VOCATIONAL/PRACTICAL NURSE (GS-0620-06) - Fort Cavazos, TX, Carl R Darnall Army Medical Center, Department of Medicine, Dermatology/Neurology/Sleep Section  

Fort Cavazos is located in the beautiful 'hill and lake' country of Central Texas between Killeen and Copperas Cove and is approximately 60 miles north of the capital city of Austin, 50 miles south of Waco, 160 miles south of Dallas, and 150 miles north of San Antonio.

Founded in 1942, this 340-sq.-mile military base is the Army's Premier Installation to train and deploy heavy forces.

A 214,968 acre installation, Fort Cavazos is now the largest active duty armored post in the U.S. Armed Forces and the only post in the United States capable of stationing and training two Armored Divisions.

The rolling, semi-arid terrain is ideal for multifaceted training and testing of military units and individuals.  Additionally, the Killeen community is a model of support for Army families. There are lots of resources and networks available to assist you.

Working for the Department of Defense comes with an abundance of benefits and perks to include competitive compensation packages, paid-time off, medical benefits, student loan repayments, and retirement package with Thrift Savings Plan to include matching employer contributions.  For more information, please visit the following link: https://www.usajobs.gov/Help/working-in-government/benefits/

Performs direct patient care and care coordination activities such as referral management, appointment booking, order reconciliation, uploading medical documents, and activity tracking for the Dermatology/Neurology/Sleep Disorders Center sections. Documents patients' chief complaints and other pertinent information in the health record. Documentation will also include medication reconciliation, screening tools, and behavioral health intake surveys. Participates in promoting patient compliance with health activities in accordance with RESPECT-Mil. Coordinates and facilitates care coordination, communicates relevant information according to the medical plan of care and nursing assessment, and documents accordingly in the health record. Assist providers with telephone and current electronic health record messaging center regarding renewal of medications, laboratory test results, and other medical requests.
Performs routine nursing care in the Dermatology/Neurology/Sleep sections to include, but not limited to, taking vital signs, reviewing of medical history, chaperoning, conducting EKGs, and patient education. Observes the patient and alerts physicians of significant abnormalities in vital signs, symptoms and general physical and emotional condition. Completes initial walk-in patient screening. Assesses the individual situation, determines acuity of the patient and appropriate schedule and level of care needed, and seeks advice from Registered Nurse, Nurse Practitioner, Physician Assistant, or Medical Doctor as necessary. Provides individualized nursing care to patients of all ages based upon the physician's medical care plan, the nursing assessment, and the physical, mental, and emotional needs of the patient. Prepares, administers, and documents oral, topical, intradermal, subcutaneous, and intramuscular medications in accordance with provider’s orders, nursing services policies and procedures, and scope of practice. Provides information on procedures, reactions, side effects, and possibility of adverse actions to staff and patients. Use terminology for describing patient reactions, patient care, and pharmacology for instructing patients and family members. Reinforces and reiterates instructions provided by the physician or other healthcare provider. Provides information for self-care and follow-up outpatient care. Provides information and guidance on meeting the goals of independent daily living. Instructs in sound health practices, taking into account the nature of the illness, physical limitations, culture, and socioeconomic status.

Performs variety of tasks requiring nursing skills. Recognizes emergency situations and functions calmly and efficiently in supplying physicians with crash cart and with requested supplies and materials. Must be prepared to assist with cardioversion. Is familiar with patient’s complaints and concerns. Assesses patient’s condition and notifies the physician of changes in patient’s physiological and psychological parameters. Monitors vital signs. If patient becomes faint or nauseated, administers spirits of ammonia. Cleans, sterilizes and assembles instruments used in procedures. Serves as chaperone if requested during exams of patients. Identifies normal and abnormal patient conditions, identifies problems, implements nursing orders, and conducts nursing interventions as prescribed and within privileges. Performs all treatment and nursing procedures associated with patient care as directed, indicated, and/or prescribed. Recognizes, identifies, and interprets serious situations and calls Registered Nurse, physician or other healthcare practitioner or takes preplanned emergency measures when Registered Nurse, physician, or other healthcare practitioner is not immediately available. 

Responsible for maintaining all treatment/procedure exam rooms in the Dermatology/Neurology/Sleep Disorders clinic. This includes performing daily and weekly equipment maintenance checks on all instruments and medical equipment. Keeping stock of supplies and checking expiration dates daily. Ensure that there are enough instruments and medical forms to perform procedures. Keeps stocks of medications and drugs, current and at working levels. Contacts pharmacy supply if running low on a medication in the Pyxis. Maintain cleanliness of medication room and ensure that medication is not left unattended at any time. Maintains the crash cart insuring that equipment is functional and that medications and drugs contained within are current and at working levels.

