Nurse Practitioner / Physician Assistant, Pediatric CVICU

Cardiovascular Intensive Care Unit (CVICU) Advanced Practice Provider

Come work in a fast pace, innovative and dynamic unit! The Cardiovascular Intensive Care Unit (CVICU) provides state-of-the-art critical care to children with congenital and acquired heart disease. We also care for adults with congenital heart disease in the immediate post-operative period. Our facility is one of the largest and most technologically advanced units dedicated to the care of critically ill pediatric cardiac patients in the western United States. We care for more than 750 patients each year. Our CVICU is currently a 29-bed unit with plans to expand to 36 beds in the next few years. We are a post-surgical and cardiac medical unit. Our Pediatric Heart Transplant program is complemented by the Pediatric Advanced Cardiac Therapies (PACT) program. PACT provides artificial circulatory assist devices as alternatives to or bridges to transplant. These include ECMO, the Berlin Heart and Heart Mate. We are one of the most experienced teams nationally in the care of these complex patients. Our APP team is currently made up of 19 highly qualified NP's and PA's. We are a strong team that works well together to provide outstanding care to our patients and families. Together we have over 90 years of nursing and pediatric cardiac experience. Our interests range from research, VAD's, anatomy and physiology, neonates, chronically critically ill, adults with congenital heart disease, and OR. We are looking for team players that share our passion for pediatric cardiac intensive care who want to be a part of a fast paced, fun, challenging, growing unit.

Specific unit responsibilities of the advanced practice provider include: Pre rounding, creating a plan of care to advance the patient in their recovery, presenting on rounds and implementing the agreed upon plan. Procedure opportunities include but are not limited to: intubation/extubation, line placement, chest tube insertion and removal, pacer wire removal. Advance Practice opportunities at the hospital wide level include: participation in the clinical ladder, APP grand rounds, APP Council, APP task forces etc.

We require a Master's or doctoral degree in nursing from an accredited college or university. Graduate of an NP program accredited by the National League of Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE) and that you meet the License and Certification requirement. Pediatric cardiac and/or ICU experience highly preferred. Encouraged: Please include a personal statement outlining your interest in this position.

This paragraph summarizes the general nature, level and purpose of the job. The Advanced Practice Provider (APP) positions are part of a collaborative team consisting of Attending Physicians, Fellows, and a team of advanced practice providers both NPs and PAs. The APP team is highly respected, we are seen as the go to team for the attendings. We actively participate in the education of fellows and visiting residents. Responsibilities for this role include: receiving sign-out from overnight team. Pre-rounding on assigned patients, developing a plan of care for the day for that patient, present patients on rounds, write a daily note, you will be responsible for implementing the plan agreed upon on during rounds and responding to any issues raised by the nurses during the course of the day. The advanced practice provider is credentialed to perform the following procedures: intubation, central line placement, arterial line placement, chest tube insertion, PD drain placement, chest tube removal, pacing wire removal.

The Nurse Practitioner functions under the general Nurse Practitioner Standardized Process Protocol approved by the Interdisciplinary Practice Committee (IDPC). The Nurse Practitioner provides routine care and management of the patient with acute and chronic complaints, in collaboration with the supervising physician and through implementation of standardized procedures. Specific functions pertaining to the Service, Clinic or Department are established by the Nurse Practitioner and the supervising physician(s), and approved by the appropriate medical and nursing administrators, the IDPC, and the Stanford Hospital and Clinics (SHC) Medical Executive Board and Board of Directors.

The Physician Assistant functions under the general Physician Assistant Role Description approved by the Interdisciplinary Practice Committee (IDPC). Specific functions pertaining to the Service, Clinic or Department are established by the Physician Assistant and his or her supervising physician(s), and approved by the appropriate medical and nursing administrators, the IDPC, and the Stanford Hospital and Clinics (SHC) Medical Board and Board of Directors.

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned. Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings. Must perform all duties and responsibilities in accordance with the Service Standards of the Hospital (s).

• An NP/PA may provide only those medical services which he/she is competent to perform, which are consistent with the NP/PA's education, training and experience, and which are performed in collaboration with a physician.
• An NP/PA shall consult with a physician regarding any task, procedure or diagnostic problem which the NP/PA determines exceeds his/her level of competence or shall refer such cases to a collaborating physician.
• Scope of Practice of the NP/PA:
• Evaluates and treats patients with acute, chronic complaints and health maintenance concerns related to specialty, according to written standardized procedures.
• Obtains complete histories and performs pertinent physical exams with assessment of normal and abnormal findings on new and return patients.
• Performs or requests and evaluates diagnostic studies as indicated upon evaluation of the patient.
• Administers, orders, furnishes and prescribes medications.
• Orders and collects specimens for routine laboratory tests, screening procedures and therapeutic procedures, including blood and blood products.
• Orders physical therapy, occupational therapy, respiratory therapy, radiology examinations and nursing services.
• Performs designated procedures after demonstrated competency, according to written standardized procedures where applicable.
• Obtains informed consent, as indicated.
• Initiates arrangements for hospital admissions and discharges and completes appropriate paperwork.
• As directed by the supervising physician, enrolls patients in investigational studies approved by the Investigational Review Board (IRB), and orders the necessary tests and medications.
• After appropriate training, assists the supervising physician in the operating room. The RN First Assistant directly assists the surgeon and practices under the supervision of the surgeon during the intraoperative phase. The RN First Assistant must adhere to standardized procedures and not concurrently function as a scrub nurse.
• Recognizes and considers age-specific needs of patients.
• Effectively communicates and interacts with patients, families, staff and members of the community from diverse backgrounds.
• Recognizes situations which require the immediate attention of a physician, and initiates life-saving procedures when necessary.
• Facilitates the coordination of inpatient and outpatient care and services as needed.
• Facilitates collaboration between providers and coordination of community resources.
• Ensures compliance with legal, regulatory and clinical policies and procedures.
• Participates in quality improvement initiatives.
• Provides and coordinates patient teaching and counseling.
• Other duties as assigned.
• Supervision:
• Supervision is provided by the supervising/sponsoring physician with clinical privileges at LPCH, or designated attending physicians in the Clinic, Service or Department. Standardized procedures, approved by the supervising physician(s) and the IDPC, are a mandatory mechanism of supervision. Other mechanisms of supervision used may be:
• Direct on-site, electronic or phone supervision by a supervising physician. A physician cannot supervise more than four (4) NP/PAs at one time.
• Chart screens on random charts by the supervising physician or designee.
• Chart audits on random charts as an integral part of selected quality improvement programs.
• Ongoing Professional Practice Evaluation (OPPE) through tracking of performance indicators.
• The NP/PA will receive a formal annual performance evaluation by the Lead Advanced Practice Provider (Lead APP), Director of Advanced Practice or supervising manager/director with input from the Lead APP, supervising physician(s) and/or physician delegates, APP peers and the supervising manager/director. Ongoing Professional Practice Evaluation (OPPE) also occurs through tracking of performance indicators.

Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

Physician Assistant (PA):

• Bachelor's degree or above from an accredited college or university.
• Graduate of