Duke Raleigh Hospital offers the latest in care and technology in a patient-friendly setting. It has been an important part of Duke Health since 1998 and has served Wake County for more than 35 years, employing more than 2,000 team members. The hospital provides 186 inpatient beds and a comprehensive array of services, including the Duke Raleigh Cancer Center, Duke Raleigh Orthopedic and Spine Center, cardiovascular services, neurosciences including the Duke Raleigh Skull Base and Cerebrovascular Center, advanced digestive care, disease management and prevention, wound healing, outpatient imaging, intensive and progressive care, pain clinic, same-day surgery, emergency department and community outreach and education programs

U.S. News & World Report ranked Duke Raleigh Hospital as high performing in orthopaedics and two adult procedures/conditions: Chronic Obstructive Pulmonary Disease (COPD) and lung cancer surgery. #DukeRaleighJobs

Position Summary

The Acute Care Surgery APP (Advanced Practice Provider) provides direct patient care services and performs medical acts under the supervision of the supervisory physician to patients on the ACS service and consulted ACS-patients.  The APP performs physical exams, collects and documents data, conducts diagnostic and therapeutic procedures, orders and schedules laboratory studies plus radiologic and professional consultations, prescribes appropriate interventions and medications, coordinates the care and discharge of patients and provides direct care to the patients on the ACS service. The ACS APP contributes to excellence in patient care, research, teaching, and provides leadership to the organization.

Based on the needs of the service, the APPs may have responsibilities in the operating room as first or second assist and may be required to occasionally collaborate with and assist the trauma service including doing primary, secondary and tertiary physical exams.

Position Requirements

Education:

NP: Work requires completion of accredited graduate level Nurse Practitioner program.

PA: Completion of an accredited Physician Assistant program. A Bachelor’s degree required; Master’s degree strongly preferred.

Licensure:

NP: Current licensure as a Registered Nurse in the state of North Carolina and approval to practice as an NP.

PA: Licensure as a Physician Assistant in the state of North Carolina.

Certification:

NP: National certification as a Family Nurse Practitioner

PA: National Commission on Certification of PAs (NCCPA) certification is required.

Experience:

NP: Master’s degree required, with a preference for a minimum of 2 years’ experience in the clinical care of trauma or general surgery. Strongly prefer candidate with at least one year of experience as a NP.

PA: Two years as a Physician Assistant in in the clinical care of trauma or general surgery strongly preferred. Strongly prefer candidate with at least one year of experience as a PA.

Life support:

BLS Required

ACLS recommended but not required

ATLS recommended but not required

Physical and mental requirements:

• Able to clearly articulate scope of practice, and practices within those guidelines as an APP 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, electronic medical records (EPIC) 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

Hours

The overall schedule will be 14 (fourteen) 12 (twelve) hours shifts per week, which will be covered by a team of three APPs to be hired for the ACS service needs. This team will be able to cover the outpatient care 5 days per week and assist with inpatient service seven days per week. The APPs, along with the Division Chief, will develop a schedule that is mutually amenable. Schedule may be changed by administrative or clinical leadership to meet department needs.

Responsible to

Primary supervising physician and back-up attending and the Medical Director for the Division of Trauma, Acute and Critical Care Surgery, and to the Duke Hospital Center for Advanced Practice Team Leader and Director. In addition, s/he will be accountable to the Division Chief and supervising physician with respect to clinical outcomes, performance improvement indicators and to the standards set forth by the Center for Advanced Practice (CAP).

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 Center for Advanced Practice, in coordination with the APPs primary supervising physician and the Division Chief of Acute Care Surgery. 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 in accordance with the NC Medical Board.

