Stephanie Morris

• Collaborate with health specialists to determine patient needs and help clients develop attainable goals.
• Meet with patients and family members to explain procedures, respond to questions and educate on proposed actions to improve health.
• Provide education to patients and their families about congestive heart failure and proper home management of the disease
• Provide diabetes education and guidance to patients and their family members to help manage their diabetes
• Instruct patients on lifestyle modifications necessary for maintaining a healthy heart such as diet management, exercise regimes and stress reduction techniques.

The RN Care Manager is responsible for managing the continuum of care for admission through discharge for assigned patients.

• Initiates appropriate referrals to internal and external interdisciplinary teams.
• Coordinates the discharge planning process in collaboration with the interdisciplinary team.
• Documents all team, physician, and patient/family communication and concerns pertaining to coordinating care and services.
• Identifies patients/families with psychosocial and/or non-medical discharge planning needs and refers to the Social Work team member as appropriate.
• Assesses the patient prior to discharge to determine if the plan is appropriate and makes necessary revisions.

Worked collaboratively with physicians and clinical staff to support Medicare(or Medicare eligible) patients through preventative healthcare by way of Annual Wellness visits.

• Facilitated communication, coordinated services, addressed barriers, and promoted optimal allocation of resources while balancing clinical quality and cost management.
• Made appropriate arrangements for follow-up and/or continuing to include (but not limited to) follow-up with PCP for identified risk factors, addressed any health maintenance needs for preventative care, provided necessary educational materials, and ensured patient was referred to needed centralized care coordination resources.
• Provided on-going education to staff members and providers regarding implementation of or changes to criteria on the Medicare Annual Wellness visit.

• Trained and mentored RNs on best practice, policies,and standards of care
• Collaborated with doctors to plan post-treatment home care.
• Assessed and prepared patients for procedures, performing initial and ongoing patient assessments.
• Evaluated patients, recognized and addressed complications, and coordinated treatment with other members of the team.

• 8 years Charge Nurse
• Distributed assignments to RNs, LPN's, and CNA's, guided work and delivered training to promote proper care standards for patients.
• Applied clinical judgement and comprehensive knowledge of facility policies to assist floor nurses with patient care decisions
• Reviewed staffing patterns and census of nursing unit, meeting staff needs and budgetary controls.
• Advised, coached and mentored experienced, new, and student nurses on medical issues, crisis management and appropriate nursing interventions.
• Organized and conducted monthly staff meetings
• Monitored staff performance and provided coaching and formal counseling to staff.
• Assisted the supervisor with yearly performance evaluations for staff