Home and Community Care Support Services Champlain is one of 14 Home and Community Care Support Services organizations in Ontario. We are dedicated to ensuring our more than 64,000 patients annually receive the highest-quality health care and services at home. Our patient-care coordination teams help develop care plans for people of most ages, focused on maintaining each patient's independence and dignity. We also provide long-term care home placement services, and facilitate our patients’ access to the community-based services they need.

Position Summary:

We are hiring for multiple positions:

Job Type (bilingual & unilingual):
• Permanent Full Time
• Temporary Full Time (Palliative)

Locations:
• Cornwall
• Hawkesbury
• Winchester
• Ottawa

Rapid Response Team:

The Rapid Response Program (RRN) program provides a variety of services to patients requiring support while transitioning home from hospital, in home visits for chronic/acute disease management, Remote Care Monitoring, Pandemic response and other initiatives that support patient health in the community. Through health teaching, symptom management, medication reconciliation and connecting patients with their primary care provider they reduce hospital and ER visits.
With the goal of reducing hospital, emergency department and long-term-care admissions through streamlined community interventions, the Nurse Practitioner acts as a primary care resource for the multidisciplinary health care partners. The Nurse Practitioner, in consultation with the Manager of Home and Community Care, and in accordance with Home and Community Care Support Services Champlain mandate, provides primary care within their scope of practice to address at-risk patient’s primary care needs while meeting the RRN program goals.

Inclusion Team:

The Inclusion team provides a variety of services to patients requiring support while transitioning home from hospital, in home visits for chronic/acute disease management, Remote Care Monitoring, Pandemic response and other initiatives that support patient health in the community. Through health teaching, symptom management, medication reconciliation and connecting patients with their primary care provider they reduce hospital and ER visits.
With the goal of reducing hospital, emergency department and long-term-care admissions through streamlined community interventions, the Nurse Practitioner acts as a primary care resource for the multidisciplinary health care partners. The Nurse Practitioner, in consultation with the Manager of Home and Community Care, and in accordance with Home and Community Care Support Services Champlain mandate, provides primary care within their scope of practice to address at-risk patient’s primary care needs while meeting the Inclusion team goals.

Palliative:

As a member of the Regional Palliative Consultation Team (RPCT), the Palliative Care Nurse Practitioner will work in collaboration with Bruyère Continuing Care (BCC).
The Nurse Practitioner will provide clinical and educational support, mentorship, coaching and facilitate care connections across the health care sectors for clients requiring palliative and end-of-life care in the community. The Nurse Practitioner will provide expert clinical palliative leadership to support seamless and integrated care delivery.

Primary Responsibilities:

Rapid Response & Inclusion Team:

• Delivers comprehensive primary health care services (including but not limited to medication reconciliations, prescribing medication, ordering lab work, chart reviews, physical exams) to at-risk patients and patients facing access barriers to health care.
• Liaises, as required, with existing patient Physicians and other community partners to help address patient needs/goals.
• Provides health promotion and education to patients in the RRN Program by utilizing a diverse range of methods tailored to each patient’s needs.
• Educates patients in the program on effective disease prevention and/or prevention of further disability.
• Conducts focused assessments based on RRN or Care Coordinators’ escalation and/or barrier identification and provides recommendations to the RRN/ Care Coordinator.
• Provides consultation and support to the RRN Program and Home and Community Care Support Services Care Coordinators.
• Ensures best practice by bringing forward ideas and opportunities to the RRN Program leaders for dialogue and consideration.
• Assists with the collaborative development and implementation of RRN Program policies and procedures.
• Acts as a Program advocate as required, and ensures positive public relations and effective co-ordination of services through ongoing liaison and participation on internal and external committees,
• Participates in regular professional development activities such as academic rounds and other educational events.

