MONTGOMERY COUNTY GOVERNMENT Code No. 2306
ROCKVILLE, MARYLAND Grade 24
COMMUNITY HEALTH NURSE II
DEFINITION OF CLASS:
This is a full performance level in clinical settings for the professional Registered Nurse staff who perform community health nursing and who incorporate the full cycle of the community health nursing process. The primary clinical site for the majority of our School CHNs is the school located health room, and as needed school grounds. Other clinical settings for our CHNs include Health and Human Services (HHS) health centers, health clinics, individual homes, hospitals, assisted living facilities, nursing homes, group homes, homeless shelters, soup kitchens, emergency shelters, and Advanced Life Support (ALS) training sites. The process requires the assessment, planning, implementation, and evaluation of clients, to provide comprehensive nursing services incorporating health promotion, optimal health prevention, disease prevention, crisis intervention, and wellness and prevention education to individuals and families. Community Health Nurse II(s) are responsible for advocating for the health rights of clients, families, and staff in the community, schools, clinics, homes, health care facilities, crisis center, shelter, assisted livings, nursing homes, hospitals and other community locations. The EMS/Fire and Rescue Services CHN II positions are responsible for facilitating the career and volunteer Nationally Registered Advance Life Support (ALS) Providers in becoming a Montgomery County ALS Provider, managing internship placement, coordinating evaluation by an EMS duty office, scheduling the credentialing interview with the Medical Director, and developing curriculum and instructional material for Obstetrical Emergencies, Preceptor Orientation, and other clinically related topics, develop and implement continuing education programs for approximately 400 current advanced life support EMS Providers to maintain their national registry and MIEMSS pre-hospital provider credentials. Content includes both required curricula (airway, pediatrics, trauma, medical and obstetric/neonatal emergencies, assessment, and pre-hospital management) and additional EMS-related classroom lecturers and skill scenarios, arrange for guest speakers, and recruit adjunct instructors for sessions.
Advanced life support EMS providing, developing and providing
educational programs for CRT/EMT-P students, instructing and evaluating paramedic
students and ALS providers in the proper procedures for health assessments and
interventions to include patient assessment, airway management, initiating vascular
access, medication administration, CPR, dysrhythmia, interpretation, defibrillation,
cardiac pacing, cardioversion, spinal immobilization, splinting, and chest decompression
and contribute to quality assurance by evaluating ongoing programs and preparation
for new programs. Maintain proper student and course records. The CHN II position
requires knowledge of the total range of community health nursing standards,
practices, and procedures; knowledge in the areas of early childhood development,
developmental delays, pediatric health care, geriatric health care, chronic
diseases/treatments, medications, psychiatric interventions, emergency preparedness,
emergency management services, licensure and regulatory services, maternal/child
and reproductive services, family functions and interactions, human growth and
development throughout the life cycle, advanced life support procedures, techniques,
current therapies and medications and complex equipment related to emergency
treatment of patients in the prehospital setting, knowledge of current Advance
Life Support (ALS) providers roles and responsibilities, advanced patient assessment,
shock, pharmacology, respiratory, cardiovascular, neurological trauma, medical
emergencies, obstetrics, pediatrics, crisis management, communications, and
mass casualty management as they apply to prehospital care, and written and
psychomotor evaluation tools. An employee in this class serves as a member of
one or more interdisciplinary teams to meet community health and social needs.
The CHNII must be culturally sensitive in order to competently serve clients
of all ages and from diverse cultural backgrounds.
Contacts include healthcare medical professionals in administrative
and clinical roles, Montgomery County Public Schools (MCPS) personnel, public
and private health care agencies, social service agencies staff, families, and
clients to coordinate; collaborate, provide or review healthcare matters; program
administrators or specialists concerning program eligibility requirements, ,
programmatic reporting, daily documentation, etc.; public safety and legal personnel
regarding law enforcement and legal implications of work; governmental and non-governmental
organizations and advocates for various populations served; personnel from Fire/Rescue
Operations, Fire/Rescue Quality Assurance, Maryland Institute for Emergency
Medical Services, and Montgomery County Local Fire and Rescue Department, .and
other persons providing service to clients in the exchange of work related information.
