JOB DESCRIPTION - ENDOSCOPY NURSE SUMMARY: The Endoscopy Nurse is responsible for assisting the physician and delivering direct/indirect patient care to those patients requiring endoscopic procedures. QUALIFICATIONS: 1. Graduate of an accredite school of professional nursing. 2. Currently licensed as a nurse in the State of Texas. 3. Special training and/or experience in endoscopic procedures. 4. Good communication and listening skills. 5. Has self-direction in improving and acquiring the abilities and skills necessary to enhance job performance. 6. Provide evidence of good health. PERFORMANCE REQUIREMENTS AND FUNCTIONS A. Assessment: 1) Use endoscopy checklist and patient interview to make initial patient assessment. 2) Reduce patient anxiety by explaining all procedure thoroughly in in a calm and reassuring manner. 3) Assess patient knowledge regarding procedure. B. Planning and Implementation: 1) Maintain room in state of readiness for procedure(s). 2) Transport patient by appropriate safe mode according to patient needs. 3) Position patient ensuring safety and proper body alignment. 4) Drape patient ina manner which adequately exposes the site, but ensures patient privace. 5) Maintain a controlled environment. 6) Assist physician within the standards of nursing practice set forth by the S.G.N.A. 7) Perform nursing actions consistent with established policies and procedures when providing direct/indirect patient care. 8) Establish and maintain open communication with patient (S.O.). 9) Monitor patient's condition and maintain accurate documentation, pre-procedure, during procedure and post-procedure. 10) Handle specimens appropriate and label correctly. 11) When implementing nursing actions, use time, effort and material economically. 12) Communicate pertinent information within appropriate time span to healthcare team. 13) Responsible for maintaining instruments and equipment and reporting when malfunctioning is noted. 14) Understand role/responsibilities in Emergency Action Plans and respond appropriately. 15) Maintain a safe and therapeutic environment for patient and self. 16) Assist with admission and discharge of patient in Endoscopy Unit. 17) Prioritize daily activities according to Endoscopy Department needs. C. Evaluation: 1) Evaluate patient care notifying Clinical Director of information received from physician and patient/S.O. D. Other Related Duties: 1) Supervise scheduling for endoscopy procedures. 2) Assist with training of new Endoscopy staff. 3) Maintain appropriate statistics/records. 4) Assist with Quality Assurance program, pertinent to Endoscopy Department. PROFESSIONAL RESPONSIBILITIES: 1. Assurme responsibility for ensuring continued professional growth by: a) annual recertification in CPR b) completion of mandatory education c) compliance with CEU requirements (24 biennium) d) seek education resources to maintain currency in area of practice. 2. Comply with attendance policies. 3. Dress according to defined code. 4. Maintain confidentiality. 5. Demonstrate a positive approach to interpersonal relationships with patients/S.O and other members of the health care team. 6. Channel suggestions, criticisms, and questions to appropriate individuals. 7. Accept and act on constructive criticism to upgrade professional abilities. 8. Respond appropriately to emergency situations. 9. Recognize legal responsibilities and function within limitations as specified by law. 10. Attend monthly Endoscopy nursing staff meetings. 11. Assume additional responsibilities as neessary. RESPONSIBLE TO: The Endoscopy Nurse is responsible to the Clinical Director JOB DESCRIPTION - LICENSED PRACTICAL NURSE POSITION: Licensed Practical Nurse QUALIFICATIONS: 1. Graduate of an approved school of practice nursing. 2. Current license to practice practical nursing in Texas 3. C.P.R. certificate or as per AEC policy. 4. Completes IV medication course as per AEC Policy. 5. Completes cross training process in Gastroenterology Department Same Day Surgery Department. REPORTS TO: Clinical Director PURPOSE: To assist the physician performing endoscopic procedures. To deliver nursing care pre/post procedure as delegated by the Registered Nurse. To deliver pre/post operative surgical nursing care to the Same Day Surgery patient as delegated by the Registered Nurse. RESPONSIBILITIES: 1. Assist physician during endoscopic procedures as delegated by the Registered Nurse. 2. Delivers care to patients pre and post procedure under the supervision of the Registered Nurse. 3. Maintains endoscopic instruments in working order pro/post procedure. 4. Administers medications accurately. 5. Demonstrates reliability. 6. Adapts to specialized assignment requests for Unit. 7. Attends mandatory inservice programs. 