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Registered Nurse - Med Surg

Company: Center for Health Care Services
Location: San Antonio
Posted on: March 19, 2023

Job Description:


Extended Observation Unit (EOU) Registered Nurses (RNs) are responsible for triaging MEDCOM phone calls and assuring patients are appropriate for the unit and coordinating with leadership. This position deals with high acuity consumers by providing crisis screening and assessments. Josephine Recovery Center (JRC) RNs are responsible for admissions of patients into the unit. Both EOU and JRC Registered Nurses provide professional nursing services for consumers, assist with laboratory, EKGs and other medical treatments, psychosocial, and make assignments to LVN and unlicensed staff. Maintain pharmaceutical oversight of medication samples, and completes associated documentation for the consumer and program, and must be capable of providing psychiatric emergency services New nurses will be assigned a home station where the majority of their time will be spent however they will be cross trained to be able to float between the 24/7 operation sites to include Detox, Crisis Center and the Crisis Step Down Unit JRC. The Crisis EOU and JRC are 24/7 facilities requiring 24/7 nursing coverage.


Essential functions are the basic job duties that an employee must be able to perform, with or without reasonable accommodation. The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification. The omission of a function does not preclude management from assigning essential duties not listed herein if such duties relate to the position.

* Administers emergency medications on combative consumers using Satori Alternate Management to Aggression (SAMA) techniques.
* Administers injections, draws labs, and completes applications for clients as needed.
* Aids in the Utilization Management function as needed by collecting, reviewing, and authorizing Medicaid and non-Medicaid covered emergency Mental Health hospitalization for consumers throughout the Center's system.
* Assists with laboratory collection, EKGs, and other medical treatments/interventions and documenting initial health history on new patients.
* Collaborates and communicates with law enforcement, outpatient clinic, hospitals, and other providers.
* Collaborates with Metropolitan Area hospitals for admission or discharges when needed
* Collaborates with SAPD, Bexar County Courthouse and Sherriff's Office and other law enforcement agencies to assure appropriate consumer care.
* Completes daily reports containing status of current consumers on unit to Crisis Providers.
* Completes patient monitoring and documents findings every 2 hours (required)
* Conforms to the Texas Nurse II Practice Act and the Board's rules and regulations and all applicable Federal, State, and local laws, rules, and regulations affecting the RN's current area of nursing practice.
* Contacts all Behavioral Health (BH) medical facilities to arrange placement for OPC, ED, medical clearance.
* Coordinates medication distribution with the Center's pharmacy contract; ensures medications, controlled substances and consumer medications are appropriately stocked and maintained.
* Coordinates with case managers to create consumer plan of care as needed.
* Coordinates with patient clinics for admission to the EOU or JRC
* Creates nursing care assignments for LVN and unlicensed observation staff and provides supervision and instruction as needed.
* Creates Nursing Plan of care at admission/discharge phases.
* Educates consumers on health-related topics and responds to questions or concerns.
* Evaluates consumer's responses to nursing interventions.
* Examines patients and prepares them for visit with prescriber as needed.
* Maintains a 24 hour line of sight monitoring
* Maintains pharmaceutical oversight of medication samples for specified units participating in the program through assigned unit level staff.
* Monitoring OOWS/ CIWA consumers for Withdrawal Symptoms
* Obtains and transcribes verbal orders to administer medication as dictated by Providers
* Obtains collateral from outpatient clinics prior to admission.
* Participates in multi-disciplinary quality assurance program to evaluate and ensure staff proficiency, quality of patient care, error reporting, environmental safety, and comprehensive documentation.
* Provides comprehensive nursing care for acutely and/or critically ill patients whose conditions escalated treatment.
* Provides professional goal-directed nursing care to individuals utilizing nursing assessments and diagnosis.
* Utilizes Satori Alternative to Managing Aggression (SAMA) techniques when confronted with aggressive behaviors demonstrated by consumers.
* Performs other related duties as required.


