Susan "Kelly" Gilbert
Yorktown,Virginia
Summary
Commpassionate Palliative Care Nurse Practitioner ready for care challenges of patients with diverse terminal conditions and serious illnesses. Supportive of patients' medical and emotional needs and adept at counseling and educating loved ones. Operates effectively in interdisciplinary care environments.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Palliative Care Nurse Navigator
Riverside Regional Medical Center
Newport News, VA
05.2022 - Current
- Presented information about care and medications in terms that were easy for patients and caregivers to understand.
- Referred patients to specialized health resources or community agencies to provide additional assistance.
- Advocated for patient needs with an interdisciplinary team and implemented outlined treatment plans.
- Modified patient treatment plans as indicated by patients' responses and conditions.
- Coordinated with the healthcare team to establish, enact, and evaluate patient care plans.
- Delivered respectful, compassionate care to each patient and family member.
- Listened to patients and loved ones, offering emotional support and kindness to help with end-of-life transition.
- Evaluated patient conditions, monitored behaviors, and provided updates to supervising physicians regarding observations and concerns.
- Utilized effective interpersonal, writing, and active listening skills to build and cultivate positive relationships with patients, caregivers, and physicians.
Registered Nurse-Community Liaison
Riverside Home Care
Newport News, VA
11.2019 - 05.2022
- Educated health care professionals on ways to humanize patients' experiences.
- Maintained highest levels of patient satisfaction, generating referrals to maintain productivity levels for home care services.
- Assessed and evaluated palliative care needs, working with multidisciplinary team to initiate, manage and modify individualized care plans.
- Communicated with healthcare team members to plan, implement and enhance palliative care strategies.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Conveyed treatment options, diagnosis information and home care options to patients and caregivers to continue care consistency.
- Facilitated goals of care discussions and assisted with advanced directives to improve patient knowledge and decisions on medical care.
- Strengthened education and nursing knowledge by taking part in ELNEC training.
Registered Nurse Case Manager
Riverside Home Care
Newport News, VA
03.2010 - 11.2019
- Coordinated with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
- Administered medications via oral, IV and intramuscular injections and monitored responses.
- Authored clinical notes and updates to be reviewed by patient's primary physician.
- Created patient assessments and plans for individual home care needs.
- Participated in on-call rotations to deliver after-hours care.
- Participated in patient and family planning process, as well as provided instructions and addressed question and concerns.
- Liaised with physicians regarding patient needs, performance and changes.
- Assessed and examined patients and documented history of current and previous conditions, diseases and injuries along with medications currently being taken.
- Effectively communicated with physicians regarding patient needs, performance, medications and changes.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Created individualized care plans based on nursing diagnosis and incorporated appropriate nursing methods to achieve positive outcomes.
- Provided home healthcare providers with training, guidance, support and supervision to achieve objectives.
- Completed initial assessments of patients and family to determine and address individual home care needs. ·
- Used McKesson, Epic and state mandated Oasis assessments to maintain database of relevant information for practitioners to access and coordinate patient care.
Registered Nurse, Medical-Surgical Unit
Riverside Regional Medical Center
Newport News, VA
08.2007 - 03.2010
- Provided direct patient care, stabilized patients and determined next course of action.
- Administered medications via oral, IV and intramuscular injections and monitored responses.
- Oversaw delivery of care for patients on medical-surgical unit, providing direct care, delegating nursing assignments, and supervising team comprised of nurses, LPNs, technicians and unit clerks.
- Provided didactic and clinical instructions to orient new nurses and potential student nurses to achieve training outcomes.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Reviewed post-operative orders and continuously monitored patients' post-operative vitals, set up PCA and fluids and oriented patients to unit.
- Monitored patient condition by interpreting and tracking EKG readings, identifying irregular telemetry readings and updating team members on changes in stability or acuity.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use and disease management.
- Provided health education to patients and families regarding discharge instructions and plans of care.
Education
Master of Science - Family Practice Nurse Practitioner
Walden University
Minneapolis, MN08-2024
Diploma - Registered Nurse
Riverside College of Health Careers
Newport News, VA07.2007
Bachelor of Arts - Human Services
Elon University
Elon, NC05.1991
No Degree - Master's of Science in Nursing Administration
Liberty University
Lynchburg, VASkills
- Compassionate and Caring
- Patient Care Assessment
- Care Coordination
- Patient Care Oversight
- Critical Thinking
- Delegation and Motivation
- Community Program Referrals
- Patient Examination
- Decision Making
- Attention to Detail
- Accurate Documentation
- Clinical Care Standards
- Lab result evaluation
- Electronic health records systems
- Interdisciplinary Collaboration
- Chronic Disease Management
Certification
- Certified in Hospice and Palliative Nursing (CHPN)
- Certified End of Life Nursing Education and Consortium (ELNEC)
- Respecting Choices Training - Advanced Directives and Living Wills
Affiliations
- Gardening
- Exercising
- Camping
- Learning
Timeline
Palliative Care Nurse Navigator
Riverside Regional Medical Center
05.2022 - Current
Registered Nurse-Community Liaison
Riverside Home Care
11.2019 - 05.2022
Registered Nurse Case Manager
Riverside Home Care
03.2010 - 11.2019
Registered Nurse, Medical-Surgical Unit
Riverside Regional Medical Center
08.2007 - 03.2010
Master of Science - Family Practice Nurse Practitioner
Walden University
Diploma - Registered Nurse
Riverside College of Health Careers
Bachelor of Arts - Human Services
Elon University
No Degree - Master's of Science in Nursing Administration
Liberty University
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