Critical Care Nurse Practitioner or Physician Assistant - Cardiothoracic Surgery ICU, CTICU

Advanced Practice Provider (APP) Cardiothoracic Intensive Care Unit (CTICU)

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States and is the number one hospital in North Carolina, according to U.S. News and World Report for 2023-2024. Duke University Hospital is the largest of Duke Health's three hospitals and features 1048 patient beds, 65 operating rooms, as well as comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.

Candidates with 2 years related experience are eligible for a $20,000 commitment bonus.

Job Location: Duke University Hospital

Job 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 in collaboration with cardiac anesthesiology 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.

Job Duties and Responsibilities:

• Provide /coordinate clinical care for cardiothoracic surgery patients at Duke Hospital being followed primarily in the Cardiothoracic Intensive Care setting 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
• Patient rounding 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;
• Perform procedures when indicated:
• 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 / management / removal
• Paracentesis
• Thoracentisis
• Blood sampling via central venous lines (CVLs) including temporary central catheters, tunneled catheters, implantable vascular access devices
• Arterial and Venous sticks
• Arterial line placement and removal
• Intraortic balloon pump (IABP) removal
• Venous line placement/central line including PA catheter placement, temporary dialysis catheter, temporary transvenous pacemaker
• Venous line removal including temporary dialysis catheters
• Place gastric or post-pyloric feeding tubes
• Management of peripherally placed central and peripheral venous catheters (PICC/C)
• Peripheral intravenous catheter placement (PIV)
• Wound management including wound vac, application of dressings and bandages, simple debridements, suture removal/placement, local cauterization, staple removal/placement
• ECG Interpretation including atrial ECG
• Defibrillation/Cardioversion
• Temporary pacemaker wire removal and clipping as well as programing
• Transcutaneous pacing
• Assisting with ECMO cannulation/decannulation
• Manage acute cardio and/or respiratory decompensation, including rapid response and/or code
• Management of Mechanical Circulatory Support Device devices
• Collaborate with the chief resident, residents and fellows to formulate treatment plans and monitor patient progress
• 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.
• Role models competence in all nurse practitioner / physician assistant advanced skills.

Job Eligibility Requirements:

Education: NP: Graduate of accredited MSN or DNP Acute Care Nurse Practitioner Program for adult care. PA: Graduate of accredited Masters or Doctorate Degree Physician Assistant Program

License: NP: Current and unrestricted RN license issued by or recognized by the NCBON with authorization to practice as a NP. PA: Current and unrestricted medical license issued by the NCMB with authorization to practice as a PA. Both: Federal and State DEA with prescriptive authority

Certification: NP: ACNP, AGACNP (no other APRN certifications will be considered). PA: PA-C

Experience: NP: 1 year experience in high acuity adult CTICU/ICU strongly preferred will consider new grads with CTICU RN experience and/or CTICU rotation as NP student PA 1-year experience as PA in an adult high acuity critical care/CTICU setting OR a one-year Critical Care Fellowship. Will consider new grad PA with CTICU rotation while in PA school

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

Job Hours: Primary hours will be 12-hour rotational shifts / 7 days per week including holidays. Permanent Nights option is also available.