Serious Illness RN
- Collaborate with the Serious Illness team to identify patients appropriate for palliative services and support their ongoing management.
- Conduct telephonic or in-person follow-ups with patients and families to assess symptoms, needs, and changes in condition.
- Provide education to patients and families on disease processes and collaborate with the Nurse Practitioner on how to proactively manage symptoms, as well as how to respond appropriately in times of crisis, and emphasize how we as an organization can support them.
- Ensure timely communication between the palliative care team and other providers involved in the patient’s care.
- Track and document patient/family interactions, and outcomes in the Electronic Medical Record (EMR).
- Monitor any barriers to care, and work to resolve them, escalating issues to the Nurse Practitioner, Social Worker, or leadership when appropriate.
- Participate in interdisciplinary team meetings and case reviews.
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