Palliative Team:

• Provide expert consultation / clinical advise to primary care providers for palliative clients and their families
• Provide a 24/7 consultation call service to primary care providers which include family physicians, care coordinators and community nurses
• Provide face to face consultations with a member of the primary care team for palliative clients to recommend and contribute to the development of comprehensive care plan
• Provide primary care when it is not available on a case-by-case and/or temporary basis; including client assessments and home visits, for unattached/unaffiliated patients
• Participate in systems planning and system integration activities with the goal of ensuring a comprehensive, high quality system of hospice palliative care
• Act as a Program advocate as required, and ensure positive public relations and effective co-ordination of services through ongoing liaison and participation on internal and external committees
• Build capacity with primary care teams through coaching, mentoring and knowledge translation
• Participate in regular business meetings with HCCSS CHAMPLAIN management, BCC, and the RPCT to assist in program development, ongoing monitoring, quality improvement and evaluation.
• Identify the educational needs of primary care providers in Champlain region
• Provide palliative care and end-of-life education for patients and primary caregivers
• Participate in regular professional development activities such as academic rounds and other educational events within the RPCT community
• Remain current with evidence-based palliative care literature; including best practice guidelines, and share best practices with colleagues
• Participate in committees, workgroups and research as required
• Conducts research as required
• Other related duties may be assigned

Education and Experience:

• Current registration with the College of Nurses of Ontario as a Registered Nurse (Extended Class) and eligible to practice as a Nurse Practitioner.
• Related nursing experience in a home or community care environment that is normally attained over a period of three years, including linkages with community health agencies and other health disciplines.
• Experience with case management and discharge planning.

For the Palliative team:
• Canadian Nurses Association Certification in Hospice Palliative Care is an asset
• LEAP training is an asset
• Minimum of two (2) years of experience as an RN, in Palliative Care Nursing is an asset

Knowledge:

Subject Matter Knowledge:

• Advanced assessment and diagnostic reasoning skills
• Demonstrated advanced knowledge in consultation and ethical decision-making

Champlain HCCSS Knowledge:
• Knowledge of Champlain HCCSS operations, quality, risk, and performance management principles
• Knowledge of relevant health care legislation
• Knowledge of Champlain HCCSS policies, procedures, strategic direction and goals
• Understanding of Champlain HCCSS partners and contracted service providers in the community
General:
• Ability to accurately complete required documentation, reports, forms, and recommendations
• Working knowledge of computer software (email, internet) and Microsoft Office applications (Word, Excel, Power Point, etc.)

Skills and Abilities:

• Works with diverse client groups with varying levels of comprehension and language capability
• Manages difficult conversations /situations in a respectful, healthy and effective manner
• Works effectively in both a team environment and independently as required
• Effective communication skills to establish and maintain relationships with a wide range of contacts which include professionals and organizations within the community
• Effective listening and strong facilitation skills are necessary to work with patients and their families/caregivers
• Well-developed analytical, critical thinking, and problem-solving skills
• Analyzes, interprets and evaluates information of varying degrees of complexity from various sources
• Vulnerable Sector Check completed within the last six month
• Fluency in English and French required for bilingual positions


Affiliation: OPSEU
Pay Rate: Wages are in accordance with the collective agreement between Home and Community Care Support Services Champlain and OPSEU and starting salaries range from $54.377/hr. - $58.256/hr

Rapid Response Team - Shift: A rotating shift schedule comprised of eight hour shifts with various start times between the hours of 8am and 8pm, seven days/week for a total of 70hours

Inclusion & Palliative Team - Shift: Monday to Friday, 8:30am to 4:30pm

Please note that selection will be in accordance with Article 12.02 of the Collective Agreement (Selection).

Home and Community Care Support Services Champlain offers flexible work options, this position will have a hybrid model of work with a combination of work locations, including community and clinical settings, patients’ homes, on-site, and remote.

All applications will be reviewed; however, only those selected for an interview will be contacted. Home and Community Care Support Services Champlain welcomes and encourages applications from people with disabilities. Accommodations are available on request for candidates taking part in any aspects of the selection process.

Home and Community Care Support Services has implemented a mandatory vaccination policy across the province that requires all staff to be fully vaccinated against COVID-19. Applicants being considered for employment will be required to provide proof of vaccination documentation confidentially to Human Resources upon hire. Any medical or human rights exemption requests will be reviewed and validated prior to an offer of employment.