Nurse Practitioner or Physician Assistant - Pediatric Critical Care Cardiac Stepdown

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About Duke University Hospital

Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States and is the number one hospital in North Carolina, according to U.S. News and World Report for 2023-2024. Duke University Hospital is the largest of Duke Health's three hospitals and features 1048 patient beds, 65 operating rooms, as well as comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.

Job Location

Duke University Hospital

Job Summary

The Duke Hospital Pediatric Critical Care Medicine Cardiac Stepdown Advanced Practice Provider (APP), including both Nurse Practitioner (NP) and/or Physician Assistant (PA), provides direct patient care services for critically ill pediatric patients aged 0-21 with acute, complex, and chronic illness across a variety of care settings. It is appropriate for the NP to provide care for an aging pediatric patient beyond the age of 21 with a pediatric condition for a limited period of time.  Pediatric Cardiac Stepdown APPs will be a part of the Pediatric Critical Care Medicine team and will care for patients on the stepdown unit.

Utilizing acquired knowledge of physiology, pathophysiology and pharmacology, the PCCM APP exercises independent decision making in the assessment, diagnosis and development of the plan of care for patients on the PCCM service. In collaboration and consultation with the supervising physician, the PCCM APP contributes to excellence in patient care.  As an advanced practice provider, the PCCM APP is additionally involved in education, consultation, research and leadership throughout the Duke Health System, organization and profession.

Job Duties and Responsibilities

Clinical Expert

• In collaboration with attending(s) and/or fellow/residents, round daily on patients to assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of patient care.
• Provide and coordinate clinical care for service specific patients through established protocols and under the supervising physician or back up physician who is either on site or available by pager.
• Collaborate with the residents, fellows, attending, other APP colleagues, nurses, and other staff to formulate treatment plans and monitor patient progress.
• Perform procedures specific to the work environment after demonstrated competency and within the guidelines of scope of practice and credentialing protocols.
• Assess patients for change in status and institute appropriate interventions. Initiate emergency interventions in an effort to stabilize the patient
• Postoperative stabilization and management.
• Develop patient care pathways, protocols and guidelines for the management of specific problems in conjunction with physicians and other members of the health care team.
• Analyze clinical practice patterns to provide the best medical care and to increase effectiveness and efficiency.
• Communicate verbally and in writing all pertinent patient information to supervising MD, nursing staff, patient resource manager, home health agency, and other relevant healthcare providers.
• Document in the patients’ medical record all relevant data including but not limited to results of diagnostic tests; laboratory results; patients’ condition and response to therapies/interventions; communications with supervising MD.
• Utilize prescriptive privileges only for identified patient population.
• Prescriptive authority for prescribing, ordering, and or administering drugs; including (but not limited to) schedule II, III, IV, and V drugs and necessary medical devices.
• Role model competence in all nurse practitioner / physician assistant advanced skills.
• Give daily handoff to appropriate attending, APP, fellow, resident and/or intern at the end of the shift.
• Provide evidence base clinical care to pediatric patients cared for by the division of PCCM
• Gather pertinent information systematically and skillfully from all sources:  History, diagnostic tests, comprehensive physical exams, behavioral and developmental assessments.
• Bill appropriately for all APP services.

Educator:

• Assess educational needs of the patient-care staff and provide one-on-one as well as formal education as needed.
• Assess educational needs of the patients / families and provide culturally-sensitive patient/family education interventions as indicated.  Use non-technical language when educating patients and families.  Document all education in patients’ medical record.
• Implement and evaluate appropriate educational programs for DUHS patient care staff and other healthcare providers as appropriate.
• Role model and precept healthcare learners through contractual agreements.

Research Utilization and Investigation:

• Utilize current research and evidence-based decision-making in all clinical practice.
• Incorporate clinical research findings in the development and implementation of standards of care.
• Support IRB approved clinical research/trials though a variety of activities including but not limited to: obtaining consent; ordering diagnostic tests; recording laboratory & diagnostic results; administering therapeutic interventions; and reporting patient outcomes including toxicities or adverse events.
• Participate in interdisciplinary quality improvement and/or research activities.
• Participate in measuring and documenting outcomes.
• Identify potential areas for research

Consultant:

• Provide expertise and resource information to other healthcare providers, patients and families, and the community at large related to pediatric diseases, procedures, interventions, and conditions.
• Implement and evaluate appropriate educational programs for referring MDs
• Develop, implement and evaluate standards of care/practice guidelines/policies and procedures/care maps/protocols within area of specialization.
• Develop programs and projects in areas of expertise to facilitate the attainment of the goals and objectives of the Duke University Hospital and Duke University Health System.

Professional Leadership and Development:

• Role model advanced practice professionalism through conduct, communication, dress, leadership, ethical decision-making, critical thinking and problem solving skills.
• Participate in at least one professional organization.
• Demonstrate responsibility for professional practice through active participation in the CAP, and professional organizations.  Meet Continuing Education requirements as designated by the NC Medical Board and/or NC Nursing Board.  Maintain professional certification.
• Enhance the body of knowledge in area of specialization through written publications, oral presentations, posters, continuing education, etc.
• Maintain all professional requirements for licensure and certification
• Attend educational conferences such as Heart Center Surgical conference, cardiology lectures, and neurodevelopmental rounds
• When caring for adults with congenital heart disease, plan for situations beyond expertise, consult with and refer to other health care providers as appropriate. 

Job Eligibility Requirements

Education:

NP:        Graduate of MSN or DNP Pediatric Acute Care Nurse Practitioner Program.

PA:        Graduate of Master’s or Doctoral Degree ARC accredited Physician Assistant program.

Licensure:  

NP:        Current unrestricted RN license issued by or recognized by the NCBON with approval to practice as an NP.

PA:        Current unrestricted medical license issued by NCMB with approval to practice as a PA.

Certification: 

NP:        PNP-AC is required

PA:        PA-C

Experience:

Prior experience as a Nurse Practitioner/Physician Assistant in a pediatric acute care clinical setting strongly preferred with preference for a cardiac-specific background. Registered Nurses with at least 2 years of ICU nursing experience preferred.  

Physical and mental requirements

• Able to clearly articulate scope of practice, and practices within those guidelines as a Nurse Practitioner / Physician Assistant in the state of North Carolina and within the Duke University Health System. 
• Able to independently seek out resources and work collaboratively to solve complex problems
• Able to communicate clearly with patients, families, visitors, healthcare team, physicians, administrators, leadership, and others.
• Able to use sensory and cognitive functions to process and prioritize information, perform health assessments, treatment, and follow-up.
• Able to use fine motor skills
• Able to record activities, document assessments & interventions; prepare reports and presentations
• Able to use computer and learn new software programs
• Able to provide leadership in clinical area of expertise and in meeting organizational goals
• Able to navigate the Hospital and DUHS to provide clinical expertise to specific patient populations
• Able to withstand prolonged standing and walking with the ability to move or lift at least fifty pounds
• Able to remain focused and organized
• Able to work collaboratively with all levels of personnel

Job Hours

Rotating 12-hour shifts to provide day and night coverage 7 days a week including holidays. Schedule may be modified by the clinical or leadership team.

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.