Clinical Expert

The APP is responsible for providing/coordinating direct clinical care to adult acute care surgical patients on designated units, short stay unit and is also responsible for maintaining the practice consistent with the rules and regulations of the North Carolina Medical Board and Duke Hospital Medical Bylaws

Standards

• The APP will assist residents in the care of new patients, consults and established patients in the hospital as well as manage common conditions in the acute care surgical patient population.
• Perform an appropriate history, physical, and tertiary exam on all assigned patients. The APP will write progress notes and summaries noting pertinent positive and negative findings; a psychosocial history will be obtained relevant to patient care. The APP will assume responsibility for developing therapeutic relationships with patients.
• Facilitate and order diagnostic studies as determined by the acute care team in review with attending MD.
• Order and schedule laboratory studies and diagnostic procedures. Explain necessity, preparation, and nature and anticipated effects of scheduled diagnostic and therapeutic procedures to the patient and family.
• Work closely with the inpatient rounding teams including attendings, APP’s, residents and Fellows to appropriately allocate workload based on daily census, clinical and operational needs.
• Assist in the training of new employees, students and fellow trainees, to the limits of competence, and actively participate in educational conferences.
• Participate in evaluations with the primary supervising physician weekly for the first month after initial hire then monthly for the first six months of a new practice engagement, and a minimum of every six months thereafter. Any complications will be monitored on a monthly basis through routine quality assurance conferences.
• Will work, along with the acute care surgery team, to provide consistent information to patients and families regarding patient condition, progress, and expectations.
• Discharge all assigned admitted/procedural/surgical patients, as directed by the Attending physician, including, but not limited to, dictating discharge summary, patient education, patient wound care instructions, prescriptions, and entering discharge orders.
• May work with Trauma Administration staff in meeting the requirements for Trauma Center site designation, to include but not limited to collection of performance improvement data, auditing of care guidelines, and participating in educational offerings.
• Will work in conjunction with the Acute Care Surgery APP Team to see select post-operative and non-operative emergent general surgery patients.
• Participate in research and performance improvement initiatives in the emergency general surgery population.
• Maintain a current, working knowledge of coding, billing and documentation

The APP may order and/or perform the following procedures:

Patient history and perform physical examination

Be familiar with OR processes & procedures

Laboratory, radiology, and/or diagnostic procedures/tests

Interpretation of laboratory, radiographic and diagnostic tests

Chest tube insertion / removal (per service requirements)

Line placement for venous or arterial access:

• Percutaneous arterial line placement
• Percutaneous central line placement
• Suture / Staple removal
• Application of dressings, bandages
• Simple debridement
• Manage and insert cantor tubes, NG tubes, G tubes, J tubes
• Manage support devices, including (but not limited to) hemovac, JP drains, arterial lines, wound vacs
• Removal of superficial foreign bodies
• Venipuncture for blood sampling
• Capillary blood sampling
• Blood sampling via central venous lines, including:
• Temporary central catheters
• Tunneled catheters
• Implantable vascular access devices

Administration of infusion therapy/ oral medications including:

IV fluids

Anticoagulants

Analgesics, Narcotics, including Patient Controlled Analgesia

Antibiotics, Antifungals & Antivirals

Antiarrhythmic

Antihypertensives

ElectrolytesBenzodiazepines

Muscle relaxantsLocal anesthetics

Blood products – Packed Red Blood Cells, FFP and/or Platelets

Total parenteral nutrition

Enteral nutrition

• 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, primary team, nursing staff, home health, hospice agency, and other relevant healthcare providers.
• Analyze clinical practice patterns so as to provide the best medical care and to increase effectiveness and efficiency
• Document in patients’ 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 & primary team.
• Utilize prescriptive privileges for identified patient population and in accordance with DUH & NC Medical Board regulations.
• Role model competence in skills and provides evidence-based practice.

Standards

In collaboration with attending physicians 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 colleague’s 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 care, resuscitation, 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, primary team, 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.
• Participate as part of the ACS Team, helping provide continuity of patient care & plans.
• Give daily handoff to appropriate attending, 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 pre- and post-op/procedure education in patients’ medical record.
• Implement and evaluate appropriate educational programs for 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 emergency general surgery, acute care surgery, traumatic injuries, interventions, and conditions.Implement and evaluate appropriate educational programs for referring MDsAssist in the development, implementation and evaluation of 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 Hospital, Trauma Center, CAP, and professional organizations. Meet Continuing Education requirements as designated by the NC Medical Board and the Trauma Center designating bodies. 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

Behavior Standards:

Excellence – We strive to achieve excellence in all that we do.

Standards:

• 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 optional 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 safety and welfare of all patients, visitors and staff.

Standards:

• 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.

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.

Standards:

• 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.

Standards:

• 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

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.

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.