Job Description - Step 1 of 10
Job Description: Private Duty Nurse
The PHC Private Duty Nursing (PDN) Staff provide the frontline services to PHC’s patient population. They deliver and document effective and efficient care. They also serve in the most fundamental role of establishing and maintaining positive working
relationships with PHC leadership, staff, patients and families. Key activities may include:
Essential Job Functions:
The PHC Private Duty Nurse divides time across clinical and administrative responsibilities. The allocation of time and effort will vary by patient and includes:
Environmental and Working Conditions
Works the majority of time in the patient’s home with occasional shifts outside the home supporting family outings and hospital or clinic visits. Noise level may be moderately high, ability to work a flexible schedule and extended hours. Ability to travel locally and some exposure to inclement weather.
Physical and Mental Effort
Prolonged sitting and some standing required. Occasional need to lift, pull, carry and push items weighing up to fifty pounds. Frequent need to stoop, kneel and reach while providing patient care. Requires working under some stressful conditions to meet deadlines, resolve interpersonal conflicts, and address employer and employee needs. Requires hand-eye coordination and manual dexterity. Requires excellent interpersonal and problem solving skills.
Shift / Schedule
Shifts and schedules vary and are determined on an individual basis. Typical shifts are 12 hour day and/or 12 hour night shifts.
Job Description Acknowledgement
I have received, reviewed and fully understand the PDN job description. I further understand that I am responsible for carrying out the listed responsibilities and successfully executing the essential functions under the conditions as described.
Hepatitis B Vaccination - Step 2 of 10
Due to your occupational exposure to blood or other potentially infectious materials, you may be at risk for acquiring hepatitis B viral (HBV) infection. The vaccination series is available, at no cost, to you. Please indicate below your declination or acceptance to receive the vaccine.
Hepatitis B is a blood borne virus which can cause a range of symptoms from mild to serious, and possibly result in fatal liver damage to health care workers who become infected. The virus can be transmitted through contact with infectious fluids of a patient who has hepatitis B virus. You have been taught the concepts of Universal Precautions concerning safe patient care and the use of equipment to avoid unnecessary exposure.
Synthetic hepatitis B vaccine is derived from yeast cells. It is not composed of human blood or plasma. It is given as a series of three injections into the arm muscle at prescribed intervals (initial shot, one month later, and six months later). It has proven to be over 80-90% effective in protecting against the disease. There may be hypersensitivity to the vaccine, and there may be soreness and swelling of the injection arm. Other side effects may occur at an incidence of under 3% of injections.
The vaccine will not be given to persons with known sensitivity to aluminum hydroxide, thimerosal, yeast or hepatitis antigen and will only be given with your personal physician’s recommendations in the cases of pregnancy or presence of other infection of immunosuppressive state. The vaccine does not grant 100% assurance of immunity.
TB Fact Check - Step 3 of 10
The following criteria is utilized to identify if an employee has potential TB. This criteria is also utilized to determine if an employee needs another chest x-ray. This information is also presented in training.
Detection of employees who may have active TB are based on the following criteria:
I have reviewed the signs and symptoms of TB. I am not experiencing symptoms of TB. I understand if I experience any of the above symptoms I am to report to management immediately.
Statement of Employability - Step 4 of 10
By execution of this document, I acknowledge that I have been informed by the Agency and agree that the Agency may conduct a State of Texas criminal history check. I agree to a search of the Nurse Aide Registry and the Employee Misconduct Registry prior to employment and at least every 12 months if hired. I understand that these checks will determine if I have a criminal conviction or have committed certain conduct that will bar me from employment with this Agency. I understand that I am unemployable if listed in the NAR or EMR per TAC §93.3 and TxH&SC Chapter 253.
Criminal History Check
I have informed this agency of all names (i.e., maiden, aliases) that I have used in the past. I understand that my employment is pending the results of the criminal history check, and that I may not have face-to-face patient contact until results are returned. I will be notified of results.
CONVICTIONS BARRING EMPLOYMENT
(A) A person for whom the facility is entitled to obtain criminal history record information may not be employed in a facility if the person has been convicted of an offense listed in this subsection:
(B) A person may also be barred from employment the duties of which involve direct contract with a client in a facility if convicted of any of the following crimes within the past 5 years:
(C) In addition to the prohibitions on employment prescribed by Subsections (A) and (B), a person for whom a facility licensed under Chapter 242 or 247 is entitled to obtain criminal history record information may not be employed in a facility licensed under Chapter 242 or 247 if the person has been convicted:
(D) In addition to the prohibitions on employment prescribed by Subsections (A), (B) and (C), a nurse aide listed as unemployable per amendment to TAC 40, §94.10(l) and §94.11( c) (d) and is listed on the NAR or EMR stating a finding of abuse, neglect or misappropriation will not be recertified therefore, is unemployable.
