General Summary

The Neonatal Escalation Safety Telemetry (NEST) program is a 24/7 remote (on-site) operation that is staffed with experienced labor & delivery RNs and provides remote monitoring of fetal tracings for obstetric patients across all UMMS hospitals. Under the direction of the Nurse Manager, the RN will work in conjunction with the bedside team at all UMMS L&D units to provide additional observation of fetal tracings and early identification and escalation of concerning tracings. He/she advances evidence-based practices, and mentors others to achieve and grow in the role of the professional nurse. As a member of the NEST team, he/she serves as a leader, change agent, and coordinator of patient care services within the obstetric service line. Takes a leadership role in overall design and implementation of a patient centered care delivery system that facilitates achievement of patient outcomes, supports continuity of care and patient flow between care delivery sites, and enhances patient safety and caregiver satisfaction. Is accountable to patients and families for the processes and outcomes of care during an episode of care. Is accountable to peers for the advancement of group practice, and to the Nurse Manager for the totality of work performance.

This role is designed for the nurse who has achieved expertise and leadership in the clinical and professional role, within the unit and beyond. He/she leads and evaluates evidence-based practice, actively participates and/or leads organizational initiatives, mentors and coaches nurses and other disciplines, exemplifies the role of the professional nurses and demonstrates active involvement in clinical and professional nursing beyond the walls of the unit and/or organization.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

Clinical Practice/Care Delivery

1. Monitors tracing for fetal physiological parameter abnormalities. Assesses individual fetal monitoring tracings and documentation of interventions done by the care team when abnormalities are identified by the NEST nurses.
2. Notifies the primary registered nurse or charge nurse of concerning electronic fetal heart rate and uterine activity tracing findings, poor-quality signal, etc. Follows the established chain of command for escalation of concerning fetal tracings.
3. Utilizes Electronic Medical Records to validate findings from remote fetal monitoring station.
4. Serves as a clinical expert and professional resource for L&D nurses and other disciplines; mentors and coaches other nurses and disciplines to advance their development. Communicate in an efficient and effective manner with all members of the care team
5. Leads and evaluates efforts to advances evidence-based clinical practice within the NEST; consistently integrates evidence into practice and uses this as a firm foundation for the NEST.
6. Utilizes clinical expertise to teach other nurses. Role models Patient-Centered Care and mentors others in their growth.

Practice Focus Areas:

Focus on use of National Institute of Child Health and Human Development (NICHD) fetal monitoring terminology in the interpretation and communication of fetal heart tracing in a timely manner.

Professional Development

1. Actively demonstrates expertise and leadership in their clinical and professional role. Engages in advancing own practice; role model for others. Mentors and coaches others to achieve/maintain competency required for the patient population served.
2. Serves as an expert preceptor and mentors others in the preceptor role; plans clinical experiences for orientation. Mentors and coaches unit leaders or those assuming leadership roles on councils or major governance initiatives.
3. Leads and evaluates unit processes for development of ancillary personnel's skills and development.

Practice Focus Areas:

1. Leads and evaluates unit based Professional Development governance activities; participates actively in divisional and organizational efforts.
2. Leads planning and delivery of unit-level education appropriate for patient population.
3. Leads program-based competency validation processes.
4. Develops and evaluates unit orientation program.
5. Provides health-related contributions through community services, such as health fairs.
6. Demonstrates active involvement in clinical and professional nursing beyond the walls of the unit and/or organization

Service Quality/Safety

1. Models customer service behaviors and service recovery skills.
2. Leads efforts to address Nursing Sensitive Quality Indicators (NSQI) improvement opportunities; develops/implements and evaluates action plans.
3. Leads performance improvement initiatives by designing, implementing, evaluating, and disseminating results.
4. Monitors patient safety standards; actively contributes to development and implementation of improvement plans.
5. Participates in some or all elements of research.

Practice Focus Areas:

1. Identifies and integrates "Best practices" for communication.
2. Trends quality data on a consistent basis and leads efforts to address deficiencies.
3. Oversees Joint Commission and other regulatory site visits (mock and actual); helps prepare unit and staff on an ongoing basis.

Unit and Organizational Operations

1. Performs charge role as scheduled; mentors and coaches nurses and other disciplines. Exemplifies the role of the professional nurse and demonstrates active involvement in clinical and professional nursing beyond the walls of the unit and/or organization. Provides orientation to newly hired RNs and supports those newly off orientation.
2. Serves as a liaison for L&D units.
3. Role models and holds peers accountable for maintaining AACN guidelines for Healthy Work Environment (communication, collaboration, effective decision making, recognition, leadership, staffing).

Practice Focus Areas:

1. Leads and evaluates governance initiatives.
2. Leads and evaluates based efforts addressing elements of Healthy Work Environment.
3. Leads and evaluates Reward and Recognition activities.
4. Leads NEST operations efforts, such as equipment maintenance, scheduling, supply utilization monitoring etc.
5. Leads NEST based peer review processes.
6. Leads and evaluates evidence-based practice.
7. Participates in and/or leads organizational initiatives.

Working Conditions

1. Weekend, shift work, holiday, on-call, and overtime may be required.
2. Work requires constantly sitting or standing at a workstation and repetitive work with both hands.

Patient Safety

Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.

1. Takes action to correct observed risks to patient safety.
2. Reports adverse events and near misses to appropriate management authority.
3. Implements policies, procedure, and standards consistently in the performance of assigned duties.
4. Develops effective working relationships and maintains good communication with other team members.
5. Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.