Registered Nurse/Clinical Coordinator – 22.5 hours/week – Permanent

Overview

The Registered Nurse/Clinical Coordinator is an integral part of a multi-disciplinary team who works co-operatively with all members of the health care team in the promotion of patient health and prevention of disease. This unique role requires an experienced RN with a strong interest in coordinating and promoting team-based care to address identified care needs in a defined patient population, while continuing to practice within their full scope as outlined in the Standards of Practice by the College of Nurses of Ontario. This is a permanent 22.5 hour/week position working at the Medical Centre.

Responsibilities

Care Coordination & Interprofessional Collaboration

• Identify potential gaps in patient care (i.e. patients overdue for screening/immunizations/diabetes care etc.) at a team-based level and work with the interdisciplinary team to develop strategies to address these
• Coordinate and run internal clinical programs, such as flu clinics, cancer-screening clinics, and diabetes education
• Collaborate with members of an interdisciplinary health team to:
  • Plan, implement, and evaluate patient care
  • Consult with patients and their families
• Assist patients in accessing social and community support services, including:
  • Identifying patient needs
  • Setting goals around social determinants of health
  • Reviewing eligibility criteria for services
• Ensure patient follow-through, provide direct support via phone calls, and offer guidance on processes and systems
• Support patient-centered care and advocate for positive patient outcomes
• Communicate ideas or concerns to the healthcare team and participate in problem-solving
• Liaise with PFHT and FHO leadership in support of these various initiatives and other mutual interests as needed

Administrative & Quality Improvement Responsibilities

• Maintain accurate, concise, and confidential documentation of patient history and encounters
• Ensure timely updates in Accuro EMR system
• Participate in quality improvement initiatives, including clinical audits and program evaluations
• Support special projects and clinical priorities as required
• Manage medical supplies and assist with clinic operations

Health Promotion & Patient Education

• Identify trends of the patient population and develop programs and services and health promotional and educational materials that will benefit all patients of the FHO
• Maintain patients health records for FHO patients to ensure they are accurate/up to date with preventative health programs, including cancer screenings, bone density, diabetes, and others as requested
• Educate FHO patients on disease prevention, healthy lifestyle choices, and self-management strategies
• Provide prenatal and postnatal care education
• Offer mental health support, crisis intervention, and referrals
• Promote immunization, cancer screening, and other preventative health initiatives
• Provide patient communication via newsletters, website updates, and outreach initiatives

Clinical Care & Direct Patient Support

• Conduct comprehensive health assessments, including physical, mental, and social determinants of health
• Perform triage and determine priority of care based on patient needs
• Administer medications, immunizations, and injections, including allergy shots and routine vaccines
• Ensure immunizations are current and educate patients on their benefits and possible side effects
• Provide wound care, dressing changes, suture/staple removal, TB testing, and ear syringing
• Conduct Cervical Screening (training can be arranged if necessary)
• Perform diagnostic testing (e.g., blood pressure monitoring, blood glucose testing, spirometry)
• Support chronic disease management (e.g., diabetes, hypertension, asthma, COPD)
• Assist in preventative health screenings (e.g., cervical , mammograms, colorectal, bone density screening)
• Provide sexual health counseling and STI screening and lifestyle counseling

Professional Development & Advocacy

• Stay current with evidence-based practices and continuing education requirements
• Provide information and education to patients, clinicians, and community partners regarding available services
• Participate in team meetings, case conferences, and training sessions

Requirements

• Self-starter with the ability to identify patient needs and create and develop new programs as required
• Ability to perform all RN clinical and technical task
• Current Certificate of Registration from the College of Nurses of Ontario
• RNAO membership
• Understands, through education and/or experience, how social determinants of health impact health and health equity
• Demonstrated commitment to principles of anti-racism, anti-oppression, equity and inclusion
• Problem solving (able to make independent service decisions)
• Demonstrated excellent interpersonal communication skills and decision-making ability
• Collaboration and teamwork. You enjoy working both independently and as a member of a dynamic team on new and existing services and special projects
• Knowledge of primary care and a demonstrated understanding of its intersection with the healthcare system
• A clear police vulnerable check
• Assumes other duties as appropriate
• The above responsibilities are not to be considered all-inclusive

Qualifications

• Minimum 5 years primary care experience
• Completion of a Bachelor of Science in Nursing
• Current Certificate of Registration from the College of Nurses of Ontario and active knowledge of CNO Standards of Practice and Best Practice Guidelines.
• Experience with project leadership and experience with quality improvement initiatives
• Knowledge of community resources and relevant legislation (e.g. OW/ODSP, CPP/-D, CFSA, WSIB), preferred.
• Honed patient assessment and triage skills.
• Knowledge of and working experience with computer systems and applications.
• Excellent verbal and written communication skills.

Hours of Work

Weekday shifts (days to be determined) and periodic day call coverage may be required to accomplish objectives.

Additional benefits of joining the Peterborough Family Health Team

• A provincial leader among Family Health Teams in Ontario
• Excellent team/office environment
• Multidisciplinary team expertise
• Organizational commitment to work-life balance
• HOOPP Pension Plan
• Optional Health and Dental Plan
• Life/Disability Insurance Plan
• Health Care Spending Account
• EAP

The Peterborough Family Health Team are leaders in advocating for full vaccination against the COVID-19 virus and its variants, for persons who are medically able to receive the vaccination. All applicants should know that PFHT employees are expected to support this position and if medically able, maintain full vaccination.

Interested candidates can email their resume and cover letter to resumes@peterboroughfht.com by the application deadline.

• Application deadline: May 22, 2025
• Hours: 22.50 hours/week; Days to be determined
• Expected start date: Date TBD
• Job type: Permanent
• Salary: $36.53 to $39.92/hour

The Peterborough Family Health Team is actively committed to creating a diverse and inclusive workplace and encourages applications from all qualified candidates. The Peterborough Family Health Team offers accommodation for applicants with disabilities in its recruitment processes.