8. Performs other duties as assigned. RESPONSIBILITIES: 1. Assists physician during endoscopic procedures as delegated by the Registered Nurse. a) Assists in preparing endoscopy suite and instruments. b) Assists physician during procedure. c) Monitors patient during procedure under the direct supervision of the Registered Nurse. d) Completes Endoscopy Procedure Sheet. 2. Delivers care to patients pre and post procedure under the supervision of the Registered Nurse a) Monitors vital signs. b) Completes post procedure nurses' notes. c) Assists patients for discharge, reinforces teaching. d) Assists patient with nourishment. e) Maintains patient confidentiality. 3. Maintains endoscopic instruments in working order, pre/post procedure. a) Checks all instruments prior to procedure. b) Maintains equipment after each procedure e.g., prepares and/or cleans equipment according to infection control guidelines and manufacturer's guidelines. 4. Administers medications accurately. a) Reviews medication kardex and medication cart for supplies. b) Determines needs for an documents blood pressure, pulse, apical rate, lab work, etc., prior to medication administration. c) Follows EC policy, procedures and protocol for scheduled medication administration. d) Determines need for prn medication, administers prn medication, documents in complicane with established protocol. e) Assesses patient for adverse medication reactions. Informs Charge Nurse of observation; documents information accurately. f) Administers IV piggy back medication after appropriate instruction. JOB DESCRIPTION - LICENSED PRACTICAL NURSE TITLE: Licensed Practical Nurse REPORTS TO: Clinical Director 1. NATURE OF POSITION A. Basic Function: This position is part of a nursing team which provides nursing services, coordinates patient care activities, and assists the medical staff in the Endoscopy Center utilizing the team approach in meeting the total needs of the patient through intensive observatin, highly specialized and techincal skills and immediate capability of initiating emergency treatment and decisions. Functions as supporting team member on the nursing team by administering treatments, medications, and assisting with the planning and implementing of individual patient care programs. B. Functions Performed: 1. Contributes to the development, implementation and evaluation of individual nursing care plans and programs consistent with the provision of quality nursing care based on the total needs of the patient. Observes, interprets, and reports to designated team members any significant change of conditions, information relating to the total needs of the patient, and related observations. Implements, under direction and supervision, that part of the nursing care plan within the scopy of responsibility and training, and under direct supervision, assists Nurse Specialist with those areas of the nursing care plan which exceeds training and scope of responsibility. 2. Develops a good rapport with patients and medical staff conducive to their well being and the alleviation of psychological manifestations such as fear and anxiety and the acceptance and understanding their procedure and illness conducive to their stay in the area. Provides orientation, instruction and information to patients, and/or patient's families related to the patients stay in the area in order to gain an acceptance of the purpose of the area and the specialized care. Provides not only physical, but emotional support to patients and/or families. 3. Provides continuous intensive observation of patients and reports any significant changes in their condition. Connects designated patients to special monitoring equipment and observes monitors for significant changes. Observes and interprets patient vital signs, visual signs, fluid, and electrolytes balance in assisting with the evaluation of the patient's condition. Recognizes the need and initiates pre delegated physician's instruction related to cardiopulmonary resuscitation and Post Anesthesia Room orders. 4. Administers medication orally, intramuscularly, subcutaneously, intradermally and assists the Nurse Specialist with the infusion of intravenous medications. Exercies knowledge of the pharmacology of drugs common in this area. Administers continuous intravenous fluid therapy utilizing special titration procedures under specific direction of the Nurse Specialist or physician. Administers emergency medications (e.g., Xylocaine, Isuprel Narcotics) under the direct supervision of the Nurse Specialist or physician. 5. Administers a variety of patient treatments and special procedures utilizing specialized skills and training unique to this area. Utilizes aggressive and assertive approach to patient treatment and involving coughing, deep breathing, ventilators and suctions when the assessment of treatment was unsatisfactory. Initiates assisted respirations as needed. 