Senior Direct Care Registered Nurse

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Brief Job Description:

Come work in an environment where we truly value and respect those we serve and believe in the mission that all people can achieve a higher level of wellness and independence. 

The state supported living centers serve people with intellectual and developmental disabilities who are medically fragile or who have behavioral problems. The centers provide campus-based direct services and supports at 13 centers located throughout the state. Learn About Our State Supported Living Centers

If you are looking for a place to work where you can establish a career that is filled with purpose, this is the job for you!

The Senior Direct Care Registered Nurse with Associate’s Degree in Nursing (ADN) performs highly complex (senior level) nursing work providing for the assessment, care and integrated treatment of individuals residing at the SSLC.  Performs highly complex and technical nursing tasks, procedures, and assessments, administers medications, immunizations and treatments in accordance with HHSC, SSLC and state regulations.   Interprets and evaluates diagnostic tests, collects specimens, and communicates findings and recommendations. Makes rounds, coordinates, and organizes nursing services and activities, monitors and reports the health of individuals.  Provides consultation, training, instruction, and technical assistance to others.  Develops in-service training and health education strategies. Provides leadership, oversight, coaching and monitoring to tasks performed by LVNs and RNs, and acts as a preceptor, as assigned, to RNs. Performs timely and accurate documentation.  Works independently and productively with all levels of staff and departments. Identifies and implements various courses of action for routine and non-routine situations and works in conjunction with other nurses and health care providers. Analyzes data, evaluates nursing intervention outcomes, and provides input to other members of the interdisciplinary team (IDT) to assist in assessing the treatment plan.   Attends assigned meetings and communicates results. Responds to emergency situations in accordance with protocols.  Provides treatment to HHS employees injured in the course and scope of employment as needed.  Performs other duties as assigned.  Works under the limited supervision of the Nurse Manager or other designated supervisor depending on SSLC needs, with considerable latitude for the use of initiative and independent judgment. 

Essential Job Functions (EJFs):

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Attends work on a regular basis and may be required to work a specific shift schedule or, at times, even a rotating schedule, extended shift and/or overtime in accordance with agency leave policy and performs other duties as assigned.

Performs highly complex and technical nursing tasks and procedures in accordance with HHSC, SSLC and state regulations, such as tracheostomy care, gastrostomy/jejunostomy care, wound care, and breathing treatments. Administers medications, immunizations, and treatments and observes patients for unusual symptoms and reactions.  For new admissions, in collaboration with the assigned RN Case Manager, provides a detailed initial assessment and review of data to present key findings to providers and other members of the interdisciplinary team.

Interprets and evaluates diagnostic tests to identify and assess individuals’ response to planned care, as appropriate to the scope of practice. Collects specimens for laboratory examination and conducts appropriate screening tests when requested by lab personnel. Communicates findings and recommendations to other nurses, Primary Care Providers (PCP) and other staff.

Coordinates and organizes the nursing services and activities they provide for individuals on their assigned home/unit to ensure tasks are completed effectively and efficiently. Observes individuals and gathers pertinent information.   Monitors individuals’ weight, diet, feedings, and vital signs.  Monitors for signs and symptoms of illness and uses appropriate nursing judgement to provide adequate care for the individual, including initiating acute care plans. Makes rounds and/or to other homes/units as needed and works in other locations at the SSLC as needed. Discusses any pressing issues or concerns that are found with the appropriate supervisor.

Communicates effectively, and provides consultation, training, and technical assistance to direct support professionals (DSPs) about individuals’ unique care needs.   Instructs DSPs on how to monitor individuals after a treatment or procedure using instruction sheets such as that used for post-sedation monitoring of signs and symptoms.  Answers questions from DSPs and other members of the treatment team, related to treatment or medication, within the scope of practice. Develops in-service training and health education strategies related to the assigned individual(s) when needed including signs and symptoms to observe for and report to a nurse. When warranted, instructs, counsels, and assists individuals in meeting their health care needs.

Assists the Nurse Manager by providing leadership and oversight within the assigned home/unit/department such as overseeing the work of, coaching and monitoring services provided by Licensed Vocational Nurses (LVNs) assigned to the nursing department.  Acts as a preceptor for other registered nurses, as assigned. Trains/instructs new nurses to perform nursing functions at the SSLC, including acclimating them to the individuals, their needs and preferences. Serves as a Nurse Manager in their absence, as appointed.

Provides support to Nurse Managers by providing day-to-day supervision including reviewing and following up on controlled drug counts, medication counts, emergency checklist logs, refrigerator temperature logs, and glucose controls.  Assists LVNs and RNs with implementation of protocols, procedures and programs to improve overall health and safety of staff and individuals.  Assists with completing follow up assessments, guidelines, acute care plan (ACP) interventions, interventions in the chronic care plan, injury reports, restraints, and med variances. Assists in monitoring the completion of chronic care plan interventions.

