Nurse Practitioner (NP) - Community Stabilization and Connection Centre (CSCC)

Background: Inner City Health Associates (ICHA) is group of more than 100 physicians working in over 50 shelters and drop-ins across Toronto. ICHA provides transitional primary care and specialist (i.e. psychiatry, substance use, and palliative care) to those who do not otherwise have access to care. We serve people who are unsheltered and temporarily living in shelters as well as those who are precariously housed. ICHA is very pleased to be expanding its interprofessional team to include nursing to offer enhanced client supports. Many of ICHA’s clients have complex health needs including untreated chronic and complex multi-system diseases, an elevated risk of acute health emergencies, and serious and persistent mental illness and substance use.

Role Description: The Community Stabilization and Connection Centre (CSCC) nurse practitioner will provide on- site clinical care to individuals who routinely present to hospital ER’s with symptoms of alcohol intoxication and mental illness. Nurses will practise using a holistic, client-centered model of care with an emphasis on harm reduction, psychosocial supports and crisis de-escalation. Nurses will use their knowledge, skill and judgement to treat clients who present to the centre in an intoxicated state who may also present with complex health conditions such as unmanaged chronic diseases, infectious diseases, skin conditions and wounds, mental illness and substance use issues. The Community Stabilization and Connection Centre (CSCC) nurse practitioner works collaboratively with ICHA nurse(s) and physicians, as well as the on-site Harm Reduction staff, Peer Workers, PSWs, and other available support staff to provide care to clients experiencing homelessness respecting PHIPA and client consent. The nurse practitioner will provide comprehensive and holistic health assessment of clients’ physical and mental health through their admission to the CSCC to address urgent and chronic health concerns, escalating issues whenever necessary to the ICHA on-call physician or to Emergency Services. Nurse practitioners will collaborate with affiliated support staff and others to provide social and emotional supports including crisis mitigation and case management. An ICHA Nurse Manager will provide indirect supervision and ongoing support.

Roles and Responsibilities:

● Conducts comprehensive health assessments of individuals experiencing acute intoxication

● Assess incoming patients and re-assess existing patients to ensure meets inclusion criteria; rule out exclusion criteria

● Participates in emergency response, including but not limited to acute substance toxicity/overdose, seizures, changes in level of consciousness, dehyration, etc

● Conduct appropriate assessment and prescribing for medications that may be required during the duration of a patient’s stay, including but not limited to benzodiazepines

● Assess for and manage acute withdrawal episodes; support in transfer to acute care setting or detox

● Facilitates and supports transfer of clients to emergency department in the event of deterioration and/or emergencies

● Assesses need for and administers appropriate medications as per medical directive

● Assesses the need for laboratory and diagnostic tests and order appropriately

● Collaborate with on-site RPN on patient careplan and interventions

● Provides supportive and lifestyle counselling which may include preventative counselling, brief supportive counselling or short term crisis management when indicated

● Draft and send referrals to community care supports based on client’s needs and personal goals for substance use continuation or cessation

● Collaborates with partners to minimize barriers to accessing services and care, including Harm Reduction supports and Peer Workers

● Assesses and manages episodic and chronic conditions commonly seen in primary health care and with various physical and mental health comorbidities

● Ensures that standards of client care are maintained according to accepted College of Nurses standards of practice, the Regulated Health Professions Act, and ICHA policies

● Participates in the development of, and gives support to, policies/strategies which are in the interest of public health and which support the recognition of the determinants of health

● Perform other nursing duties as required by Nurse Managers

Qualifications:

● Current registration as a Registered Nurse (EC) with the College of Nurses of Ontario in good standing

● Evidence of liability protection/malpractice insurance

● Current CPR certification

● Minimum of 3 years nursing experience in NP role in acute care; emergency medicine experience preferred

● Willingness to work from a harm-reduction and anti-oppression, trauma-informed framework; experience working with homeless or marginalized service users preferred

● Able to work independently in non-typical community-based primary care setting (i.e. improvised hotel clinic) with remote MD support as needed

● Knowledge of relevant community services for individuals experiencing homelessness

●Demonstrated thorough knowledge and understanding of infection control and prevention practices

● Able to manage unpredictable client presentations and situations in a collaborative and calm manner

● Experience working with clients who use substances and who have serious and persistent mental illness

● Knowledge of and commitment to client–centred philosophy

● Open minded, non-judgmental with a commitment to upholding the rights and dignity of all people and respecting their diversity

● Knowledge and proficiency in current, evidenced-based methods and practices in health care delivery, with an emphasis on mental health, health promotion and risk management/reduction

● Demonstrated commitment to and knowledge of community-based health care

● Awareness of and sensitivity to the health issues of a diverse community and experience working with marginalized populations

● Excellent verbal and written communication skills

● Strong interpersonal, organizational and administrative skills that include computer literacy and ability to work with EMR (OSCAR)

● Police check/clearance documentation (i.e. vulnerable sector screen) required