Public Health Nurse II

Job Description:
Under the direction of the Communicable Disease Program Manager works with high latitude for the use of initiative and independent judgment by performing highly specialized and comprehensive tuberculosis nurse consultation services in the counties of PHR 8. Serves as the tuberculosis nursing expert on all tuberculosis case management processes and assures adherence to TB prevention and control activities in line with DSHS TB standing delegation orders and standards of performance. Develops regional procedures that support DSHS nursing practices specific to case management, contact investigation and disease intervention for tuberculosis activities. Develops disease prevention strategies, priorities and standards for achieving program goals. Participates in program strategic planning activities. Provides team leadership to TB and field office nurses. Coordinates quality assurance activities to evaluate TB nurse case management practices in the regional field offices and local health departments. Provides technical assistance to local health departments, regional field staff, correctional facilities and the general public regarding tuberculosis. Designs and coordinates appropriate training to increase awareness of tuberculosis. Assists with other communicable disease activities in the Region. Work is performed within the guidelines of the TB standing delegation orders with demonstrated nursing competencies in the assessment, evaluation and management of TB suspects, cases and contacts. Must be able to independently drive and travel throughout the State of Texas and out-of-state to complete essential job functions.

Essential Job Functions:
35% TB Case Management:
Performs TB case management of tuberculosis (TB) suspects, cases, and persons with TB infection for assigned PHR 8 counties, congregate settings and correctional facilities, patients who are contacts to cases or referred for an evaluation by other jurisdictions, and patients referred through the EDN system. Educates tuberculosis suspects, contacts, and cases on tuberculosis transmission, infection, disease, and treatment within three (3) days of the initial report. Examines TB patients either in person or via telehealth. Prepares and monitors patients for tests, therapy, or treatments. Performs thorough assessment of the patient's needs, living and employment conditions and preferences, and documents on TB program forms. Performs TB screening tests. Prepares patient summary reports and participates in case reviews to ensure treatment guidelines are met. Reviews TB reporting forms (TB 400s) for accuracy and completeness with timely submission. Ensures all medical case management forms are complete and appropriately placed in medical charts. Obtains sputum specimens for acid-fast bacteria (AFB) testing and packages for mail to DSHS lab. Provide education to patients and contacts of patients on TB, the transmission of TB, exposure risk, the rationale for testing, meaning of test results, and, if positive for TB infection, actively encourages treatment regimens. As part of TB case management will complete the following: phlebotomy, drawing labs; obtaining routine vital signs and reporting abnormalities to Regional Medical Director for direction, providing directly observed therapy (DOT); collecting sputum specimens; performing monthly toxicity screenings, documenting appropriately in patient's charts, carrying out data entry, following through on medical director instruction, educating clients and family and performing other patient management tasks as needed. Provides DOT to TB cases/suspects and DOPT to TB contacts or TBI clients as ordered by TB physician. Reviews adverse reactions with client or parent at every visit. Documents each visit on the DOT checklist. Meets patient at assigned time and place and documents and notifies TB nurses if the patient does not show or cannot attend DOT. Assures treatment compliance by providing DOT/DOPT services. Monitors VDOT (both synchronous and asynchronous). Performs thorough assessment of the patient's needs, living and employment conditions, and preferences and documents on TB program forms. Assesses patient environment to reduce risk of transmission and minimize delinquency. Performs DOT/DOPT toxicity checks and documents on appropriate forms. Track DOT mileage. Abides by standing delegation orders and program procedures. If a patient moves outside of the initial county of diagnosis will continue to follow-up with other jurisdictions and facilities outside of the county of diagnosis, to ensure proper patient management and treatment completion. Reviews vaccination status and administers vaccinations as appropriate. Makes rounds or home visits. Provides patient transportation, if needed. Maintain strict confidentiality of patient information as provided by law and agency confidentiality procedures and policies. Stays up to date on required tuberculosis-related continuing education, program, and other region-required training. Carries out data entry of clinical data collected from patient encounters, lab results, and chest x-ray results. Abides by standing delegation orders and program procedures. Must be able to independently drive and travel throughout the State of Texas and out-of-state to complete this essential job function.
20% Contact Investigations:
Assesses regional contact investigation practices conducted by regional and local health department nurses/contact investigator and provides recommendations to enhance performance; reviews contact investigation forms to assure identification and successful evaluation of high risk contacts. In collaboration with the CD program manager identifies target areas to implement blood assay testing. In collaboration with TB Epidemiologist uses TB genotyping data to determine unidentified outbreaks and transmission patterns and initiate appropriate action. In collaboration with TB Epidemiologist reviews TB DNA fingerprinting patterns associated with Region 8 and compares that to unique or recurring patterns statewide. Oversees the contact investigations of community contacts in assigned areas and provides guidance and leadership to contact investigator and journey level nursing staff. Ensures collaboration between contact investigator and nursing staff to complete all contact investigations. Oversees contact investigations occurring in congregate settings; nursing homes, correctional facilities and other long term facilities. In collaboration with the TB Epidemiologist submits to DSHS central office incident reports involving media sensitive investigations including outbreak investigations. With advanced interviewing techniques, elicits, and verifies contact information within seven (7) days of suspect/case identification. Using the concentric circle approach investigates to locate all appropriate contacts. Educate contacts on TB infection, disease, and treatment. Evaluate contacts for infection or disease based on window and post window tuberculin skin testing or blood tests. Assures appropriate follow-up to complete evaluation. Accurately completes contact evaluation and investigation forms with timely submission to the lead contact investigator. Reviews contact information forms for completeness. Using the concentric circle map assesses investigation results to determine contact expansion. Actively case manages contacts to a known source case. Interviews patients with confirmed TB or suspected to have TB within 7 days of notification to DSHS TB staff. Collaborates with contact investigation coordinator to: determine the scope of the contact investigation, provide a summary of contacts listed and whether the contacts are low, medium, or high priority, update current results from contacts tested, obtain CXR referrals for patients as needed and data enter patient information. Completes 340/341 reporting form and sends completed form to contact investigation coordinator for audit and reporting. Ensures all documentation is provided to contact investigation coordinator to obtain orders for treatment of contacts to the index case. Abides by standing delegation orders and program procedures. Must be able to independently drive and travel throughout the State of Texas and out-of-state to complete this essential job function.
