Facilitates clinical management and continuity of care for patients with advanced organ failure who require complex medical regimens. Patient assessment, collection and analysis of clinical data, patient education, collaboration with physicians, and research activities are additional dimensions of the role.

Assesses organ failure patients during clinic visits, arranges for routine diagnostic testing and physician consultation. Communicates with clinic physicians, referring physicians, and other health professionals regarding patient condition and needs.

Provides comprehensive teaching and counseling to patients and families. Identifies and addresses potential deterrents to compliance with medical regime.

Monitors, evaluates, and communicates relevant data regarding clinical problems to appropriate members of the interdisciplinary team.

Provides teaching and discharge planning in collaboration with hospital nursing staff.

Monitors progress of hospitalized organ failure clinic patients and collaborates with other team members to ensure continuity of care.

Follows-up on patient condition as needed, by maintaining telephone contact when patient returns home.

Continues to provide continuity of care as patient is treated in an outpatient or clinic setting.

Maintains organized and accessible medical records.

Participates in ongoing medical and nursing research activities relative to organ failure patients.

Licenses & Certifications

Registered Nurse license issued by the state in which the team member practices.

Degrees

Associate's Degree in Nursing.

Required Functional Experience

Typically requires 3 years of experience in patient care, including care of patients with advanced organ disease, such as heart or liver disease.

Knowledge, Skills & Abilities

Advanced clinical practice experience which includes background with end-stage organ disease. Strong interpersonal skills are essential.