Job Description

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Are you an experienced registered nurse (BScN or diploma) looking for a different kind of practice environment, and comfortable practising both independently and as part of a team? This could be what you've been looking for.

As an integral part of our Rapid Response Nursing (RRN) team, you will work with medically complex children, and frail adults and seniors with complex needs and/or high-risk characteristics such as congestive heart failure, to ensure a smooth transition from acute care to home care. You will achieve this in two ways: by connecting with primary care and by providing hands-on rapid response home care.

This program is designed to ensure effective transitions from acute to home care for two target populations: medically complex children and frail adults and seniors with complex needs and/or high risk characteristics e.g. congestive heart failure. To ensure communication and linkage with primary care; and provide timely and effective rapid response home care.



The Rapid Response Nurse provides the first in-home nursing visit within 24 hours from hospital discharge for high needs seniors and children. During this visit, the nurse will confirm the patient hospital discharge care plan, communicate the importance of primary care to avoid re-hospitalization, and perform medication reconciliation for the client.



What will you do?
In hospital, screen potential patients for program eligibility Once the patient is home, confirm scheduling of outstanding medical tests, availability of transportation, etc. Either directly or in partnership with a pharmacist, ensure new prescriptions are filled and there are no drug interactions or contraindications Review medication protocol with the patient and caregiver, and answer any questions Either directly or through a LHIN Care Coordinator, contact the primary care physician and provide an update on the patient's acute care event and post-discharge regime Facilitate the patient's one-week follow-up visit with the primary care physician Provide direct care to patients in collaboration/consultation with a LHIN Care Coordinator or Service Provider(s), as assigned Identify patients requiring an accelerated assessment and home care services, and facilitate the home assessment visit Support the LHIN Care Coordinator in developing the LHIN patient care plan and ensuring a smooth transition to the ongoing care team Participate in establishing, maintaining and monitoring case management standards


What must you have?

Membership, in good standing, with the College of Nurses of Ontario Registered Nurse (BScN or diploma) in good standing with the College of Nursing Case Management Certificate is an asset Minimum of five (5) years of experience relevant experience as a Registered Nurse (BScN or diploma) Working knowledge of community resources and roles of health care professional Emergency/critical care and community nursing experience an asset Knowledge of direct care / case management models used in community health care organizations Solid knowledge of health care related legislation and practices Advanced assessment and diagnostic reasoning skills Must be able to practice independently and interdependently Effective interpersonal and communication skills Effective organizational and planning skills Basic proficiency with computerized information systems French language is an asset Must have a valid driver's license and access to a vehicle Demonstrates commitment to Ontario Health atHome mission and values. Effectively maintain a constant flow of verbal and written communication with others throughout the workplace as well as outside the organization Able to communicate with clients', their families, and other relevant individuals in order to follow through with care plan directives Demonstrated awareness of cultural diversity, as well as ability to behave discreetly and sensitively to confidential issues


What would give you the edge?Case Management Certificate Emergency/critical care, community nursing, medicine/surgical and rehab experience Ability to speak French or another second language


What do we offer?

We know wellness is supported with work-life balance.

In an inclusive culture committed to support your passion for continuous learning, growth and innovation, we offer:Attractive comprehensive compensation packages and benefits Valuable development opportunities Membership in a world class defined benefit pension plan


Who we are

We are Home and Community Care Support Services, ready to serve every person in Ontario.

We partner with patients and caregivers, primary care providers, hospitals, long-term care and retirement homes, service providers and Ontario Health Teams, to deliver responsive, accessible, integrated, patient-centred care.

If you're interested in driving excellence in care and service delivery

, and seeking an unparalleled opportunity to lead and learn, partner and connect, care and be cared for, this is your home.



Equity, Inclusion, Diversity and Anti-Racism Commitment
Home and Community Care Support Services is committed to a culture of equity, inclusion, diversity and anti-racism. We are committed to attracting, engaging and developing a workforce that reflects the diverse communities we serve. We welcome and encourage applications from all qualified applicants. Accommodations for persons with disabilities required during the recruitment process are available upon request.

We thank all applicants for their interest; however, only those selected for an interview will be contacted.