The purpose of the contacts is to provide nursing care, exchange work information,
coordinate actions of mutual concern and provide health education in order to
improve the County population's health status. Public service/assistance is
provided through lengthy and/or detailed questioning to obtain clients' significant
health and social history in order to determine and provide appropriate health
The Community Health Nurse II (CHN II) provides the public assistance
by providing community health services to the entire community, providing services
at vaccine clinics and Ability to Benefit (ATB) clinics; serving as First Responders
for Emergency Public Management services to the entire community; providing
first aid care to school age children; providing medical care and primary care
services; providing case management and referrals for clients; and providing
guidance and training to Montgomery County Public School (MCPS) staff. Additional
services afforded include providing first aid in a school health room; providing
education in-service for the staff; maternal/child services; behavioral health
services; linking services and resources; and providing prenatal education and
education to empower clients to access health care through the complete health
The Community Health Nurse II performs work under the general
supervision of a Manager whose background may not be in healthcare whose responsibility
is to ensure that program requirements are met. The Community Health Nurse II
independently arranges the sequence of the work, obtains the necessary information,
materials and supplies, and select appropriate methods and procedures in responding
to a wide variety of case needs. Work is performed independently in homes, clinics,
schools, shelters, and in the community where the nurse must rely on their own
knowledge sound judgment in the performance of work assignments. An employee
in this class is assigned a large proportion of difficult and unusual cases
requiring the utilization of different approaches or methods in providing nursing
services. Complexity of the work is derived from the need to gather and categorize
information such as client medical/social history and medical test results;
ascertaining their significance; determining, implementing, monitoring an appropriate
health treatment plan; providing emergency response including establishment
and covering emergency shelters; handling legal matters when the facts, issues
and precedents are unclear; and developing continuing education curricula in
two similar areas: nursing and pre-hospital Advanced Life Support and integrating
these two area in an adult learning environment with different levels of skill
and knowledge requirements based on standards and use of cognitive, psychomotor
and affective domains. The School Community Health Nurse (SCHN) must be able
to review, assess, and evaluate complex health issues; conduct assessment of
unusual circumstances related to complex levels of care and rare diagnoses;
and mainstream complex clients into the school system and the community which
are not covered under guidelines. Community Health Nurse II(s) are responsible
for providing services that respond to the complexity and diversity of health
needs in various populations and locating resources for clients; planning and
instituting emergency actions that occur for medical emergencies; managing multiple
work sites; delegating tasks to licensed and unlicensed medical staff; and providing
recommendations and advice to Montgomery County Public School (MCPS) staff,
Emergency Preparedness staff, families, and clients. The Emergency Services
CHN Nurse must be able to provide an educationally sound and safe environment
for ALS providers the didactic, practical and affective objectives of the ALS
continuing education program utilizing adult learning principles, evaluate the
effectiveness and knowledge of ALS training students by conducting oral, written
and practical exams, and ensure safe and appropriate delivery of patient care.
The work involves establishing criteria; formulating projects; conducting thorough
analysis of a variety of complex issues; or investigating and analyzing a variety
of unusual conditions, problems or questions to ensure that programs, functions,
and services achieve their desired objectives by assessing results.
Work is performed in accordance with such guidelines as established
by the American Nurses' Association, Federal, Maryland State, County and Department
of Health and Human Services regulations, policies, procedures, standards of
care, sanitation and ethics guidelines, Maryland Nurse Practice Act (Code of
Maryland Regulations, Title 10, Subtitle 27), Code of Maryland Regulations (COMAR),
State Highway Administration (SHA), Mandatory Maryland Occupational Safety Health
Administration (MOSHA), Health Insurance Portability and Accountability Act
(HIPPA), American Heart Association training standards, U.S. DOT National Standard
Curriculum, Maryland Medical Protocols, Montgomery County Paramedic Program
Standards, National Registry of EMTs and Maryland Institute for Emergency Medical
Services Systems (MIEMSS), standards of care, best practices in community health
nursing for the generally-accepted nursing and health care procedures and techniques,
case management, and established departmental and program policies, procedures,
practices and priorities. Employees in this class independently select the appropriate
guidelines, methods or procedures to use; exercise considerable latitude in
implementing practices, and methodology depending on the patient and problems
encountered; identify, assess, intervene, implement and evaluate outcomes for
each client; resolve most conflicts that arise; interpret policies on own initiative
in terms of goals and objectives established; and determine priorities of visits.
Regulations and guidelines are used to evaluate compliance with standards of
care and treatment, and universal precautions for clients in accordance with
the Maryland State Board of Nursing and Nursing Practice Act to ensure the health
and safety of clients in the school, home, clinics, community, and other community
locations. The Community Health Nurse II ensures the health and well being of
the student population, elderly, pregnant women, special needs populations,
CHN II(s) perform duties that encompass the entire nursing process including assessing clients health needs; coordinating and performing case management in schools, clinics, homes and other community facilities (i.e., crisis centers, assisted living facilities, shelters, nursing homes, and hospitals); and providing and promoting health care services (i.e., primary care, chronic care, emergency triage, emergency first aid, disease prevention, intervention, education, and emergency and continued care of clients); and evaluating client health outcomes. CHN II(s) advocate for the health rights of clients, and families; provide wellness and prevention education for these clients; and coordinate all aspects of the clinical portion of pre-hospital education for students and facilitate the credentialing of existing Advanced Life Support (ALS) providers that wish to practice ALS in county, and coordinate and develop curriculum for ALS students and continuing education for ALS Providers. Nursing interventions have an important impact on the outcome of the health program and an effect on the health of individuals, families, and the community. Nursing interventions include establishing a nurse/client relationship in order to assist clients to address health matters, identify client health problems, and collaborate with interdisciplinary team members to decrease/eliminate these health problems. The CHNII class is distinguished from the CHNI class by a greater knowledge base and experience required to perform the variety of difficult and complex case assignments with a minimum of supervision.
