Hospice Nurse Practitioner

The Hospice Nurse Practitioner (NP) is responsible for providing advanced clinical assessment, symptom management, and palliative care services to hospice patients in collaboration with the Hospice Medical Director, attending physicians, and interdisciplinary group (IDG).

The NP serves as a clinical resource to staff, patients, and families; conducts face-to-face encounters required for hospice eligibility determinations and recertifications; participates actively in interdisciplinary care planning; provides hospice education and mentoring to clinical staff; and participates in after-hours and weekend on-call coverage as assigned.

The Hospice Nurse Practitioner promotes quality end-of-life care through effective symptom management, timely clinical interventions, collaboration with the interdisciplinary team, and adherence to hospice regulations and organizational standards.

This role supports continuity of care and ensures patients receive individualized, compassionate care consistent with hospice philosophy.

PRIMARY JOB DUTIES

Provide advanced assessment, evaluation, and management of patient symptoms related to terminal illness, including pain, dyspnea, agitation, nausea, anxiety, wounds, and other end-of-life symptoms.

Conduct hospice eligibility and recertification Face-to-Face (F2F) encounters in accordance with Medicare Conditions of Participation and organizational policies.

Collaborate with the Hospice Medical Director and attending physicians regarding eligibility determinations, symptom management recommendations, medication adjustments, and changes in patient condition.

Participate in the development, review, and revision of individualized plans of care in collaboration with the interdisciplinary group, patient, and family.

Attend and actively participate in interdisciplinary group (IDG) meetings, providing clinical recommendations and support related to patient care needs, hospice eligibility, symptom burden, and disease progression.

Order, prescribe, and adjust treatments, medications, and interventions within the scope of licensure and collaborative practice agreements.

Provide patient and family education regarding disease progression, symptom management, medication administration, goals of care, and hospice services.

Serve as an educational resource for clinical staff by providing mentoring, training, competency support, and evidence-based hospice and palliative care education.

Assist with clinical case reviews, documentation audits, quality improvement initiatives, and regulatory readiness activities as requested.

Provide after-hours, weekend, and holiday on-call coverage as assigned, including telephonic consultation and in-person patient visits as clinically indicated.

Support transitions between levels of hospice care, including routine home care, continuous care, respite care, and general inpatient care.

Maintain accurate, timely, and complete clinical documentation in accordance with Medicare regulations, state requirements, and organizational policies.

Demonstrate positive interpersonal relations and effective communication with patients, families, physicians, referral sources, and all members of the interdisciplinary team.

• 1.0 45% QUALITY OF WORK
• 1.1 15%

Effectively assesses, evaluates, manages patient symptoms and clinical needs, ensures accurate and timely eligibility as evidenced by:

• Completion of comprehensive advanced assessments during patient visits.
• Timely implementation of symptom management interventions.
• Appropriate medication recommendations and adjustments.
• Communication of significant findings to physicians and the IDG.
• Documentation supporting clinical decision-making and plan of care updates.
• Support of patient comfort, quality of life, and goal-concordant care.
• Assessing the patients’ and family/caregivers’ physical, psychosocial, bereavement, environmental, safety, and developmental needs.
• Provide support, instruction, and education of the patient, family and other caregivers who participate in the care of the patient in relation to needs identified on the plan of care, including, but not limited to: disease process and progression, medications, pain, symptoms associated with disease, oxygen safety, hospice philosophy, and care of the terminally ill.
• Completion of required Face-to-Face encounters within regulatory timeframes.
• Thorough documentation supporting terminal prognosis and continued hospice eligibility.
• Effective collaboration with physicians regarding recertification recommendations.
• Appropriate identification of patients requiring eligibility review.
• Compliance with Medicare and agency documentation requirements.
• 1.2 15%

Effectively and efficiently assists in the care of hospice patients and assists in the coordination of care with the interdisciplinary team.

• Active participation in IDG meetings.
• Timely communication regarding patient condition changes.
• Collaboration with nursing, social work, chaplaincy, hospice aides, and physicians.
• Recommendations that support care plan development and patient outcomes.
• Contribution to coordinated, patient-centered care.
• Maintains open communication and coordination of care, acting as a liaison between hospice medical provider, patient/family, and hospice team.
• Performs ongoing assessment of the patient based on the Plan of Care and communicates findings to the Hospice Physician and other interdisciplinary team members as appropriate.
• Performs and reports on assessment findings of the patient’s pain and other undesirable symptoms to the Hospice Physician in a timely manner.
• Maintains an accurate and updated medical record, including all coordination of care notes, on-going assessments, communications with others involved in patient care, and any other information pertinent to the care of the patient.
• Ensures that arrangements for equipment and other necessary items and services are available.
• Reports abuse and neglect in accordance with state laws and regulations as well as organization policy and procedure.
• 1.3 10%

Appropriately communicates information in accordance with agency policies and procedures and discipline specific guidelines.

