ANNA MARIE APPEL BSN RN

Facilitates care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and right to self determination.

Completes comprehensive assessment within 24 hours of patient admission to identify and document anticipated transition plan for patients.

Integrates key elements of patient assessment, patient choice and available resources to develop and implement a successful transition plan.

Identifies patients at risk for readmission and applies appropriate intervention including risk assessment and referral to social work or complex case review.

Delegates the implementation of the transition plan to discharge planner and follows up to ensure the transition plan is completed timely and accurately.

Ensures all elements of the transition plan are implemented and communicated to the healthcare team, patient/family and post acute providers to achieve optimum clinical outcomes.

Ensures consults, testing and procedures are sequenced to support the patients clinical needs with timely and efficient care of delivery.

Ensures the plan of care is clinically appropriate, consistent with patient preference, choice and available resources.

Provides education to patients, physicians and the healthcare team relevant to effective progression of care, appropriate level of care and safe and timely patient transition.

• Provides direct patient care including medication administration via oral and intramuscular injections and monitors responses
• Works with the patient and other healthcare professionals to ensure high quality and effective nursing care
• Provides nursing care with detailed notes for any assessment and care given
• Manages care from admission to discharge, including patient assessments, care planning, health educations and discharge support
• Assists patient with ADLs to promote optimal recovery
• Advocates for patients by communicating care preferences to practitioners to make sure that treatment goals are met
• Trains new nurses in proper techniques, care standards, operational procedures and safety protocols
• Works in psych ED to process admission screenings and physical and mental health assessments
• Assessed and reported changes in patients'' mental status, working closely with the treatment team to appropriately adjust care plans.

• Provided hands-on care to patients undergoing rehabilitation to ensure optimal recovery
• Provided direct patient care to patients in a nursing home setting
• Worked as a relief house supervisor overseeing the 153-bed skilled nursing and rehabilitation facility

• Administered medications via oral and intramuscular injections and monitored responses
• Managed care from admission to discharge, including patient assessments, care planning, health educations and discharge support