Duties - 1: Provides comprehensive professional nursing services of an advanced nature requiring critical thinking skills. Provides professional nursing care through the delivery, management, and coordination of care and services in a clinic setting through face-to-face encounters or via telecommunications technology (telehealth/virtual nursing) by performing nursing triage to determine the appropriate level of care, and home care advice which may be considered part of the triage process. Assesses and manages acute and episodic healthcare concerns, health maintenance and promotion, disease prevention and management, patient education and counseling, patient advocacy, case management, and coordination of care for patients throughout the healthcare system. Screens and prioritizes encounters based on the patients condition and preferences, the situation, cultural and age-specific considerations, education level and health literacy, and/or anticipated need for urgent and emergent care. Gathers information and/or documentation required for continuation of care referral requests; lab and diagnostic test results (under credentialed provider or clinical support staff protocol guidance); providing healthcare information; and/or care coordination. Gathers critical information for patient medication renewal requests. Conducts a comprehensive medication list review; verification of any side effects, allergies, contraindications, and continued treatment needs with the patient IAW current policies/guidance. Obtains and screens radiology, laboratory, and pathology study results, notifying the credentialed provider of abnormal results. Relays results to patients and arranges for appropriate follow-up care and treatment as directed by the provider. Executes medical orders. Performs assessment by systematically collecting focused data relating to the health needs and concerns of an individual patient, group, or population. Collects subjective and objective health status from patients, caregivers, members of the healthcare team, medical records, and other relevant sources. Makes independent nursing diagnoses by analyzing assessment data to determine patient care needs, i.e., preventive services, health promotion, health maintenance, or health-related problems or issues. Identifies expected outcomes in a plan of care individualized for a specific patient, group, or population. Ensures the plan activities reflect current rules, regulations, statutes, and ambulatory care nursing evidence-based standards and practices. Incorporates the most valid, cost-effective, evidence-based care and integrates current trends and available research. Facilitates the development/continuous improvement of mechanisms for plans to be recorded, reviewed, evaluated, and updated. Ensures compliance with professional standards of care and practice. Documents all nursing care and services in the patients electronic health record. Conducts patient tracking to include review and entry/update of clinical documentation systems. 2: Performs procedures, such as urinary catheterizations, visual acuity tests, Electrocardiography (ECG/EKG), blood glucose monitoring, nebulization therapy, irrigation of eyes and ears, intravenous fluid therapy, wound care, etc. Assesses patients response to intervention(s). Utilizes analytical thinking and critical decision making prior to treatment(s) based on knowledge of the effects on the physiological processes and current condition of the patient. Assists providers with procedures and treatments. Competently performs medication administration via various routes (e.g., oral, optic, ophthalmic, rectal, vaginal, intramuscular, subcutaneous, intravenous, topical, etc.). Maintains knowledge of approved medication dosages and independently verifies safe dosages of medications/ immunizations prior to administration. Addresses uncommon dosages for medications with the ordering credentialed provider. Manages adverse medication/immunization reactions and documents and submits appropriate reports. Satisfies training requirements for medication renewals. Documentation of training in order entry, computational pharmacology, and medication administration is required in order to input medications for renewal in the electronic health record (for provider signature). Provides for the safekeeping and accurate accounting of controlled drugs and narcotics. Orders clinic stock drugs and narcotics. Monitors and ensures proper rotation of medications to manage expiration dates. Sets up and operates a variety of specialized medical equipment, such as, but not limited to, Automated External Defibrillators (AEDs), cardiac and vital sign monitoring devices, IV pumps, EKG units, pulse oximetry, and electronic fetal monitoring devices. Provides pre- and post-procedural education. Verifies patients are informed of procedure purpose, risks, and benefits, and documents consent prior to invasive procedures. Monitors patients pre-, during, and post-procedure per established protocols and AFIs. Assesses post-procedure patients prior to their release from the clinic. Any procedures or treatments performed; or medications administered, will be appropriately documented and coded. Coordinates and/or provides emergency care, including initiation of life-sustaining measures, such as Cardiopulmonary Resuscitation (CPR), choking first aid, bleeding control, treatment of injuries, etc. 3: Provides health education/coaching to patients, significant others, and/or family members/caregivers. In coordination with the credentialed provider and other healthcare team members, provides individualized and thorough patient care instructions (i.e., self/home care instructions for acute and chronic conditions, preventive and health promotion recommendations, reinforcement of pre/post-surgical/procedural instructions). Evaluates patients/caregivers understanding of current health and health literacy. Incorporates patient care outcome goals and ensures appropriate care coordination. Ensures patients, families, and/or caregivers verbalize understanding of instructions and participate in the plan of care. Follows evidence-based protocols using analytical thinking and critical nursing judgment to individualize instructions to meet each beneficiarys needs and evaluates their understanding. Provides additional services, such as establishment of educational classes/clinics or support groups for target groups, as identified. Assesses resources and utilizes community agencies and serves as a liaison and expert consultant as appropriate. Any patient education conducted will be documented and coded appropriately. Provides healthcare instructions, health promotion, and/or health maintenance guidance based on evidenced-based standards (i.e., US Preventive Services Task Force Guidelines, DoD/VA Clinical Practice Guidelines, etc.). Serves as a point of contact for coordination of care across multiple service agencies and/or healthcare organizations and evaluates and documents reassessment of progress toward the attainment of stated outcomes. 