Organization Overview

Durham Community Health Centre (DCHC) is a registered, charitable organization that provides integrated, accessible, and equitable community based primary care, wellness services, and health education to Durham community members who face multiple barriers to their health and well-being.

DCHC also provides equity-based programs and services that focus on priority populations such as Indigenous, Black, the 2SLGBTQI Community, Newcomers to Canada, Seniors, and Unattached patients (i.e., those without a family doctor), to name a few. DCHC ensures Durham community members receive not only sick care, but preventive care as well.

At DCHC, we are a team-based interprofessional group of staff including physicians, nurse practitioners, nurses, counselors, dietitians, outreach workers, medical secretaries, and other administrative staff. We always place every client at the center of our approach to care, based on their needs. We address these needs through integrated clinical and wellness care and health education.

It's an exciting time to be joining DCHC, while we are embarking on an energizing path with a focus on making our biggest impact yet on the health of Durham community members by diversifying, expanding, and leveraging our Strategic Plan, Theory of Change, Brand, Client Stories and Resources.

DCHC’s 2023 – 2026 Strategic Goals

• Drive Program and Service Integration and Client Experience Across All that DCHC Does
• Evolve Program Offerings to Improve Health Equity and Meet the Needs of DCHC’s Priority Populations
• Establish DCHC as a System Advocate and Champion for Equity
• Enhance DCHC’s Brand and Awareness Across Durham Region
• Become an Employer of Choice with a Focus on Recruitment, Retention, and Development

Position Overview

Within DCHC’s Clinical Services portfolio, the GAIN RPN is part of the Geriatric Assessment and Intervention Network (GAIN) Community Team. The GAIN RPN will be engaged in the care of clients referred to the GAIN Community Team, who are primarily individuals living with aging and frailty who have been identified through direct referrals from community, family physicians or through indirect referrals from Emergency Department(s) in the Durham Region. The GAIN RPN is responsible for conducting client assessments both in the GAIN clinic and within clients’ homes.

The GAIN RPN will be an effective, collaborative member of DCHC’s inter-professional team that includes Family Physicians, Nurse Practitioners (NP), Registered Nurses (RNs) and Therapists, Social Workers, Registered Dieticians, Personal Support Workers, Occupational Therapists and Pharmacists, who are providing clinical services to marginalized and at-risk geriatric members of our community, in the context of safe and ethical nursing practice. The collaborative practice of this position includes accepting referrals from, consulting with, or referring to other health care providers in order to promote comprehensive and continuous care.

Employment Status: Temporary Full-time Contract until March 27, 2026 (Maternity Leave coverage)

Position Status: This is a Bargaining Unit position. All terms and conditions of the collective bargaining agreement apply.

Hours of Work Schedule: 35 hours per week

Salary Range: Annualized salary range of $48,461 - $56,806, commensurate on skills and experience plus HOOPP

Hiring Manager: Senior Manager, Integrated Care & Experience

Primary Location: Oshawa & Pickering (with flexibility to work/transition to any DCHC locations as required).

Key Responsibilities

• Assessment: In collaboration with the GAIN multi-disciplinary team, the clinician will contribute to a comprehensive bio-psychosocial assessment of clients living in the community who are experiencing behavior changes. This includes performing assessment activities such as conducting client interviews, assessing psychosocial, cultural, and ethnic factors affecting client needs, and collecting and reviewing comprehensive client health data. Additionally, the role involves supporting our Geriatricians, Care of the Elderly Physicians, and Nurse Practitioners during their clinic days and clinical consults. This support includes assisting with patient assessments, preparing medical records, facilitating patient flow, and providing direct care to elderly patients, ensuring efficient and effective care delivery in a collaborative and patientcentered environment.
• Development: Identifies expected outcomes derived from the assessment data and individualizes expected outcomes; formulates a comprehensive plan of care. Provides and leads person-centered care planning through the utilization of validated tools and methods related to psychogeriatric assessment and care (P.I.E.C.E.S, Montessori Based Dementia Care, CCSMH Best practices, GPA, U-First etc.)
• Planning: Provides the care team assistance in interprofessional implementation and monitoring of responses to therapeutic interventions
• Implementation: Provides consultation, therapeutic intervention, education and creative enhanced problem solving to the client, caregiver(s), and care team participating in the care planning of complex psychogeriatric issues. Documents client history, regular progress notes, referrals as appropriate, MOH forms, insurance forms, team rounds and family conference notes and other pertinent information in an accurate and timely manner according to organizational policies, procedures, and guidelines which includes dictating admission and discharge notes.
• Evaluation: Evaluates client/family response to goals identified in care plan, whether patient attaining expected outcomes, and modifies the plan of care to ensure effective care

Other duties as required include education, translating research to practice, and supporting all applicable agency policies and procedures.