6. Operates, under the supervision of the Nurse Specialist, a variety of specialized equipment requiring special knowledge, skills and training. Sets up and uses a variety of monitoring equipment and interprets data obtained. Sets up and assists with the operation of the defibrillator Identifies and reports any equipment not functioning properly. 7. Assists in the maintenance of appropriate and necessary records related to the effective implementation of patient care and the proper utilization of the team approach. Maintains a variety of records verifying the level of care regquired to meet the total needs of the patient. Maintains accurate, concise, meaningful records of the nursing and medical care given to individual patients to assure continuity among the nursing shifts, historical records and to assist in evaluating the level of care given. Assist in requisitioning replacement equipment, supplies and medication as needed. 8. Provides assistance, instruction, and orientation to non- professional and professional team members in the accepted Post-Anesthesia room nursing practices, procedures and techniques. Orients and instructs new professional and non-professional personnel temporarily assigned, students and visiting personnel. 9. Performs a variety of activities consistent with the team concept of "total patient care". 10. Maintains the area in a clean and orderly manner. Cleans transport carriers an changes linen following patient discharge. Assists in washing and scrubbing equipment and maintains work areas and storage areas in a clean and orderly condition. Stocks the assigned area daily and contributes to the over all stocking of materials within the area. 11. With an awareness of the high stress which is characteristic of this area, contributes to the development and maintenance of a positive work climate. Provides counsel, and support to patient's, families and nursing team members Maintains good rapport and communication between medical staff and nursing team members. Establishes own personal goals related to present position and team goals and explores ways in which each of these goals might be achieved. Contributes to the development and setting of goals for the Post-Anesthesia Room of which this position is a part. 12. Continually increases knowledge and skills related to new Innovations and developments in Post Anesthesia Room care and applies these concepts, techniques and skills through nursing practice. 13. Performs other functions and accepts additional responsibilities as assigned by supervisor. Performs relief or fill in assignments as required and rotates shifts as necessary. II. SPECIAL REQUIREMENTS A. Education: Requires graduation from high school and completion of one (1) year practical nurse training, and current Texas State registration as a Licensed Practice Nurse. B. Experience: Desire a minimum of six (6) months general nursing experience although a recent graduate may be accepted who has demonstrated the necessary academic preparation and desires to participate in the assertive and aggressive approach to patient care. C. Knowledge: Requires specialized Post Anesthesia Room nursing techniques, skills, and knowledge unique to this area. Requires knowledge of the specialized equipment, including proper use and care. III. SUPERVISION A. Immediate Supervisor Functions under the supervision of the Clinical Director B. Supervision Received: Receives assignments, instructions, and evaluation of the quality of functions performed from the Supervisor. The Nurse Specialist for the unit may request assistance, recommend duties or provide instruction when necessary. 5. Demonstrates reliability a) Reports or work at designated time; leaves at designated time. b) Limits lunch break to 30 minutes, coffee break to 15 minutes. c) Provides proper notification for absence or tardiness. d) Does not abuse or take advantage of sick time. 6. Adapts to specialized assignments/requests for unit. a) Demonstrates support of DDS policies b) Demonstrates flexibility to meet staffing needs of unit c) Participates in unit staff meetings. 7. Attends mandatory inservice program. a) Attends Fire Safety program annually. b) Attends Infection Control Insrevice program annually. c) Attends C.P.R. update program annually. d) Attends Licensed Practial Nurses Development programs. e) Identifies own learning needs and communicates need to Nurse Manager. f) Practices within scope of professional limitations. 8. Maintains the area in a clean and orderly manner. a) Cleans carriers and change in an orderly manner. b) Assists in washing and scrubbing equipment and maintains work areas and storage areas in a clean and orderly condition. c) Stocks the assigned area daily and contributes to the over all stocking of materials in the area. 9. Performs other duties and accepts additional responsibilities as assigned by supervisor. JOB RESPONSIBILITIES OF LICENSED PRACTICAL NURSE QUALIFICATIONS: Licensed as Licensed Practical Nurse in the state of Texas. GI experience preferred. Completed level II medical course. RESPONSIBLE TO: Clinical Director RESPONSIBILITIES: 1. Maintains the endoscopy equipment, accessoried and supplies as directed. To ensure proper use, functioning and infection control. 