Nurse Practitioner - Behavioural Support Outreach Team

Posted Date 2 weeks ago(2/19/2021 8:56 AM)
Job ID
Job Location
# Positions
Job Type
Job Industry
Government and Public Sector, Healthcare and Medical Services
Toronto Central LHIN
Career Level
Years of Experience

Job Description

Interested Applicants, please apply by March 5, 2021 before 11:59pm


JOB TITLE: Nurse Practitioner, Behavioural Support

START DATE: March 2021

DURATION: Full Time, Permanent  

REPORTS TO:  Manager of Client Services, Professional Practice

DEPARTMENT: Home and Community Care




Reporting to the Manager, Clinical Practice, this position promotes excellence in behavioural support for clients with responsive behaviours related to dementia, mental health, substance use and/or other neurological disorders. As a Nurse Practitioner, you will use your advanced practice nursing skills to triage referral urgency and priority for clients at risk of adverse outcomes related to responsive behaviours. You will work collaboratively with Care Coordinators, Primary Care, Geriatric Psychiatry and Geriatric Medicine, interdisciplinary teams and community partners to achieve an integrated care plan for Toronto Central LHIN clients identified with responsive behaviours living in the community. You will complete comprehensive geriatric assessments with a focus on behavioural challenges (including the completion of a medication reconciliation) for clients transitioning from TC LHIN Emergency Departments (ED), acute care and/or living in the community and who may require Long Term Care (LTC) placement. The Nurse Practitioner will work with an inter-professional team, to provide primary care services for seniors that are complex, frail and marginalized with medical, functional, psychosocial and mental health issues. Working as a member of the Behaviour Support Outreach Team (BSOT), the NP will work to full scope of practice including diagnosing and prescribing where indicated.




Nurse Practitioner                                                                                                             $48.53 to $59.11 per hour




  • Performs clinical tele-triage role for all clients referred to the BSOT team who are at risk of an ED admission and/or adverse outcomes related to responsive behaviours secondary to dementia, mental health, substance use and/or other neurological disorders
  • Assesses urgency of referral based on objective evaluation of client/caregiver risk factors and takes appropriate action
  • Recognizes and promptly addresses adverse events (including medication issues) or any issue affecting safety or quality of care
  • Uses standardized assessment tools, standards of practice and guidelines related to the care of older adults with psychogeriatric conditions
  • Initiates timely and appropriate consultation, referrals and collaboration with other healthcare providers as indicated
  • Provides a comprehensive in-home assessment where indicated, with a focus on utilizing a bio-psychosocial framework to identify factors contributing to responsive behaviors
  • Completes a medication reconciliation as part of an in-home assessment; identifies discrepancies and resolves these where possible
  • Collaborates with primary care physicians for clients that are homebound and unable to access primary care services
  • Collaborates with client’s care coordinator, care partners, and the client’s circle of care to co-create an individualized behavior management care plan/safety plan as indicated
  • Collaborates with BSOT clinicians and other community providers to provide behavioural support expertise, coaching and capacity-building through partnerships
  • Works closely with hospitals, crisis teams and other community teams to develop an integrated care pathway for clients with responsive behaviours
  • Identifies gaps in available clinical services; advocates for the addition of or access to services that will improve the client’s care or support for the caregiver(s)
  • Advocates to meet client needs while ensuring the protection of client rights
  • Acts as a clinical resource by providing knowledge and teaching to interdisciplinary team members as well as to clients and families
  • Participates as a leader in change management initiatives; acts as a champion for continuous improvement and participates in the development of policies, procedures, systems and tools to improve service delivery
  • Participates in researching, integrating and promoting leading client service delivery models and best practices in order to achieve established objectives and targets
  • Participates in data collection and reporting on a number of accountability measures





  • Masters Degree in Nursing with registration in good standing, with the College of Nurses of Ontario
  • Certificate of Registration in the Extended Class from the College of Nurses of Ontario, and eligible to practice as a RN-EC in primary care


  • Minimum of 3 years of recent experience in geriatrics/geriatric psychiatry in settings such as Memory Clinics, specialized Behaviour Support Units in LTC and/or the ED
  • Expertise and knowledge of working with individuals presenting with behaviours related to dementia, delirium, depression, and neurological and other mental health disorders.
  • Competence in the use of standardized assessment tools used in geriatric nursing and geriatric mental health practice
  • Experience working collaboratively with primary care and specialists in the care of older adults with responsive behaviours
  • Familiarity with the  interRAI HC and knowledge of behavioural, cognitive, psychosocial, and environmental assessments relating to responsive behaviours is an asset
  • Excellent clinical-reasoning, critical-thinking and problem-solving skills
  • Formalized training in or knowledge of Gentle Persuasive Approach (GPA), P.I.E.C.E.S., U-First!, Montessori Approach is an asset
  • Effective assessment, intervention, and collaborative care planning skills
  • Experience providing caregiver education, support and counselling related to caring for a person with responsive behaviours
  • Community health experience is preferred
  • Experience with program development, evaluation and quality improvement initiatives, an asset
  • Cultural competency working with clients of diverse ethno-cultural backgrounds
  • A valid CPR/Basic Cardiac Life Support certificate is required
  • A valid driver’s license and availability of a car
  • Excellent written, interpersonal and communication skills with strong organizational, time-management and problem-solving capabilities
  • Basic functional computer and information technology skil


Toronto Central LHIN is committed to creating a diverse, inclusive workforce that reflects the communities we serve, to ensuring our services and communications are accessible to all individuals, and to embedding equity into our employment practices.


In accordance with the Accessibility for Ontarians with Disabilities Act and the Ontario Human Rights Code, Ontario Health will provide accommodations throughout the recruitment, selection and/or assessment process. If selected to participate in this process, please inform Human Resources of the nature of any accommodations that you may require in respect of any materials or processes used to ensure your equal participation.


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