Education and Experience

* Associate's Degree in Nursing
* Two (2) years of nursing experience, with at least one (1) year in psychiatric, mental health/intellectual disability or substance abuse setting

Licenses or Certifications

* Current Registered Nurse Certification to practice in the State of Texas

Other Requirements

* Crisis Care Center and JRC Units: Incumbent will act as a rover across both units. Schedule will include day and night shifts providing appropriate coverage at all times
* Crisis Care Units work 12 hour shifts
* Must maintain a valid driver's license and automobile insurance coverage, be able to travel as needed, and be able to meet on a consistent basis the driving record requirements of the Company's auto insurance carrier if you drive your vehicle during company business
* Must maintain required credentials and mandatory training requirements to ensure compliance with all State regulations and CHCS policies
* Must be able to meet the physical requirements to complete SAMA and CPR training including lifting up to 12 lbs. and supporting up to 55 lbs.; bending, stooping and getting on and off the floor without assistance.

COVID-19 Mandate Requirements

Unvaccinated Staff options:

a. Get Vaccinated per the CMS Mandate.

b. Have a medical/religious exemption. Unvaccinated staff will need to test once a week at the employees own time/expense and must wear enhanced PPE to include an N95 face mask and a face shield.

c. Consumer facing staff DO NOT have the option to be unvaccinated without an exemption.

d. If the position is not consumer facing, staff members may continue to be unvaccinated, without an exemption and test once a week at the employee's own time/expense and must wear enhanced PPE to include an N95 face mask and a face shield.

Vaccinated Staff options:

a. For employees who are vaccinated and consumer facing, we are continuing to require wearing an N95 mask.

b. For all other vaccinated employees, we are requiring a cloth, surgical or N95 mask be worn in all shared spaces.

c. Vaccinated employees may only go unmasked if in a single occupancy office.


* Bachelor's Degree in Nursing (BSN)
* Bilingual (English/Spanish)


* Responsibility to supervise LVNs, Integrated Care Technician, Recovery Support Specialists, CMA's, CNAs


Knowledge of:

* Applicable software applications (including Microsoft Office)
* CHCS nursing requirements and standards of practice
* Community and center resources to tailor discharge planning
* Federal, State, and local laws, rules, or regulations affecting the current area of nursing practice
* Legal requirements for EDs, MHWs, 4 hour letters and OPC process
* MEDCOM diversion process and communication expectations
* Medical diagnosis and applicable medications
* Mental health nursing practices
* Phlebotomy procedures

Skilled in:

* Critical decision making to differentiate between psychiatric, substance induced and medical needs and making arrangements to facilitate transfers as needed
* De-escalation and conflict resolution
* Monitoring patients for adverse reactions to medications
* Organization and time management

Ability to:

* Accurately organize and maintain paper documents and electronic files
* Coordinate telemedicine visits with outside agencies
* Effectively communicate, both verbally and in writing
* Establish and maintain effective working relationships
* Maintain accurate and complete records
* Maintain the confidentiality of information and professional boundaries
* Meet schedules and deadlines of the work
* Monitor patients for adverse reactions to medications
* Obtain and transcribe verbal orders
* Perform a variety of duties, often changing from one task to another of a different nature
* Perform basic mathematical functions such as addition, subtraction, multiplication, division, percentages, and ratios
* Respond to patient needs
* Understand and carry out oral and written directions
* Verify active order for labs and injections and confirm labs ordered
* Work via tele court with the Judge to facilitate the probable cause hearings associated with the OPC


* Must be able to meet the physical requirements to complete SAMA and CPR training including lifting up to 12 lbs. and supporting up to 55 lbs.; bending, stooping and getting on and off the floor without assistance.
* Must have adequate mobility that requires frequent walking, standing, bending, stooping, kneeling, reaching (vertical and horizontal), using fingers, hands, feet, legs and torso in various care. The employee must be able to regularly lift and/or move up to 40 pounds and occasionally must lift and/or move up to 50 pounds. The employee must be able to occasionally transfer a consumer.

Sunday - Saturday 7:00pm-7:00am 601 N Frio BLDG 1

Code : 1375-3

HOURLY RATE RANGE: $30.10-$45.15

Keywords: Center for Health Care Services, San Antonio , Registered Nurse - Med Surg, Healthcare , San Antonio, Texas

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