2. Has knowledge of infection control measures within the endoscopy unit. This includes equipment, personnel protection, the unit itself, waste disposal and patient protection. 3. Is CPR certified. 4. Completes the required nursing documentation for patients undergoing endoscopy procedures. 5. Assures responsibility for continuing education. 6. Encouraged to become members of their professional nursing organization. 7. Reports all unusual occurrences promptly. 8. Supports the asst. policies consistently. 9. Attends monthly staff meetings. 10. Assists physicians with endoscopy procedures. 11. Assesses patients and delivers appropriate care, initiating physicians order pre, during and post procedures, documents actions and responses. 12. Demonstrates reliability showing ability to be prompt concerning hours of work. 13. Does not abuse or take advantage of sick time. 14. Demonstrates flexibility to meet staffing needs. 15. Attends and participates in inservice programs. 16. Must be in good physical and emotional health. 17. Must be able to assist patients on and off stretcher and move occupied stretchers about endoscopy unit. **************************************************************************** I have read the above job description and will abide by these standards. The evaluation period will be a three (3) month probationary period and a yearly annual evaluation. ________ Employee's signature DATE JOB DESCRIPTION - NURSE SPECIALIST - PACU TITLE: PACU Nurse AREA: Post Anesthesia Care Room 1. Nature of Position: A. Basic Function: This position is part of a nursing team which provides nursing services, coordinates patient care activities, and assists the medial staff in the Post Anesthesia Room, a highly specialized area utilizing the team approach to meeting the total needs of the patient requiring intensive observation, highly specialized and technical skills and immediate capability of initiating emergency treatment. Primary responsibilitiy is to function as a highly trained "nursing specialist" in intensive post anesthesia care and cardiovascular care. Functions as a team member on a nursing team which involves working very closely with other professional and non-professional members of the multi-disciplinary patient care team, implementing and evaluating individual patient care programs. B. Functions Performed: 1. Responsible for the preparation and implementatin of individual nursing care plans during patient's stay in the area based on assessment of patient's condition before, during and after surgery. Assures quality nursing consistent with the total needs of the individual patient based on continuous evaluation of patient's condition and the level of care being provided. 2. Develops a good rapport with patients and/or families conducive to their well being and the alleviation of psychological manifestations such as fear, anxiety and the acceptance and understanding of their illness conducive to their stay in the area. Provides orienttion and instruction including pre-operative visits to patients and/or patients families related to patients stay in the area and in order to gain acceptance and understanding of the purpose of the area and the specialized equipment. Provides not only physical, but emotional support to patients and/or families. Upon patient transfer to other nursing units, provides staff of the receiving unit sufficient information by which understanding and acceptance of patient's condition and continuity of care can be made. Utilizes members of the multi-disciplinary patient care team to assist patients and/or families. 3. Performs a variety of nursing functions requiring a high degree of professional knowledge and judgement based on intesive observation. Provides continuous observation and evaluation of patient's condition by means of vital signs, special monitoring equipment, visual signs, pathophysiology, fluid and electrolyte balance. Notifies physician of any significant change in patients conditions including interpretation of output from special monitoring equipment. Exercises a high degree of independent nursing judgements in determining when pre-delegated physicians instructions should be implemented based upon significant changes in patient's condition; including "during surgery" observation and evaluation with the surgeon of patient's surgical correction, pathology and physiology. Exercises knowledge of the pharmacology of drugs, principles of treatments, diagnostic