Checks working conditions of all Dermatology/Neurology/Sleep Disorders clinic medical/surgical equipment (laser machines, lights, chairs, phototherapy units, dermabrader, electrocautery, vital signs machines, etc.). Ensure that all medical/surgical equipment inventory is timely repaired and replaced, and contacts medical maintenance personnel as necessary to ensure safe operating conditions. Coordinates equipment purchases with department hand receipt holder, DMLSS coordinator, and/or CNOIC. Delivers instruments to and from Sterile Processing Department per SOP.

Provides primary support to the dermatologist during all examinations and surgical procedures. Assists in providing a suitable and comforting environment. (Many surgical procedures performed involve removal of cancers from the face, ears, neck and hands. Much of the equipment used is of “space age” design and totally foreign to the patient). Pretreatment/surgical responsibilities include: Preparation of treatment and surgical rooms by assembling and preparing necessary instruments, supplies, and equipment required for the type of procedure scheduled. Receives and prepares patients reporting for examination, procedure, or surgery. Assures that charts and necessary medical treatment records accompany the patient. Notes drug allergies and alerts dermatologist to presence of pacemakers, anticoagulants, and SBE prophylaxis. Required to perform local anesthesia during minor dermatology procedures under the guidance of the attending provider. Preceding surgical procedures, prepares and delivers appropriate local anesthetic per clinic protocol, sets up sterile surgical instrument trays, prepares surgical site with appropriate antibacterial solution, positions and surgical drapes the patient, and ensures proper lighting. During surgery, passes instruments and materials, maintains a sterile field (performs electrocautery, basic cutaneous suturing), assists in sharps and needle counts, and appropriately disposes of contaminated materials.

Assists in photographing surgical sites before and after surgery. Photographs are maintained as part of the in-house file. Immediate post-procedural duties include application of appropriate dressing with attention to size and location. Provide patient and family instructions for home care of the site. Daily post procedural responsibilities are wound/suture checks, care and cleaning of the surgical site, redressing, and suture removal. During wound check and suture removal clinic, prepares the patient for physician evaluation by obtaining and documenting medical history and brief examination.
Instructs and educates new LVN's, military technicians, and new dermatology residents on how to set up and assist with punch, shave, and excisional biopsies, Moh's layers, electrodessication, curettage, sclera-therapy, patch testing, chemical peels, nail surgery, electro-surgery, dermabrasion, and cryosurgical/cryotherapy procedures of the skin. QAssists physicians and surgeons during specialized diagnostic, therapeutic, and surgical procedures including punch, shave, and excisional biopsies, Moh's layers, electrodessication, curettage, sclera-therapy, patch testing, chemical peels, nail surgery, electro-surgery, dermabrasion, and cryosurgical/cryotherapy procedures of the skin. Assuring that all consents and procedural time out forms are filled out accurately and completely prior to dermatology procedures.
Assists surgeons with laser procedures. Before surgery, sets up the laser procedure room, initializing warm-up of the laser procedure equipment and ensures that the proper gear is available. Prepares anesthesia prescribed by the physician. Physically prepares the patient for and provides psychological support. Post-procedure, applies proper dressing to invaded site as ordered by the surgeon. Shuts down laser equipment according to prescribed shut-down procedure. Insures that all equipment is accounted for before closing the surgical room. Assuring that all consents and procedural time out forms are filled out accurately and completely prior to all laser procedures.
LVN administers and monitors patient getting phototherapy/photo-chemotherapies (Narrow Band UVB, UVA, Blu-U). Schedules appointments for and administers sequential doses of photo-chemotherapy over time per physician orders. Prepares the patient for therapy by providing first time orientation to the prescribed phototherapy unit used. Ensures that protective eyewear is worn by the patient. Makes sure that areas of the body that are not being treated with UV rays are always protected. On subsequent visits, check affected sites of last treatment for possible complications. Reports any complications, problems or breaks in therapy to the patient’s physician. Calculates dosage of successive treatment from percent increases or decreases prescribed by physician. Administers therapy from calculated dosage. Ensures that chart in reviewed and signed by supervising physician and notes changes in therapy ordered by the physician. Responsible for measurements of ultraviolet output and calibration of phototherapy units using ultraviolet meters. Responsible to document results of testing and report deviations from past readings to the supervising physician. Responsible for daily maintenance and pre-treatment burn-in of ultraviolet units. Assuring that all consents and procedural time out forms are filled out accurately and completely prior to all phototherapy treatments.

