Full Time LPN-LVN Job TX


4 days ago

Posted by: Defense Health Agency

Employer: Defense Health Agency

Job Description

The Dermatology/Neurology Department provides inpatient/outpatient treatment and diagnosis for members of the Armed Forces, their beneficiaries and training for dermatology resident physicians. Patients range from ambulatory to critically ill with a wide variety of dermatological disorders from simple skin irritations to skin carcinomas. Some procedures are unique to this facility; consequently patients from throughout the Department of Defense (DoD) receive treatment here. The aim of this position is to provide technical and specialized nursing care requiring a Licensed Vocational Nurse (LVN). Nursing care duties and responsibilities run a diverse spectrum, from care and treatment of patients to surgical/operating room procedures, with a patient range from pediatric to geriatric. 1. Performs direct patient care and care coordination activities such as referreal management, order reconciliation, and activity tracking. Documents patients' chief complaints and other pertinent information in the health record. Documentation will also include medication reconciliation, screening tools, and behavioral health intake surveys. Participates in promoting patient compliance with health activities in accordance with RESPECT-Mil. Coordinates and facilitates care coordination, communicates relevant information according to the medical plan of care and nursing assessment, and documents accordingly in the health record. 2. Provides primary support to Mohs micrographic surgeons before, during and after highly specialized skin cancer surgery. Pre-appointment responsibilities include: Reviewing Moh's record of patient to determine the reason for the procedure(s), pathology results, allergies, requirement for prophylactic medications (for patients with prosthesis, mitral valve problems, etc.) prior to the procedure. Documents in patients Moh's record appropriately as required by clinic standards. Calls all Moh's patients a week prior to procedure to review surgery date, pre-op instructions and medications. 3. Provides primary support to the dermatologist surgeon during all surgical procedures. Pretreatment/surgical responsibilities include: Preparation of treatment and surgical rooms by assembling and preparing necessary instruments, supplies and equipment required for the type of procedure scheduled. Receives and prepares patients reporting for examination, procedure or surgery. Assures that charts and necessary medical treatment records accompany the patient. Notes drug allergies and alerts surgeon to presence of pacemakers, anticoagulants, SBE prophylaxis. Preceding surgical procedures, prepares and delivers appropriate local anesthetic per clinic protocol, sets up sterile surgical instrument tray, prepares surgical site with appropriate antibacterial solution, positions and surgical drapes the patient and ensures proper lighting. During surgery, passes instruments and materials, maintains a sterile field (performs electrocautery, basic cutaneous suturing), assists in sharps and needle counts and appropriately disposes of contaminated materials. Checks working condition of equipment (lasers, lights, chairs, dermabrader, electrocautery) and contacts medical maintenance personnel as necessary to insure safe operating conditions. 4. Photographs the surgical site before and after surgery. Photographs are maintained as part of the in-house file. Immediate post-procedural duties include application of appropriate dressing with attention to size and location. Provide patient and family instructions for home care of the site. Daily post procedural responsibilities are wound/suture checks, care and cleaning of the surgical site, redressing and suture removal. Maintains surgical equipment inventory to ensure timely repair and replacement. Coordinates equipment purchases with department NCOIC. During wound check clinic, prepares the patient for physician evaluation by obtaining and documenting history and brief examination, performs patient triage. 5. Performs routine nursing care in the Dermatology/Neurology Clinic to include, but not limited to, taking vital signs, reviewing of medical history, chaperoning, and patient education. Observes the patient and alerts physicians of significant abnormalities in vital signs, symptoms and general physical and emotional condition. Completes initial walk-in patient screening. Assesses the individual situation, determines acuity of the patient and appropriate schedule and level of care needed, and seeks advice from Registered Nurse, Nurse Practitioner, Physician Assistant, or Medical Doctor as necessary. Instructs new LVN's, operating room technicians, military technicians and new dermatology residents on how to set up and assist with excision biopsies and Moh's layers. 