4: Participates in continuing education programs and engages in evidence-based improvement projects to update and/or maintain skills and advance clinical practice. Utilizes data and literature in daily practice; redesigning care that is effective, safe, and efficient. Obtains/maintains/documents professional Continuing Nursing Education (CNE) to comply with licensure requirements, MTF initial and annual training requirements, and required unit-specific in-services/training. Following principles of adult learning, provides in-service education and instruction to professional, paraprofessional, and ancillary personnel regarding disease impact; available prevention services throughout the healthcare continuum; signs of physical, emotional, and mental deviation from normal; provision of emergency services; and crisis intervention, etc. Serves as a professional resource for in-service education provided to or by ancillary personnel. Seeks opportunity to conduct and/or participate in nursing research or evidence-based quality improvement projects. Implements evidence-based findings into daily practice, processes, and policies. Applies community and population health management principles and processes. Prepares health program maintenance, submission of reports, and assists in writing clinic policies and procedures as assigned. Participates in evaluation of the quality and effectiveness of activities/services of the unit by organizing nursing monitoring and evaluation services. Participates in performance management and risk management activities. Participates in/attends, but not limited to, mandatory organizational ancillary training programs; continuing educational programs to update and/or maintain the knowledge and skills needed to meet or enhance competency requirements; interdepartmental and unit-level in-services/briefings; continuing quality (i.e., Trusted Care, Team-STEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), Root Cause Analysis); process improvement training/forums; disaster team training; and multidisciplinary team meetings. Uses current research findings and other evidence-based practices to expand professional knowledge, enhance role performance, and increase knowledge of ambulatory care nursing professional issues. Completes/maintains training and licensure requirements to include initiation and updates to an electronic training record. Coordinates with the Group Practice Manager (GPM) to analyze demand-forecasting information based on the demographics and needs of the enrolled patient population. Coordinates Durable Medical Equipment requests to reduce ineffective consumptions of healthcare and increase usage of heath promoting services. Collaborates with colleagues, appropriate departments, and/or disciplines to operate more effectively and efficiently in achieving the best possible patient outcomes. 5: Provides oversight and mentorship to paraprofessional and newly assigned staff. Orients, trains, and mentor's civilian, military, and/or contract personnel. Participates in peer review activities. Oversight, mentorship, orientation, and/or training may include, but is not limited to, aerospace medical technicians, medical/nursing assistants, administrative medical personnel, physicians/physician assistants/nurse practitioners, registered and/or licensed practical/vocational nurses, volunteers, and/or students, as assigned. Provides oversight for assigned personnel providing assistance to providers with patient examinations, therapeutic measures, and procedures. Ensures assigned personnel have thorough understanding and application of infection control standards. Mentors junior and newly assigned nursing staff team members. Delegates appropriate nursing interventions to ambulatory care nursing team members based on their demonstrated competency, state practice acts, available evidence-based guidelines, regulatory standards, and organizational policies ensuring assignments/duties are compatible with the individuals skill level. Serves as a role model for staff, management, and providers on how to identify and problem solve, including how to analyze causes and contributing factors to avoid negative conflict. Actively participates and provides feedback in the peer review process for professional and paraprofessional staff. 6: Executes approved Clinical Support Staff Protocols (CSSPs) IAW local guidance providing coordinated care for high volume, low or high-risk symptoms and/or diagnoses. Uses clinical judgement and knowledge of organizationally approved CSSPs to determine when patients can be managed with a CSSP. Educates the patient on the process and conducts a patient assessment, to include a history and physical exam, and applies the appropriate algorithm/flowchart. Utilizes critical thinking skills to effectively identify exclusionary criteria, if any, and elevates the encounter to a credentialed provider. Recognizes that protocols are intended to augment, but never substitute for provider or nursing assessment of the patient. Provides any pertinent education/handouts. Follows up with the patient as indicated. Documents pertinent information, to include patient education provided, codes the encounter, and forwards the patient encounter to a credentialed provider for review/co-signature as per the protocol. Completes all designated CSSP training requirements as designated in the Training Plan and ensures training is documented in the training record. Perform other duties as necessary