Summary

The Cardiothoracic Surgery team at the VA St. Louis Healthcare System seeks an experienced Nurse Practitioner with full practice authority to provide outpatient, inpatient, operative, and ICU care. This position requires knowledge in ordering and titrating cardiac medications, first assist, hemodynamic surveillance, chest tube management, VAD implantation support, transplant evaluation, and participation in the on-call rotation.

Duties

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The Cardiothoracic Surgery Nurse Practitioner (CTSNP) is a licensed independent practitioner with advanced education and national certification who provides evidence based care for a population of patients education and national certification who provides evidence-based care for a population of patients. CTSNP provides comprehensive care to patients with undergoing heart and lung surgery, providing care from pre-operative consultation through post-operative management and recovery. The role includes both clinical and surgical assistance such as diagnosing conditions, performing procedures, assisting in the operating room and managing patients in intensive care unit.

Major Duties Included, but are not limited to:

• Advance assessment and diagnosis - conducting thorough patient evaluations, interpreting complex clinical data and making diagnoses for critically ill patients.
• Therapeutic interventions: initiating and managing complex treatments like ventilator management, hemodynamic monitoring, vasopressor administration, and advance life support measure
• Medication management: Prescribing and adjusting medication based on critical care needs, including high-risk medication and infusions.
• Diagnostic test ordering and interpretation: Ordering and interpreting advanced diagnostic tests like arterial blood gases, central venous pressure monitoring, intracranial pressure monitoring, and advance imaging studies.
• Collaboration with other healthcare professionals: Consulting with specialist like pulmonologist, cardiologist, surgeons, anesthesia, neurologists, nephrologists to optimize patient care.
• Patient and family education: Providing comprehensive information and support to critically ill patients and their families regarding complex medical conditions and treatment options.
• Complex procedures: Performs procedures Independently, within scope of practice.

Nurse Practitioners are clinicians with advanced training who provide primary, acute, and specialty health care services and delivers care under a set of privileges, based upon education, training, and certification.

VA offers a comprehensive total rewards package: VA Nurse Total Rewards

Pay: Competitive salary, regular salary increases, potential for performance awards

Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year)

Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA

Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement)

Licensure: 1 full and unrestricted license from any US State or territory

Work Schedule: Monday through Friday, rotation may vary

Telework: Not available

Virtual: This is not a virtual position.

Relocation/Recruitment Incentives: Not authorized

Permanent Change of Station (PCS): Not authorized.

Requirements

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Conditions of employment

• U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
• All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
• English Language Proficiency. In accordance with 38 U.S.C. 7402(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English.
• Selective Service Registration is required for males born after 12/31/1959.
• Subject to background/security investigation.
• Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
• Must pass pre-employment physical evaluation/examination.
• Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
• You may be required to serve a probationary period.
• Complete all application requirements detailed in the "Required Documents" section of this announcement.

Qualifications

Advanced Practice Nurse (Nurse Practitioner) Basic Requirements

• Education: A post-master's certificate or master's or doctoral degree as a Nurse Practitioner. (Applicants pending the completion of educational requirements may be referred and tentatively selected but may not be hired until the education requirements are met.) Must be a graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant:
  
  • The Accreditation Commission for Education in Nursing (ACEN) OR
  • The Commission on Collegiate Nursing Education (CCNE). OR
  • NOTE: Foreign Education. Graduates of foreign schools of professional nursing programs, the nurse practitioner degree equivalency must be validated through an Agency recognized degree equivalency evaluation agency, such as the International Consultants of Delaware (ICD). Candidates with equivalent nurse practitioner masters or doctorate level degrees who possess current, full, active, and unrestricted registration and certification will meet the requirement of graduation from an approved school of professional nursing to warrant appointment.
• License - All APN (NPs) must possess and maintain an active, current, full, and unrestricted APN license to practice as an NP in a State, Territory or Commonwealth of the United States, or in the District of Columbia.
• Basic Board Certification - All APN (NPs) must maintain full and current basic board certification in one of the following: Acute Care Nurse Practitioner (ACNP) or Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) from one of the following: the American Nurses Credentialing Center (ANCC), American Academy of Nurse Practitioners Certification Board (AANPCB), or other nationally recognized certifying body in the area in which the Nurse Practitioner is academically prepared.

NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and an APN (NP) assignment that are also performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification.

