Registered Nurse

POSITION SUMMARY

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The Registered Nurse - Chronic Disease Education is an integral member of a collaborative interdisciplinary primary health care team. They are responsible for provision of prevention, education, care and support services for clients of the Diabetes and Heart Health Program. Activities include client assessment and care planning, chronic disease self-management education and support (individual and group), and prevention activities in the community utilizing the population health promotion model, in-service education for other professionals, administrative responsibilities, and research/evaluation. Clients include individuals, families, groups, communities and health care providers.

The Nurse IV recognizes and fulfills their professional responsibilities by practicing in a manner consistent with professional obligations to take actions as per the Canadian Nurses Association Code of Ethics for Registered Nurses and Registered Psychiatric Nurses, The College of Registered Nurses of Manitoba Standards of Practice for Registered Nurses, the scope of practice as defined by the Registered Nurses Act, and other Provincial and Federal legislation.

RESPONSIBILITIES:

Overview:

Supports the client in self-management of chronic disease. Applies the nursing process by: assessing the needs of clients, families, groups and communities considering the determinants of health, age and developmental stage, physical and psycho-social health status; analyzing, developing and implementing a plan of care; and evaluating outcomes based on professional judgment and skills to guide decision-making for the delivery of client care/ services through various methods. Employs health promotion, health education, motivational interviewing, behaviour change, and harm reduction strategies to support behavioural changes conducive to health ( smoking cessation, physical activity, healthy eating and mental wellbeing) jointly with the client, defining and incorporating these strategies into the health plan.  Provides group education presentations and facilitation activities. Assesses for risk factors for developing chronic diseases, and for the signs and symptoms of complications of diabetes and other chronic diseases according to clinical practice guidelines, facilitating referrals as appropriate. Provides care that is culturally competent and respectful of diversity ( economic and social status, race, culture, belief systems, and sexuality). Practices as a member of a collaborative inter-disciplinary team, including being a liaison, consultation, routine and priority reporting, and referral as required. Consults with and refers to other members of healthcare team when client needs exceed level of competence or scope of practice. Collaborates with partners to promote and support the adoption of clinical practice guidelines for the management of chronic disease management. Reviews client medications in accordance with regional policy. Identifies and addresses client learning needs and readiness. Practice is consistent with professional standards of practice, codes of ethics and current knowledge, including clinical practice guidelines for major chronic diseases. Completes documentation according to nursing standards and PMH regional and program policies and guidelines, including reports to other health providers as appropriate, including the client’s primary care provider (MD or NP). Encourages maximum independence and accountability for self-care according to the client’s capacity. Acquires and maintains a comprehensive understanding of health/social services and referral processes including: diagnostic services, specialists, hospital care, rehabilitation and support programs, education programs and community based health services and agencies; refers clients and/or coordinates services as required. Responds appropriately in crisis situations. Prioritizes workload effectively. Completes administrative requirements as required. Protects the confidentiality of information in accordance with the Personal Health Information Act. Monitors and orders necessary supplies and medications. Ensures clinical equipment is in working order and addresses any malfunctions or deficits. Participates in the orientation and training of new staff. Provides supervision, mentorship, orientation and teaching opportunities to students, ensuring that program goals and objectives are met. May be asked to assist other programs in accordance with provincial protocols and regional policies and procedures ( Acute Care, Public Health Nursing, Home Care, and Mental Health). Participates in research activities and utilizes results in evidence-informed practice. Informs manager of any unsafe acts, working conditions, incidents, near misses, injuries or illnesses, workload issues, issues of a political nature or media interest. Other duties as assigned.

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