Palliative Care Registered Nurse / Linda Vista / FT (464)
Description
Job Title: Palliative Care Registered Nurse (Monday- Friday; 8AM-5PM)
Location: Linda Vista
Job Type: Full Time
Salary Range: $110,000- $140,000 (Based on experience)
Salary Range: $110,000- $140,000 (Based on experience)
About Us:
At Focus Health, we're reimagining primary care delivery in San Diego through an innovative, patient-centered approach that integrates specialized care directly into the primary care setting. As a growing foundation medical group, we're disrupting traditional healthcare models to create more accessible, comprehensive care for patients with serious illness.
Our embedded palliative care program represents a groundbreaking approach to supporting patients with serious illness, with a particular focus on dementia care and a plan to integrate other service lines in future phases. Our specialized care pod provides comprehensive support across the entire care continuum, primarily in our outpatient clinic setting while maintaining flexibility to support patients wherever they are in their journey. The pod model consists of a physician, nurse practitioner, social worker, RN, and MA.
Job Summary:
The Palliative Care Nurse serves as a clinical expert and care coordinator for patients with dementia or other serious illnesses requiring palliative care. This position plays a vital role in supporting comprehensive, patient-centered care across the continuum of care settings. Working within an interdisciplinary team that includes physicians, advanced practice providers, social workers, and chaplains, the nurse delivers expert palliative nursing care with a specialized focus on patients with serious illness. The role encompasses coordinating care transitions, managing symptoms, facilitating advance care planning, patient/family education, and serving as a resource to healthcare staff across multiple care settings.
Key Responsibilities:
Clinical Care
- Assess, facilitate, and coordinate new and existing patient access to full-scope palliative care services using Epic workflows
- Conduct comprehensive serious illness assessments, including physical symptoms, medication side effects, cognitive status, functional abilities, medication review, and psychosocial/cultural needs
- Collaborate with the palliative care team to implement triage criteria that prioritizes urgent patient needs
- Manage incoming referrals, determine eligibility, assess urgency, and input referrals into appropriate tracking systems
- Maintain an organized patient panel with stratification by acuity level to ensure appropriate resource allocation and follow-up frequency
- Prepare daily census accounting for patient changes and staffing needs
- Coordinate care transitions between inpatient, outpatient, and community settings
- Attend interdisciplinary rounds and contribute meaningfully to patient care discussions
- Develop and implement care plans that support patients in acute, sub-acute, home, telehealth and community settings to prevent unnecessary hospital admissions, including early identification of symptom escalation and appropriate interventions
- Identify families in crisis and follow established protocols to ensure their needs are addressed promptly
Clinical Care and Symptom Management
- Provide expert nursing assessment and interventions for symptom management in patients with serious illnesses
- Document all care accurately and timely in the electronic medical record according to departmental policies
- Oversee the management of patients in lower acuity levels of need by performing needs assessments and applying program interventions
- Apply non-pharmacologic management strategies for disease-related behaviors and provide caregiver education/support
- Participate in advance care planning discussions with elderly patients and families
- Complete documentation of advance directives and POLST forms
- Implement evidence-based interventions for pain and symptom management specific to older adults
- Communicate palliative care plans to referring providers and unit clinical teams to ensure recommendations are implemented
- Monitor moderate to distressing symptoms and report to palliative care physicians/APPs
- Facilitate family meetings to address goals of care and end-of-life planning
- Maintain regular contact with patients and families via telephone and in-person visits to address evolving needs
Patient and Caregiver Support and Education
- Serve as a resource to patient care units, outpatient clinics, and care staff regarding palliative care
- Identify learning needs of patient care staff and communicate these to program leadership
- Provide education to patients and families about palliative care options, advance care planning, and services available
- Make referrals to appropriate community-based services based on comprehensive needs assessment
- Develop and deliver educational presentations on palliative care topics to clinic staff
- Identify and communicate opportunities for quality improvement to program leadership
- Create and maintain educational resources for patients and families
Quality Improvement and Program Support
- Contribute to maintaining and updating program tools (questionnaires, assessment instruments)
- Create ad hoc reports for program leaders and team members as needed
- Set appropriate priorities among competing demands
- Identify barriers to optimal pain and symptom management in patients with serious illnesses
- Collaborate with team members to develop and implement quality improvement initiatives
- Utilize available information technology to support day-to-day work operations
- Meet weekly with interdisciplinary team to review patient panel and summarize interventions
- Follow clinic policies and documentation protocols (documentation and compliance)
Qualifications:
Education and Licensure
- Bachelor's degree in Nursing required
- Current Registered Nurse license in California
- Preferred or willingness to obtain certification in palliative care, dementia or hospice and palliative nursing (CHPN, ACHPN, or GRN)
- Minimum of 2-5 years clinical nursing experience
- Experience in an academic medical center or large community hospital preferred
- Demonstrated experience with patients with serious illnesses, patient assessments and symptom management
- Experience facilitating advance care planning conversations
- Experience with Epic electronic health record system preferred
Knowledge and Abilities
- Expert knowledge of evidence-based palliative care practices
- Strong understanding of pain and symptom management
- Knowledge of age-related physiological changes and their impact on medication management
- Excellent communication skills with ability to discuss sensitive end-of-life issues
- Ability to communicate clearly, patiently, professionally, and compassionately via telephone and written communications
- Strong organizational and critical thinking skills with ability to triage multiple competing priorities
- Ability to work independently while collaborating effectively with interdisciplinary teams
- Demonstrated skill in care coordination across multiple settings
- Cultural competency in providing care to diverse patient populations
- Proficiency with electronic health records, Microsoft Office Suite, and basic computer applications
- Ability to maintain patient confidentiality and adhere to HIPAA regulations
- Demonstrated skill in accurately assessing patient/family needs and identifying those requiring urgent intervention
- Demonstrate a commitment to professional development by staying current with evidence-based palliative care practices emerging research, and clinical guidelines.
- Actively seeks to integrate new knowledge into patient care workflows to ensure optimal outcomes and quality of life for patients and their families
Working Relationships:
- Reports to: Medical Director of Palliative Care
- Works collaboratively with: Palliative care physicians, APPs, social workers, chaplains, pharmacists, unit-based nursing staff, primary care teams, and care management staff
Physical Requirements:
- Ability to perform standard physical demands of clinical nursing role
- Capability to spend extended time sitting, standing, and walking between patient areas
- Ability to communicate clearly in person and by telephone
What We Offer:
- Comprehensive benefits package including healthcare, retirement plans, and paid time off
Join Our Quest: Ready to make a difference every day? We're calling on heroes like you to revolutionize patient care. Let's make healthcare history together!
Metis Practice Solutions is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, marital status, status as a protected veteran, or status as a qualified individual with disability.