6. Provides individualized nursing care to patients of all ages based upon the physician's medical care plan, the nursing assessment, and the physical, mental, and emotional needs of the patient. Assists physicians and surgeons during specialized diagnostic, therapeutic and surgical procedures, including punch, shave and excisional biopsies, Moh's layers, electrodessication, curettage, sclera-therapy, chemical peels, nail surgery, electro-surgery, dermabrasion and cryosurgical procedures of the skin. 7. Assists surgeons with laser surgery. Before surgery, sets up the laser surgery room, initializing warm-up of the laser surgery equipment and ensures that the proper gear is available. Prepares anesthesia prescribed by the physician. Physically prepares the patient for and provides psychological support. Post surgery, applies proper dressing to invaded site as ordered by the surgeon. Shuts down laser surgical equipment according to prescribed shut-down procedure. Insures that all equipment is accounted for before closing the surgical room. 8. Performs variety of tasks requiring nursing skills. Recognizes emergency situations and functions calmly and efficiently in supplying physicians with crash cart and with requested supplies and materials. Must be prepared to assist with cardioversion. Is familiar with patients complaints and concerns. Assesses patients condition and notifies the physician of changes in patients physiological and psychological parameters. Monitors vital signs. If patient becomes faint or nauseated, administers spirits of ammonia. Cleans, sterilizes and assembles instruments used in procedures. Serves as chaperone during exams of female patients. 9. Required to perform local anesthesia during minor dermatology and neurology procedures. The LVN will proceed under the guidance of the attending provider. Must be able to prepare the lumbar puncture kit for the neurologist prior to the scheduled procedure and ensure proper disposal of the equipment on completion of the LP. Assists in providing a suitable and comforting environment. (Many surgical procedures performed involve removal of cancers from the face, ears, neck and hands. Much of the equipment used is of space age design and totally foreign to the patient.) Counsels patients and supports the patient and/or family member(s) with emotional concerns. Reinforces instructions to the patient on procedures previously provided to the patient by the physician/surgeon. 10. Responsible for the surgical room, including performing general equipment maintenance, keeping stock of supplies, instruments and medical forms. Keeps stocks of medications and drugs, current and at working levels. Maintains the crash cart insuring that equipment is functional and that medications and drugs contained within are current and at working levels. 11. Performs tests and procedures basic to diagnostic laboratory work in dermatology, including bacterial, viral and fungal cultures of the skin. Prepares labels and takes specimens to the laboratory. Retrieves processed dermatology specimens and pathology reports from the laboratory. Files slides and maintains a log book with appropriate information. 12. The supervisor provides oversight during patch testing, phototherapy and galvanic treatments in absence of departmental photo/patch GS LVN. Maintain Fisher galvanic unit for iontophoresis and administer iontophoresis treatments under a physician's direction. Counsel patients about iontophoresis and schedule treatments. 13. As new technologies are adopted by the Department, the incumbent is responsible for learning the new techniques and becoming proficient in administering treatments and counseling patients about the new technology. Responsible for teaching existing and new technologies to technicians, nurse assistants, other nursing and medical personnel at the direction of the Chief of Dermatology and Neurology. 14. Administers phototherapy UVB, narrow band UVB, photo-chemotherapy. Schedules appointments for and administers sequential doses of photo-chemotherapy over time. Prepares the patient for therapy by providing first time orientation to the equipment used. Ensures that protective eyewear is worn by the patient. Makes sure that areas of the body that are not being treated with UV rays are always protected. On subsequent visits, check site of last treatment for possible complications. Reports any complications, problems or breaks in therapy to the patients physician. Calculates dosage of successive treatment from percent increases or decreases prescribed by physician. Administers therapy from calculated dosage. Ensures that chart in reviewed by supervising physician and notes changes in therapy ordered by the physician. Responsible for measurements of ultraviolet output and calibration of phototherapy units using ultraviolet meters. Responsible to document results of testing and report deviations from past readings to the supervising physician. Responsible for daily maintenance and pre-treatment burn-in of ultraviolet units. 