Palliative Care Access Nurse

The Mass General Hospital Division of Palliative Care & Geriatric Medicine is seeking a dedicated Registered Nurse to play a pivotal role in our team, ensuring patients have access to comprehensive palliative care that honors their values and preferences.

The Patient Navigator Nurse will function in a clinical integration and patient care coordination role in partnership with Emergency Department, Inpatient Palliative Care Consultative Team, the Supportive Care Unit and Palliative Care clinical staff and other key stakeholders. The Navigator Nurse will gather pertinent clinical and social information to identify appropriate level of care and location of care within the hospital/health system, ensuring patients are assigned to appropriate service lines.

The role is responsible for directing the patient's progression through the Emergency Department in collaboration with the intradisciplinary care teams - including physician, advanced practice, nursing, case management, social work, chaplaincy, and non-clinical support staff. The primary focus of this role will be identifying patients suitable for our Care Transitions Program (CTP) and facilitating their seamless transition from the Emergency Department to most appropriate clinical program based on patient need: the Supportive Care Unit; Inpatient Unit with Palliative Care Consultative Service; or to the community/home with the appropriate resources. The role will also assist with inpatient referral triage, ensuring that patients receive timely and appropriate palliative care interventions aligned with their clinical needs and personal preferences, thereby improving quality of life and patient outcomes.

At Mass General Hospital's Division of Palliative Care & Geriatric Medicine, we are committed to delivering the highest quality care in a respectful, efficient, and safe environment. We prioritize open communication, value each team member's contributions, and are dedicated to advancing disease diagnosis and treatment through research and education. Our team ethos emphasizes innovation, collaboration, and leadership by example.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Clinical Duties:

• Receiving inpatient consult referrals from various sources, such as other healthcare providers, outpatient clinics, and emergency department; communicate with referring healthcare providers to gather additional information to ensure prioritization of referrals based on the severity of symptoms, acuity of illness, and patient/family needs. This prioritization ensures that patients with the most urgent palliative care needs receive timely intervention and support.

• Facilitate communication and coordination among healthcare providers across different specialties involved in the patient's care, ensuring continuity and consistency in care delivery.

• Identify patients who may be candidates for the Care Transitions Program pathway.

• Huddles with Emergency Department, Palliative Care, and other clinical teams to assess patient appropriateness for program protocols and pathways.

• Educate clinicians and staff on programmatic pathway criteria and facilitates appropriate patient entry into the corresponding pathway.

• Follows patient progression into appropriate pathway and through to placement into the next appropriate step in their care.

• Interface with Clinical Team and Case Management regarding patient disposition.

• Gathers pertinent clinical and social information to identify appropriate level of care and location of care within the hospital/health system.

• Ensures patients are assigned to appropriate service lines.

Communication:

• Clear and direct in verbal and written communication.

• Effective in facilitating group processes of decision-making for patient, family, and staff

• Is empathic and respectful.

• Is congruent with interpretation of plan of care to members of care team.

• Accepts responsibility for conflict resolution between patient, family, and staff.

• Advocates for patients' choices.

Professional Development:

• Engages in self-performance appraisal on a regular basis, identifying areas of strength as well as areas for professional/practice development

• Identifies learning needs and goals on a regular basis and designs a plan to meet them

• Maintains necessary clinical skills through continuing education and direct clinical practice

• Establishes self as a resource in areas of the hospital where expertise may be required

• Collaborates with leadership in identification of current and future service needs and shares responsibility for meeting these need

• Maintains membership in one or more national nursing organization

Quality Assurance & Process Improvement:

• Participates in developing policies, procedure, and standards of care.

• Monitors patient outcomes.

• Recommends changes in practice as needed.

• Participates in regular case review, data analysis, and quality improvement efforts.

Qualifications

SKILLS/ABILITIES/COMPETENCIES REQUIRED:

• Integrates theoretical knowledge base and clinical expertise in decision making.

• Advocates for patients, their significant others, coworkers, the community.

• Consistently demonstrates accountability.

• Champions collaborative practice with coworkers and other disciplines and departments.

• Consistently demonstrates compassion to internal and external stakeholders.

• Dynamically represents the program and nursing profession in internal and external forums.

• Exemplifies a professional behavior.

• Fluent in verbal and written language skills; effective communicator with the ability to transfer knowledge.

• Computer skills to support clinical & administrative tasks, to include EHR & Microsoft Office application

• Possession of collaboration and team-building skills.

• Ability to receive and incorporate feedback, as well as provide constructive feedback to others.

• Flexibility and involvement in change management experience.

LICENSES, CERTIFICATIONS, and/or REGISTRATIONS

• Current Massachusetts licensure as a registered nurse.

• Current Basic Life Support (BLS) certification.

• Specialty certification, desirable.

EDUCATION:

• Graduate of an accredited school of nursing.

• Bachelor's degree in nursing preferred.

EXPERIENCE:

• Relevant clinical experience in the acute care setting with patients with advanced and serious illness (palliative care, geriatrics, emergency nursing).

• Minimum two years of clinical nursing experience required.

• Working knowledge of Epic electronic health record desirable.

SUPERVISORY RESPONSIBILITY (if applicable):

None.

FISCAL RESPONSIBILITY (if applicable): Indicate financial "scope" information, i.e.: size of budget, volume, revenue, etc.; Indicate total physician/non-physician FTE scope.

None.

WORKING CONDITIONS: Describe the conditions in which the work is performed.

Acute care hospital setting, including emergency department, inpatient care unit, ambulatory care environments.

10-hour day shift, including weekday, weekend, and holiday coverage required.

EEO Statement

Massachusetts General Hospital is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.