CHN II(s)may come into close and continuing contact with human/animal body fluids, risk of exposure to physical attacks, infectious agents, communicable diseases, Air Borne pathogens; needles, animal and human excrement, rotting food, aggressive animals, and bug infestations when attending to clients in their homes and the community. CHN II(s) are provided and must wear personal protective equipment (PPE) and appropriate safety equipment as appropriate to minimize risk to self and persons in care. CHN II(s) are exposed to unpredictable situations (i.e., mentally unstable and/or violent patients, clients under the influence of controlled substances, hoarders, gang neighborhoods, weapons, and fast paced traffic). Performance of this work involves occasional long periods standing or walking, occasionally lifting, carrying or moving objects weighing up to fifty pounds, typically performing work sitting at a desk or a table, walking over rough, uneven, rock surfaces, long periods of standing, typically bending, crouching or stooping in confined spaces, operating keyboard devices or VDT's where speed, accuracy, and volume of work are required for production oriented work, and prolonged fine finger movements. Work performance is reviewed and evaluated for technical accuracy, effectiveness in meeting objectives or expected outcomes and contribution to maintaining a healthy environment in homes, schools and the community. Work is observed through records, reports, conferences and observation for desired results, adherence to professional standards and established policies, and contribution to the goals of the community health program.
Authority to Delegate: In accordance with Authority: Health Occupations Article, §102, 8-205, 8-6A-01, 8-6A-03, 8-6A-05(a) (4), and 8-6A-08(f) (5), Annotated Code of Maryland, Nursing Practices Act, Title 10, Subtitle 27, Delegation of Authority is defined as follows:
Community Health Nurse II(s) provide clinical supervision in the delivery of nursing care, and are responsible for delegation of nursing functions in accordance with Department of Health and Mental Hygiene, Nurse Practice Act, Title 10, Subtitle Board of Nursing (Authority Health Occupational Article). Community Health Nurses II(s) may assign nursing acts or delegate nursing tasks to individuals who are competent to perform those acts or tasks, where the assignment or delegation does not jeopardize the client's welfare. As such, Community Health Nurses provide clinical supervision and delegate particular nursing functions to certified licensed unlicensed staff (i.e., School Health Room Aides (SHRAs), Home Health Aides (HHA), Certified Medication Technicians, community health worker, community service aids, Certified Nursing Assistants (CNA), Volunteers, Nursing student interns, Advanced Life Support (ALS) Providers, and staff members). The CHN II(s) maintain the ultimate responsibility and accountability for the management and provision of nursing care. In accordance with the Nursing Practice Act, Authority to Delegate, the delegating nurse is responsible for an individualized assessment of the patient and situational circumstances, and for ascertaining the competence of the licensed or unlicensed health care worker before delegating any task. CHN II(s) are accountable for performance of tasks delegated; supervising performance of the task(s); ensuring the appropriate documentation of the task(s); evaluating the entire delegation process; and reassessing and adjusting the overall plan of care as needed. CHN II(s) are responsible for participating in orientation and in-service training of licensed and unlicensed personnel. CHN II(s) attend and participate in meetings, conferences, and seminars related to nursing and health care, and participate on various committees as required.
EXAMPLE OF DUTIES: (Illustrative Only)
In All Program Areas
Provide primary nursing health care generalized community health nursing services in safeguarding client's safety, promote healthy lifestyles and prevention, provides crisis intervention, provides rehabilitation treatment, and carries out comprehensive full cycle nursing care. Nursing services encompass preventive and intervention services, therapeutic nursing care, and emergency nursing services including life saving procedures such as Cardiopulmonary Resuscitation (CPR) to patients (clients) and/or families in their homes, clinics, schools, and health centers with specific emphasis on a family-centered preventive approach.
Identify high risk groups within the community and participate
with others in developing appropriate multi-disciplinary individualized health
care plans, coordinates and executes a plan of care with families, individual
and community resources, and developing a plan of care in accordance in to the
professional Nursing Standards of Care and Department of Health and Human Services
(DHHS)/PHS established policies and procedures governing the specific programs.
Conduct health assessments of the newborn, infants, children, adolescents, adults,
and the elderly. Provide early detection of health needs and physical and mental
handicapping conditions; assist individuals and families to plan and obtain
appropriate health care; and develop and make recommendations for long term
care plans to encourage clients to achieve the highest level of independence
remain independent in the community, and who are not at immediate risk for hospitalization
Maintain clinical records and prepare written and statistical
reports. Collects and analyzes health data reflecting client's needs that may
affect community service and programs needs. CHN II(s) may contribute to the
evaluation of ongoing programs and planning through departmental committee participation.
