The HospiceCare Registered Nurse Hospital Case Manager organizes and directs hospice care in the hospital setting and is experienced in nursing, with emphasis on community health education/experience.  The professional nurse builds from the resources of the community to plan and direct services to meet the needs of individual and families within their homes and communities.

1. Completes an initial, comprehensive and ongoing comprehensive assessment of patient and family to determine hospice needs.  Provides a complete physical assessment and history of current and previous illness(es).
2. Provides professional nursing care by utilizing all elements of nursing process.
3. Assesses and evaluates patient’s status by:
   1. Writing and initiating plan of care
   2. Regularly re-evaluating patient and family/caregiver needs
   3. Participating in revising the plan of care as necessary
4. Initiates the plan of care and makes necessary revisions as patient status and needs change.
5. Uses health assessment data to determine nursing diagnosis.
6. Develops a care plan that establishes goals, based on nursing diagnosis and incorporates palliative nursing actions.  Includes the patient and the family in the planning process.
7. Initiates appropriate preventive and rehabilitative nursing procedures.  Administers medications and treatments as prescribed by the physician in the physician’s plan of care.
8. Counsels the patient and family in meeting nursing and related needs.
9. Provides health care instructions to the patient as appropriate per assessment and plan.
10. Assists the patient with the activities of daily living and facilitates the patient’s efforts toward self-sufficiency and optional comfort care.
11. Acts as Case Manager when assigned by Clinical Supervisor and assumes responsibility to coordinate patient care for assigned caseload.