Registered Nurse Tier 1 (Union)
Company : Appalachian Regional Healthcare
Location : Middlesboro, KY, 40965
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
- Bachelor's Degree Preferred
- Associate's Degree Required
- Mastery of problem solving and decision making skills.
- Mastery of collaboration and teamwork.
- Mastery of growth mindset (agility and developing yourself and others) skills.
- Mastery of execution and delivery (planning, delivering, and supporting) skills.
- Ability to consider the relative costs and benefits of potential actions to choose the most appropriate one.
- Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.
- Mastery knowledge of phases of care transitions and resources available for patients.
- Mastery of digital literacy skills.
- Registered Nurse. Required
- BLS upon hire Required
- De-Escalation Training within 6 months of hire Required
- Advanced Dysrhythmia/EKG (Med/Surg telemetry unit ONLY) Required
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Frequently asked questions
Registered Nurse Tier 1 professionals in Middlesboro engage with a diverse patient population, requiring quick, evidence-based decisions. The role demands balancing patient care with collaboration among physicians and teams, reflecting local healthcare needs and cultural nuances unique to Appalachian Regional Healthcare's service area.
In this region, beyond the foundational RN license and BLS, de-escalation training and advanced dysrhythmia/EKG certifications are highly valued. These credentials enhance clinical readiness for the med/surg telemetry units prevalent in Appalachian Regional Healthcare facilities.
This position emphasizes mastery in clinical problem-solving, teamwork, and patient advocacy. Tier 1 RNs are expected to supervise and mentor, combining hands-on care with leadership in care planning and execution, setting them apart from entry-level or assistant roles.
Appalachian Regional Healthcare offers structured mentorship and continuing education programs allowing Tier 1 nurses to advance through specialized certifications or leadership tracks, fostering career development within the rural healthcare system.
The company integrates evidence-based practices within its nursing protocols, emphasizing interdisciplinary collaboration and patient-centered care. Registered Nurse Tier 1 roles here involve active participation in committees and quality improvement, aligning with Appalachian Regional Healthcare's commitment to excellence.
Yes, Appalachian Regional Healthcare provides strong mentorship networks and hands-on orientation for new Tier 1 RNs, fostering professional development and ensuring smooth integration into their multidisciplinary teams.
The average Registered Nurse Tier 1 in Middlesboro earns between $58,000 and $68,000 annually. This reflects the local cost of living and the regional demand for skilled nursing professionals within Appalachian healthcare facilities.
Middlesboro and surrounding areas have a steady demand for registered nurses, spurred by an aging population and rural healthcare needs. This translates to relatively stable job opportunities with Appalachian Regional Healthcare and similar employers.
Nurses here often navigate limited resources and must adapt to a broad scope of patient needs, including cultural sensitivities specific to Appalachian communities. Strong communication and resourcefulness are essential skills in this setting.
Unlike general entry-level nursing roles, a Tier 1 Registered Nurse carries supervisory duties, mentors students, and participates actively in care planning and clinical committees, reflecting a blend of hands-on and leadership responsibilities.