Sr. Research Nurse
The Johns Hopkins School of Nursing (JHSON) seeks a motivated, energetic, and caring individual to serve as a Sr. Research Nurse (RN) as part of an interdisciplinary care team for the Neighborhood Care Pathway (NCP) pilot program. This pilot, 3-year, research program seeks to improve the health and well-being of up to 600 older residents (age 50+) living in the Johnston Square, Greenmount West, and Oliver East Baltimore community through use of team-based health education, care navigation, referrals to community based resources, and implementation of specialized programs (i.e. CAPABLE).
The RN will be an integral member of the project team and will contribute to the development, refinement, standardization, and implementation of the NCP and CAPABLE program protocols as well as contribute to the community outreach and engagement strategy over the course of the project. Working within the interdisciplinary team, the RN responsible for day-to-day implementation of the NCP and CAPABLE RN-based protocols. This will include initial and follow-up home- and telehealth- based encounters. Activities will include health and clinical symptoms screenings and assessment (in coordination with other team members); collaboration with team to create, monitor, revise the NCP person-centered action plans with goal setting based on individual’s unique motivations and realistic expectations for outcomes; screen, triage and facilitation of recommended prevention and intervention strategies for medical and social needs as indicated; implementation of CAPABLE program protocols in coordination with CAPABLE Occupational Therapist as indicated by care plans (structured RN sessions, up to 4 home visits over 4-5 months per participant); and maintaining fidelity to the protocols.
The RN will receive initial program training and ongoing supervision and support from the program team and will use training and motivational interviewing techniques to foster a trusting alliance with the program team members and with program participants. Training will include program-specific protocols, health education (e.g., health aging), identifying and linking to local community resources and services, cultural competency, working in an interdisciplinary team, home visit safety, and health information privacy and human subjects research policies. The NCP program will provide gap-filling services to ensure older adults receive high-quality, compassionate care that enables them to age well at home. Candidates who are native to, or who have familiarity/experience working within, the neighborhoods of Johnston Square, Greenmount West, or Oliver in East Baltimore City are highly encouraged to apply.
Specific Duties & Responsibilities
- Complete training related to NCP and CAPABLE program intervention delivery components, protocols, and community-engaged, person-centered research/human subject's research. This includes training on program recruitment, health assessment and care planning, health care system navigation, communication, cultural humility, health advocacy, and on resources available to older adults in the community.
- Collaborate with field team to conduct comprehensive assessments to identify and prioritize issues related to medications, management of medical conditions, pain, depression, strength and balance, daily functioning, primary care provider communication, and other topics as prioritized by the older adult.
- Provide oversight/guidance to NCP Community Care Navigators, and support with logistical and other day-to-day activities through regular interactions and weekly interdisciplinary clinical consultation/case rounds.
- Provide the CAPABLE intervention (up to 4 RN home visits over 4-5 months) to participants that screen into the program and agree to the services.
- Directly engage with participants in education, problem solving, and coaching to address health conditions, safety and health risks, self-efficacy, self-management, and to identify behavioral and environmental contributors that may impact function and ability to live at home in the community, as indicated.
- Collaborate as needed with multiple providers and community partners to implement coordinated interventions that leverage existing evidence-based programs and resources to serve participants based upon three levels of care need (low, medium, or high-risk).
- Develop strong community relationships by attending and participating in community-based outreach events, to cultivate trust within the community.
- Assist in developing and disseminating health education and training to the community through community education events (e.g., Lunch and Learn).
- Ensure timely and accurate coding and documentation in electronic records and on other data management platforms.
- Assist in program assessment and evaluation.
- Travel to participant homes in Baltimore area and conduct home visits (Baltimore City) as needed, following protocol guidelines.
Additional Knowledge, Skills, & Abilities
- Must successfully complete the CAPABLE nursing curriculum.
- Strong understanding of health-related community-based resources and supports.
- Must have transportation to, from, and around the targeted community.
- Must be comfortable working in the Community, visiting people in their home’s, and interacting regularly with older adults and/or their caregivers.
- Excellent interpersonal and communication required with ability to develop rapport and provide good customer service.
- Comfortable working closely and cooperatively with others and ability to adapt well to team functions.
- Applicants must be dependable, self-directed, and motivated.
- Excellent organizational skills required, with ability to prioritize multiple tasks.
- Commitment to culturally competent practices and compassionate care.
- Commitment to maintaining patient privacy and maintaining HIPAA and IRB standards at all times.
- Willingness to work off-site up 50-75% of the time.
- Competent in motivational interviewing, health literacy education and counseling.
- Training on standards for the ethical treatment of human subjects in clinical research.
- Work with infectious diseases, knowledge of vaccine initiation in older adults and harm reduction leveraging community partnerships.
- Ability to work from a collaborative, client-directed model.
- Willingness and ability to implement a protocol and balance with clinical judgement.
- Drug testing.
- Current CPR certification required.
- Must maintain current licensure and certification during duration of employment.
- Completion of the JHH credentialing process is required prior to start date.
Minimum Qualifications
- Individual must be a registered nurse, licensed in the State of Maryland or state where practicing.
- Bachelor's Degree in Nursing or related discipline.
- Minimum of two years' experience in the specialty or a related area.
Preferred Qualifications
- Experience working with and managing care for older adults with multiple, complex conditions in the community.
- Experience conducting health education, community outreach, and community participatory research.
- Master’s Degree.
Classified Title: Sr. Research Nurse
Role/Level/Range: ACRP/04/MF
Starting Salary Range: $75,100 - $131,700 Annually ($99,804 targeted; Commensurate w/exp.)
Employee group: Full Time
Schedule: Monday-Friday 8:30 - 5:00
FLSA Status: Exempt
Location: Hybrid/School of Nursing
Department name: Community Programs
Personnel area: School of Nursing