of professional nursing, possession of a current, full, active and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing. Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia. Grade Determination: The following criteria must be met Nurse III - Master's degree in nursing or related field with BSN and approximately 2-3 years of nursing practice/experience; OR a Doctoral degree and approximately 2-3 years of nursing practice/experience. Note regarding MSN degrees: If your MSN was obtained via a Bridge Program that qualifies for professional nursing registration, a BSN is not required. Reference: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-6 Nurse Qualification Standard. This can be found in the local Human Resources Office. Physical Requirements: Physical standards as specified in VA Directive and Handbook 5019 to include lifting up to 35 pounds for 8-12 hours, intermittently; moderate carrying (15-35 pounds) for 8 to 12 hours, intermittently; lifting over 35 pounds with assistive devices in accordance with the Safe Patient Handling Policy except in emergent situations requiring prompt patient care; pulling for 8 to 12 hours, intermittently; pushing for 8-12 hours, intermittently; reaching above the shoulders for 8-12 hours, intermittently, both hands required; walking 8-12 hours, intermittently; standing 8-12 hours intermittently; kneeling 8 to 12 hours, intermittently; repeated bending for 8-12 hours, intermittently; climbing and use of both legs and arms for 8-12 hours, intermittently, both legs required; near vision at 13 to 16" Jaeger 1 to 4, far vision correctable in one eye to 20/20 and to 20/40 in the other eye; ability to distinguish basic colors; hearing aid permitted; twisting, simply grasp and fine manipulation.

Education

IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

Contacts

• Address Fresno VA Medical Center 2615 East Clinton Avenue Fresno, CA 93703 US
• Name: Ieisha Freeman
• Phone: 4102304400
• Email: [email protected]