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Specialty Home Care

Role and Facility Information

Why Fraser Health?
Fraser Health is responsible for the delivery of hospital and community-based health services to over 1.9 million people in 20 diverse communities from Burnaby to Fraser Canyon on the traditional territories of the Coast Salish and Nlaka’pamux Nations.



Our team of 43,000 staff, medical staff and volunteers is dedicated to serving our patients, families and communities to deliver on our vision: Better health, best in health care.



Effective October 26, 2021 all new hires to Fraser Health will need to have full COVID 19 vaccination (have received a full series of a World Health Organization “WHO” approved vaccine against infection by SARS-COV-2, or a combination of approved WHO vaccines). Please note this applies to all postings, and individual medical exemptions must be approved by the Provincial Health Officer.



Detailed Overview
Plans, organizes, implements and evaluates professional nursing care for clients with acute, chronic or palliative health care needs and their caregivers in a clinic, client's home and/or community setting. Care is family-centered and emphasizes the promotion, maintenance and restoration of health, the prevention and treatment of disease through teaching, counselling and direct nursing care and the provision of support for the client with a terminal illness, caregivers and other health care providers; participates in health promotion activities and acts as a liaison between the program, hospital units, community health provides and community support services.

Responsibilities
Provides nursing services to clients in their homes, community setting and/or clinic by assessing physical, emotional and psychosocial needs of the clients and their families; develops and implements a nursing care plan which emphasizes self care and incorporates collaboration with the client, family, the client's physician, other health care professionals and community resource workers.
Collaborates with clients in formulating short and long term goals; coordinates a multi-disciplinary care plan; evaluates the care plan to ensure continuity of care; discharges the individuals where and when appropriate; acts as an advocate for the client and provides support for the caregiver by providing information to the client while respecting the client's wishes.
Participates in the delivery and coordination of individualized client care by assessing, planning, implementing and evaluating client care needs; completes client assessments and provides direct client care in a clinic, client's home and/or community setting.
Assists with the triage of client referrals, in accordance with the established guidelines and criteria; reviews information received from family, community health providers, family physicians and multi-disciplinary staff, as required.
Follows up with clients and/or families, physicians and other health care providers regarding complex medical conditions through client reassessments an the sharing of medical information; evaluates the outcomes of treatment plans and modifies interventions, as needed to meet desired outcomes.
Coordinates home care services by liaising with other Home Health staff and community agencies; coordinates discharge planning of clients in the hospital and arranges for home support services for the client, where required.
Provides health education to individuals, families, caregivers and other staff to increase knowledge regarding health promotion to enhance the client's health status; teaches nursing care and procedures to the caregiver; participates in health promotion activities by liaising with community groups and professional staff.
Arranges and participates in joint home visits to clients and/or families with other health professionals, as required; provides advice to the client and/or caregiver about available community resources.
Documents and communicates client information and administrative information according to established policies and procedures; maintains related records, documentation and statistics; prepares reports in accordance with established standards and procedures, as required.
Conducts education sessions for clients, caregivers, other health care professionals and the public by preparing, presenting and sharing educational material and content to increase awareness and understanding of current and related health issues and the role and function of the designated program.
Participates in quality improvement activities in the development, implementation and the evaluation of new programs and/or services by attending meetings, identifying areas needing improvement and providing input, as requested.
Assists with the orientation of nursing and ancillary staff by developing and providing relevant informational material and acting as a preceptor, where appropriate; identifies self learning needs and attends educational programs to maintain and enhance clinical competencies.
Performs other related duties as assigned.
Qualifications
Education and Experience


Graduation from an approved school of Nursing. One (1) year recent related community nursing experience in the designated clinical area, or an equivalent combination of education, training and experience.

Current practicing registration as a Registered Nurse with the British Columbia College of Nurses and Midwives (BCCNM). Valid BC Driver's License and access to a personal vehicle for business related purposes, as required.



Skills and Abilities


Demonstrated ability to work effectively in an interdisciplinary team environment
Demonstrated ability to teach clients/families, community caregivers, students and staff
Demonstrated ability to mentor and act as a preceptor to staff
Knowledge of chronic disease management models
Knowledge of broad health care services, community resources, agencies and their role and responsibility in providing a continuum of care
Demonstrated ability to independently manage and prioritize caseload/workload and make decisions regarding intervention and access to subsidized resources
Demonstrated ability to develop and implement a comprehensive plan of care
Ability to plan, organize, analyze and make appropriate decisions
Ability to be empathetic, establish and maintain good interpersonal relationships and to relate well with people from a wide variety of socioeconomic and cultural environments
Ability to communicate effectively, both verbally and in writing
Ability to operate related equipment including applicable software applications
Physical ability to carry out the duties of the position

Terms

Live and work in BC

Burnaby

With its pristine lakes, stunning botanical gardens, and grand parks, Burnaby pairs indoor and outdoor adventure flawlessly. Centrally located in the Lower Mainland, it is a perfect destination for exploring the great outdoors and the spirited Metro Vancouver. Housing the third largest shopping mall in Canada and the renowned Playground of the Gods, Burnaby is for outdoor enthusiasts and urbanites alike.

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