Clinical Nurse - Transition Care Program (TCP)
Core
Coordinate goal-oriented clinical care for older adults in their homes and community settings to help them regain independence after a hospital stay.
Role type
Clinical Nurse (Transition Care Program)
Builds
Individualized care plans and smooth transitions from hospital to home/community
Domain
Geriatric care and community health
Deliverable
physical/clinical work
Required skills
Geriatric care, community care coordination, clinical assessment, care plan development, health status monitoring, clinical documentation
Preferred skills
Autonomous work in community settings, multidisciplinary team collaboration, conflict resolution, resilience
Technologies
None stated
Responsibilities
Conduct comprehensive assessments and develop individualised care plans; Coordinate with allied health and community providers; Monitor and respond to changes in client health status; Maintain accurate clinical documentation
Seniority
Mid-level, part-time contract