Nurse III - Skin Integrity/Wound Care 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!

Free CEUs and updated resources through Lippincott access for all nurses.

The Nurse III, Skin Integrity/Wound Care Nurse performs highly complex (senior-level) nursing work within the scope of practice attributed to the skills of a registered nurse. Coordinates and evaluates nursing services and activities related to skin integrity and wound care. Makes recommendations for additions or changes to standards of care to promote skin integrity or prevent injuries. Plans, develops, coordinates, evaluates, and treats skin issues and evaluates skin/wound/ostomy care.  Monitors and evaluates the effectiveness of the skin integrity program operations and processes. Reviews reports and takes action according to results. Conducts skin integrity rounds and utilizes the results to identify areas of risk that can be addressed proactively to prevent new or existing skin impairments. Collaborates with others professionals to evaluate individuals for special needs or adaptive equipment.  Leads the SSLC system-wide in the development and implementation of a skin integrity program, policies and procedures.  Monitors and evaluates the effectiveness of the skin integrity program operations and processes. Instructs, counsels, and assists individuals on issues impacting skin integrity and wound care. Develops in-service training and educational programs.  Provides consultation, training, and technical assistance to all levels of staff about routine skin integrity issues, addressing identified risk factors as well as decubitus and ostomy care. Serves as a lead worker, providing direction and guidance to others. Provides treatment to HHS employees injured in course and scope of employment.  This position is supervised by the Chief Nurse Executive or Nurse Operations Officer.  Works under limited supervision, with considerable latitude for the use of initiative and independent judgment.

This position may be eligible to earn additional pay for work performed on evenings, nights and/or weekends.

Essential Job Functions (EJFs):

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.

May serve in an on-call status on a rotating schedule as required to meet operational needs of the facility.

Coordinates and evaluates nursing services and activities related to skin integrity and wound care. Leads the nursing team during discussions about wound care and skin issues such as at skin integrity committee meetings.  Makes recommendations on how to improve nursing services and activities related to skin integrity and wound care.  Responds to referrals to review and ensures that standard precautions are being implemented. Makes recommendations for additions or changes to standards of care to promote skin integrity or prevent injuries.  Conducts audits to evaluate skin integrity care plans and provides findings including recommendations for improvement to the assigned supervisor. Reviews and evaluates data for trends related skin integrity issues such as causes of wounds.  Determines if training or other process changes are helping improve trends. 

Plans, develops, coordinates, evaluates, and treats skin issues and evaluates skin/wound/ostomy care.  Responds to notification of an identified wound.   Assesses the individual’s skin impairment, including reviewing information about the wound and wound care and more general information about the individual such as weights, nutrition, wound care, lung assessment and aspirations. Implements the treatment plan, monitors and follows up to ensure that wound/ostomy care procedures are implemented, and individual treatment plans are implemented/modified as needed. When necessary, reviews individuals upon return from a hospital, in collaboration with the assigned nurse.   As needed (such as due to staffing issues, complex cases, or for the purpose of on-the-job training), provides direct care nursing services. Provides treatment to HHS employees injured in course and scope of employment.   

Conducts skin integrity rounds and utilizes the results to identify areas of risk that can be addressed proactively to prevent new or existing skin impairments. Performs routine skin integrity observations during bathing or check and change activities.  Identifies, compiles, reviews, and analyzes data for trends, and implements procedures and training to prevent or halt progression of skin impairments. Notifies the hospital liaison or other designated staff when an individual with a history of skin integrity issues is hospitalized to ensure that preventative and adaptive equipment and direction on implementation accompanies the individual. 

Collaborates with others such as medical staff, habilitation therapy staff and other nurses, to identify individuals’ needs for adaptive equipment such as a specialized bed or equipment to prevent pressure wounds.  Evaluates the need to consult a specialized wound care physician such as a wound that needs to be debrided or is otherwise outside the scope of the practice of SSLC medical professionals. 

Monitors and evaluates the effectiveness of the skin integrity program operations and processes such as check and changes procedures or using barrier products to prevent moisture-related wounds. Interprets skin integrity situations and communicates them effectively in writing and orally in accordance with local procedures. Collects reports detailing all skin impairments at the SSLCs (such as those noted by RN Case Managers), analyzes trends and reports findings and recommendations for interventions in assigned meetings such as skin integrity committee, Quality Assurance/Quality improvement (QAQI) committee or other designated oversight groups.  Submits a monthly report on targeted areas such as pressure injuries or wounds attained by medically fragile individuals. 