Provide case management services and coordinates client care. Make professional
general health and sociological assessment of the community to which assigned,
and develops a plan of action with specific objectives to meet identified health
needs. Monitor and detect potential hazards in the community including physical
and emotional sexual abuse of all ages in a variety of settings; child abuse,
geriatric abuse, housing, sanitation, and unsafe environmental conditions. Recognize
early occurrences of increased incidence and prevalence of communicable or chronic
diseases, after obtaining a health and developmental history on assigned clients
and/or their families, record those findings, and make a critical analysis of
factors documented to pinpoint health problems. Perform medical health screenings
to differentiate between normal and abnormal findings to recognize early stages
of health care problems and needs. Provide direct nursing intervention and preventive
measures for clients care to reduce distress and enhance coping ability of clients.
Monitors client's compliance to medical and nursing treatment plans, adjust
treatment plans within established criteria and recognizes when to refer the
client to their health care team.
Plan and coordinate with other professional workers and social
and health agencies health care services to be provided to families. Works collaboratively
with the Physician in the management of complex medical problems. Periodically
evaluates the nursing and medical care plans and make revisions in collaboration
with appropriate persons. Provide in-depth health counseling and education to
individual and family about the health care program.
Maintains liaison with other community nurses, health centers,
hospitals, and personnel in other community agencies to provide for the continuity
of health care. Involve clients in the development and implementation of their
health care plans and serves as advocate for clients/families and consumers.
Refer individuals and families to available health and community services to
provide follow-up care.
Emergency Preparedness/Disaster Response: The CHNII serves as
first responder during states of emergencies requiring shelter management. The
County emergency shelter policy dictates that the CHNII is the only licensed
professional who can open, manage and close a shelter. Shelters operate during
biohazard and dangerous weather conditions. The CHNII's responsibilities include
the assessment of all clients in the shelter, maintenance of records, the emergency
dispensing of medications. The CHNII assumes a role in the County Command System
assisting and coordinating in the preparation of the public for emergency/disaster
and communicable disease responses. The CHNII operates mass vaccination clinics
(e.g. Flu Clinics), distribute emergency medicines, supplies or equipment, and
educate individuals in preparing for a rapid evacuation or an in-home disaster
kit. Follow guidelines and assists the community in implementation of Federal,
Maryland State, and County regulations including communicable disease control
and emergency/disaster plans. Serve on Shelter/Emergency Preparedness Team,
ODSE Team, EMT/IEP Team, Student Assistance Team (MDSAP. Interpret guidelines
and assists the community in implementation of Federal, Maryland State, and
County regulations including communicable disease control and emergency/disaster
Provide client evaluation and care plan development services, pre-admission screening, and annual review of nursing home residents. Monitor and evaluate the effect of care on client health. Collect and analyze health data reflecting community service and program needs, and contributes to evaluation of ongoing programs and planning for new programs through departmental committee participation. Serves as a member of interdisciplinary team to meet the health and social needs of individuals, families, and the community. Identifies client needs community resources and may develop additional community resources.
DUTIES SPECIFIC FOR THE FOLLOWING DISCIPLINES:
Community Health Services
CHN II(s) provides Case Management services to pregnant women, children, and pregnant and parenting teens focusing on families who are often times medically underserved, low income and at risk for poor pregnancy outcomes. Case management series include on-going interactions with individual clients, their families, and other service providers through routine home visits, office visits, and by phone for the purpose of achieving health pregnancy outcomes, improving parenting knowledge/skills, and promoting health and safety of the infants and their families. Performs Risk Population Assessment and Case Management Services, and conduct health and psychosocial assessment of special needs children and women that are identified and referred by hospitals and other providers. Special needs clients include newborns and infants with complex medical and psychosocial risk factors, Hepatitis B-infected pregnant women and their infants, and children exposed to high levels of lead, refugees and those needing HIV and TB education and services. Through direct contacts with the clients and referral sources, identifies immediate needs for health service coordination, education, and long term-case management services, educates, supervises, coordinates, and/or monitors clients' compliance with treatment plans, and provide ongoing case-management services as needed.
Children's Immunization Services: Conducts childhood immunization services in the designated clinics according to Federal and Maryland State guidelines including screening for history of immunization, assessing the need for additional immunizations, reviewing risk factors, obtaining informed consent, educating accompanying parents/adults; administering the vaccines; collecting the data; ensuring safeguard of vaccines, and communicating with PHS Immunization Program Manager as needed. Group Health Education: Conducts pre-natal, post-natal, and reproductive health education services for the clients who are not individually case managed, and prepares, teaches, and evaluates the class.
Homeless Health Program
Provide on site, time limited, medically focused nursing case management services for homeless clients in emergency and transitional shelters in Montgomery County.
Proactively participates in discharge planning activities for clients who are admitted to hospitals within Montgomery County to ensure appropriate discharge with an after care plan.
Provides periodic oversight of client medications managed by shelter providers including review of medication records, compliance monitoring and referral to community resource as needed.
Provides telephone triage with linkage to urgent medical appointments.