• Documents assessments, identified problems, measurable goals of care, and limitations to provision of care, care interventions, and response to care in the electronic medical record.
• Documents all patient related visits and phone calls within the EMR and ensures documentation is completed and synchronized after visit completion.
• Completes, maintains, and submits accurate and relevant notes regarding patient’s condition and care given.
• Records pain/symptom management changes/outcomes as appropriate.
• Documents and signs all orders received within the EMR.
• Consults and collaborates with the hospice interdisciplinary team and others involved in the patient’s care.
• Maintains close contact with the patient’s family/caregiver to provide information, support, and continuity of care.
• Maintains collaborative relationships with long-term care facility personnel to support patient care and ensure quality symptom management.
• 1.4 5%

Contributes to program effectiveness as evidenced by

• Participation in staff orientation and onboarding activities.
• Provision of clinical education and mentoring to staff.
• Assistance with competency validation and skill development.
• Support of evidence-based hospice practices.
• Availability for consultation regarding symptom management and hospice eligibility questions.
• Provides holistic, patient/family-centered care across treatment settings to ensure continuity of care and facilitate attainment of goals of care.
• Provides medication review and reconciliation of medication list within the EMR. Ensures medications necessary to ensure patient comfort are available.
• Maintains a high level of knowledge pertaining to the management of pain and symptoms in the dying process.
• Assumes responsibility for personal growth and development and maintain and upgrade professional knowledge and practice skills through attendance and participation in continuing education and in-service classes and completion of required annual training.
• Actively participates in quality assessment, performance improvement teams and activities.

2.0 30% EFFICIENCY AND EFFECTIVENESS

• 2.1 20% Organizes and performs work effectively and efficiently as evidenced by:
• Scheduling self to reduce driving time and mileage and utilizing resources to prevent duplicate driving or trips by determining if others are in the area.
• Ordering only supplies that are needed and is conscientious of minimizing on-hand inventory.
• Ensuring provision of medical supplies is limited to only what is needed in the home.
• Assessing and cleaning medical supply care boxes, bags, and electronic devices every month, maintaining appropriate documentation
• Practicing personal cost containment by responsible use of equipment, supplies, and resources.
• 2.2 10% Maintains and adjusts schedule to enhance team performance as evidenced by:
• Reporting to work on time and returning promptly from errands, breaks, and meals.
• Managing personal work schedule and time off to promote smooth agency operations.
• Assisting other team members to ensure completion of all work assignments.
• Demonstrating flexibility with changing workload/assignments.
• Does not exceed accrued PTO or qualified leave of absence(s). * Cannot exceed

3.0 25% TEAMWORK, MISSION, VISION, VALUES

3.1 25% Demonstrates positive interpersonal relations in dealing with all members of the team (i. e. co-workers, supervisors, physicians, etc.) as evidenced by:

• Responding to all customers in a courteous, sensitive, and respectful manner.
• Demonstrating respect for team members.
• Managing stress and personal feelings without a negative impact on the team
• Working collaboratively and cooperating with other departments.
• Completing the review period without any formal disciplinary action.
• Presenting a clean and neat appearance in personal attire and one’s work area.
• JOB SPECIFICATIONS

1. Education: Graduate of NLN accredited school of nursing and current license to practice professional nursing as a Registered nurse in the state; bachelor’s degree preferred.

Licensure / Certifications: Must have current Registered Nurse license in NC, active and legal driver’s license with an automobile that is insured in accordance with state or organization, and a current American Heart Association CPR certification.

3. Experience: Minimum of one years' clinical experience required; hospice experience preferred.

Essential Technical/Motor

Skills: Working knowledge of Word, E-mail, typing of 30 wpm, basic technical or medical knowledge of home health billing requirements.

Advanced customer service skills to respond with simple answers, etc.

5. Interpersonal Skills: Ability to work independently as well as effectively as part of an interdisciplinary team.

6. Essential Physical Requirements: Intermittent physical activity including walking, standing, sitting, lifting, and supporting patients

Essential

Mental

Abilities: Ability to concentrate with large volumes of paperwork and data entry, handle pressure of deadlines, good judgment, ability to organize and prioritize workload independently.

Emotional/mental stability and stamina

8. Essential Sensory Requirements: Keen observation skills.

9. Exposure to Hazards: May be exposed to virus, disease and infection from patients and specimens in working environment.

10. Other - Hours of Work: To be determined with supervisor, some on-call required in rotation, including weekends and holidays.

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