and monitoring devices based on an understanding of the current accepted concepts of nursing in intensive and coronary care and post anesthesia care. Transcribes physician orders and assures timely implementation. Utilizes the physician-nurse team approach in assuring that physician orders are properly understood, interpreted and implemented. Administers emergency medications, treatments, and utilizes special equipment based on evaluation of patient's condition e.g., cardiac monitoring, closed chest cardio-pulmonary resuscitation, assisted ventilation, respiratory maintenance, electrical pacing, countershock, hypothermia and hyperthermia, arterial and venous pressure monitoring and the intra-aortic balloon pump. 4. Provides assistance, instruction, and orientation to other professional and non-professional team members in the accepted post anesthesia care nursing practices, procedures, and techniques. Orients and instructs new personnel, personnel temporarily assigned, students, and visiting personnel. Provides instruction related to new and unusual procedures and/or equipment insuring adequate level of performance during emergency procedure. Provides instruction and technical assistance to other areas of the EC as needed. Participates in in-service education programs both in general and in those designed especially for the area. 5. Operates a variety of specialized equipment requiring special knowledge, skills and training. Initiates the use of a variety of monitoring and ventilator equipment and interprets the level of proficiency and data obtained. Operates a variety of other equipment most common to this area, e.g., defibrillator, respirators, hypothermia, and similar equipment. Identifies and reports any equipment not functioning properly to assure prompt repair or replacement. 6. Maintains appropriate and necessary records related to the effective implementation of the patient care plan and the proper utilization of the team approach. Observes, records, and reports to appropriate nursing and medical personnel patient symptoms, reactions, and progress. Maintains a variety of records verifying the level of care required to meet the total needs of the patient. Maintains accurate, concise, meaningful records of the nursing and patient care given to individual patients to assure continuity among the nursing shifts, historical records, and to assist in evaluation the level of care given. Requisitions equipment, supplies and medication as ordered and needed. 7. With an awareness of the high stress which is characteristic of this area, contributes to the development and maintenance of a positive work climate. Provides counsel, and support to patient's families and nursing team. Establishes own personal goals related to present position and explores ways in which each of these goals might be achieved. Contributes to the development and setting of goals for the nursing care unit of which this position is a part. 8. Continually increases knowledge and skills relative to new innovations and developments in post anesthesia and coronary care and applies these concepts, techniques, and skills through nursing practice and team instruction. Serves as a nursing consultatnt to other areas of the AEC and acts as a resource for both medical and paramedical personnel. 9. Performs other functions and accepts additional responsibility as assigned by the Supervisor or delegated Supervisor of the area. II. SPECIAL REQUIREMENTS A. Education: Requires graduation from an accredited School of Nursing, and current Texas State registration as a Registered Professional Nurse, and completion of a recognized Critical or Coronary care course. B. Experience: Minimum of two (2) years experience of intensive nursing efforts in highly skilled areas is preferred, new graduates which excel in assertive techniques in patient care and with the ability to encompass numerous techniques particular to this area will be considered. C. Knowledge: Requires highly specialized Post Anesthesia/Cardio-Vascular nursing skills, techniques, and knowledge unique to this area of the EC. Requires special knowledge of the location and operation of the specialized equipment foudn in this area. Requires an awareness of the medicolegal aspects of aggressive and assertive patient care. Requires the ability to analyze complex technical information and to use discretion and exercise independent action. Requires the understanding and application of human relations skills in daily practice. III. SUPERVISION A. Immediate Supervisor: Functions under the supervision of the Clinical Director B. Supervision Received: Clinical Director is responsible for making assignments, proving instruction, and evaluating the quality of work performed. Provides and/or obtains the specialized knowledge or skills to solve unusual nursing care problems.