(E) For purposes of this section, a person who is placed on deferred adjudication community supervision for an offense listed in this section, successfully
completes the period of deferred adjudication community supervision, and receives a dismissal and discharge in accordance with Section 5(c), Article 42.12,
Code of Criminal procedure, is not considered convicted of the offense for which the person received deferred adjudication community supervision.
Consent to Drug / Alcohol Testing - Step 5 of 10
I hereby agree, upon a request made under the drug/alcohol testing policy of Pediatric Healthcare Connection Inc., herby after to be referred to as PHC to submit to a drug or alcohol test and to furnish a sample of my urine, breath, and/or blood for analysis. I understand and agree that if I at any time refuse to submit to a drug or alcohol test under PHC policy, or if I otherwise fail to cooperate with the testing procedures, I will be subject to immediate termination. I further authorize and give full permission to have PHC and/or its company physician send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to PHC and/or to any governmental entity involved in a legal proceeding or investigation connected with the test. Finally, I authorize PHC to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding or investigation connected with the test.
I understand that only duly-authorized PHC officers, employees, and agents will have access to information furnished or obtained in connection with the test; that they will maintain and protect the confidentiality of such information to the greatest extent possible; and that they will share such information only to the extent necessary to make employment decisions and to respond to inquiries or notices from government entities.
I will hold harmless PHC, its company physician, and any testing laboratory PHC might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol test, even if a PHC or laboratory representative makes an error in the administration or analysis of the test or the reporting of the results. I will further hold harmless PHC, its company physician, and any testing laboratory PHC might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of the information is within the scope of this policy and the procedures as explained in the paragraph above.
This policy and authorization have been explained to me in a language I understand, and I have been told that if I have any questions about the test or the policy, they will be answered.
I understand that the PHC will require a drug screen and/or alcohol test under this policy whenever I am involved in an on-the-job accident or injury under circumstances that suggest possible involvement or influence of drugs or alcohol in the accident or injury event, and I agree to submit to any such test.
Emergency Disaster Receipt and Acknowledgement - Step 6 of 10
I hereby confirm that I have read Pediatric Healthcare Connection’s or PHC Emergency Disaster Plan and that it describes the content and behavior expected of me as an employee of Pediatric Healthcare Connection.
I also acknowledge that Tanya Howell is PHC’s Disaster Coordinator and that Steve Willingham is PHC’s Alternate Disaster Coordinator. They can both be reached at the numbers provided below:
Tanya Howell: Cell Phone: (512) 660-0207
Steve Willingham: Cell Phone: (512) 660-0508
ANE - Step 7 of 10
I acknowledge my responsibility as an employee to report abuse, neglect and exploitation. I understand that I should report any incident that I suspect may be abuse, neglect or exploitation even if I am not sure. I realize I may be criminally liable for failing to report abuse, neglect or exploitation.
Texas Abuse/Neglect Hotline: (800) 252–5400 (24 hours a day, 7 days a week)
Texas Health and Human Services: (800) 458-9858
HIPAA Agreement - Step 8 of 10
(Health Insurance Portability and Accountability Act of 1996)
I understand that while performing my jobs duties for Pediatric Healthcare Connection (PHC) at my workplace, I may have access to protected health information (PHI) about patients or residents of hospital or nursing homes and rehabilitation centers (hospital).
PHI means any information specifically relating to the past, present or future physical or mental health condition of an individual, the provision of healthcare to an individual or payment for healthcare to an individual, and is limited to information created or received by me from the hospital.
To insure confidentiality and privacy of PHI, I agree to:
OSHA Employment Agreement - Step 9 of 10
I have read and understand my job description and the policies set forth by Pediatric Healthcare Connection (PHC) and I agree to abide by them.
In addition, I have been advised of the “Right to Know” Law and have been instructed by my employer in the use and safest way to handle the chemical substance, which I use in my work. I understand it is my responsibility to take safety precautions when necessary.
Furthermore, I have received an inservice on Universal Blood and Body Fluid Precautions, from PHC. I am capable of following said Precautions as established by C.D.C. I have also been informed of the H.R.S. Guidelines pertaining to blood and body fluids.
Sign and Date - Step 10 of 10
Please sign and date below. If a PHC representative is not present you may click "Save/Omit" below the signature field.
Annual Packet Completed!
Thank you! All PHC Annual forms have been submitted.