Registered Nurse - Transitions

Saint Elizabeth; Golden Horseshoe; Hybrid; CAD 65,000 - 85,000; Full time

Job summary

A healthcare organization in Ontario is seeking dynamic Nurses (RN) to provide client-centered care in home and community settings. This full-time role emphasizes collaboration with an interdisciplinary team to create personalized care strategies. Candidates must be registered nurses with at least two years of nursing experience and a passion for community care. The position offers competitive compensation and flexible scheduling options.

Benefits

Competitive salary

Tuition Assistance Programs

Support for professional development

Flexible scheduling

Qualifications

• Minimum of two years of nursing experience.
• Experience in home/community care, acute care, or chronic disease management.
• Ability to work independently and in a team environment.

Responsibilities

• Provision of comprehensive care in an interdisciplinary team.
• Lead discharge and transition care planning discussions.
• Support clients and families to develop self-care strategies.

Skills

Excellent assessment skills

Clinical leadership experience

Interpersonal communication skills

Organizational skills

Case management skills

Education

Registered Nurse in good standing with the College of Nurses of Ontario

Job description

The Acute Care Transitions Program ensures seamless, compassionate care as patients move from hospital to home. Designed to support both patients and their families, the program connects individuals with community-based healthcare providers, social support services, primary care and acute care teams. Together, they create personalized plans that improve outcomes and ease the transition to home.

POSITION SUMMARY:

We are seeking a dynamic and passionate Nurses (RN) who wants to be part of the transformational change in home and community care by providing care in a truly client-centered approach. You are excited about working in an environment that puts the care team in the driving seat; being part of a self-directed team that offers a high level of professional autonomy and responsibility. You will be part of a diverse care team that will provide services to a roster of clients in the community. You be part of a collaborative team that will conduct joint care planning with a focus on client-centered goals addressing client’s physical, cognitive, social, emotional, and spiritual domains, creating a holistic care plan. Each client is assigned a primary care clinician, a member of the interdisciplinary team who will lead care planning for that client and facilitate interdisciplinary team to reach client’s care goals. As part of the SE Transitions team, you will be a part of the team that will be accountable for the care and services you provide and the outcomes your clients achieve.

Full time permanent role - guaranteed 37.5 hours a week with 12 hours shifts.

Why join our team?

• Competitive Compensation. Our Total Rewards package includes a competitive salary, group benefits, RRSP pension, on demand pay and exclusive perks/discounts available only to SE Health staff

• Develop yourself with SE.We have Tuition Assistance Programs, continuing education, training, and professional development to support your lifelong learning. And our leadership team will support you to practice to full scope, to integrate the most current evidence into your practice, and to be part of a strong and supportive team that gives you the right mix of team and independence. SE’s orientation and development programs are designed to support both new and seasoned practitioners to excel, and to enable you to provide the very best care in a warm and nurturing way.

• Grow your career.SE Health is a large national organization with diverse healthcare business lines. You’ll have an opportunity – and will be supported – to do different types of patient-facing therapy roles in different locations if that is what you’re interested in. Or you can pivot to supporting or leadership positions where you use your therapy skills as a foundation to contribute and make an impact in different ways.

• Manage your life.At SE, you’ll have the flexibility to control your schedule to balance your life around child care or elder care, or whatever it is you need to do to have a healthy balance of life and work. You have the freedom to set and adjust your schedule, with your roster of clients.

• Support to be your best. SE Therapists are afforded the time they need to help their patients, to build rapport, to accomplish patient care and recovery goals, and to understand the home and life environments that impact recovery in a way you can’t in most other settings. At SE, you meet your patients where they are, and together you take them to new heights!

  
  

RESPONSIBILITIES:

• Provision of comprehensive care in an interdisciplinary team
• Primary contact for a client when designated as the primary care provider/clinician for the client’s interdisciplinary team
• Provide continuous and comprehensive support to your team in the delivery of care for your client’s
• Complete a client assessment and develop an interdisciplinary care plan based on best evidence/practices and on client’s unique needs.
• Lead the care planning process and work with other disciplines to complete and implement interdisciplinary client care plans
• Facilitate regular interdisciplinary team communication (e.g. huddle, rounds, status updates) when designated as the primary care provider/clinician
• Lead discharge and transition care planning discussions during regular integrated team meetings with their front-line staff when designated as the primary care provider/clinician
• Facilitate and organize family and caregiver meetings
• Support the client through care transitions by collaborating and connecting the client with community support services in their local community.
• Support clients, families and caregivers to develop strong self-care strategies, anticipate and address health issues, as well as optimize their health through effective health promotion strategies

REQUIREMENTS:

• Registered in good standing with the College of Nurses of Ontario
• Minimum of two years of nursing experience
• Experience in one of the following areas: home/community care, acute care,chronic disease management, health promotion, palliative care and mental health
• Having diverse nursing experiences with different client groups will be an asset
• Community experience is an asset.
• Demonstrated clinical leadership experience
• Enthusiasm and love of community rehabilitative care and interest in sharing knowledge
• Excellent assessment skills and a strong clinical background
• Ability to be flexible and adaptable with excellent organizational skills
• Ability to take initiative and adaptable to rapidly changing demands
• Excellent interpersonal, communication (oral and written) and critical thinking skills
• Demonstrated skills working independently and in a team environment
• Excellent skills in case management and working with/coordinating interdisciplinary care teams
• Vulnerable sector check (current).
• A vehicle and valid driver’s license and the ability to travel.

About SE Health

At SE, we love what we do. Every day, we bring hope and happiness to clients, homes, and communities across Canada. We treat each person with dignity and love, like our own family; we build empathy; and we do the right thing. We are always inspired to make a difference. As a not-for-profit social enterprise, we share knowledge, provide the best care, and help each client to realize their most meaningful goals for health and wellbeing. We are an inclusive workplace offering competitive pay, benefits, pension, and work life balance. We’re a great place to work, and we hope you’ll join our team.

In the interest of the health and safety of our patients/clients, employees, and greater good of public health, SE Health requires those that wish to work for this organization to be fully vaccinated against COVID‑19. Fully vaccinated means a person has received both doses of the COVID‑19 vaccine and it has been 14 days since the last dose.

SE Health is committed to the success of all its employees. If you feel you need accommodations because of illness or disability, please do not hesitate to contact the Talent Acquisition team at [e-mail] at your earliest convenience.