Leads the SSLC system-wide in the development and implementation of a skin integrity program, policies and procedures.  Ensures policies and procedures related to wound prevention are implemented and maintained.  As assigned, contributes to development, review and revision of the state-wide skin integrity policy. 

Reviews the Electronic Medical Records to evaluate the effectiveness of the skin integrity program and compliance with standards of care and quality of service.   Conducts routine analysis of statistical data and performance evaluation reports.  Follows up on issues with the Nurse Managers, NOO and/or CNE.

Monitors and reviews nursing care plans, consulting with RN Case Managers on new or worsening skin issues and ensuring skin integrity interventions are in the nursing care plan. Recommends treatment plans to PCP for orders.  When assigned, attends off-campus wound care consults with individuals. 

Instructs, counsels, and assists individuals that are more independent on issues impacting skin integrity and wounds care such as wearing proper footwear, changing wet socks, using their adaptive equipment properly, proper hygiene, and positioning such as keeping feet propped up.  Collaborates with the Interdisciplinary Team (IDT) to instruct, counsel and assist with skin integrity and wound care health needs for all individuals. For individuals who are transitioning to community placement, coordinates outreach to the receiving placement to provide pertinent education. 

Develops in-service training and educational programs for all levels of staff understanding on topics such as maintaining skin integrity and preventing pressure injuries. Creates both general New Employee Orientation (NEO) training and specialized training/in-service material such as material responsive to a serious injury.  Collaborates with the Nurse Educator to provide training/retraining in nursing department meetings. 

Provides consultation, training, and technical assistance to all levels of staff about routine skin integrity issues, addressing identified risk factors as well as decubitus and ostomy care.  Collaborates and consults with staff at wound care clinics and at hospitals. Provides technical assistance on how to take care of a certain wound, such as a pressure wound.  Provides assistance during special investigations and consultation on cause or contributing factors of a wound to an individual. 

Reviews literature and research findings to keep abreast of current wound/ostomy care and wound prevention, nursing care standards, state and federal laws (ICF/IID rules and regulations) and serves as the resource person for skin integrity issues. Leads interdisciplinary groups/committees to continually address skin integrity issues such as skin integrity committee and/or pressure-injury workgroup. As assigned, serves as the back-up to other specialty nursing positions such as the PNMT nurse, infection control nurse or hospital liaison. 

Serves as a lead worker providing direction and guidance to Licensed Vocational Nurses (LVNs) on basic care, to DSPs on technical issues such as positioning and promoting healing, and to all staff on wound care treatment.  Provides recommendations to physician when writing wound care orders such as the type of mesh that will work best for the wound.  

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):

• Considerable 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, practices, and procedures; of program regulations and procedures; and of utilization review and control measures.

• Knowledge of nursing care standards, the Settlement Agreement, and the Healthcare Guidelines or ability to quickly gain the knowledge.

• Knowledge of state and federal laws and Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) rules, regulations, policies, and procedures related to SSLCs or ability to quickly gain that knowledge.

• Knowledge of 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.

• Knowledge of wound and ostomy care, and wound prevention. 

• Skills in the use of computer/software and an electronic health record system.

• Skill in writing policy, procedures and guidelines.

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

• Skill in the care and treatment of patients.

• 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; to recognize patterns of medical necessity treatment; and to provide technical assistance and consultation to others.

• Ability to interpret regulations and communicate them effectively both orally and in writing.

• Ability to appropriately interact with individuals with intellectual/developmental disabilities, with their family members, and with staff members and with staff members. 

• Ability to work independently and productively with all levels of staff.

• Ability to train/in-service all levels of staff.

• Ability to make recommendations to SSLC leadership including on-call administrators.

• Must maintain current CPR certification.  Must have strength and flexibility to safely perform CPR. 

• Ability to work independently and productively with all levels of staff.

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). Wound Care Certification (WCC) required.

Initial Screening Criteria:

• At least one (1) year experience as a practicing registered nurse is required.

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

• Bachelor's Degree is preferred.

• Previous 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