Duke University Hospital is consistently rated as one of the best in the United States and is known around the world for its outstanding care and groundbreaking research. Duke University Hospital has 957 inpatient beds and offers comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center; a major surgery suite containing 51 operating rooms; an endo-surgery center; an Ambulatory Surgery Center with nine operating rooms and an extensive diagnostic and interventional radiology area. In fiscal year 2018, Duke University Hospital admitted 42,916 patients and had 1,085,740 outpatient visits in fiscal year 2017.

U.S News & World Report named Duke University Hospital #1 in North Carolina and #1 in the Raleigh-Durham area in 2018-19.

Duke University Hospital is ranked in the top 20 nationally for seven adult specialties, including cardiology and heart surgery, nephrology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology.

In addition to its hospitals, Duke Health has an extensive, geographically dispersed network of outpatient facilities that include primary care offices, urgent care centers, multi-specialty clinics and outpatient surgery centers.

Duke Nursing Highlights:

• Duke University Health System is designated as a Magnet® organization
• Nurses from each hospital are consistently recognizedeach year as North Carolina’s Great 100 Nurses.
• Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy for being strong advocates of specialty nursing certification.
• Duke University Health System has 6000 + registered nurses
• Quality of Life: Living in the Triangle!
• Relocation Assistance!

Duke University Health SystemDepartment of Center for Advance Practice

Job Description Neonatal Nurse Practitioner

Position SummaryThe Neonatal Nurse Practitioner/ Critical Care Pediatric Nurse Practitioner (NNP) provides direct patient care services and performs medical acts as a Nurse Practitioner under the supervision of the supervisory physician to infant’s birth through 2 years of age in patient care units Duke Hospital ICN/Intermediate Care Nurseries and the Special Care Nurseries in the Duke University Health System. The NNP 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, and provides direct patient care services. The NNP contributes to excellence in patient care, research, teaching, and provides leadership in the organization.

Position Requirements

1. Completion of either an accredited Neonatal Nurse Practitioner Program
2. Master’s degree in nursing
3. Minimum 3 years as Registered Nurse in neonatology
4. Current licensure as a Registered Nurse in North Carolina
5. National Certification as a Neonatal Nurse Practitioner required
6. Current DEA License
7. Current CSR account
8. Current BLS, NRP, PALS certification mandatory
9. Current Moderate Sedation Competency Provider Course certification
10. Demonstrate and maintain credentialing and licensing requirements for Duke University Hospital, North Carolina State Board of Nursing and North Carolina Board of Medical Examiners

Schedule

Primary hours will be rotational covering 24 hours / 7 days per week including nights, weekends, and holidays. The NNP must also be flexible to provide on-call coverage, as needed.

Responsible to

The NNP will report directly to the Center for Advance Practice (CAP) Team Leader and Director. The NNP clinical practice is under the supervision of the Supervising Physicians for the NNP team, Dr. David Tanaka and Dr. Margarita Bidegain, and will also work under the supervision of all back-up attending physicians listed in the Collaborative Practice Agreement. In addition, s/he will be accountable to the Division of Neonatal-Perinatal Medicine/Department of Pediatrics for clinical outcomes and defined quality indicators and to the standards set forth by the Department of Center for Advance Practice.

Process of Evaluation

Evaluation will be ongoing and will encompass the six general areas of competency as defined by The Joint Commission (patient care, medical/clinical knowledge, practice-based learning & improvement, interpersonal & communication skills, professionalism and systems-based practice). Annual and midyear evaluations using the CAP PPR process will be conducted by the Department of Center for Advance Practice, in coordination with NP’s primary supervising physician. Ongoing Review of Care and Quality Improvement meetings with supervising physician will be conducted and documented monthly for the first six months, in accordance with Duke University’s and the designated Board’s standards, then at least once every six months.

Departmental Job Responsibilities and Standards

Clinical Expert

• Collaborate with the neonatologist and healthcare team to assess, diagnose, plan, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of patient care.
• Provide /coordinate clinical practice for neonatal patients at:
• Duke Hospital being followed on the clinical care units of Intensive/Intermediate Care Nurseries Setting
• Duke Regional Hospital being followed on the clinical care unit of Special Care Nursery Setting through established protocols and under the supervision of a Duke Neonatologist who is either onsite or available by pager

In collaboration with the neonatal attending, the NNP will round daily on patients to assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of neonatal patient care;

Provide evidence-based clinical care by actively engaging in review of literature

May order and/or perform the following procedures:

Patient history and physical exam

Laboratory, radiology, and/or diagnostic procedures/tests

Interpretation of laboratory, radiographic and diagnostic tests

Intubation / Extubation and airway management

Mechanical ventilation

Flexible bronchoscopy for non-biopsy purposes in patients that are already intubated or has a tracheostomy

Conscious / Moderate Sedation per protocol

Chest tube insertion / removal

Paracentesis

Thoracentesis

Evaluation of pleurovacs (chest tube drainage systems)

