Registered Practical Nurse - Attachment Team - Full Time (x3)

Hamilton Family Health Team; Hamilton; Hybrid; CAD 75,000 - 95,000; Full time

Benefits offered by this job

HOOPP pension

Extended health care (health, dental,视

Vision & critical illness insurance

12 paid stat holidays + 1 float day

Hybrid work schedule

Sustainable/green initiatives

Job summary

Hamilton Family Health Team seeks three full-time Registered Practical Nurses (RPNs) to join the Attachment Team. The role involves traveling between HFHT clinic sites to attach unattached and at-risk patients to primary care providers, with in-person, virtual, and phone-based interactions.

You will support onboarding, chart preparation, and care transitions while coordinating outreach with community partners. A background in primary care and EMR use is essential.

Qualifications

• Current registration in good standing with the College of Nurses of Ontario as an RPN.
• Minimum two years of clinical nursing experience in primary care, community health, or ambulatory care.
• Experience with electronic medical records (OSCAR Pro or PS Suite a asset).
• Ability to work independently within the RPN scope of practice and provide trauma-informed care.

Responsibilities

• Conduct proactive outreach to unattached patients and those at risk of losing primary care access via phone, virtual platforms, or in-person visits.
• Engage with patients in a trauma-informed, culturally responsive manner to support connection to primary care.
• Facilitate warm handoffs between patients, community partners, and care providers to support attachment at point of care.
• Identify and address barriers to attachment, including social determinants of health, and connect patients to resources.
• Maintain accurate EMR documentation and complete onboarding/review of patient charts.

Skills

Clinical assessment

EMR experience

Outreach coordination

Independent work

Patient communication

Education

Diploma in Nursing (RPN)

Tools

OSCAR Pro

PS Suite

Job description

Together, we do amazing things every day.

Imagine a supportive employer, a career that fits your lifestyle, and many learning opportunities. With the Hamilton Family Health Team, you can have all of that, and more. We work hard to create an innovative and diverse workplace that values the contributions of our employees. No matter what your role, working with us is about making a difference – every day!

The Registered Practical Nurse (RPN), Patient Attachment, is a mobile member of HFHT’s Attachment Team, working across all clinic sites to support the attachment of unattached and at-risk patients to primary care providers. This role is central to HFHT’s patient attachment strategy, functioning at the point of care to coordinate outreach, complete clinical onboarding, and facilitate warm connections between patients and their care teams.

The RPN is expected to travel between HFHT clinic sites on a regular basis and may work from various clinical and community settings. Work may include in-person, virtual, and telephone-based interactions. This position is a full-time role and will involve interactions with patients who may be experiencing social vulnerabilities. We are currently looking to hire 3 full time RPNs for HFHT’s Attachment Team.

Roles and Responsibilities:

Patient Outreach and Engagement

• Conduct proactive outreach to unattached patients and those at risk of losing primary care access, via telephone, virtual platforms, or in-person visits.


• Engage with patients in a trauma-informed, culturally responsive manner to support their connection to primary care.


• Facilitate warm handoffs between patients, community partners, and care providers to support seamless attachment at the point of care.


• Identify and address barriers to attachment, including social determinants of health, and connect patients to appropriate resources.

Clinical Onboarding and Chart Preparation

• Initiate patient charts in the electronic medical record (EMR) upon attachment and complete initial patient profiles.


• Gather and document patient medical history, family history, social history, and current medications.


• Review and update immunization records


• Complete screening tools and preventive care checklists as part of the patient onboarding process.


• Prepare clinical summaries to support provider readiness for first patient visits.


• Conduct in-person, virtual, and telephone visits with patients as part of the attachment and onboarding process.


• Perform nursing assessments within the RPN scope of practice, including vital signs, health history collection, and identification of urgent care needs.


• Refer patients to appropriate providers or services when clinical concerns are identified during onboarding interactions.

Community and Partner Engagement

• Build and maintain working relationships with community partners, social service agencies, and health system navigators to enable patient attachment.


• Represent HFHT at community outreach events and community partner tables as needed.


• Support point-of-care attachment initiatives in partnership with community-based organizations, including within priority equity communities.


• Participate in care transitions and handoff processes for patients connecting from community settings to HFHT care.

Documentation and Quality

• Maintain accurate, timely, and complete documentation in the EMR consistent with HFHT standards and professional obligations.


• Contribute to data collection and tracking related to patient attachment outcomes and outreach activity.


• Participate in quality improvement initiatives related to attachment, access, and patient experience.


• Adhere to all HFHT policies, clinical protocols, and privacy legislation including PHIPA.

Teamwork and Collaboration

• Work as an integrated member of the multi-site Attachment Team and broader interprofessional care teams.


• Communicate effectively with clinic staff across sites to coordinate scheduling, patient flow, and handoffs.


• Participate in team meetings, conferences, and practice development activities.


• Support onboarding and knowledge sharing with new team members as required.

Qualifications and Skills:

• Current registration in good standing with the College of Nurses of Ontario (CNO) as a Registered Practical Nurse.


• Minimum two (2) years of clinical nursing experience, preferably in primary care, community health, or a similar ambulatory care setting.


• Demonstrated experience with electronic medical records (experience with OSCAR Pro or PS Suites an asset).


• Strong clinical assessment skills and the ability to work independently within the RPN scope of practice.


• Experience in outreach, case coordination, or community health roles (preferred)


• Experience working with unattached or marginalized patient populations, including those facing complex social circumstances (preferred)

Why join the HFHT?

Competitive Employee Value Proposition including, but not limited to:

• Healthcare of Ontario Pension (HOOPP)


• Extended health care benefits including health, dental, vision & critical Illness insurance


• Meaningful, purpose-based work


• 12 paid Stat holidays and one (1) extra float day


• Hybrid work schedule


• Ongoing green initiatives

Summary

Classification: Non-Union

Primary Location: Hamilton

Employee Class: Full-Time 1.0 FTE (40 hours/week)

Schedule: Monday-Friday

Start Date: ASAP

Application Instructions:

Note:

If successful in receiving a job offer with the Hamilton Family Health Team, new hires may be required to provide proof of full COVID-19 vaccination prior to start date as a condition of their employment. If successful candidates are unable to get their COVID-19 vaccination as a result of a medical exemption, they may be required to submit supporting documentation to establish that they are exempt from this requirement.

The HFHT is committed to building a respectful, caring, equitable, and inclusive workplace where staff reflect the diversity of the communities that we serve. As such, we welcome applications from all qualified individuals including all equity-deserving groups. In addition, we are committed to accessibility and creating a barrier free hiring process in accordance with the Ontario Human Rights Code, and the AODA (Accessibility for Ontarians with Disabilities Act, 2005). Accommodation is available upon request at any point in the selection process by notifying the recruitment staff.