Registered Nurse/Registered Psychiatric Nurse, Community Mental Health & Substance Use Services Integrated Homelessness Action Response Team (IHART) - RCH

Posted per NBA Article 17.02

 

Fraser Health is responsible for the delivery of hospital and community-based health services to over 1.9 million people in 20 diverse communities from Burnaby to Fraser Canyon on the traditional territories of the Coast Salish and Nlaka’pamux Nations.

 

Our team of 43,000 staff, medical staff and volunteers is dedicated to serving our patients, families and communities to deliver on our vision: Better health, best in health care.

 

Effective October 26, 2021 all new hires to Fraser Health will need to have full COVID 19 vaccination (have received a full series of a World Health Organization “WHO” approved vaccine against infection by SARS-COV-2, or a combination of approved WHO vaccines).  Please note this applies to all postings, and individual medical exemptions must be approved by the Provincial Health Officer.

 

The IHART (Integrated Homelessness Action Response Teams) provide integrated, coordinated health services to members of our population who have inadequate or unstable housing. Utilizing a hands-on and direct approach of meeting individuals where they are currently situated means that IHART connects with individuals who are unsheltered, in shelters, in homeless encampments, and/or supportive housing environments. IHART is comprised of multidisciplinary teams capable of responding to health, mental health, and substance use issues including health promotion and prevention. Teams will also support continuity of care by providing cohesive linkages to primary care, and Specialized Community Services Programs (SCSP) such as Assertive Community Treatment (ACT) Teams and specialized care services focused on seniors. IHART addresses a broad spectrum of health care concerns, including new and chronic conditions, by enabling supportive wrap-around care for those greatest in need and who have, historically, had the least access to services due to inadequate or unstable housing.

 

 

In accordance with the British Columbia College of Nurses and Midwives (BCCNM) standards of practice and the Mission and Values of Fraser Health, and working collaboratively and in partnership with the interprofessional care team in the provision of person-centered and recovery oriented care, the Registered Nurse/Registered Psychiatric Nurse provides treatment and care management services that are both inclusionary and flexible for individuals with mental illness and concurrent disorders (e.g. substance use, developmental disorders) to meet the needs of the client and to provide integration and continuity across the care continuum. Works collaboratively within an interdisciplinary team-based model of care and promotes rapid engagement in the provision of consistent, relevant and timely delivery of client and family-centered care. With an emphasis on recovery and rehabilitation, reducing barriers to enter the system of care, and promoting a culturally-safe and responsive, trauma-informed approach, establishes a welcoming therapeutic environment and promotes client self-determination and independence.

1. Coordinates care for clients by collaborating with interprofessional care team, performing intake functions, conducting mental health assessments, developing, implementing, maintaining and adjusting comprehensive treatment plans based on client needs and best practices, administering prescribed medications, and monitoring and assessing clients''''' mental state, response to medications and efficacy of treatment plan to ensure optimum use of resources and to facilitate client centred care.


2. Plans and provides direct nursing care to clients in compliance with standards of practice by performing activities such as reviewing client/family history, conducting physical/psychosocial assessments, assessing vital signs, developing a care plan specific for the client and collaborating with other members of the health care team to discuss and review the care plan, and implements other treatment modalities as required such as ADLs, wound care and administering of medications.


3. The nurse works from a strengths-based model, using motivational interviewing and engagement techniques and works collaboratively with clients and professionals to develop and implement individualized care plans and assists clients to access appropriate services in the community.


4. Establishes, maintains and enhances therapeutic relationships based on respect with client and their informal support network by engaging stakeholders in treatment planning and evaluation, providing support and follow-up planning, promoting and supporting clients to manage self care, encouraging informed decision making and empowering the client to improve the clients' quality of life. Teaches client and their family about management and treatment of specific psychiatric conditions, concurrent substance use issues, their symptoms and integration of illness into their lifestyle.


5. Provides treatment services including crisis intervention, individual counselling and education according to a variety of theoretical models to clients and their informal support network as required by methods such as assessing situation, eliciting concerns, exploring emotional response to illness, identifying goals and expectations, reviewing client and family learning needs, assisting with understanding of illness, teaching coping strategies, and consulting with colleagues when required.


