Nurse (Clinical/Critical Care) Joint Base San Antonio
Time to invest in some new footwear because if you’re San Antonio-bound, you’d better show up in boots! The Alamo City is one of the military’s most envied postings and is often referred to as “Military City USA”. Lo w cost of living, affordable homes, and the lack of state tax on retirement income are a few financial perks to living and retiring in this Texas city. A robust job market that seems partial to government and defense/security contracting ensures employment opportunities for spouses or transitioning service members. San Antonio is the country’s seventh fastest growing city yet has somehow managed to retain a “small town feel.” Quality schools and friendly locals (most with military ties) are additional perks to living in San Antonio.
Some things you should know before you get here: trucks are the norm (the bigger, the better), love for The Spurs (NBA) runs deep, the H-E-B obsession is real (it’s a grocery store), rodeos are life, and don’t call it “San Antone”—that’s just wrong. The community boasts a vibrant Hispanic population, and enhances everything from the food, to the music, to community events. You don’t necessarily need to speak Spanish to get around, but you’d better know how to say barbacoa, tamales, and cascarones.
Name brand shopping (IKEA is the latest arrival of note), restaurants, and all variety of entertainment all add to San Antonio’s quality of life. SeaWorld, the San Antonio Zoo, Six Flags Fiesta Texas, and downtown museums are all fun outings for kids and families. Tube or kayak down a river, play or fish in the lakes, or relax by San Antonio’s famous downtown River Walk. Museums, art galleries, and historical landmarks—remember The Alamo?—round out San Antonio’s cultural offerings. Tex-mex cuisine arguably originated here, and some up and coming culinary trendsetters are making a name for themselves in the Pearl District downtown, alongside several notable breweries.
San Antonio has over 300 days of sunshine with some hot summers, mild winters and pleasant spring and fall seasons. San Antonio is in Bexar County (it’s pronounced “BEAR”) in south central Texas, and is just south of the gorgeous Hill Country. It’s only about two hours from Austin, the beach, or the desert.
Working for the Department of Defense comes with an abundance of benefits and perks to include competitive compensation packages, paid-time off, medical benefits, student loan repayments, and retirement package with Thrift Savings Plan to include matching employer contributions.
Responsibilities
MAJOR DUTIES:
Incumbent provides comprehensive intensive care nursing to critically ill patients on one of the Critical Care Units at the San Antonio Military Medical Center (SAMMC). SAMMC, a Level I Trauma Center which provides training for all types of military and civilian personnel. The intensive care nurse serves as an expert in advising other experienced and inexperienced personnel in the care of patients to include formal and informal training, orientation, and precepting of new personnel.
1. As a critical care nurse assigned to an Intensive Care Unit (ICU), he/she provides an advanced level of specialized nursing care to complex, critically ill patients having multiple complicating conditions. High levels of acuity resulting from the hospital's designation as a Level I Trauma Center, require highly specialized nursing care with patients presenting real or potential life-threatening health problems. These life-threatening health problems include but are not limited to patients undergoing extracorporeal life support, ventricular assist devices, balloon pump management, other unnamed cardiac assistive modalities, continuous renal replacement therapy, hemofiltration, other unnamed renal support modalities, unnamed pulmonary support modalities, moderate sedation, and post-operative recovery. The ICU nurse provides continuous observation and monitoring and must intervene to prevent complications and attempt to restore health.
In the absence of a physician, independently makes decisions and implements proper emergency measures after identifying and interpreting life-threatening conditions. Initiates life-saving measures which include, but are not limited to advanced cardiopulmonary resuscitation; calculating dosages and preparing emergency drugs prior to arrival of a physician and administering these drugs upon the physician's directives. Administers special medications via oral, intra-muscular, subcutaneous, intradermal and intravenous. Defibrillates if ventricular fibrillation occurs without physician in attendance, according to established guidelines. Performs various pulmonary treatments such as oxygen and compressed air through various means. Performs arterial punctures for assessment of blood gases and makes various ventilator adjustments, in accordance with unit policy, based on blood gas interpretations. Assists in the performance of endotracheal intubation and administers a variety of respiratory therapy treatments as prescribed.
Continually observes, monitors and assesses patient's condition. Interprets signs and symptoms of deterioration in condition and takes corrective action. Consults with physician regarding medical and nursing management. Starts intravenous line if none is available and if the critical condition of the patient makes access to circulatory system mandatory for administration of resuscitative medications. Knows and ensures infection control standards are applied in accordance with unit and department operating instructions.
Assists the physician with complex and potentially life-threatening procedures such as cardio-version and insertion of invasive lines, e.g., arterial, venous and pulmonary artery catheters, chest tubes, and endotracheal tubes. Discontinues invasive lines as ordered, under established guidelines. Maintains invasive lines and dressings as prescribed by Infection Control Policies/Procedures and Guidelines. Inserts intravenous catheters and performs venipunctures to collect blood samples. Monitors intake and output and notifies physician when caloric or fluid needs change. Inserts/monitors the patient with nasogastric, nasoduodenal, nasojejunal, and percutaneous endoscopic gastrostomy (PEG) tubes per established guidelines. Assesses and manages other enteric feeding tubes per established guidelines. Assesses patient's response regarding cardiac output, vital signs, peripheral perfusion, and level of consciousness. Performs continuous respiratory ventilation assessments, evaluating blood gas results from both arterial and mixed venous sources. Obtains cultures; uses crash cart appropriately in emergencies; suctions endotracheal tubes and other adjunct airway devices and assists with tissue biopsies.
