Description
SUMMARY OF THE POSITION
A person who assumes responsibility for a nursing care program based on the bio-psycho-social needs of users or groups of people entrusted to his/her care. He/she assesses the state of health, determines and ensures the implementation of the therapeutic nursing plan, the nursing care and treatment plan for users with complex health problems or varied bio-psycho-social dimensions. He/she initiates and provides nursing and medical care and treatment to maintain or restore health and prevent illness. He/she may prescribe laboratory analyses, treatments, products, drugs and dressings in the fields of wound care, public health and routine care, in accordance with current regulations.
He/she designs, implements and evaluates care programs requiring advanced knowledge, targeting complex health problems or involving varied bio-psycho-social dimensions. He/she participates in the development or adaptation of clinical and care quality assessment tools. He/she coordinates teamwork and plays an advisory role to the care and interdisciplinary teams.
Identifies user needs and interventions requiring coordination of services within the facility and between different facilities or organizations in the community. Where necessary, he/she coordinates these services.
He/she provides orientation for new staff and participates in the training of trainees. He/she supervises teaching for users, their families and groups of people in specific programs, and collaborates on research.
SPECIFIC FUNCTIONS
The Case Manager for pre and post renal transplant patients is responsible for guiding, supporting and ensuring the rigorous clinical follow-up of clients through the kidney transplant process. Her roles and responsibilities include evaluation, surveillance, psychological and emotional support, education, planification, promotion and prevention. She co-ordinates team work and plays an advisory role with colleagues and the interdisciplinary team in the management of renal transplant. She collaborates with the multi-disciplinary team to ensure comprehensive, holistic patient care.
• Establishes an ongoing relationship with the patient, his family, his community, the MUHC nephrology team and transplant team, the local team and the liaison department. For all these people, she is the reference professional throughout the kidney transplant process (pre and post);
• Navigates the system so that time is not lost or the clients are not lost during their steps to be registered on the transplant waiting list and then to receive post-transplant follow-up;
• Provides the patient with explanations and information throughout the process. If necessary, she meets the patient in person to ensure that he or she understands the various tests and follow-up procedures;
• She works with all the software used for clinical patient monitoring: Nephrocare, Care4, Myle, Medipatient, Omnilab/optilab, Oasis, DSQ, SiPMI, etc;
• Works under the supervision of the DPSQA-Health, in close collaboration with the various parties involved.
External collaborators: MUHC nephrology team (including MGH, Lachine & GLEN), MUHC transplant team;
• Chibougamau (CPS & HD).
Internal collaborators:
• Specialized services;
• Wiichihiituwin, Hotel Espresso;
• Pre-dialysis nurses;
• Local team (Tchayou department, Nisk team, Hemodialysis and Home Hemodialysis departments);
• Regional nurse counsellor.
REQUIREMENTS
Education:
• Bachelor Science in Nursing;
• Member in good standing of the O.I.I.Q.
Experience:
• Two (2) years of experience as a nurse.
Knowledge and Abilities:
• Excellent communication skills;
• Excellent organisational and time management skills;
• Excellent critical thinking, problem solving and decision-making skills;
• Minimum of one (1) year of experience with the chronic kidney clientele;
• Experience in Hemodialysis is an asset.
LANGUAGE
• Fluent in English;
• Fluency in Cree or French is an asset.
OTHER
• Available to travel inside and outside of the Eeyou Istchee territory as required;
• Possibility of telework;
• This position offers the possibility of telework, depending on operational needs and after agreement with the employer. Please note that this is not a permanent condition of the position, and the employer reserves the right to request regular physical presence in the office.
