Michelle Russell
Stoney Creek,Ontario
Overview
23
23
years of professional experience
Work History
Integrated Care Coordinator
Niagara Health System
05.2022 - Current
- Provided patient-centered system navigation, intensive case management, and coordination of services for clients with COPD/CHF across hospital and community settings.
- Identified and facilitated timely access to appropriate services by assessing client needs and collaborating with an inter-professional team, families, informal supports, and formal service providers.
- Acted as a key resource and liaison for ICC Home Care staff, hospital staff, and external community support service providers regarding the ICC program and patient care plans.
- Coordinated seamless care transitions between hospital and community, ensuring continuity of care through direct follow-up and ongoing case management.
- Promoted client self-management by sharing knowledge about health conditions, services, and resources to improve quality of care.
- Leveraged cutting-edge technology to support smooth transitions from hospital to community settings and to enable ongoing community management.
- Ensured cost-effective client care by efficiently utilizing available resources and collecting data to evaluate outcomes of integrated care delivery.
- Reported to the Director of Clinical Programs, maintaining accountability for delivering high-quality, coordinated, and patient-centered care.
Registered Nurse, Charge Nurse, Team Lead
St Joseph's Homecare Hamilton Integrated Comprehensive Care Program (ICC)
01.2012 - Current
- Contributed to the successful transition of the ICC project into a permanent program.
- Work with identified clients from various streams, thoracic, esophageal, head and neck, general surgery, peritoneal dialysis, total joint replacement/revisions, COPD/CHF to provide home based care focusing on their care needs.
- Helping clients, at home, navigate through their post-surgical or post-hospital recovery, manage appointments, coordinate care with the hospital and team, including family doctors and specialists to ensure client's needs are met.
- Collaborated in creating and evaluating care paths for chronic patients, thoracic, and joint conditions.
- Lead and mentor a team of staff which included monitoring scheduling and staffing, working with clerical to assign clients to staff, resource coach for nurses and PSWs, attending weekly team meetings, orientation of new staff, and education for staff.
- Helped develop, implement and work the Charge Nurse role within the Hamilton team. Took on the role as Charge Nurse for 3 months when the pilot project rolled out in Kitchener hospital.
- Development and maintenance of electronic charting documents used in the project.
- Skills used but not limited to: daily case management, planning client care, cardio respiratory assessments, PD set up and disconnects, suture and staple removal, chest tube care, pleural catheter drainage and care, PICC and PIV maintenance, pain management, simple and complex wound care, including VAC therapy and health teaching.
Visiting Nurse/Clinical Resource Coach
St. Joseph’s Homecare Hamilton
01.2009 - 01.2012
- Supervising over 60 nurses with clinical skills and education with another coach.
- Facilitated monthly education sessions to enhance RN and RPN competencies.
- Providing orientation to all new nurses within the home care role.
- Integrated updates from CCAC meetings into the visiting program.
- Developed pamphlets for clients and staff for IV care and IV pump use.
- Managed on-call responsibilities for clients and nurses, initially weekly for two years, then every third weekend for one year.
- Provided care to clients in their homes as per medical direction. Skills included but not limited to: IV, Mid line and central line care, IV medications, palliative care and pain management, ostomy care, wound care, cardio respiratory assessments, G-tubes.
Case Manager- Geriatric Day Hospital Program
St. Joseph’s Healthcare Hamilton
01.2003 - 01.2009
- Worked closed with a multidisciplinary team to provide outpatient rehabilitation to seniors.
- Coordinated client care by assessing, planning, implementing, and evaluating health concerns.
- Provided targeted training on effective management of medications, pain, diabetes, and blood pressure to support client care.
- Coordinated with client's family doctor, caregivers, and community resources to maintain care continuity.
- Utilized home visits to asses' clients and provide feedback on managing medications at home and safety in the home.
- Ability to administer the Standardized Mini Mental, Geriatric Depression Scale, Montreal Cognitive Assessment, ABC's and Trail B.
- Preceptor to 3rd year nursing students.
- Infection Control Group Member.
- Creation of information sheet to assist in increasing referrals.
- Organized and attended CCAC Resource Fair, McMaster Gerontology Program Fair to provide information on the Day Program Hospital.
Education
Registered Nurse - undefined
Sheridan College
Mississauga, Ontario01.1995
Skills
- Case management and program development
- Able to handle and multitude of tasks at once
- Strong communication and interpersonal skills
- Honest, motivated, reliable, detailed oriented and productive
- Flexibility to adapt and overcome difficult situations
- Proficient in Procura, Microsoft Outlook and Microsoft Word
Languages
English
Professional Working
Affiliations
- College of Nurses Ontario (CNO)
- Ontario Nurses Association (ONA)
Timeline
Integrated Care Coordinator
Niagara Health System
05.2022 - Current
Registered Nurse, Charge Nurse, Team Lead
St Joseph's Homecare Hamilton Integrated Comprehensive Care Program (ICC)
01.2012 - Current
Visiting Nurse/Clinical Resource Coach
St. Joseph’s Homecare Hamilton
01.2009 - 01.2012
Case Manager- Geriatric Day Hospital Program
St. Joseph’s Healthcare Hamilton
01.2003 - 01.2009
Registered Nurse - undefined
Sheridan College
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