15% Nurse Consultation:
Serves as the tuberculosis nursing expert on all tuberculosis case management protocols. Provides expert consultation to regional and local health department nurses on DSHS treatment standards, case management protocols and contact investigations activities. Provides training on nurse case management processes; assures new hires are trained on all aspects of TB nurse case management principles. Prepares curriculum, operational manuals, educational materials and training programs to assure technical and skill development for professionals and nonprofessionals participating in TB activities. Provides orientation and training for regional staff and DOT contractors on tuberculosis policies, procedures and guidelines. Serves as a resource for private providers and nurse practitioners on TB prevention and control principles. Serves as resource for TB nurse case management practices for long term care and correctional facilities. Coordinates continuing education to community providers, correctional facilities, other health care providers that serve at risk populations to ensure standard of practice of TB control activities. Oversee the medical management of patients who reside in Region 8's western counties. Completes and oversees the management of TB cases in assigned areas and provides guidance where needed to journey level nursing staff. Overseeing medical management includes fielding questions from nurses managing patients, reviewing the status of the patient, ensuring physician's orders are being implemented and to provide medical input during case review. Provide education to community members for TB and other communicable diseases. Stays up to date on required tuberculosis related continuing education, program and other region required trainings. Ensures team stays up to date on required tuberculosis related continuing education, program and other region required trainings. Serves as a TB or immunization nurse as needed. Oversee the medical management of assigned correctional patients in Region 8 and coordinate care with correctional facility liaison and DSHS Surveillance staff. Review new cases and suspected cases of TB with Surveillance staff. Coordinate with surveillance staff to obtain needed medical information and to ensure physician's orders are implemented. Oversee write-up of case review reports by the surveillance coordinator for presentation at monthly case reviews. Provides assistance to nursing staff on managing patients diagnosed with TB, suspected TB, LTBI, or contacts/patients referred through EDN system. Provides directly observed therapy (DOT). Responds to information requests for patient information, provides updated information, and ensures team also responds to information requests from the TB epidemiologist by the agreed upon deadlines. Completes interjurisdictional TB notice (IJN) forms for community patients and provides copy to Epidemiologist for tracking purposes. In collaboration with Epidemiologist, structures cohort reviews so TB case management practices including contact investigation activities are adequately assessed. Participates in cohort reviews quarterly, completes cohort review forms, and ensures team completes cohort review forms, which include reviewing charts, completing cohort review forms, coordinating meetings in collaboration with TB epidemiologist to review cohort review forms and completing forms by the agreed upon deadlines for timely submittal to Austin. Stays up to date on required training. Carries out data entry of clinical data collected from patient encounters, lab results and chest x-ray results. Must be able to independently drive and travel throughout the State of Texas and out-of-state to complete this essential job function.
10% Team Leadership:
Provides significant input to the Communicable Disease Program Manager in the development, review and updating of job descriptions and participates in the screening and selection process. Orients, trains and monitors the performance of assigned team staff to ensure they complete all essential job functions and meet program and personal performance standards. Develops schedules for and assigns work to the Program's regional staff. Makes recommendations regarding personnel actions, discipline of and rewards for employees. Provides guidance and technical assistance to program staff on policies and procedures. Orients and trains staff to ensure they meet program and personal performance standards. Makes recommendations regarding personnel actions to Communicable Disease program manager as requested. Must be able to independently drive and travel throughout the State of Texas and out-of-state to complete this essential job function.
10% Nursing Administration:
Works with program administration to develop regional procedures to facilitate the application of DSHS TB standing delegation orders and standards of performance. Maintains current information on federal guidelines on TB nurse case management practices. Advises program administration on updated TB guidelines. Works with federal, state and local partners to ensure consistent interpretation of TB program policies as it relates to case management, contact investigation and screening practices. Develops procedures, disease prevention strategies, priorities and standards for achieving nurse case management objectives. Assures implementation of nurse case management practices region-wide and evaluates adherence to procedures. Provides leadership on quality assurance activities performed by nursing staff. Prepares and submits evaluation findings of case management practices by clinical staff to the Region 8 Communicable Disease Program Manager. Works with the state TB nurse consultant on initiatives to enhance nurse case management practices statewide. Perform QA evaluations on patients who are managed in the Western counties. Provides input to Communicable Disease Program Manager and Nurse V to revise standing delegation orders or TB program procedures. Act as a liaison to medical community in Western counties on TB and LTBI. Provides leadership and support in completing the TB program Annual Report and TB Program Manual. Ensures team completes activities as outlined in the Texas TB Work Plan. Must be able to independently drive and travel throughout the State of Texas and out-of-state to complete this essential job function.
10% Other Duties:
Works with the Immunization, HIV/STD, Zoonosis and Epidemiology Response Teams to provide communicable disease services or conduct investigations related to communicable diseases. Provides immunizations to adults and children as needed in collaboration with the Immunization program, provides testing and treatment of STD patients, and assists with disease outbreak investigations. Provides general nursing or other support services to the Regional Epidemiology Response Team in the event of a natural or man-made disaster. Participate in on-call rotation to ensure 24/7 availability on holidays, weekends, and after normal duty hours. Provide support in completing strategic plan objectives. Responds to requests from the Communicable Disease Manager by the designated deadlines. Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency's obligations for disaster response and/or recovery or Continuity of Operations activation. Such participating may require an alternate shift pattern assignment and/or location. Safe operation of either a state-owned vehicle or personal vehicle is required to conduct state business and an acceptable driving record must be maintained in accordance with DSHS Policy OS-3901, Fleet Operations and Management & Procedures and standards developed by the Texas Department of Public Safety. Must be able to independently drive and travel throughout the State of Texas and out-of-state to complete this essential job function. Complies with the Department of State Health Services Immunization Policy.

