The Department of Medicine, Division of Infectious Diseases is seeking a Clinical Nurse to provide nursing assessments and coordination of care for activities related to TB prevention, as well as provide HIV/STD education and testing, provide medical case management services to patients and contacts served at Baltimore City Health Department (BCHD) STD/HIV/TB clinics.
Duties and Responsibilities:
Serve as the point-person to coordinate and facilitate TB prevention activities within the TB program and Baltimore City. Responsibilities include identifying, evaluating and providing oversight of treatment and case-management for individuals with latent and active TB, documentation of clinical and public health activities, generation of program reports, delivery of education to community providers and patients, and facilitating HIV and STD evaluation and testing.
Manage a latent TB referral program. Management includes triage and coordination of care for individuals referred to BCHD for evaluation or treatment of latent TB, nursing assessment of patients in the TB clinic, and working collaboratively with the TB program manager, TB clinicians, TB active case managers and other ancillary staff. The TB prevention nurse is responsible for executing the medical treatment and monitoring plans as developed by BCHD clinicians or clinicians designated by BCHD within the community.
Conduct TB contact investigations in the field. The TB prevention nurse is will be responsible for initiating evaluation of contacts of individuals with active TB. The goal of contact investigation is to identify individuals at risk for latent TB infection (LTBI) and active TB disease. Initial evaluations of patients may occur out in the field, in a patient's home or in the office. The evaluation will include screening, testing, and treatment. Testing includes STD and HIV evaluation in addition to LTBI evaluation and may involve PPD or IGRA testing, HIV testing, syphilis testing, chest x-ray referrals, and coordinating medical evaluations with the clinicians.
Initiate and coordinate LTBI evaluations among individuals at high risk for infection or progression to active TB, including in the field (e.g., homeless shelters). In addition to contact investigations, the TB prevention nurse will work with the TB program manager, TB clinicians, and community partners to identify populations recommended for LTBI care services, including conduct of nursing evaluations, testing, and case-management to additional care.
Provide support to community partners involved in TB care activities. This includes outreach and education, facilitating referrals, and working on community TB initiatives in conjunction with the TB program manager and medical director.
Provide oversight and implementation of TB infection control activities, including quarantine and isolation. The TB prevention nurse will work with BCHD leadership and community partners to establish protocols and procedures to minimize transmission risks in the community. This includes working with partners on housing options, hospital discharges, and other care coordination of individuals with infectious forms of TB.
Provide HIV and STD education and testing
Provide nurse case management for all individuals receiving TB prevention services in the field or at BCHD TB clinic. This population includes individuals being evaluated or treated for LTBI or active TB (such as contacts to active TB cases) as well as individuals immigrating with class B-waivers (i.e., evidence of latent or active TB).
Case-management duties includes care-coordination, active follow-up, education and adherence counseling for individuals being evaluated or treated for latent or active TB. Responsibilities additionally include gathering all relevant clinical data on patients from clinics, hospitals, nursing homes, and other sources. This data includes, but is not limited to, all microbiologic data (including TB, HIV, STD, and other microbiological studies), all laboratory data, discharge summaries, and radiologic reports.
Perform and document a monthly case-summary, and will ensure that all monitoring benchmark labs (LFT's, HIV testing, CXR, and sputum smears and cultures) are performed and documented in a timely fashion. The nurse shall monitor treatment progress (including documentation of monthly dose counts) within the medication administration record (MAR). For patients that are missing, make reasonable efforts at finding the patient, including home visit, contacting local hospitals/shelters/DOC, etc.
The TB prevention nurse will work collaboratively with the active TB case-manager's in identifying high and medium risk contacts of active pulmonary TB cases, completing testing, and ensuring treatment or window prophylaxis when indicated. 90% of patients with smear-positive active TB should have contact investigation testing completed within 15 business days.
Cross-train in the active TB program to successfully provide case-management services for patients with active TB. This includes conducting nursing assessments for individuals with confirmed or suspected active TB, individuals with latent TB, and contacts of TB cases.
Provide documentation in medical records and surveillance systems. Complete documentation of all contact investigations, clinical summaries, case-manager evaluations, communication with patient and providers. Ensure that all relevant data is entered accurately into relevant BCHD or other databases.
Assists with public health reporting of notifiable diseases, and coordinate public health activities between BCHD and Maryland Department of Health and Mental Hygiene (MDHMH) and Centers for Disease Control and Prevention (CDC). Latent Tuberculosis has been a notifiable disease in Maryland State since 2018. The reporting of contact investigations in quarterly cohort reviews to the MDHMH.
Generate written and verbal reports on TB program indicators and metrics (e.g., number of individuals referred to TB prevention program, proportion of individuals treated), and present to the TB program manager and medical director on a routine basis
Coordinates interjurisdictional transfers of TB or latent TB patients or contacts, when indicated.
Attends TB weekly meetings with staff to discuss patient care and progress. Collaboration and follow-up with TB case managers regarding latent TB suspects that may require active TB work-ups.
Dispenses TB medications, according to standing orders and the BCHD RN dispensing formulary.
Provides directly observed therapy of TB treatment in the field when indicated.
Provides education on STD/HIV/TB to patients, contacts, and health care providers
Assist with clinic initiatives as necessary.
Individual must be a registered nurse, licensed in the State of Maryland. Bachelor's degree in nursing or related discipline preferred. Current American Heart Association or American Red Cross CPR certification required. Must maintain current licensure and certification during duration of employment. Acceptable completion of the JHH credentialing process is required within two weeks of start date.
Preferred Qualifications: Medical and conversational Spanish is preferred.
Special Knowledge, Skills, and Abilities:
Knowledge and interest in TB/HIV/STD diseases and treatment. Knowledge and interest in public health aspects of infectious disease control.
Ability to work with culturally diverse patients, staff and community populations. Ability to work in multidisciplinary, multi-organizational team setting.
Strong organizational skills with attention to detail and follow-through. Self-starter with the ability to work with minimal supervision.
Proficiency in medical and conversational Spanish is preferred.
Sitting, standing and walking for extended period. Reaching by extending hand(s) or arm(s) in any direction. Finger dexterity required to manipulate objects with fingers rather than with whole hand(s) or arm(s). Ability to move standard equipment through a hospital or clinical environment.
This position will require travel and the need for a personal vehicle. There is the possibility of teleworking on non-clinic days but the employee will be maintaining a clinic at the Baltimore City Health Department. The employee will also be traveling throughout the city to various clinics, FQHC's, shelters, and other locales as needed. There are no weekends required but flexible hours may be required during some contact investigations.
This description is a general statement of required duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned.
Classified Title: Clinical Nurse Role/Level/Range: ACRP/03/ME Starting Salary Range: $60,945.00-$83,865.00;Commensurate with experience Employee Group: Full Time Schedule: Monday - Friday, 8:30am -5:00pm Exempt Status: Exempt Location: School of Medicine, East Baltimore Campus Department Name: Medicine, Infectious Diseases, Baltimore City Health Department Personnel Area: School of Medicine
The successful candidate(s) for this position will be subject to a pre-employment background check.
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During the Influenza ("the flu") season, as a condition of employment, The Johns Hopkins Institutions require all employees who provide ongoing services to patients or work in patient care or clinical care areas to have an annual influenza vaccination or possess an approved medical or religious exception. Failure to meet this requirement may result in termination of employment.
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