Montgomery County Home Care
Conduct group education classes in clinics, schools and other community locations. Provides case management services and coordinates client care. Contribute to orientation and in service training for new Community Health Nurses, nursing students, and SHRAS (certified medication training). Refer individuals and families to available health and community services and provides follow up care.
Behavioral Health and Crisis Services (BHCS)
Direct client care including assessment, monitoring, planning and implementation of medication administration and evaluation of clients regarding their medical services. Dispense methadone ordered by the staff psychiatrist using the computerized dosing system and adheres to all DEA requirements for administration of narcotics. Prepares daily methadone inventory and maintain clinical records twice a day and prepares reports. Deliver methadone medication to residential treatment facilities or a skilled rehabilitation center for clients. Administers medication (methadone) and evaluate clients as provided by the Maryland Nurse Practice Act. Provide case management services to assigned clients and documentation of client activity in client record, identify high risk GPS in the BHCS (i.e., diabetic, cardiac and pregnancy), provide IHCP development guidance to staff in the areas of asthma, sickle cell, seizure disorders and autism, and provide emergency nursing services/crisis intervention services.
Dispense methadone as assigned using computerized dosing system and adhere
to all DEA requirements for administering drug administration for narcotics.
Prepares daily methadone inventory and maintain clinical records twice a day
and prepares written and statistical reports. Deliver client dosages of medications
to other treatment facilities when a client is hospitalized as in patient clients.
Collect and analyze health data reflecting community service and evaluate ongoing program needs of Public Health Services and HHS. Collaborate with external and internal partners and other community partners to obtain services for clients. Refer and research community resources for needs of clients within Montgomery County, within United States and other countries and communicating the clients' needs with hospitals and other clinics. Provide education for preventive care for clients in need of medical care including hepatitis, human immunodeficiency virus (HIV), diabetes, and pregnancy preventive care.
Licensure and Regulatory Services
Conduct inspections/complaint investigations of health care facilities to ensure they are in compliance with federal, state and county laws and regulations.
Evaluate and assess residents for quality of care and quality of life, observe
resident care processes, staff/resident interactions, medications/pharmacy services,
nursing services, physician services, rehabilitation services, environmental
standards of cleanliness, and review compliance with legal requirements concerning
resident rights, state regulations, COMAR and DHR.
Provide a written report that summarizes the survey findings and observations
and determines the scope and severity of the deficiencies cited. The scope and
severity of the deficiencies are primary factors in determining the appropriate
corrective action to be taken against the facility.
Serve as first responders during emergencies such as severe weather conditions and/or dispensing medications during bioterrorist emergencies.
SCHOOL HEALTH SERVICES
School Health Services
Provide school/community health nursing services to clients. Provides case management services and coordinates client care. Provides emergency nursing services and crisis intervention, and develops and maintains HR Guide for licensed and unlicensed medical personnel. Identify high risk students, General Population Students in the school community (i.e., diabetic, cardiac and pregnancy, asthma, sickle cell, seizure disorders, autism, etc.). Develop Individual Health Care Plan (IHCP) and provide guidance and training when indicated to MCPS staff. Work to minimize barriers to obtaining health care for uninsured, undocumented, homeless and victims of abuse.
SCHN ll(s) provide Maternity/Infant case management services to pregnant teens. They train and delegate on an ongoing basis to MCPS staff. Case management services include on-going interactions with individual clients for the purpose of achieving good reproductive health, healthy pregnancy outcomes and improved parenting knowledge/skills and to promote the health and safety of infants. SCHN IIs lead teen and parent support groups which also focus on smoking cessation and substance abuse education.
Through direct contact with clients and referral sources, identifies immediate
needs for health service coordination, education, and long term case management
services; educates, supervises, coordinates and/or monitors clients' compliance
with treatment plans and provides ongoing case management services as needed.
Provides childhood immunization services according to Federal and Maryland State guidelines including screening for history of immunization and risk factors; educating accompanying parents/adults; administering the vaccines; collecting the data; ensuring safeguard of vaccines and communicating with PHS immunization Program Manager as needed.
May participate in teaching SHS staff the Certified Medical Technician (CMT) Course, CPR and First Aid and other trainings. Provides training for MCPS and SHRAs for delegated nursing tasks including medication administration, treatments such as tube feedings, blood sugar monitoring etc., and recognizing signs and symptoms of health emergencies including appropriate actions. Provides health education for students and families about chronic health conditions (i.e. managing asthma, diabetes, seizure disorders anaphylaxis) by hosting health fairs and providing home visits.
School Health Services (School based Health Clinics) (SBH)/Wellness Centers
Provide school/community health care nursing services to constituents. Work to minimize barriers to obtain Health care for illegal immigrants, homeless, and victims of abuse. Provide illiterate population assistance in understanding guidelines and resources available, complete forms, speak to different departments on families' behalf, and serve as an advocate for receiving services. Coordinate transportation, make appointments, remind families of appointments, follow up with prescriptions care and obtain medications, and teach families how to care for themselves. Teach Certified Medical Technician (CMT) Courses, MCPS staff trainings, SHS staff trainings, student and family health training (i.e., managing asthma, diabetes, seizure disorders, etc.).
