Clinical Nurse Specialists - Geriatrics

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Community Geriatric Nurse Specialist (CGNS)
Durham Ontario Health Team (OHT) Initiative

An innovative change initiative, this position has the opportunity to shape new practices and capacity in the community care sector that will help seniors flourish at home where they want to live, or provide expedited care to specialized services that will help them maintain their optimal well-being.

As an eligible applicant for the CGNS pilot program you must hold a certificate of registration in good standing from the Ontario College of Nurses; begin employment no later than May 31, 2021; commit to 12-months of employment at a full-time work schedule offered by CCD. Schedule may include 8 & 12 hour shifts; Days/Evenings/Weekends /Statutory Holidays Schedule (Subject to change).


Clinical Nurse Specialists (x2)
Full Time – 1 Year Contract, 35 hours/week

Reporting to the Vice President of In-Home Support Services, the CGNS Clinical Nurse Specialists will work collaboratively across Durham Region supporting clients of Adult Day Programs (ADPs), Supportive Housing (SH), and Assisted Living Services (ALS) and other Community Support Services (CSS) to provide rapid front-line nursing response to older adults living in the community who are at risk, or who have experienced a gerontological event that may result in the loss of independence, Emergency Department visit, hospitalization or a move to a long-term care setting without timely intervention. As the CGNS project is a Durham Ontario Health Team (OHT) pilot project, the nurse will also work closely with the CGNS project implementation team to contribute to the development of the model of care while coordinating and delivering high quality geriatric care in compliance with Ontario College of Nurses standards and CCD policies and procedures.

CGNS specialize in geriatric care to assess, plan interventions, implement and evaluate care of older adults in collaboration with the clients, their caregivers, Primary Care, Specialized Geriatric Services (SGS) inter-professional teams, and community partners. The CGNS will receive referrals from CSS staff, assess older adults living in the community, provide timely appropriate interventions, stabilize, link to other services as needed and collaborate with Most Responsible Practitioner (MRP). The CGNS will also provide support and education to other regional team members.  



  • Utilize and demonstrate a comprehensive theoretical knowledge base and advanced level of clinical competence in providing care for older adults in the community
  • Receive referrals and attend to needs of older adults living in the community with complex and chronic health conditions and/or frailty who are experiencing an emerging/episodic change in condition
  • Perform assessment activities, including conducting client interviews, comprehensive physical examinations and assessment of psychosocial, mental health, cultural, and ethnic factors affecting client needs
  • Provide interventions as appropriate and stabilize  
  • Initiate care plans to facilitate care in advance of pending in-depth consultations and further interventions
  • Evaluate the effectiveness of interventions and adjust comprehensive plan of care as needed
  • Link to other services as needed
  • Collaborate and coordinate care with Most Responsible Practitioner (MRP) (CGNS will not carry a caseload)
  • Play a coordinating role by liaising with other services and team members
  • Facilitate communicating the plan of care to the client/caregiver and members of the healthcare team
  • Assess learning needs and serve as a knowledge-to-practice facilitator to enhance CSS team’s ability to recognize changes in client condition
  • Document client history, physical examination data, progress notes, referrals as appropriate, family conference notes and other pertinent information in an accurate and timely manner according to organizational policies, procedures, and guidelines
  • Contribute to building clinical expertise in the CSS Sector

Quality Improvement & Safety

  • Promote innovation and spread in the CSS Sector in response to the changing care needs of the population
  • Participate in regular data collection
  • Identify opportunities for improvement and participate in quality initiatives
  • Contribute to process and system design
  • Participate in the development of CCD policies and procedures standards, protocols, and clinical pathways
  • Participate in scholarship and research 
  • Practicing within the guidelines stipulated in the CCD infection control policies
  • Adhere to Public Health directives regarding communicable disease management

Related Duties

  • Understand and adhere to CCD policies in carrying out the job duties
  • Contribute to program by performing related tasks as required
  • Maintain patient confidentiality and protects CCD operations by keeping information confidential
  • Maintain skills/knowledge by attending educational sessions and keeping informed of CCD policies and procedures
  • Model CCD Values and culture
  • Provide care within a health equity framework


  • Registered Nurse in good standing with the College of Nurses of Ontario
  • Membership with the RNAO preferred
  • Current CNA certification in Geriatrics preferred or equivalent experience
  • Master's degree in Nursing
  • Minimum of 2-3 years’ recent experience in specialized geriatrics – assessing, treating and developing care plans for older adults
  • Recent community and/or primary care experience with older adults preferred
  • Extensive clinical knowledge and skill (understanding diagnosis, signs and symptoms, treatment) as they apply to the older adult.
  • Experience with geriatric mental health, cognitive impairment and dementia
  • Demonstrated ability to provide excellent customer service when dealing with clients, colleagues, volunteers and other members of the community and public;
  • Practice in accordance with established CCD Code of Conduct
  • Demonstrated understanding of and commitment to CCD’s comprehensive safety program and practices including staff, patient, and environmental safety and participation in regular in-service education in this area;
  • Awareness of community support services in Durham Region for older adults
  • A proven ability to liaise with referral sources and other community agencies to promote effective inter-collaborative communication and positive relations among care partners
  • Excellent interpersonal and team building skills that enable rapport building with stakeholders to achieve outcomes of a complex nature
  • Proven leadership skills that foster engagement and strength-based outcomes
  • Must be able to practice independently and interdependently within their scope of practice
  • Proficient in Microsoft Office and ability to learn host agency EMR Community Information Management Systems (CIMS)
  • Well-developed coaching, mentoring, presentation and teaching skills
  • First Aid Certification with HCP Level CPR Training
  • Excellent written and verbal communication, interpersonal and critical thinking skills
  • Excellent problem solving and decision-making skills
  • Ability to be flexible and adaptable with excellent organizational skills
  • Valid Ontario Driver’s License and full-time use of reliable vehicle required with 2 million dollar’s liability insurance
  • Ability to travel throughout Durham Region geography
  • Police with Vulnerable Sector Check
  • Bilingual (French) would be an asset
  • Confirmation of immunization status and 2 step TB test


Compensation: Commensurate with knowledge and experience.

Please apply in writing referencing posting number 2021-08, outlining qualifications and experience to: Human Resources, Community Care Durham email:


We are an Equal Opportunity Employer committed to providing an inclusive workplace that embraces diversity, values differences and supports the full participation of all employees. We recognize the importance of ensuring that all job seekers and employees are treated with equal respect and dignity, and are protected from discrimination and harassment. In accordance with the Accessibility for Ontarians with Disabilities Act, 2005 and the Ontario Human Rights Code we provide accommodations to applicants with disabilities throughout our hiring process. If you require this information in an alternate format; require communication supports; an accommodation in applying for a posting and/or if you are selected for an interview, please inform our HR department.