Duke University Hospital

Center for Advanced Practice

Pediatric Cardiac Stepdown Advanced Practice Provider (APP)

Nurse Practitioner or Physician Assistant

Job Location

Duke University Hospital

Job Summary

The Duke Hospital Pediatric 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.

Utilizing acquired knowledge of physiology, pathophysiology and pharmacology, the Pediatric Cardiac Stepdown APP exercises independent decision making in the assessment, diagnosis and development of the plan of care for patients on the Pediatric Cardiac stepdown service. In collaboration and consultation with the supervising physician, the APP contributes to excellence in patient care. As an advanced practice provider, the 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 the attending of service and/or 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 hospitalist supervising physician or back up physician who is either on site or available by pager.
• Collaborate with the chief resident, residents, fellows, attending other APP colleagues, nurses, and patient resource managers 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 until physician support arrives.
• 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 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, resident and/or intern at the end of the shift.

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.

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

Job Eligibility Requirements

Education

NP: Graduate of an accredited MSN or DNP Acute Care Pediatric Nurse Practitioner program.

PA: Graduate of an ARC accredited Physician Assistant program.

Licensure

NP: Current unrestricted RN licensure issued by or recognized by the NCBON with authorization to practice as an NP

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

Certification

NP: National certification as an NP (PNP-AC is the only certification accepted)

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 pediatric cardiac 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

12-hour shifts to provide day and night coverage 7 days a week including holidays. Rotating schedule, nocturnist (nights-only) schedule, and weekend-only schedule options available.