In addition to functions specified under School Health Services, SBH/WC School Community Health Nurses (SCHN(s) coordinate health clinic primary care services in the school setting. Provide school/community health care nursing services to clients. Work to minimize barriers in obtaining health care for uninsured or under insured, undocumented individuals, homeless, and victims of abuse. Assist clients in understanding guidelines and resources available, completing forms, speaking to different departments on families' behalf, and serving as an advocate for receiving services, utilizing interpreters when indicated. Provides or coordinates with partners to provide transportation, make appointments, remind families of appointments, obtain medications, and teach families how to care for themselves.
School Health Services, Head Start
In addition to functions specified under School Health Services, refers individuals and families in this at risk population, to available health and community services, work to minimize barriers (transportation, insurance, health care appointments, language, form completion, literacy, knowledge deficit, etc.), and provides follow up care. Provide case management services and coordinates client care. Conduct group education classes in clinics, schools and other community locations. Participate in health fairs for the school community. Maintain clinical records and prepare written and statistical reports.
ACCU and DACCT Team
Provide care coordination services for pregnant teens, women, children, and adults with special needs which include assisting clients assess and navigate health care services within the Medical Assistance Managed Care Organization (MCO) to improve maternal/child and adult health outcomes. Collaborates with other multidisciplinary teams to resolve complex health care issues that create barriers to health care access within the Managed Care Organization system; Investigate disputes between Medical Assistance recipients and Managed Care Organizations. Identify client's medical and psychosocial needs of families and links with appropriate community resource as needed. Serve as an Advocate for high risk pregnant women and pregnant women who are late entry into prenatal care. Collaborate with MCOs to ensure that clients receive the needed services for which there are eligible. Works with the Service Eligibility Unit to assist clients assess Medical Assistance/Health Choice services. Participates in the annual flu clinic.
AGING AND DISABILITY SERVICES/AERS
Aging and Disability Services/AERS
Provide Adult Evaluation and Review Services (AERS) for the following programs: Older Adult Waiver (OAW), Living at Home Waiver (LAH), Increased Community Services (ICS), Medical Adult Day Care Waiver (MADC), Geriatric Evaluation Services (GES), Pre-admission Screening and Resident Review (PASRR), Statewide Evaluation and Planning Services (STEPS), and Adult Protective Services (APS). PASRR is a federally mandated program which provides pre-admission screening and resident review services to clients diagnosed with a major mental illness and/or intellectual disabilities prior to nursing home admission. GES is a state mandated program which requires an evaluation of anyone age 65 years or older referred for admission to a State psychiatric facility. AERS nurses also provide consultations and/or referrals for the Senior Care Program, the In Home Aid Services Program (IHAS), Medical Assistance Personal Care Program (MAPC), hospice care, Waiver Registry, and the Senior Assisted Housing Group Home Subsidy Program. The CHN II(s) also provides intake services, procedures clarification, manual development, community partners' education, and coordination with MHA/DDA and contractors. CHN II(s) also participate in County and State work groups (i.e., Elder/Vulnerable Adult Abuse Task Force, Hoarding Task Force, Maryland Department of Aging work groups Delegating Nurse Committee) and pilot numerous software programs and client assessment tools that are being considered by the State, monthly and quarterly meetings for the Older Adult Waiver and End of Life Coalition. Provide limited case management services and coordinate client care with Social Work colleagues. Collaboration includes placement referrals (e.g. hospital/nursing home admissions and/or discharges, homelessness, evictions, assisted living facilities, etc.) in complex and difficult situations involving vulnerable adults to help facilitate the least restrictive safe environment for the client. The CHN II(s) also participate in APS investigations including on-call situations with the APS social worker partner for clients who are at imminent risk for abuse/neglect. The CHN II(s) also conduct emergency assessments to stabilize situations and provide advocacy for clients in need of hospitalization or emergency placement. The goal is to reduce the level of risk and to establish a safe plan of care.
CHILDREN, YOUTH AND FAMILY SERVICES
Children with Special Needs
The SCHNs assigned to the Infants and Toddlers Program conduct health assessments of the newborn, infants, and children (birth - 3) to provide for early detection of health needs, physical, and mental handicapping conditions, and assist families to plan and obtain appropriate health care. Conduct developmental screenings and evaluations as part of an interdisciplinary team. Provide consultation, instruction and guidance to County school staff and the school community concerning specific health problems and school health policy. Provide support and health counseling to the Montgomery County Infant and Toddler Program (MCITP) families and staff. Work to minimize barriers to obtaining health care for uninsured or under insured, undocumented individuals, homeless, and victims of abuse.
For assigned clients and those with chronic health issues, identifies immediate needs for health service coordination, education, and long term-case management services, educates, supervises coordinates and/or monitors clients' compliance with treatment plans, and provides ongoing case-management services as needed.