Timely and accurately documents and reports pertinent treatments and observations in the individual’s electronic medical record (EMR) in accordance with SSLC procedures and protocols.  When training others, oversees the completion of their required documentation.

Works independently and productively with all levels of staff and departments. Identifies and implements various courses of action for routine and non-routine situations and works in conjunction with other nurses and health care providers.  For example, assists the Infection Control nurse by implementing measures that prevent the spread of disease, assists the Quality Assurance Nurse in developing and implementing quality assurance programs, and assists in the implementation of therapeutic nursing programs.  Participates in facility Quality Assurance/Quality Improvement initiatives.  Makes recommendations to supervisors on how to improve processes to ensure quality services for individuals.

Analyzes data, evaluates nursing intervention outcomes, and provides input to other members of the interdisciplinary team (IDT) to assist in assessing the treatment plan.   As assigned, attends and/or provides information to a designee for meetings related to the status and care of assigned individuals such as daily morning medical, Incident Management Review Team (IMRT), or IDT meetings to ensure nursing issues or concerns are addressed promptly. Follows local SSLC policies and protocols to ensure pertinent information, such as diagnoses and treatment plans is clearly communicated to SSLC staff and, when instructed to do so, to guardians/Legally Authorized Representatives (LARs).

Responds to emergency situations to ensure safety of individuals. Follows safety and infection control procedures of the SSLC.  Provides educational and safety training to SSLC staff upon request. Provides treatment to HHS employees injured in course and scope of employment.

Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation.  Such participation may require an alternate shift pattern assignment and/or location.

Knowledge, Skills and Abilities (KSAs):

Knowledge of:

State and federal laws and Intermediate Care Facility for individuals with intellectual disabilities (ICF-IID) rules, regulations, policy and procedures related to State Supported Living Center or ability to quickly gain that knowledge.

Evidence-based practices applicable to treatment of individuals with developmental disabilities

Emergency procedures and emergency equipment, i.e., Cardiopulmonary Resuscitation (CPR), and ability to assess and care for residents and/or staff members in emergency situations.

Advanced knowledge of nursing techniques, standards, and procedures; of health care laws and regulations; of medical diagnoses and procedures; of accepted medical treatment patterns; of community health and nursing care principles, best practices, and procedures; of program regulations and procedures; and of utilization review and control measures

Advanced knowledge of nursing care standards and Healthcare Guidelines.

Skill in:

The care and treatment of patients.

The use of computer/software and an electronic health record system.

Working with individuals with complex physical and nutritional management needs, behavioral challenges and varying methods of communication.

Excellent verbal and written communication skills and the ability to present ideas clearly and concisely in both written and oral communications.

Ability to:

Provide patient care; to prepare and maintain records; to organize, coordinate, and evaluate nursing activities and delivery of health services; to interpret policies and procedures; to interpret health care regulations; and to recognize patterns of medical necessity treatment.

Interpret regulations and communicate them effectively both orally and in writing. 

Appropriately interact with individuals with intellectual/developmental disabilities, with their family members, and with staff members and with staff members.  

Work independently and productively with all levels of staff.

Train, in-service, coach, monitor and instruct all levels of staff in accordance with the scope of practice. 

make nursing decisions and recommendations to the team.  

Must maintain current CPR certification.  Must have strength and flexibility to safely perform CPR, safe use of restraint (SUR) and Ukeru techniques (once trained).

Registrations, Licensure Requirements or Certifications:

Licensed to practice as a registered nurse in the State of Texas (or a state that recognizes reciprocity through the Nurse Licensure Compact)

Initial Screening Criteria:

Associate degree in nursing (ADN) is required.

At least two (2) year of experience as a practicing registered nurse in a health agency, hospital, or health-care facility is required.

Experience in assessment and documentation of health status is required.    

Specialized training or experience working with individuals with complex medical and behavioral health issues is preferred.

Experience working with Individuals with Intellectual and/or Developmental Disabilities (IDD) is preferred.

Additional Information:

Applicants must pass a fingerprint criminal background check, pre-employment drug screen, and registry checks including the Client Abuse/Neglect Reporting System (CANRS), Nurse Aide, Medication Aide and Employee Misconduct and HHS List of Excluded Individuals/Entities (LEIE).

Males between the ages of 18 – 25 must be registered with the Selective Service.

All State Supported Living Center Employees are subject to Random Drug Testing.

Flexibility in work hours may be required for this position. The position may be required to work overtime and/or extended hours. Must be willing to work weekends and holidays.

All applicants must be at least 18 years of age to be considered for employment at a state-operated facility.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.