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CARDIOTHORACIC ICU NURSE PRACTITIONER or PHYSICIAN ASSISTANT - DUH - Full Time

Employer
Duke University
Location
ADVANCED PRACTICE PROVIDERS-HEART SERVIC

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Administrative Jobs
Institutional & Business Affairs, Health & Medical Services
Employment Type
Full Time
Institution Type
Four-Year Institution
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Job Details

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

Status: Exempt

Job Description

Position Summary

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 Requirements

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.

Experience

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

Hours

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.

Responsible to

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).\

Clinician Standards

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.

    1. Patient history and physical exam
    2. Orders appropriate laboratory and or diagnostic procedures
    3. Interpretation of laboratory and diagnostic tests
    4. Order / Administer infusion therapy per collaborative/supervisory practice agreement, including IRB approved research protocols
    5. Manage support devices, including (but not limited to) hemovac, NG tubes, G tubes, J tubes, JP drains
    6. Order blood products
    7. Order / Manage Enteral nutrition
    8. Intubation / Extubation and/or airway management
    9. Flexible bronchoscopy for non-biopsy purposes in patients with an artificial airway
    10. Ventilator Management
    11. Tracheostomy tube changes
    12. Removal of diaphragm sutures
    13. Chest tube insertion / removal
    14. Evaluation and management of chest tube and drainage systems
    15. Paracentesis
    16. Thoracentisis
    17. Blood sampling via central venous lines (CVLs) including: Temporary central catheters, tunneled catheters, implantable vascular access devices
    18. Arterial sticks
    19. Arterial line placement
    20. Intraortic balloon pump (IABP) removal
    21. Arterial line removal
    22. IABP removal
    23. Venous sticks
    24. Venous line placement/central line including PA catheter placement, temporary dialysis catheter, temporary transvenous pacemaker
    25. Venous line removal including temporary dialysis catheters
    26. Removal of temporary peritoneal drains
    27. Place gastric or post-pyloric feeding tubes
    28. Management of peripherally placed central and peripheral venous catheters (PICC/C)
    29. Peripheral intravenous catheter placement (PIV)
    30. Urinary bladder catheterization
    31. Wound management including wound vac, application of dressings and bandages, simple debridements, suture removal/placement, local cauterization, staple removal/placement
    32. Removal of superficial foreign bodies
    33. ECG Interpretation including atrial ECG
    34. Defibrillation/Cardioversion
    35. Hypothermia Protocol
    36. Temporary pacemaker wire removal and clipping
    37. Temporary pacemaker programming including rapid atrial pacing
    38. Transcutaneous pacing
    39. Assist in operating room
    40. Assisting with ECMO cannulation/decannulation
    41. Internal/external hemorrhage control
    42. Manage acute cardio and/or respiratory decompensation, including rapid response and/or code
    43. Opening of sternotomies or clamshell incisions (post-surgery)
    44. Management of Mechanical Circulatory Support Device devices
    45. Peripheral intravenous catheter placement (PIV)
    46. Administration of infusion therapy, including
      • IV Fluids
      • Antibiotics
      • Antifungals
      • Antivirals
      • Electrolytes
      • 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.

Educator Standards

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.

Consultant Standards

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.

Organization

Read our Diversity Profile History

Duke University was created in 1924 by James Buchanan Duke as a memorial to his father, Washington Duke. The Dukes, a Durham family that built a worldwide financial empire in the manufacture of tobacco products and developed electricity production in the Carolinas, long had been interested in Trinity College. Trinity traced its roots to 1838 in nearby Randolph County when local Methodist and Quaker communities opened Union Institute. The school, then named Trinity College, moved to Durham in 1892, where Benjamin Newton Duke served as a primary benefactor and link with the Duke family until his death in 1929. In December 1924, the provisions of indenture by Benjamin’s brother, James B. Duke, created the family philanthropic foundation, The Duke Endowment, which provided for the expansion of Trinity College into Duke University.Duke Campus

As a result of the Duke gift, Trinity underwent both physical and academic expansion. The original Durham campus became known as East Campus when it was rebuilt in stately Georgian architecture. West Campus, Gothic in style and dominated by the soaring 210-foot tower of Duke Chapel, opened in 1930. East Campus served as home of the Woman's College of Duke University until 1972, when the men's and women's undergraduate colleges merged. Both men and women undergraduates now enroll in either the Trinity College of Arts & Sciences or the Pratt School of Engineering. In 1995, East Campus became the home for all first-year students.

Duke maintains a historic affiliation with the United Methodist Church.

Home of the Blue Devils, Duke University has about 13,000 undergraduate and graduate students and a world-class faculty helping to expand the frontiers of knowledge. The university has a strong commitment to applying knowledge in service to society, both near its North Carolina campus and around the world.

Mission Statement

Duke Science"James B. Duke's founding Indenture of Duke University directed the members of the University to 'provide real leadership in the educational world' by choosing individuals of 'outstanding character, ability, and vision' to serve as its officers, trustees and faculty; by carefully selecting students of 'character, determination and application;' and by pursuing those areas of teaching and scholarship that would 'most help to develop our resources, increase our wisdom, and promote human happiness.'

“To these ends, the mission of Duke University is to provide a superior liberal education to undergraduate students, attending not only to their intellectual growth but also to their development as adults committed to high ethical standards and full participation as leaders in their communities; to prepare future members of the learned professions for lives of skilled and ethical service by providing excellent graduate and professional education; to advance the frontiers of knowledge and contribute boldly to the international community of scholarship; to promote an intellectual environment built on a commitment to free and open inquiry; to help those who suffer, cure disease, and promote health, through sophisticated medical research and thoughtful patient care; to provide wide ranging educational opportunities, on and beyond our campuses, for traditional students, active professionals and life-long learners using the power of information technologies; and to promote a deep appreciation for the range of human difference and potential, a sense of the obligations and rewards of citizenship, and a commitment to learning, freedom and truth.Duke Meeting

 “By pursuing these objectives with vision and integrity, Duke University seeks to engage the mind, elevate the spirit, and stimulate the best effort of all who are associated with the University; to contribute in diverse ways to the local community, the state, the nation and the world; and to attain and maintain a place of real leadership in all that we do.”

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