Child Welfare (CWS) and Public Health
Participate on multiple community boards, coalitions, advocacy groups, and Maryland State committees that address the varying needs of Child Welfare Services (CWS) populations, and identify weaknesses in legislation and policies that decrease the quality of care available to CWS children or adults. Advocates for health care legislation that provides or enhance services to clients and their families by working closely with coalition groups, as they work towards improving services to our clients. Meet with groups in Montgomery County and work collaboratively to establish initiatives and introduction of new concepts and ideas to legislative bodies. Participates in multidisciplinary team meetings on as needed basis, and provide input from medical perspective to ensure holistic and optional medical care and consideration is offered CWS clients.
FIRE AND RESCUE, EMERGENCY MEDICAL SERVICES (EMS)
Fire and Rescue, Emergency Medical Services (EMS)
Clinical Coordinator: Supervise, track, and grade Advanced Life Support (ALS) Providers students' clinical paperwork to include time spent, patients' assessments and skill acquisition. Simultaneously monitor ALS training courses and contribute to County re-accreditation documents as it pertains to EMS Operations. Develops and maintain Maryland State and National EMS Accreditations. Assist co-workers with Microsoft Office Program and other non EMS Projects as part of the academy staff. Review and revise training related documents. Maintain Hospital Contracts related to student clinical rotations. Serve as a liaison between the training academy and the skilled nursing facility. Schedule hospital clinical time for Advanced Life Support (ALS) and Basic Life Support (BLS) students, and accompany the students on days that require skill training or additional supervision. Arrange for students from each ALS class to spend a day at the Maryland State Anatomy Board performing ALS skills on cadavers. Facilitates the process of assisting career and volunteer Nationally Registered ALS Providers become Montgomery County ALS Providers. Manage internship placements, coordinate evaluations by an EMS duty officer, and schedule the credentialing interviews with the county Medical Director. Address personnel issues, intern remediation, and subsequent termination of unsuccessful ALS Providers and Intern for the ALS credentialing process.
EMS Nurse Clinician: ALS Training Coordinator
Develop and provide education for CRT/EMT-P students who deliver pre-hospital care to individuals and families in the community. Educational objectives are derived in the DOT/NHTSA Paramedic Curriculum, the Maryland CRT/EMT-Paramedic Protocols, National Education Standards, and AHA ACLS Guidelines. Topics include: roles and responsibilities, patient assessment; airway management; respiratory, cardiovascular, shock, neurological, endocrine, trauma, medical, obstetric, and pediatric emergencies; pharmacology; crisis management; and communications.
Develop, implement, and apply appropriate cognitive, affective and psychomotor domains of learning to develop curricula for ALS training and continuing education programs to prepare competent, comprehensive EMS care providers, utilizing current national curriculum models, National Registry standards, NHTSA standards, National Scope of practice, and Code of Maryland Regulations (COMAR) Title 30 (MIEMSS).
Instruct and evaluate paramedic students and providers in the proper procedures for health assessments and interventions to include: patient assessment, airway management, initiating vascular (intravenous, intraosseous, and jugular) access, medication administration (intramuscular, intraosseous, endotracheal tube, IV bolus and IV drip, CPR, dysrhythmia interpretation, defibrillation, cardiac pacing, cardioversion, spinal immobilization, splinting, and chest decompression.
EMS Nurse Clinician: ALS Coordinator
Develop and implement continuing educational programs for approximately 400 current Advanced Life Support EMS providers to maintain their National Registry (NREMT) and Maryland Institute of Emergency Medical Services Systems (MIEMSS) pre-hospital provider credentials.
Content includes both required curricula (airway, pediatrics, trauma, medical, and obstetric/neonatal emergencies, assessments, and pre-hospital management) and additional EMS-related educational content. Instruct and evaluate current ALS provides in classroom lectures and skill scenarios, arrange for guest speakers, and recruit adjunct instructors for sessions.
This includes curricula development, writing objectives, outlines, scenarios as well and cognitive and psychomotor test development, implementation and application of appropriate cognitive, affective and psychomotor domains of learning to maintain competent, comprehensive ALS care providers, utilizing current national curriculum models, National Registry of Emergency Medical Technician (NREMT) standards, NHTSA standards, National Scope of Practice and Code of Maryland Regulations (COMAR) Title 30.
Experience: Two (2) years of full-time equivalent post-licensure experience as a RN Nurse, one year of which must have been in the nursing area of specialization to which assigned.
Education: Graduation from a National League for Nursing accredited college or university or an equivalent program as determined by the Maryland Board of Examiners with a Bachelor's Degree in Nursing.
Equivalency: An equivalent combination of education and experience may be substituted.
Knowledge, Skills, and Abilities KSA(s):
Knowledge, Skills, and Abilities KSA(s) will be based upon Program Area directly related to assignment of the position.
