HPB Surgery- Full Time NP/PA

The Nurse Practitioner/Physician Assistant functions as an independent healthcare provider who, working collaboratively within a multidisciplinary health team, is responsible for providing comprehensive care to both well and ill patients in both the inpatient and outpatient setting. This position requires working weekends and holidays. He/she demonstrates a high degree of clinical expertise in working with patients with acute and chronic illnesses commonly encountered in Hepatobiliary Pancreatic Surgery. He/she is responsible for assessment, diagnosis, treatment, management, education, health promotion and care coordination for patients and families with acute and chronic health needs. The NP/PA practices as a member of the Hepatobiliary Pancreatic Surgery provider team. This position may participate in weekly GI tumor board conferences as available. The Nurse Practitioner/Physician Assistant demonstrates an advanced level of medical/nursing clinical knowledge, communication and interdisciplinary collaboration, professionalism and systems-based practice. He/she works with administrative, nursing, physician, and university faculty to assure safe, effective, quality patient care and to promote Advocate Health educational and research missions.

The Nurse Practitioner/Physician Assistant will provide care within his/her scope of practice as outlined by applicable state law, licensing, regulations, institutional policy and practice agreements. The Nurse Practitioner/Physician Assistant is eligible to begin practice after he/she is credentialed and privileged by Advocate Health and Clinics Medical Staff. Active hospital privileges will be required and to maintain employment within this practice. The Nurse Practitioner/Physician Assistant will need to be credentialed and obtain and maintain professional privileges required for employment within this department.

Outside of minimum work requirement, he/she will be eligible for excess pay for additional shifts worked, per Advocate Health policy, Paid Time Off, and performance incentive bonuses. Each year, he/she will have $2500 and a total of 40 hours of CME.

Major Responsibilities

Clinical Knowledge

1. Demonstrates knowledge of etiologies, risk factors, pathophysiology, presentation and epidemiology of medical conditions.
2. Performs history and physical exams of patients that are accurate, complete, concise, relevant and appropriate for age, gender and clinical problem.
3. Orders appropriate diagnostic studies and correctly interprets the results.
4. Utilizes critical thinking to synthesize and analyze collected data.
5. Develops, implements, evaluates and alters the care plan as needed.
6. Manages general medical and surgical conditions based on knowledge of the indications, contraindications, side effects, interactions and adverse reactions of pharmacologic agents and other relevant treatment modalities.
7. Counsels and educates patients and families.
8. Demonstrates proficiency in procedural skills pertinent to practice area.
9. Maintains accurate, complete, concise and timely documentation in the electronic medical record.

Patient Care

1. Provides care that is patient and family centered, compassionate, appropriate and effective for the promotion of health, prevention of illness and treatment of disease throughout the lifespan.
2. Facilitates consistent, coordinated care and clear communication among all members of the healthcare team.
3. Incorporates the patient and family in care planning and treatment across settings.
4. Serves as an advocate for patients and families in navigating the health care system.

Practice Based Learning and Clinical Improvement

1. Demonstrates insight into own strengths, limitations and knowledge deficits.
2. Demonstrates initiative to meet identified learning needs using multiple resources.
3. Actively participates in self-evaluation by seeking and utilizing guidance and constructive feedback in a professional manner.
4. Continuously seeks opportunities for clinical advancement and knowledge and skill attainment.

Communication and Interdisciplinary Collaboration

1. Communicates and collaborates effectively with physicians, other health professionals and health related agencies.
2. Works effectively with multidisciplinary team members.
3. Promotes mutual respect and trust working within a team model.
4. Communicates effectively with patients and families, incorporating gender, age, culture, race, religion, disabilities and sexual orientation.

Professionalism

1. Follows ethical principles regarding patient confidentiality, informed consent and unanticipated adverse outcomes.
2. Demonstrates the highest level of accountability for professional practice.
3. Participates in education of students and other health care professionals.
4. Maintains effectiveness where circumstances and priorities are changing. Is flexible, resilient and change oriented.
5. Welcomes and participates in opportunities to advance the mission of Advocate Health through service, scholarship, science and social responsibility.
6. Participates in organizational and departmental meetings, educational opportunities, committees and workgroups as necessary.

