About Us

About Nurse Nexus

Approach

A Registered Nurse holds the pivotal role for the Nurse Nexus patient. The Nurse Nexus nurse will provide the physician and the patient with the individualized Transitional Care Plan. This plan will be developed through assessment, planning, implementation, and evaluation. Nurse Nexus will communicate with the physician on an as-needed basis until discharge. Education is the key component of Nurse Nexus. A Registered Nurse will conduct an in-home assessment to identify the patient's level of understanding, answer pre-operative questions and conduct a safety assessment (move rugs, lighting, etc.) to allow for the development of the Transitional Care Plan.

The Nurse Nexus Registered Nurse will meet the patient at the hospital and work with the hospital discharge team and the patient's family to assist with their complete understanding of the Transitional Care Plan. Follow up visits, as needed, will be conducted for up to a total of twenty-four (24) hours of care. The Discharge Care Plan will include the continuation of pain management, infection prevention/control, medication reconciliation and adherence plan, ADL instruction and assistance, physical therapy instruction as prescribed post discharge, etc. A follow-up visit with the primary care and/or specialist physician will be scheduled prior to discharge from Nurse Nexus.

Partnerships

Nurse Nexus will contract with partner hospitals and health plans to establish program goals and financial reimbursement. Direct physician relationships will be established with commitment to the program.

Patient Enrollment

Patient eligibility and enrollment will be determined prior to admission in accordance with clinical qualifications as defined by our partnership members. Nurse Nexus will directly manage coordination of patient enrollment in collaboration with contracted partners including hospital payer and physician.