Considerable knowledge of the total range of community health nursing standards, practices, and procedures. Considerable and specific knowledge in the area of early childhood development, developmental delays, pediatric health care, geriatric health care, chronic diseases/treatments, medications, psychiatric interventions, emergency preparedness, emergency management services, family functioning and interactions, and human growth and development throughout the life cycle, considerable knowledge of advanced life support procedures, techniques, current therapies and medications and complex equipment related to emergency treatment of patients in the prehospital setting. Considerable knowledge of treatment and management of communicable diseases, disease intervention strategies to include outbreak investigations and disease interviewing and investigation methods. Considerable knowledge of current Advance Life Support (ALS) providers roles and responsibilities, advanced patient assessment, shock, pharmacology, respiratory, cardiovascular, neurological trauma, medical emergencies, obstetrics, pediatrics, crisis management, communications, and mass casualty management as they apply to prehospital care, and written and psychomotor evaluation tools.
Ability to collect, organize, record, and communicate pertinent and significant data in primary health assessments. Considerable knowledge of drugs and pharmaceuticals, and their expected action, dosage, methods of administration, contraindications, and the side effects of medication which may arise from administering medication. Advanced ability to manage complex acute and chronic diseases and chronic and communicable health problems, such as HIV/Aids, tuberculosis, venereal diseases, neurological conditions, hypertension, Hepatitis, vaccine-preventable diseases (i.e., measles, chickenpox and meningitis) and diabetes in clinics and home environments. Considerable ability to perform and interpret special screening and/or developmental tests and selected laboratory findings to provide quality nursing care and improve the health status of an identified target population (e.g., handicapped, geriatric, adolescent, parents, mentally challenged, and substance abusers). Skill in counseling and health teaching to give guidance to individuals and families, exchanging information with other health, education, welfare, and community workers, and providing expertise in adult learning and multidisciplinary team process. Advanced ability to train and guide other licensed and unlicensed nursing personnel, considerable skill and ability to assist in planning and reviewing the work of licensed and unlicensed personnel and instructors, and ability to instruct them in nursing techniques.
Considerable knowledge and ability to understand and interpret the significance of epidemiological findings, health research studies, and statistical data.
Advanced knowledge of preventive health measures, human behavior, and methodology affecting motivation of consumers in accepting the responsibility for their health maintenance and promotion. Considerable knowledgeable in a wide scope of medical technology including insulin pumps, tracheotomies, catheterizations, colostomies, peripherally inserted central catheter (PICC) lines, gastrointestinal devices, and Automated External Defibrillators (AEDs). Considerable knowledge of nursing and public health theories and practices, and Federal, Maryland State, and county laws and regulations required to provide community health nursing care to individuals, families and the community. Considerable knowledge of functions of other members on assigned interdisciplinary teams, and ability to work cooperatively with these members. Knowledge of available community resources for referral. Knowledge of demographic and data collection methods. Considerable skill in operating medical and nursing equipment. Considerable skill and ability to provide emergency treatment, such as CPR for life-threatening conditions. Considerable ability to perform and interpret special screening and/or developmental tests and selected laboratory findings to provide quality nursing care and improve the health status of an identified target population (e.g., handicapped, geriatric, adolescent, parents, mentally challenged, or critically ill patients in the HIV or TB clinics). Ability to identify morbidities among populations at risk. Ability to prioritize work and maintain client/patient records. Ability to attend meetings or perform other assignments at locations outside the office as necessary.
Ability to develop educational curricula for ALS students; ability to develop written and psychomotor evaluation tools; ability to identify commonalities of medical or trauma problems among pop and initiation of appropriate treatment; ability to supervise and provide direction to adjunct instructors and students.
Possession of a current license to practice as a Registered Nurse in the Maryland State, of Maryland issued by the Maryland Board of Examiners is required at the time of appointment. If the license is temporary, a regular Maryland RN license must be obtained within ninety (90) days of appointment.
The State of Maryland accepts as valid the current RN licensure from a candidate's primary state of residence if that state has an interstate compact with Maryland. The states having this interstate compact are Arizona, Arkansas, Colorado, Delaware, Idaho, Iowa, Kentucky, Maine, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, and Wisconsin. (This equivalency only applies to candidates whose primary residence is not Maryland). Any Registered Nurse (RN) or Licensed Practical Nurse (LPN) applying for licensure and living in a member state of the Multistate Licensure Compact must take the NCLEX exam in their home state.
Individuals appointed or promoted to a bargaining unit position in this class will be required to serve a probationary period of six months. Individuals appointed to a non-bargaining unit position in this class will be required to serve a probationary period of twelve months, or if promoted to a non-bargaining unit position, will be required to serve a probationary period of six months. Performance will be carefully evaluated during the probationary period. Continuation in this class will be contingent upon successful completion of the probationary period.
MEDICAL PROTOCOL: Limited Core Exam.
Class Established: July 1975
Revised: May 1985
May 1993 (M)
April, 2002 (M)
October 2012 (M)