The following Scope, Education and Experience, and Dimension criteria must be met to qualify for Advanced Practice Nurse (Nurse Practitioner) II:

Exception to Licensure for Graduate Nurse Technicians. Candidates who otherwise meet the basic requirements, but do not possess the required licensure and/or certification, may be appointed at the entry step of the Nurse II, as a Graduate Nurse Technician - Nurse Practitioner on a temporary appointment up to any period not-to-exceed one year and a day under the authority of 38 U.S.C. a7 405(c)(2)(B).

• Scope: Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others
• Education and Experience Requirement: Meets basic education requirement for APN (NP). Nurse II is considered the entry grade level for APN (NPs); no experience is required.
• Dimension Requirement: APNs (NPs) at level II are expected to meet the following dimension requirements:
  
  • Clinical Practice. Delivers evidence-based health care, demonstrating proficiency in the ability to manage a patient panel, population, or program.
  • Outcome Focus. Utilizes research and evidence-based practice to evaluate the patient care delivery system within a patient panel or program, presents findings and contributes to changes that enhance the quality and timeliness of veteran/patient care.
  • Leadership. Works effectively as a leader within a team/unit/group and seeks interdisciplinary collaboration as appropriate to enhance patient care.
  • Professional Development. Acquires knowledge and skills to develop expertise in area of practice.
  • Professionalism/Collegiality. Demonstrates effective communication skills and professional behavior, promoting cooperation and teamwork. Participates in interdisciplinary teams and processes that positively impact patient outcomes.

The following Scope, Education and Experience, and Dimension criteria must be met to qualify for Advanced Practice Nurse (Nurse Practitioner) III:

• Scope: Executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex client care.
• Education and Experience Requirement: Meets basic education requirement for an APN (NP) AND one year of specialized APN (NP) experience equivalent to the Nurse II grade level.
• Dimension Requirement: APN (Nurse Practitioners) at grade III are expected to meet the following dimension requirements:
  
  • Clinical Practice. Influences and models the delivery of evidence- based health care, demonstrating expertise in the ability to manage a patient panel, population, or program.
  • Outcome Focus. Leads and implements changes that enhance the quality and timeliness of Veteran/patient care applying research and evidence in the delivery of healthcare for patient populations.
  • Leadership. Initiates and leads interdisciplinary teams informed by structured approaches and processes to improve outcomes that positively impact care for a patient panel, population, or program.
  • Professional Development. Acquires knowledge and skills, then disseminates acquired information within and/or outside the medical facility.
  • Professionalism/Collegiality. Initiates and leads interdisciplinary teams developing systems that positively impact outcomes at the panel, population, or program level. Demonstrates effective communication skills and professional behavior, promoting cooperation and teamwork

Physical Requirements: This is a direct patient care position and may require long hours of standing, walking, stooping, bending, lifting and positioning patients for examinations. There may also be extended periods of time sitting at a computer entering patient data.

Preferred Experience:

• Provides comprehensive preoperative care by obtaining medical histories, performing focused and comprehensive physical examinations, and ordering and interpreting diagnostic tests (e.g., ECGs, laboratory studies, and imaging) to optimize patients for cardiothoracic surgery.
• Functions as an intraoperative first assist, including surgical exposure, tissue handling, suturing, hemostasis, and closure; performs conduit harvesting during CABG; participates in chest closure, cannulation, valve placement, decannulation, and chest tube placement within granted privileges.
• Provides comprehensive postoperative care, including entering and managing orders, participating in ICU/PACU transfers, conducting postoperative rounds, performing wound care and pacing wire removal, and coordinating discharge planning.
• Manages immediate ICU care for post-cardiac surgery patients, including oversight of intubated and ventilated patients, ventilator weaning, and interpretation of arterial blood gases.
• Monitors and manages chest tubes and hemodynamics, including surveillance and documentation of chest tube output, early recognition of complications such as hemorrhage, tamponade, or low cardiac output, and adjustment of therapy.
• Minimum of two (2) years of recent cardiothoracic perioperative experience (operating room and ICU), demonstrating independent titration of cardiac medications, ventilator weaning, chest tube and hemodynamic surveillance, and rapid recognition of life-threatening complications.
• Demonstrated prescriptive authority consistent with APRN scope and institutional privileging, using a formulary that includes inotropes, antiarrhythmics, anticoagulants, diuretics, and analgesics/controlled substances, consistent with VA APRN practice authority and local privileging.

Additional information

Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

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This job opportunity announcement may be used to fill additional vacancies.

This position is in the Excepted Service and does not confer competitive status.

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