15. Administers Patch Sensitivity Tests, prepares palette of reagents to be used for sensitivity test, as ordered by the physician. Prepares marks and applies test palette to patient, schedules and counsels patient. Prepares a log for physician on loci of reagents. Instructs patient on precautions and care of test site. Schedules patient for test reading by physician. Removes patches and ensures markings are maintained. Documents skin reactions at time of patch removal. Assists with final reading of patch tests. Documents skin reactions and relevance as noted by the supervising physician. Provides patient information regarding sources of allergens, cross-reactions and alternative products to replace those to which patient is sensitive. Schedules repeat testing of allergens as indicated by supervising physician. Maintains inventory of stocks of patch testing supplies and reagents. Coordinates ordering of replacement supplies and reagents with the clinic NCOIC. 16. Performs photosensitivity testing and MED (minimal erythemogenic dose) testing as ordered by a physician. Schedules testing, counsels patient, ensures eye protection is read. Documents light doses and immediate responses. Schedules follow-up reading and documents results of testing in medical record. 17. Performs both administrative and logistical tasks as a member of the healthcare team for the clinic by contributing to maintaining the environment and resources to deliver healthcare. Reviews expiration dates for medications, vaccines, and supplies; and initiates the reorder. Coordinates with designated clinic administrative staff for maintenance of adequate vaccines and supply levels. In the absence of the medical receptionist, assists with the responsibilities for checking patients into the system, completion of records and other clerical duties as assigned. Reviews laboratory results and brings abnormal results to the attention of the physician and per physician's instructions, telephones patients regarding any follow-up care that is required. Duties include the use of automated systems (i.e. Armed Forces Health Longitudinal Technology Application (AHLTA), Composite Health Care Syste,(CHCS), Medical Operational Data System (MODS)and the Medical Protection system (MEDOROS). Reviews chart for coding compliance and ensures all procedures are documented to obtain accurate capture or workload. Attends mandatory training as directed by supervisor or command. Will be trained in documenting adverse medication reactions in the VAERS or local system. Participates in and may coordinate performance improvement activities. PERFORMS OTHER DUTIES AS ASSIGNED Conditions of Employment - Appointment may be subject to a suitability or fitness determination, as determined by a completed background investigation. - A Personnel Security Investigation is required. - This position may have specific initial background investigation and periodic re-verification requirements since its duties may require interaction with children and youth under the age of eighteen (18) years of age on a recurring basis. - Selectees may be required to sign a statement (Condition of Employment) consenting to seasonal influenza vaccinations or must provide a recognized exemption. - This position is a Testing Designated Position subject to pre-employment screening and random drug testing. Selectees will be required to consent to participation in random drug urinalysis testing. - A pre-placement medical examination may be required. - Immunization screening may be required. Hepatitis B immunization is required for all positions with direct patient contact. Applicants may be required to show proof of other immunizations depending on the type of position. - May be required to obtain and maintain current Basic Life Support (BLS) certification through the American Red Cross or American Heart Association. Advanced certification (e.g., ALS) does not supersede BLS. - May be required to obtain and maintain certification in Pediatric Advanced Life Support (PALS). - May be required to obtain and maintain certification in Advanced Cardiac Life Support (ACLS). - May be required to obtain and maintain certification in Neonatal Resuscitation Program (NRP). - This position may include shift work (evenings, weekends, holidays). - This position may require rotating shifts (i.e. work schedule that requires employees to continuously rotate from one shift to another at predetermined intervals). - This position may require the incumbent to work during irregular work hours which may include evenings, weekends, holidays, and/or varying work schedules. - This position may require the incumbent to work on call during irregular work hours which may include evenings, weekends, holidays, and/or varying work schedules. - This position may require the incumbent to work weekends and/or holidays. - Moderate to heavy lifting may be required. - This position may require the incumbent to have tuberculosis testing. - Additional requirements may be determined as positions arise and will be communicated during the hiring process if you are selected. - Applicants must be able to fulfill non-privileged professional credential requirements.

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