Key Qualifications

• Current registration with the College of Nurses of Ontario (in good standing)
• Specialized Geriatric care experience is strongly preferred • Geriatric training and certificates such as P.I.E.C.E.S., Montessori, G.P.A., U-First! are strongly preferred
• Minimum 3-5 years related clinical experience, preferably in a community healthcare setting or combination of community and hospital or public health settings.
• Skills/experience to fulfill major functions of the role including wellness care, assessment, and diagnosis.
• Proven ability to coordinate care collaboratively with other interdisciplinary team members as well as to effectively function independently with clients.
• Demonstrated ability to relate therapeutically with clients. Includes strong negotiation and conflict resolution skills.
• Commitment to change management, continuous quality improvement and demonstrated ability to cope with change.
• Must have a well-developed clinical understanding of dementia, depression, and delirium as well as knowledge in forms of communication, clinical knowledge and skills related to mental health, addictions, responsive behaviours and neurological conditions as they apply to older adults and the ability to assess the unique impact of these health problems
• Knowledge of and commitment to knowledge exchange as a means of continuous quality improvement, education and capacity building in the individual, team, organization, and system.
• Demonstrated effectiveness working with minimal supervision.
• Facilitation skills for education and health promotion activities
• Demonstrated leadership in the advancement of clinical practice and the achievement of program goals.
• Demonstrated use of evidence-based practice.
• Knowledge and the ability to practice in a culturally sensitive manner, understanding how values and beliefs may impact behaviour.
• Must have valid driver’s license and regular access to a vehicle
• Experience with Electronic Medical Records (EMR) and competence in Microsoft Office applications

Key Attributes include

Demonstrated Minimum Attributes core to the Agency: Service oriented, Initiative, Results oriented, Flexible/Adaptable, Collaborative, Effective Communication Skills, Team Player, Ability to manage risk within one’s responsibility & accountability, Ability to take Accountability.

In addition, the following are role-specific attributes: Conceptual thinker; Efficient, Organized, Attention to Detail, Creative & Innovative Thinker, Analytical/Systematic, Forward Thinker, Problem-Solving skills, Crisis Management Skills, Empathic.

Physical/Mental Demands Analysis

• Regular hand-eye coordination, as a result of computer use (electronic medical records system, regular PC).
• Some occasional periods of high concentration demands, as result of multiple and simultaneous service priorities when dealing with the public and vulnerable sector.
• Regular public/client relations.
• Moderate standing, sitting and walking, to fulfill provision of primary care services to vulnerable sector clients.
• Regular frequency of multi-tasking, within a dynamic open-office environment requiring regular changing and simultaneous priorities.
• Regular interaction and collaborative work with same-role colleagues, across disciplines, and with community partners.
• May experience stress and stress related symptoms due to regular interaction with vulnerable sector clients in crisis.
• May be exposed to illness and unsanitary conditions in which established H&S protocols must be adhered to at all times. In this, may be in contact with individuals and families in crisis as a result of mental health issues, may be using substances and/or not attentive to personal health and safety for themselves.
• May have to manage physically threatening clients and be prepared to be responsible for own safety and safety of others, within H&S protocols.
• Must monitor their own time and stress levels to ensure that they are able to effectively assist clients. They may find that they are continually interrupted and may have to quickly assess situations to respond appropriately.
• May be placed in life-threatening situations for others such as instances of attempted suicide, violence or other mental-health and physical related risks – requiring crisis management protocols.

Full vaccination against COVID-19 is mandatory for this position (DCHC will however adhere to its duty to accommodate those who are unable to be fully vaccinated for a reason related to a human right protected ground).

Application Process

1. While we thank all applicants for their interest in applying, only those qualified and considered for an interview will be contacted. All applicant submissions will be kept on file for six months, for future consideration.
2. All applicants are encouraged to provide a valid email address for communication purposes. Applicants may receive written correspondence regarding this job posting directly to the email address provided on their resume. As an applicant, it is your responsibility to ensure that you check your email regularly.
3. All positions are subject to the successful completion of the following pre-employment conditions for all external hires: Reference Checks; and Criminal Background checks (including Vulnerable Sector Screening).
4. Please be advised that AI Technology is used during the screening process of applications. All final hiring decisions are made by our recruitment team

Durham Community Health Centre is committed to complying with all applicable standards as set out in the Accessibility for Ontarians with Disabilities Act, 2005 (AODA),the provisions of the Ontario Human Rights Code, and any other applicable legislation. Accessibility: If you have accessibility needs and require alternate formats or other accommodations, please contact Human Resources at 905-723-0036, or by email to recruiting@durhamchc.ca. Durham Community Health Centre, and staff are dedicated to creating an inclusive environment that welcomes diversity