Exceptional Care–Exceptional People The Brant Community Healthcare System is a two site Community Hospital located in Brantford and Paris, Ontario.

• The Brantford General is an acute care hospital
• The Willett in Paris is an urgent care centre and transitional beds

By choosing to work at Brant Community Healthcare System (BCHS), you are joining an organization with more than 130 years of making a positive difference in the lives of the people we serve throughout our communities. We value Care, Accountability, Respect and Equity, and we are working together to build a healthier community!

Why Choose BCHS?

• Tuition Reimbursement (Centralized Education Fund)
• Casual, Part time and Full time positions (4 on 5 off for full time nurses)
• HOOPP Pension Plan
• Predictable work locations
• Discounted onsite parking (no shuttles or waiting lists)
• Support 24/7- you’re not on your own (managers on call, physicians, allied health and support staff).
• Wellness matters, our Employee Assistance program is free and confidential to all employees and family members.
• Ongoing infection and prevention control measures, education, appropriate PPE and support available to all employees.

Position Summary Reporting to the Manager of Access and Flow, the Transition Planner (MIP) will be responsible for facilitating patient flow into, throughout, and out of the Medicine units at BCHS. The Transition Planner drives the discharge plan in collaboration with the patient, the physicians and the care teams. The focus of the Transition Planner is ensuring seamless transitions throughout the episode of care and is integral in identifying and addressing processes and/or other issues that impede the patient’s flow from admission to discharge.

Please note that this position is for the B7 Medical Unit however the successful applicant will be required to cover the other two medical units as well (B6 and B8).

Position Requirements

• In collaboration with leadership, the care team, and Home and Community Care Support Services, the Transition Planner will support all units within the Medicine programs at BCHS with a focus on patient flow and discharge planning while promoting safe patient care. They will also ensure that key performance metrics for patient flow in the post-acute programs are being met, such as length of stay, Estimated Date of Discharge (EDD) etc.
• In collaboration with the Clinical Manager and Allied Health Team, the Transition Planner will review applications to Medicine programs (Low and High Intensity Rehab, Medically Complex, A/R) to ensure that patients are meeting the provincial criteria as set forward for programs by the Rehab Care Alliance.
• Work with the patient/family to identify individual discharge needs and goals.
• As an integral member of the Care Team, the Transition Planner will actively review patients on a daily basis with team members to support the development and progression of a collaborative plan to support the patient’s goals of care, including an effective and realistic discharge plan.
• Actively leads discharge planning conversations with patients/families, including articulating/adjusting the Estimate Date of Discharge (EDD), identifying discharge barriers, ALC designation, and may include 48-hour conversations after arrival to the units.
• Supports BCHS’s bed capacity plan to facilitate patient flow throughout the organization in accordance with funded beds and engages in activities to enhance the patient experience.
• Facilitate the accurate assessment and designation of ALC.
• Shapes patient, family and team expectations through exceptional communication of high-quality information delivered in an accessible manner that respects patient/family preference.
• Contributes to knowledge translation of discharge and transitional planning best practices across the inter-disciplinary teams, departments and community partners.
• Participates in action rounds, bed meetings and ALC rounds as appropriate.
• Supports an environment that promotes continuous quality improvement and staff engagement to achieve established clinical benchmarks and outcomes
• Demonstrates skill in navigating and communicating in a complex environment.
• Interacts with staff, patients, families and community partners in an ethical, consistent, fair, timely, appropriate and decisive manner in accordance with BCHS policies.

Mandatory Qualifications

• Graduate of an accredited college or university nursing program
• Registered and in good standing with the College of Nurses of Ontario
• Current Basic Cardiac Life Support (BCLS) certification
• Minimum of two years’ recent clinical experience in an acute care setting.
• Demonstrated experience with patient flow, discharge planning, utilization management and community resources.
• Demonstrated commitment to professional development
• Demonstrated good attendance and performance records with the ability to maintain these same standard

Mandatory Competencies

• Strong understanding of Alternate Level of Care (ALC), patient flow processes, and community partnerships.
• Demonstrated knowledge of the provincial standards as set forward by the Rehab Care Alliance
• Demonstrated commitment to patient/client centred care
• Demonstrated knowledge of the Home First Philosophy
• Experience in collaborative care planning within hospital and community setting
• Demonstrated understanding of financial and personal care capacity, and the ability to consider capacity for the purposes of Discharge Planning
• Comprehensive and demonstrated knowledge of community resources including congregate care, housing, community supports services, and social service agencies
• Evidence of effective organizational, interpersonal, communication, leadership, judgment and decision-making skills
• Applies BCHS values and professional practice standards to patient/client care and service
• Demonstrated commitment to patient and family education and the ability to promote health and wellness
• Demonstrated commitment to patient safety and safe transitions in care
• Integrates education, critical thinking, and relevant practical experience in problem solving
• Proficiency in both official languages (English and French) will be considered an asset
• Safety (patient, worker & workplace) is a BCHS Corporate Priority. The successful applicant will demonstrate good stewardship in the identification, reporting and mitigation of unsafe acts or conditions.

Accommodation The Brant Community Healthcare System (BCHS) is an equal opportunity employer, committed to employment equity and diversity in the workplace. We welcome applications from women, Indigenous persons, members of racialized groups, visible minorities, persons with disabilities, persons of all sexual orientation and persons of any gender identity or gender expression.

Brant Community Healthcare System is committed to creating an accessible and inclusive organization. We are committed to providing barrier-free and accessible employment practices in compliance with the Accessibility for Ontarians with Disabilities Act (AODA). Should you require Code-protected accommodation through any stage of the recruitment process, please make them known when contacted and we will work with you to meet your needs. Disability-related accommodation during the application process is available upon request.

To ensure there is equal opportunity during the recruitment and selection process, please contact your Recruiter to discuss accommodation.