6. Initiates and participates in case conferences/meetings with clients, family, service providers and members of the interprofessional team for identification of client mental health issues, concerns regarding services and coordination, emergent issues, and discussion of on-going follow-up care to ensure a coordinated approach to treatment. Acts as client advocate to protect and promote clients' right to autonomy, respect, privacy, dignity, and access to information.


7. Consults and collaborates with members of the interprofessional care team including MH&SUS Physicians, Primary Care Providers (GP/NP), Team Coordinator, Clinical Nurse Educators, and other health care professionals/providers in the identification and resolution of issues, adjustments to care plans as required, and in regard to changes in client condition.


8. Monitors Extended Leave as required under the Mental Health Act by methods such as reviewing conditions of Extended Leave, determining if client is following the conditions and tracking renewal of certification due dates to ensure continuity of appropriate treatment.


9. Aids client access to services such as medical appointments, hospitals, and social programs by methods such as providing healthcare information, contacting relevant programs/services, and assisting clients with processing forms, transportation issues, and daily living tasks.


10. Documents assessments, care plan, observations, interventions, client/family responses, outcomes/evaluations, and referrals according to practice standards and Fraser Health procedures.


11. Maintains a safe environment for clients, visitors and employees by adhering to established safety and emergency practices and procedures and reporting any risks and anomalies to the Team Coordinator.


12. Identifies own learning needs/goals, reviews these with the Team Coordinator and engages in a variety of activities to meet these needs/goals.


13. Participates in research and quality improvement activities by identifying client care issues, collecting data, and identifying needs and recommendations for corrective action and changes to practices, procedures or protocols.


14. May be required to: plan, coordinate, and deliver educational sessions to clients and their family members, other service providers, and community agencies regarding Mental Health & Substance Use services.


15. May be required to: facilitate group sessions utilizing psychodynamic, cognitive/behavioural, interpersonal, and supportive interventions in conjunction and consultation with other interprofessional team members.


16. May be required to: provide outreach nursing care to clients in their home setting, primary care setting, or suitable alternative including individuals who are homeless or at risk of homelessness performing nursing functions such as assessing substance use/dependence, determining physical and mental status, monitoring withdrawal symptoms and evaluating response to medications administered; formulate and explain plan of care to client/family or supportive care persons; transport and/or accompany clients to physician appointments for assessment to determine suitability for program or to designated safe bed for withdrawal management support.


17. May include working with residential facilities or community agencies/homes to conduct client assessments, facilitate placement, develop individualized care/service plan, monitoring of client progress and ensuring appropriate referrals and discharges.


18. Performs other related duties as required.

Education and Experience

Graduation from approved School of Nursing or Psychiatric Nursing.

Two (2) years recent related experience providing treatment services to individuals with mental health and/or concurrent disorders, or an equivalent combination of education, training and experience. May require completion of substance use certificate program. Current practicing registration as a Registered Nurse and/or Registered Psychiatric Nurse with the British Columbia College of Nurses and Midwives (BCCNM). Valid Class 5 BC Driver''s License and access to personal vehicle with appropriate insurance coverage.

Skills and Abilities

• Ability to complete initial and ongoing mental health and substance use client assessment and provide nursing care through appropriate/prescribed technical, therapeutic, safety type interventions including crisis intervention.


• Knowledge of mental illness and substance use treatment


• Knowledge of psychopharmacology (indications and side-effects).


• Counselling and group facilitation skills.


• Knowledge of legislation and government policies and procedures that relate to mental health and substance use practices.


• Ability to communicate effectively verbally and in writing with clients, families/care givers, the public, medical staff and members of the interprofessional care team.


• Ability to promote person-centered care that demonstrates empathy for clients/families/care givers, sensitivity to diverse cultures and preferences, including advocacy for special populations.


• Ability to educate clients and families/care givers about topics essential to their health care and well-being.


• Ability to organize and prioritize work.


• Ability to collaborate with and promote cooperation among members of the interprofessional care team.


• Ability to use factual information and basic principles and procedures to support nursing decisions and actions with relevant research-based evidence/evidence-informed practice.


• Ability to operate related equipment including relevant computer applications.


• Physical ability to perform the duties of the position.