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Alternate Level of Care Community Nurse

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Riverside Health Care

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Location:
Canada

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Category:
Nursing

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Contract Type:
Not provided

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Salary:

44.19 - 57.68 CAD / Hour
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Job Description:

The Alternate Level of Care (ALC) Community Nurse will ensure that hospital goals and objectives are met while creating an environment that supports the mission, vision, and values of the hospital, health centres, long-term care, and community programming; as well as ensures the creation of an environment for innovation and excellence in resident and client/patient-focused care.

Job Responsibility:

  • Work to create/broaden partnerships with allied health and social wellness partners throughout the region to transition ALC patients more effectively from hospital to community programming, home, and long-term care (LTC)
  • Proactively engage with local and regional allied health and social wellness partners to develop pathways that will avoid ALC designations by addressing patient/client needs and barriers pre-emptively
  • Become involved in creating strategies that lead to early identification of potential ALC patients in the community and hospital setting
  • Examine causes of delayed transitions for ALC patients and, as part of an interdisciplinary team, design approaches to counter the delays
  • Collaborate with health partners to collect, analyse, and critically evaluate data as it relates to ALC patient trends for the Rainy River District
  • Facilitate transitions of care
  • Be physically present for warm hand-offs to ease the transition for the ALC patient moving from hospital to home care (nursing/PSS)
  • Be physically present for ALC patient discharges from hospital to home for those with little to no caregiver support
  • Complete regular, on-site check-ins for assessment of instrumental activities of daily living for this patient population
  • Facilitating transitions from Hospital to long-term care
  • Palliative/end of life transitions from hospital to home with Advanced Care Planning completed ahead of discharge
  • Be on hand for emergency department (ED) transitions of potential or diagnosed ALC patients
  • Complete in-home medication assessments for recently transitioned potential and/or ALC patients
  • Health system navigation for ALC patients/caregivers being considered for discharge as well as for clients identified in community as potential ALC patients
  • In collaboration with leadership, bring cases forward that would best utilize ALC flexible funding for ALC patient avoidance initiatives and improve ALC to discharge transitions
  • In collaboration with leadership and Riverside educators, create a training program and instruct staff on Forethought in ALC patient avoidance at care transitions, Hospital ALC patient needs assessment, Care and treatment of ALC patients, ALC discharge planning considerations, Early recognition of potential ALC patients and ALC designation avoidance in community
  • Other duties as assigned, by Director, Community Services or designate

Requirements:

  • University degree in Health or Social Sciences field
  • or College Diploma with five (5) years’ work experience in the health and/or social work field
  • Clinical experience is an asset
  • Experience in rural nursing, working with indigenous people is an asset
  • Knowledge of community programming, long term care, convalescent care and other health and services agencies – locally and regionally
  • Work experience in primary care is an asset
  • Knowledge of Informed Decision Making, Patient Capacity, Patient Rights and Consent for Treatment
  • Possess effective oral and written communication and organizational skills
  • Strong interpersonal and team building skills
  • Demonstrated initiative and experience working independently and with minimal supervision
  • Proven ability to develop and maintain effective working relationships with others both internal and external to the organization
  • Demonstrated critical thinking skills and problem solving
  • Knowledge of, and in compliance with relevant legislation in health and safety and employment, (OH&S Act and its Regulations, WSIB, Human Rights)
  • Physically capable of performing essential duties of the job
  • Regulated Health Professional or a relevant blend of education and experience deemed appropriate by Riverside Health Care
  • Social services work experience is an asset
  • Minimum of five (5) years of relevant experience in a health care setting
  • Experience in rural/remote healthcare, working with indigenous people is considered an asset
  • Demonstrated knowledge of local and regional community health and social service providers, an understanding of the long-term care system, comprehension of Ontario Health’s Home and Community Care Support Services
  • Proficient in using MS Office application, including MS Word, Excel, and PowerPoint, and other computer skills necessary for virtual modality’s of care, communication and research
  • Knowledge of Informed Decision Making, Patient Capacity, Patient Rights, Consent for Treatment, and Alternate Level of Care (ALC)
  • Ability to work autonomously and support the creation of program guidelines and materials
  • Must have a valid G class driver’s license and be in good standing
  • Travel throughout the region

Nice to have:

  • Clinical experience
  • Experience in rural nursing, working with indigenous people
  • Work experience in primary care
  • Social services work experience
  • Experience in rural/remote healthcare, working with indigenous people

Additional Information:

Job Posted:
February 07, 2026

Employment Type:
Fulltime
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