1. Lumbar puncture

1. Exchange Transfusion
2. Line placement for venous or arterial access:
3. Umbilical venous and arterial lines
4. Percutaneous arterial line placement
5. Percutaneous central line placement
6. Suture / Staple removal
7. Internal and external hemorrhage control
8. Application of dressings, bandages, wound vacs
9. Simple debridement
10. Manage NG tubes, D tubes, G tubes, J tubes
11. Manage support devices, including (but not limited to), JP drains, arterial lines, wound vac
12. Bladder catheterization

1. Extra digits / skin tag removal

1. Drainage of superficial abscesses

1. Venipuncture for blood sampling

Capillary blood sampling

Blood sampling via central venous lines, including:

Temporary central catheters

Tunneled catheters

Implantable vascular access devices

Umbilical venous and/or arterial lines aa. Administration of infusion therapy, including:

IV fluids

Analgesics, Narcotics

Antibiotics

Antifungals

Antivirals

Electrolytes

Benzodiazepines

Muscle relaxants

Local anesthetics

Blood products – Packed Red Blood Cells and / or Platelets

Total parenteral nutrition

Enteral nutrition

• Application of dressings and bandages.
• Inhalation therapy or medications to alleviate the distress of dyspnea or shortness of breath.
• Assess patients for change in status and institute appropriate interventions. Initiate emergency interventions in an effort to stabilize the patient until physician support arrives.
• Communicate verbally and in writing all pertinent patient information to supervising MD, referring MD, nursing staff, home health, hospice agency and other relevant healthcare providers.

• Document in patients’ charts 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.

• Provide leadership and coordination of care and services for the neonatology service.
• Provide / coordinate clinical care for neonatal patients requiring Transport to Duke Hospital in collaboration with the Life Flight Team, in accordance with Neonatal and Life Flight guidelines
• Utilize prescriptive privileges for identified patient populations and in accordance with DUH and NC Board of Nursing/NC Medical Board regulations.
• Role model competence in advance nursing skills and provides evidence-based practice.

Educator:

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

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 and 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 neonatal diseases, procedures, interventions, and conditions.
• Implement and evaluate appropriate educational programs for referring physicians and nurses
• 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 Nursing 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 Department of Pediatrics/Division of Neonatal-Perinatal Medicine, CAP Department and professional organizations.
• Share clinical expertise, program accomplishments, and research findings with other professionals through written publications, oral presentations, posters, continuing education, etc.
• Maintain all professional requirements for licensure and certification.

Behavioral Standards

Excellence – We strive to achieve excellence in al that we do

• Acts – and makes decisions - .in the best interests of patients and their loved ones, and willingly accepts accountability for outcomes
• Improves performance that enhances patient care and advances individual, team and organizational goals
• Effectively uses DUHS resources (time, budget and property) to support optimal patient care and operational performance while adhering to organizational policies and procedures
• Seeks opportunities to improve service provided to patients and their loved ones related to clinical care and support

Safety – We hold each other accountable to constantly improve a culture that ensures the sfety and welfare of all patients visitors and staff

• Strictly adheres to all established patient, staff and faculty safety procedures
• Contributes to an environment of safety and security for patients and staff through individual actions
• Speaks up about all risk of harm; reports patient, staff safety or injury events within twenty-four hours of incident or awareness of incident
• Actively participates in all mandatory patient and staff safety training

Integrity – Our decisions, actions and behaviors are based on honesty, trust, fairness and the highest ethical standards

• Is truthful and honest with patients, their loved ones and co-workers, and consistently exhibits actions that reflect our values
• Is accountable for actions and decisions involving patient care or other operational activities, and strives to learn and improve from experience
• Follows through on commitments made to patients, visitors, co-workers and others
• Conducts work positively while doing so in full compliance with all organizational policies, procedures, expectations and patient- centered values

Diversity – We embrace differences among people

• Applies cultural understandings and sensitivities to enhance patient care and improves interactions with people of diverse backgrounds
• Treats all individuals – patients, visitors and co-workers – with courtesy, dignity and respect
• Contributes to a work environment that is welcoming to all – whether patients, visitors, staff or faculty
• Demonstrates a sensitivity and awareness of the needs of a diverse workforce and patient population

Teamwork – We have to depend on each other and work well together with mutual respect to achieve common goals

• Willingly shares expertise and information with others to improve patient care, unit or departmental performance without compromising individual responsibilities
• Celebrates the accomplishments of others in making a difference in the lives of patients and the success of the organization

• Takes ownership of decisions made by specific patient care or project teams and team leaders and the individual role needed to support them

• Manages multiple demands while maintaining quality and courtesy; acknowledges and resolves patient or visitor issues

Working conditions

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 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 and 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 Hospitals 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 independently seek out resources and solve complex problems
• Able to work collaboratively with all levels of personnel

Work Environment:

The work environment involves risk discomforts that are typical of an acute care setting to include working with patients under isolation and universal precautions. It requires safety precautions, ongoing education and health risk monitoring. Contact with specimens, chemicals, sharps, radiation, technical equipment and fumes are possible. Employees are required to wear personal protective attire according to hospital policies and OSHA guidelines. The work activity and patient acuity levels can create a stressful atmosphere.

The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.

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.