Systems Based Practice

1. Considers cost effectiveness and risk/benefit analysis when making decisions about patient care.
2. Uses evidenced-based medicine to systematically analyze and improve patient care practices.
3. Participates in quality initiative/performance activities.
4. Participates in development, evaluates and implements standards of care within area of specialization (policies, protocols, etc).

Roles and responsibilities specific to area of clinical practice:

Outpatient Specific Responsibilities

1. Participate in pancreatic cyst clinic, follow up for non-operative drain management, post-operative care and management of postoperative complications.
2. Conduct comprehensive or episodic health history and physical exam of patients with acute, chronic and/or potential health problems, including follow up for post-operative care and management of postoperative complications.
3. Order appropriate diagnostic laboratory and imaging tests pertinent to active health problem(s).
4. Establish medical diagnosis.
5. Medical Management within the parameters set in the Collaborative Practice Agreement:
   • Prescribe appropriate medications pertinent to active health problems.
   • Order therapeutic interventions as appropriate for pertinent health problems.
   • Perform wound and drain care, including removal of drains as appropriate.
6. Provide counseling and education to the patient and family regarding active health problems.
7. Initiate outpatient referrals as appropriate.
8. Document the encounter in the electronic medical record and assure follow up plan.
9. Provide appropriate direction to clinic staff regarding patient care issues.
   • Orders to be instituted at the bedside (ie: staple removal, drain removal, etc).
   • Follow-up plan.
   • Ordering of lab work and/or other diagnostic tests.
   • Other patient needs within the scope of practice for the clinic staff.
10. Communicate effectively with referring health care providers
11. Communicate collaboratively with other health care providers who are participating in the care of each patient as it relates to the active health problems managed by HPB Surgery.
12. Be available to address outpatient needs for our patients by addressing calls/questions in collaboration with the clinic staff.
13. Perform peer-to-peer reviews as necessary.

Inpatient Specific Responsibilities

1. Perform inpatient consultations and round on established patients daily.
   • Perform comprehensive H&Ps for new patients and episodic histories for established inpatients.
   • Review and interpret diagnostic tests.
   • Order additional tests as appropriate.
   • Order therapeutic interventions as appropriate.
   • Perform bedside care, including wound and drain care, in accordance with the collaborative practice agreement.
   • Facilitate patient discharges in collaboration with case management, charge nurse, bedside nurse, physicians/APPs from other services involved in the patient’s care, and any other hospital staff involved in the care.
   • Attend interdisciplinary rounds each weekday.

Procedures

1. Common procedures performed on HPB Surgery
   • Wound Care
   • I&D
   • Drain removal

Position Qualifications:

1. Education Requirements:
   • Graduation from an accredited Adult Gerontology Acute Care NP or PA program.
   • A master's degree is required.
2. Licensure/Certification
   • Current license to practice as a NP or PA in North Carolina.
   • PA: Certification from the National Commission on Certification of Physician Assistants preferred. Current or pending CAQ certification preferred.
   • NP: Certification from the American Nurses Credentialing Center or The American Association of Critical Care Nurses required.
3. Current prescriptive privileges and DEA license required.
4. Work Experience:
   • Must have at least 1 year of experience as an APP
   • Preference will be given to applicants with experience in Hepatobiliary Surgery
   • Experience in a surgical practice preferred.
5. BLS for healthcare provider from AHA required.
6. Demonstrates appropriate critical thinking and interpersonal skills when working in a fast-paced, high acuity work environment. Able to perform thorough history and physical assessment. Also, able to evaluate, assess, and monitor other co-morbid medical conditions.

Minimum Work Requirements:

1. Current MWR:

• Five days per week, 8-hour shifts. Mix of clinic and inpatient hospital coverage.
• One weekend per month on- call for possible weekend coverage

2. The minimum work standard is subject to change to meet the needs of the practice.