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Appalachian Regional Healthcare

Registered Nurse Tier 1(Union) OR

Company : Appalachian Regional Healthcare

Location : Harlan, KY, 40831

Job Type : Full Time / Part Time

Date Posted : 30 December 2025

Overview

The Registered Nurse requires substantial specialized knowledge, judgement and nursing skills based upon the principles of psychological, biological, physical, and social sciences in the application of the nursing process in the respective departments in which assigned. The RN must collaborate with physicians and multidisciplinary team members; provide physical and psychological support to patients, friends, and families; supervising assigned team members and students.

Responsibilities

  • Completes patient assessments, formulates plan of care, oversees implementation of plan of care, evaluate and adjust plan of care utilizing critical thinking skills
  • The performance of other nursing acts which are authorized or limited by the board, and which are consistent either with American Nursing’s Association Standards of Practice or with Standards of Practice established by nationally accepted organizations of registered nurses.
  • Care, counsel health teaching and promotion, utilizes Teach Back methodology as affirmation of comprehension
  • The administration of medication, intravenous therapy and treatment as prescribed by a LIP
  • Supervision, delegation and follow-through to other personnel in the performance of activities relating to nursing care.
  • Mentors and precepts students and orient new staff as assigned
  • Reports up chain of command Clinical Nurse Manager/Nurse Manager/House Nurse Coordinator pertinent information
  • Participates on various teams, committees or performance improvement initiatives
  • Ensures a safe and secure environment for patients, coworkers and self
  • Participates in Discharge Planning and Transition of Care (able to define pt needs)
  • Serves as a patient advocate and escalates patient related concerns timely
  • Timely documents pertinent findings in medical record
  • Assist patients in performing activities of daily living and functions as an active team member
  • Assumes responsibility for personnel professional development
  • Utilizes effective communication skills and active listening, exhibits compassionate and empathetic attitude
  • Practices Hands Off communication utilizing SBAR; Performs Bedside Shift reporting utilizing SBAR (unless contradicted)
  • Functions as a positive influence, role model and adheres to professional code of conduct
  • Respects dignity and confidentiality of all matters relating to patients
  • Refer to Special Addendum and Staff Nurse Position Description
  • Performs other job duties as assigned.

Qualifications

  • Associate's Degree Nursing Required
  • Bachelor's Degree Preferred
  • Up to 1 year Preferred
  • Assures all members of the surgical team have been instructed in the surgical procedures performed and periodically updates personnel on new techniques, instrumentation and procedures.
  • Prepares for each assigned case by ensuring the room is properly prepared and equipped, the required documentation is present on the medical record, and the patient is properly identified.
  • Prepares the patient for operative procedure by positioning and grounding the patient as required, securing the patient on the table, assisting with intubation, and preparing operative site. Accompanies the patient to recovery room and may be required to provide nursing care in the recovery room.
  • Monitors operative procedures by documenting proper patient positioning, breaks in sterile procedure, instrument, needle and sponge counts, preservation and labeling of all specimens, drugs and blood administration, and critical incidents during the operative procedure.
  • Functions as a team member within the surgical department by assisting with gowning and gloving; procuring required medication, blood and supplies; coordinating involvement of other departments with the procedure; properly processing operative specimens.
  • Maintains a safe and productive work environment by assisting with cleaning, maintenance, and re-supply.
  • Successful completion of a training program and demonstrated competence in circulating nurse duties as determined by the Director of Surgical Services.
  • The nurse shall be adequately oriented to unit policies, procedures and equipment. Orientation shall include safety procedures, infection control practices, and performance improvement activities.
  • Training for OR shall consist of completion of competencies in various areas or roles the nurse will function.
  • RN Required
  • Basic Life Support Certification Required
  • ACLS Required
  • PALS Required
  • De-Escalation Training within 6 months of hire Required

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Frequently asked questions

In Harlan, KY, employers highly value certifications like Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), and Pediatric Advanced Life Support (PALS) for Registered Nurse Tier 1 roles. These credentials demonstrate readiness for emergency care and align with Appalachian Regional Healthcare's standards.

Harlan, KY has a moderate demand for entry-level registered nurses, influenced by its smaller population and regional healthcare needs. While demand may not be as high as in metropolitan areas, Appalachian Regional Healthcare actively recruits to maintain quality staffing in rural settings.

A Registered Nurse Tier 1 at Appalachian Regional Healthcare handles patient assessments, medication administration, care planning, and close collaboration with multidisciplinary teams. The role also involves mentoring students, ensuring patient safety, and meticulous documentation in a fast-paced clinical environment.

The Tier 1 designation indicates foundational nursing responsibilities with a focus on direct patient care, supervision of support staff, and adherence to standardized protocols. Unlike advanced nursing roles, Tier 1 nurses concentrate on executing care plans and supporting multidisciplinary teams.

Appalachian Regional Healthcare encourages Registered Nurse Tier 1 employees to engage in continuous education, preceptorship, and participation in performance improvement teams. This approach fosters skill advancement while aligning with nursing best practices and evolving clinical standards.

Nurses in this setting often navigate limited resources and serve diverse patient needs typical of rural healthcare. The role requires adaptability, strong clinical judgment, and effective communication to ensure quality care amidst regional healthcare disparities.

Given Appalachian Regional Healthcare’s established presence, Tier 1 roles attract numerous applicants, blending local and regional talent. Competitive candidates often possess required certifications, clinical competence, and a demonstrated commitment to community health.

Registered Nurse Tier 1 salaries in Harlan, KY, typically range from $48,000 to $58,000 annually, reflecting local cost of living and market standards. Appalachian Regional Healthcare offers compensation packages that align with rural healthcare benchmarks and nursing experience.

Strong candidates combine an associate’s or bachelor’s degree in nursing, current RN licensure, and certifications like BLS, ACLS, and PALS. Experience with surgical or clinical nursing and skills in patient advocacy further distinguish applicants.

Yes, the healthcare system prioritizes competencies in intravenous therapy, medication administration, and critical thinking. Training in de-escalation techniques within six months of hire is also mandatory, underscoring a focus on patient safety and communication.

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