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 University Health System
Duke Heart Center Advanced Practice Provider Job Description
Cardiothoracic Surgery Intensive Care Unit Advanced Practice Provider (APP)
Job Title: Acute Care Nurse Practitioner / Physician Assistant
The Duke Hospital Cardiothoracic Intensive Care Unit (CTICU) Advanced Practice Provider (APP) provides direct patient care services for complex critically ill cardiothoracic surgery and Advanced Heart Failure patients, predominately in an intensive care setting, as well as other units within Duke University Hospital including the OR, PACU, Step-down units, inpatient units, emergency department (ED), and hospital- based clinic settings in collaboration with cardiac anesthesiologist and under the supervision of the cardiothoracic surgeon(s) and the Medical Director of the CTICU. 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. The CTICU APP contributes to excellence in patient care, research, teaching, and provides leadership to the organization.
Position requires completion of an accredited Nurse Practitioner (NP) / Physician Assistant (PA) program. For NPs, certification as an Acute Care NP by a national certifying body is required. For PAs, national certification as a PA required and prefer equivalent of one year as a PA in a critical care setting, formal critical care fellowship or critical care rotation(s) during PA training program. Must demonstrate and maintain credentialing and licensing requirements of Duke University Medical Center and The North Carolina Medical Board and/or North Carolina Nursing Board. A Master’s degree is strongly preferred. The APP must have AHA healthcare provider status for BLS and ACLS certification.
1 Year of Experience in an ICU setting (RN or NP), 3 years of experience strongly preferred.
One year as a Physician Assistant in a critical care setting required.
Physical and mental requirements:
- Able to clearly articulate scope of practice and practices within those guidelines as an NP/PA in the state of North Carolina and within the Duke University Health System (DUHS)
- 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, 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 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
Primary hours will be rotational covering 24 hours / 7 days per week including holidays. Schedule and hours may be changed by ACP leadership in consultation with clinical service line leadership based on service needs.
Primary supervising physician and back-up cardiothoracic surgeons, cardiac anesthesiologists, critical care rounding intensivists for CTICU, Medical Director of the CTICU, and to the Duke Hospital Department of Advanced Clinical Practice Team Leader and App Director heart Center.
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 ACP PPR process will be conducted by the Department of Advanced Clinical Practice, in coordination with the APP’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 in accordance with the NC Medical Board.
Specific Job Responsibilities and Standards
Provide /coordinate clinical care for cardiothoracic surgery patients at Duke Hospital being followed primarily in the Cardiothoracic Intensive Care 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),cardiac anesthesiologist(s), CTICU intensivists, and Medical Director of the CTICU, 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 the chief resident, residents and fellows to formulate treatment plans and monitor patient progress;
May order and/or perform the following procedures:
Please note: A signed competency sheet will be submitted once training is complete.
- Patient history and physical exam
- Orders appropriate laboratory and or diagnostic procedures
- Interpretation of laboratory and diagnostic tests
- Order / Administer infusion therapy per collaborative/supervisory practice agreement, including IRB approved research protocols
- Manage support devices, including (but not limited to) hemovac, NG tubes, G tubes, J tubes, JP drains
- Order blood products
- Order / Manage Enteral nutrition
- Intubation / Extubation and/or airway management
- Flexible bronchoscopy for non-biopsy purposes in patients with an artificial airway
- Ventilator Management
- Tracheostomy tube changes
- Removal of diaphragm sutures
- Chest tube insertion / removal
- Evaluation and management of chest tube and drainage systems
- Blood sampling via central venous lines (CVLs) including: Temporary central catheters, tunneled catheters, implantable vascular access devices
- Arterial sticks
- Arterial line placement
- Intraortic balloon pump (IABP) removal
- Arterial line removal
- IABP removal
- Venous sticks
- Venous line placement/central line including PA catheter placement, temporary dialysis catheter, temporary transvenous pacemaker
- Venous line removal including temporary dialysis catheters
- Removal of temporary peritoneal drains
- Place gastric or post-pyloric feeding tubes
- Management of peripherally placed central and peripheral venous catheters (PICC/C)
- Peripheral intravenous catheter placement (PIV)
- Urinary bladder catheterization
- Wound management including wound vac, application of dressings and bandages, simple debridements, suture removal/placement, local cauterization, staple removal/placement
- Removal of superficial foreign bodies
- ECG Interpretation including atrial ECG
- Hypothermia Protocol
- Temporary pacemaker wire removal and clipping
- Temporary pacemaker programming including rapid atrial pacing
- Transcutaneous pacing
- Assist in operating room
- Assisting with ECMO cannulation/decannulation
- Internal/external hemorrhage control
- Manage acute cardio and/or respiratory decompensation, including rapid response and/or code
- Opening of sternotomies or clamshell incisions (post-surgery)
- Management of Mechanical Circulatory Support Device devices
- Peripheral intravenous catheter placement (PIV)
- Administration of infusion therapy, including
- IV Fluids
- Total Parenteral nutrition, in collaboration with the attending physician and infusion team
- Enteral nutrition
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 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.
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 models competence in all nurse practitioner / physician assistant advanced skills.
Assess educational needs of the CTICU and Duke University Hospital patient-care staff and provide one-on-one as well as formal in-service education as needed.
Assess educational needs of the CTICUand Duke University Hospital patients / families and provide patient/family education interventions as indicated. Document all pre and post-op education in pts medical record.
Implement and evaluate appropriate educational programs for referring MDs, DUHS patient care staff, and other healthcare providers as appropriate.
Role model and precept healthcare learners through contractual agreements.
Research Utilization and Investigation Standards
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 including Society of Thoracic Surgery (STS) database data collection and entry.
Participate in measuring and documenting outcomes.
Provide expertise and resource information to other healthcare providers, patients and families, and the community at large related to cardiothoracic diseases, procedures, interventions and conditions.
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 CTICU, Duke University Hospital, and Duke University Health System.
Professional Leadership and Development Standards
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 CT Surgery Department, ACP Department, professional organizations, and obtaining a minimum of 50 continuing medical education hours/year, and in maintaining 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.
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.