Advanced Practice Registered Nurses / Physician Assistants
Internal Number: 168399
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.
ABDOMINAL TRANSPLANT FELLOWSHIP
Position Code: 5082 (PA) or 5063 (NP) Status: Exempt
The Duke Abdominal Transplant Surgery Advanced Practice Provider (NP or PA-C) Fellowship rotates through all clinical settings in the transplant service this includes inpatient and outpatients locations. The APP transplant fellow will work alongside APPs and MDs to provide direct patient care services for surgically and medically ill adult, adolescent and pediatric patients at Duke University Hospital or in the clinic in collaboration with medical and surgical physicians. The APP Fellow 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, may assist in the operating room and provides direct patient care services. The APP Fellow contributes to excellence in patient care, research, teaching, and provides leadership in the organization.
Goals of APP Transplant fellowship:
Acquire a deep and broad knowledge base of the common disease processes for which patients are hospitalized, understanding the pathophysiology, various presenting clinical presentations and disease prognosis
Develop a diverse differential diagnosis and respective diagnostic and treatment plan based upon the patient's presenting symptoms along with evidence-based and cost-effective medical care
Manage patients effectively throughout the whole hospital stay, including admission, daily rounds and continuing evaluation, and dismissal, while remaining cognizant of the patient's emotional, physical and spiritual needs
Learn practice management, including strategies in training APPs and APP students
Develop keen verbal skills to effectively communicate with colleagues, physicians, patients and ancillary staff to ultimately become a key part of the inpatient health care delivery team
PA: Work requires graduation from a Physician Assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) or its predecessor agencies.
NP: Work requires completion of accredited graduate level Family Nurse Practitioner program.
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.
PA: National Commission on Certification of PAs (NCCPA) certification is required
NP: National certification as an FNP or similar to be able to see adult and pediatric patients
X BLS (required)
ACLS (not required but recommended)
Primary hours will be a minimum of 14 to a maximum of 16, 12-hour shifts a month covering 7 days a week including days, nights, weekends and holidays. Flexibility is required to meet clinical needs of the service.
Physical and mental requirements:
Able to clearly articulate scope of practice, and practices within those guidelines as a Nurse Practitioner / Physician Assistant
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
Lines of Responsibility
Primary supervising physician and back-up physicians and the Medical Director for the department of surgery, and to the Duke Hospital of Center for Advanced Practice Team Leader and Director. In addition, s/he will be accountable to the surgery department for clinical outcomes, defined quality indicators and to the standards set forth by the Department of 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 NP/PA'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
In collaboration with attending surgeon(s) 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 NP/PA 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 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, resident and/or intern at the end of the shift
The APP Fellow may order and/or perform the following procedures:
Interpretation of laboratory, radiographic and diagnostic tests
Chest tube insertion / removal (per service requirements)
Interpretation of PA, CVL, SG, VS interpretation and critical thinking skills
Suture / Staple removal
Application of dressings, bandages, NPWT
Manage and insert cantor tubes, NG tubes, G tubes, J tubes
Manage support devices, including (but not limited to) hemovac, JP drains, arterial lines, NPWT/Wound Vacs
Removal of superficial foreign bodies
Venipuncture for blood sampling
CAPillary blood sampling
Blood sampling via central venous lines, including:
Temporary central catheters
Administration of infusion therapy/ oral medications including: but not limited to
Analgesics, Narcotics, including Patient Controlled Analgesia
Blood products – Packed Red Blood Cells and / or Platelets
Total parenteral nutrition
v. Application of dressings and bandages.
w. Inhalation therapy or medications to alleviate the distress of dyspnea or shortness of breath.
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 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.
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.
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 Cardiology department, CAP Department, 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
Excellence – We strive to achieve excellence in all 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 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.
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 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.
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.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.