Administers Patch Sensitivity Tests, prepares palette of reagents to be used for sensitivity test, as ordered by the physician. Prepares marks and applies test palette to patient, schedules and counsels patient. Prepares a log for physician on loci of reagents. Instructs patient on precautions and care of test site. Schedules patient for test reading by physician. Removes patches and ensures markings are maintained. Documents skin reactions at time of patch removal. Assists with final reading of patch tests. Documents skin reactions and relevance as noted by the supervising physician. Provides patient information regarding sources of allergens, cross-reactions and alternative products to replace those to which patient is sensitive. Schedules two (2) subsequent appointments (readings) during the same week and counsels patient on when to return and what to expect during take home test. Maintains inventory of stocks of patch testing supplies and reagents. Coordinates ordering of replacement supplies and reagents with the clinic CNOIC and/or DMLSS coordinator. Assuring that all consents are filled out accurately and completely prior to all allergy patch testing procedures.

Performs photosensitivity testing and MED (minimal erythemogenic dose) testing as ordered by a physician. Schedules testing, counsels patient, ensures eye protection is read. Documents light doses and immediate responses. Schedules follow-up reading and documents results of testing in medical record. Maintain Fisher galvanic unit for iontophoresis and administer iontophoresis treatments under a physician's direction. Counsel patients about iontophoresis and schedule treatments. Assuring that all consents and procedural time out forms are filled out accurately and completely prior to all iontophoresis procedures. Provides primary support to Mohs micrographic surgeons before, during, and after highly specialized skin cancer surgery. Pre-appointment responsibilities include: Reviewing Moh's record of patient to determine the reason for the procedure(s), pathology results, allergies, and requirement for prophylactic medications (for patients with prosthesis, mitral valve problems, etc.) prior to the procedure. Documents in patients Moh's record appropriately as required by clinic standards. Calls all Moh's patients a week prior to procedure to review surgery date, pre-op instructions, and medications.

Performs tests and procedures basic to diagnostic laboratory work in dermatology, including bacterial, viral and fungal cultures of the skin. Prepares labels and takes specimens to the laboratory. Retrieves processed dermatology specimens and pathology reports from the laboratory. Files slides and maintains a log book with appropriate information. The supervising physician provides oversight during all dermatology treatment plans and procedures such as patch testing, phototherapy, medication administration, galvanic treatments, etc.Provides primary support to the Neurologist during all examinations and procedures. The LVN must be able to prepare the lumbar puncture kit for the neurologist prior to the scheduled procedure and ensure proper disposal of the equipment on completion of the LP. Assists in providing a suitable and comforting environment. Counsels patients and supports the patient and/or family member(s) with emotional concerns. Reinforces instructions to the patient on procedures previously provided to the patient by the physician/surgeon. Assures that all medication orders are correctly ordered and placed in the EHR. Reconstitutes and draws up medications (Botox and Occipital Nerve Blocks) per physician orders for common chronic neurological conditions such as migraines, cervical dystonia, etc. Hands medication after proper labeling to provider for administration to patient. Ensures that patient is monitored post injection for any adverse side effects. Immediately notified physician for signs of adverse side effects. Assuring that all consents and procedural time out forms are filled out accurately and completely prior to all injection procedures. As new technologies are adopted by the Dermatology, Neurology, and Sleep Disorders clinics, the incumbent is responsible for learning the new techniques and becoming proficient in administering treatments and counseling patients about the new technology. Responsible for teaching existing and new technologies to technicians, nurse assistants, other nursing and medical personnel at the direction of the Chief of Dermatology, Neurology, and Sleep Disorders Center.

Performs both administrative and logistical tasks as a member of the healthcare team for the clinic by contributing to maintaining the environment and resources to deliver healthcare. Reviews expiration dates for medications, vaccines, and supplies; and initiates the reorder. Coordinates with designated clinic administrative staff for maintenance of adequate vaccines and supply levels. In the absence of the medical receptionist, assists with the responsibilities for checking patients into the system, completion of records and other clerical duties as assigned. Reviews laboratory results and brings abnormal results to the attention of the physician and per physician's instructions, telephones patients regarding any follow-up care that is required. Duties include the use current automated Electronic Health Records system. Reviews chart for coding compliance and ensures all procedures are documented to obtain accurate capture or workload. Attends mandatory training as directed by supervisor or command. Will be trained in documenting adverse medication reactions in the VAERS or local system. Participates in and may coordinate performance improvement activities. Fills out Patient Safety Report (PSR) as necessary, and informs supervisor of all incidents requiring a PSR immediately.

Performs other duties as assigned.

Who May Apply: US Citizens