Knowledge Skills Abilities:
Knowledge of public health law (tuberculosis), public health nursing and public health principles/practice including epidemiology, disease prevention, health promotion, health and community assessment, and community collaboration.
Knowledge of CDC's treatment protocols and guidelines including directly observed therapy, targeted screening for latent TB infection and contact investigation.
Knowledge of case management techniques.
Knowledge of local, state, and federal laws and procedures pertaining to tuberculosis and disease surveillance.
Knowledge of community resources.
Knowledge of medical terminology.
Knowledge of teaching/learning theories and curriculum development principles.
Knowledge of principles of quality assurance, evaluation methods and data analysis.

Skill in administering medication and vaccines and phlebotomy.
Skill in developing and conducting individual and group training/ continuing education workshops.
Skill in conducting patient assessments, administering and reading TB skin tests, performing screening procedures, conducting case management and investigational interviews with patients, contacts and health care providers.
Skill in case analysis for case management purposes.
Skill in interpreting and evaluating treatment, radiographic and bacteriology data.
Skill in developing guidelines/protocols.
Skill in the use of a personal computer

Ability to plan, coordinate and evaluate the delivery of direct public health services and essential public health services to individuals, families and communities; conduct objective, comprehensive assessment plans.
Ability to interpret public health law
Ability to function independently, plan, assign and/or supervise staff, delegate appropriately and maintain confidentiality.
Ability to prepare reports, develop training, and motivate public health disciplines in program planning and implementation.
Ability to apply time management strategies and principles to maximize work productivity.
Ability to maintain interdisciplinary collaboration working relationships with the public and medical community using tact and diplomacy.
Ability to work well and effectively in a team environment.
Ability to meet agency employee immunization requirements; meet the physical demands of the job functions; and comply with HIPAA regulations.
Ability to independently drive and travel throughout the State of Texas and out-of-state to complete essential job functions.
Ability to collect sputum and carry out phlebotomy.
Ability to provide transportation.

Registration or Licensure Requirements:
Current license to practice as a Registered Nurse by the State of Texas or state that recognizes reciprocity through the Nurse Licensure Compact.
Valid Texas Class C Driver License or equivalent from another state

Initial Selection Criteria:
Bilingual and biliterate in Spanish and English.
Nursing work experience

Additional Information:
In-basket exercise is required as part of the interview process.

MOS Code:
66B; 290X SC; 46AX; 66C; 46FX; 66E; 66F; 66G; 46SX; 66H; 46YX; 66P; 66R; 66S; 66T; 66W; 290X; 46NX; 46PX

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I-9 Form - Click here to download the I-9 form.

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

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