Job Location

Duke University Hospital Heart Center

Job Summary

The Duke University Hospital Cardiothoracic (CT) Surgery Step-Down Unit (SDU) Advanced Practice Provider (APP) provides direct patient care services for complex critically ill Cardiothoracic Surgery and Advanced Heart Failure patients in collaboration with and under the supervision of the cardiothoracic surgeon(s) and medical director of the CT SDU. The APP performs physical exams, collects and documents data, conducts diagnostic and therapeutic procedures, orders and schedules laboratory studies and professional consultations, prescribes appropriate interventions and medications, coordinates the care and discharge of patients, and provides direct patient care services.

Job Duties and Responsibilities

• Provide /coordinate clinical care for cardiothoracic stepdown surgery patients at Duke Hospital being followed primarily in the Cardiothoracic Step-down setting but also throughout Duke Hospital and clinic through established protocols and under the supervision of the cardiothoracic surgeon or back-up supervising physician who is either on site or available by pager (including the OR, PACU, Step-down units, all inpatient units, ER and clinic setting).
• In collaboration with attending cardiothoracic surgeon(s) round daily on patients to assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of cardiothoracic patient care;
• Collaborate with residents, fellows and attendings to formulate treatment plans and monitor patient progress;
• Assess patients for change in status and institute appropriate interventions. Initiates emergency interventions in an effort to stabilize the patient until physician support arrives.
• Preoperative evaluation; including (but not limited to) establishing diagnosis, and baseline status
• 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 so as 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 patient's chart 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 populations.
• 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 models competence in all nurse practitioner/physician assistant advanced skills.

Job Eligibility Requirements

Education:

PA: Graduate of an ARC-accredited Physician Assistant (PA) program. Master's degree or Doctoral required.

NP: Graduate of an accredited MSN or DNP Acute Care Nurse Practitioner (NP) program for adult care.

Certification:

PA: PA-C

NP: ACNP or AGACNP

Licensure:

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

NP: Current unrestricted RN license issued by or recognized by NCBON with authorization to practice as a NP.

Both: Federal and State DEA with unrestricted prescriptive authority

Experience:

PA: 1 year's experience as a PA in a relevant clinical area preferred.

NP: 1-year NP experience or 2+ years RN experience in a cardiovascular or cardiothoracic surgery unit is preferred

*Will consider a new graduate with prior CTICU/CVICU or CTSD RN experience

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

Primary hours fourteen (12) hour shifts/month, rotating shifts, 7 days per week including holidays.