Job responsibilities:

• Screen referral based on patient’s needs, preferences and care goals with consideration of resource availability and efficiency.
• Analyse biopsychosocial assessment findings for patients to identify complications and evaluate follow-up actions.
• Implement care plans and carry out the care interventions based on the assessment findings of the doctor. Perform timely and appropriate follow up including updating the service plan for effective scheduling.
• Collaborate with the multidisciplinary team for care integration and transition
• Coordinate care to deliver holistic patient care with all members of the care team
• Handle incoming clinical enquiries via various modes of communication. Perform clinical triage for stable patients requesting adhoc consultation. Escalate to Supervisor when it is beyond her capacity to handle
• Assist in managing unexpected and abnormal changes in the client’s health and social conditions and collaborate with the care team to resolve the issues.
• Escalate to Assistant Nurse Clinician and/or Care team on complex clinical enquires and any problems encountered in patient’s condition and/or in the handling of patients and/or caregivers/family members.
• Build rapport therapeutic relationships and empower the clients, families and/or caregivers for self-management through health promotion, caregivers training and motivational techniques
• Liaise with patients/NOK, pharmacist and physician on prescription-related issues.
• Inform operation team on laboratory orders and any special instruction to facilitate scheduling with outsourced laboratory. Ensure that investigation forms are duly signed by the doctor.
• Receive critical laboratory results and provide timely communication with the primary doctor.  Perform read-back of the laboratory results and carry out follow-up action with the patient, if required. Document the details of the communication and doctor’s order accurately. 
• Performing Home visits or telephonic care assessments when necessary to support holistic patient care e.g. SMF
• Maintain timely and accurate documentation of patients’ condition and care given
• Engage patients, family and caregivers for advance care planning in collaboration with the care teams.
• Advocate for patients, families and caregivers on community needs based on their readiness.
• Perform Swab for patients when activated
• Perform Caregivers training/health promotion programme for clients, families and/or caregivers according to their learning styles and readiness.
• Participate in Inservice Education and peer sharing sessions (Medication, wound roundings).

Job requirements:

• Registered Nurse with the Singapore Nursing Board.
• Minimum 5 years experience working in an acute hospital setting and/or community hospital/ care setting.
• Degree in Nursing and/or Advanced Gerontology or other specialty preferred; experience in Home Nursing (preferred).
• Possess good communication skills to establish therapeutic relationship that fosters optimal quality patient care. Has good telephone etiquette.
• Able to make clinical judgments regarding patient care with minimal guidance.

To apply, email your resume to recruit@hnf.org.sg.