Administers and monitors the use of therapeutic agents (medications) in accordance with Department of Nursing and unit operating instructions, Mosby’s Manual of Nursing and in conjunction with American Association of Critical Care Nursing (AACN) Core Curriculum guidelines, and initial orientation and/or certification, to include: chemotherapy drugs; pain-relieving drugs including narcotics; antibiotics including experimental agents; and specific agents used in the care of oncology patients. Prepares and administers prescribed emergency medications and is familiar with correct dosages and potential side effects. Must monitor drugs which alter the affects of another drug if administered concurrently. Administers and regulates intravenous fluids such as lipids and blood volume expanders. Administers and regulates vasoactive drugs.
2. Uses specialized patient equipment such as respiratory equipment, including oxygen masks, ambu bags and ventilators, intravenous infusion pumps, and wall suction, Emerson pumps and pleurovacs, cardiovascular monitors used for measuring cardiac output, defibrillators, invasive thermodilutional catheters, arterial and central venous catheters and EKG machines; equipment used for continuous renal replacement therapy, peritoneal dialysis and exchange transfusion, intra-aortic balloon pumps, Ventricular Assist Devices (VAD), Extracorporeal Membrane Oxygenation (ECMO) and others specialized equipment as required. Uses various hemodynamic monitoring devices, Intracranial Central Pressure (ICP) and Carbon Dioxide (CO2) monitors. Upon proper training and competency evaluation, may serve as the critical care nurse on the Critical Care Transport Team (CCTT). The CCTT is responsible for inter-facility ground transport of the critically ill patient undergoing extracorporeal life support (ECLS), which encompasses ECMO, VAD, and/or the intra-aortic balloon pump management, continuous renal replacement therapy and other unnamed support modalities. May serve as member of the Rapid Response Team (RRT) responding to hospital-wide RRT calls.
Independently assesses patient and family to include physical and psychosocial needs by preparing and documenting in the electronic patient record a comprehensive nursing physical and assessment. Provides care in accordance with patient-specific nursing care plans, either developed by incumbent or another critical care nurse. Continuously reevaluates, updates and documents patient's care plans as patient's needs or condition change. Determines and implements nursing orders. Evaluates nursing interventions based on the patient’s response and revises nursing diagnosis and care plan accordingly. Develops meaningful goals to assist the critically ill patient and family in attaining the optimum level of physiological, sociological and psychological balance within the limitations imposed by the illness. Provides constant support to patient and family by providing information on disease process, pre and post operative care, diagnostic procedures, use of equipment related to disease and care, expected and possible adverse reactions to medication, as well has health maintenance and illness prevention. Provides an anticipatory, sound discharge plan that includes rehabilitation and health teaching both for patient and family.
As an expert in the nursing care of critically ill patients, serves as a resource person with whom other experienced nurses and other health care providers consult when particularly difficult problems in the care of critically ill patients arise. Serves as a role model to experienced critical care nurses as well as those who are not fully trained. Provides guidance and leadership to other professional nurses, and oversees the work of paraprofessional personnel. Provides orientation and on-the-job training for such personnel. Serves as a preceptor for newly assigned and student nurses. Provides educational in-services and provides formal and informal ICU training. Leads patient care conferences, as needed or applicable.
Performs difficult and demanding patient advocacy tasks and effectively manages the most difficult advocacy problems that occur in a critical care setting. Advocacy matters involve patient's options, and actions or activities of physicians, other health care providers, family members and significant others.
Collaborates with physicians and other health care team members to assure the delivery of the optimal level of overall care to critical care patients. Participates in the development of standards of care and in the establishment of quality assurance goals for the critical care unit.
Serves as a charge nurse on all shifts. As charge nurse, provides guidance and leadership to other professional and para professional nurses. Floats to other units as required. The incumbent supports the patient care mission by covering on-call shifts allowing personnel recall to supplement staff as needed to cover surges in patient care requirements.
Performs other duties as assigned.
Basic Requirements:
US Citizenship required
Employee must have a current, active, unrestricted, valid Registered Nurse license in at least one US state or province/territory of the United States.
Employee must have a current Basic Life Support (BLS) certification.
Advanced Cardiac Life Support (ACLS) is highly desirable.
Position is Designated Testing Position (DTP) for drugs.
Position requires the incumbent to have passed a Child Background Check (works with Adolescent patient).
Position may require incumbent to work alternate shifts.
* This position is subject to drug testing if the incumbent:
Has direct patient contact or performs diagnostic or therapeutic functions
Extracts or works with patients' body fluids or tissues; prepares patient specimens for examination, performs specialized or non-routine tests on body fluids or tissue samples, or confirms patients' test results
Maintains, stores, safeguards, inputs, fills or distributes drugs and medicines
This position has a mandatory seasonal influenza vaccination requirement and is therefore subject to annual seasonal influenza vaccinations. Applicants tentatively selected for appointment to this position will be required to sign a statement (Condition of Employment) consenting to seasonal influenza vaccinations.