FAMILY NURSE PRACTITIONER OR PHYSICIAN ASSISTANT

Advanced Practice Provider

The Advanced Practice Providers (APP) will be responsible for the assessment, health case management, diagnosis, treatment, follow up, and referral of ambulatory patients seen in the Primary Care Walk-In Clinic under the direction of the Clinic Medical Director. The APP will fill in as needed for the Primary Care Clinic. The APP assists in the development and updating of protocols with the cooperation and input of the Clinic Medical Director, Chief Executive Officer, and the Primary Care Practice Manager. As a Critical Access Hospital serving the Lake Almanor region and surrounding communities, Seneca Healthcare District is committed to improving access to high-quality healthcare for rural and underserved populations. This position plays a vital role in expanding access to primary and walk-in care services, supporting continuity of care, and strengthening the rural healthcare workforce.

The APP takes responsibility for keeping his/her knowledge and credentials current and for upgrading his/her knowledge. Evaluation of the quality of care delivered is accomplished using active Quality Assurance which is reviewed and developed conjointly by the Clinic Medical Director, Clinic Administration, and APP.

Essential Functions

The APP plans patient care in a walk-in setting using skills specific to their individual training and experience and works under established protocols. Such care may include but not be limited to:

• Taking patient histories – database gathering.
• Physical assessments – episodic and ongoing.
• Ordering needed laboratory, x-ray, and other testing specific to patients' problems (diagnoses) and in accordance with established protocols.
• Initiating treatments which are appropriate to patients' problems and diagnoses and specific to the individual needs of patients, i.e., cultural, ethnic, sociological, religious, emotional, physical needs are taken into consideration in planning of care.
• Establishing a plan of care which will assist patients to move towards better health and healing.
• Educating, counseling, and appropriate referrals to assure the patients' ongoing needs are met as well as episodic problems cared for.
• Ongoing case management can include discussions of patients' health care problems with supervising physician and referrals to a physician or specialist when needed.
• Furnishing of appropriate medications and treatments according to established protocols including respiratory therapy, physical or occupational therapy, speech therapy, or other appropriate interventions.

Knowledge, Skills, and Abilities

Leadership:

• Works with the Primary Care Clinic Practice Manager to assure that clinic hours are covered by adequate staff and arranges schedule so that clinic can be open as designated by Administration.
• Manages time well.
• Supports philosophy and objectives of Administration.
• Acts as a liaison between patients, families and physicians when needed.
• Assumes personal responsibility for providing quality patient care.
• Provides direction to clinic staff to ensure patient care is delivered appropriately.
• Sets an appropriate clinical role model for other nursing personnel.

Developing Patient Assessment Data Base:

• Demonstrates knowledge and ability to gather data pertinent to patient plan of care and assessment.
• Per protocol, orders necessary and related lab tests or other diagnostic testing.
• Obtains complaint related history and gathers all other history information needed for complete plans of care.
• Specifically gathers information on adverse drug reactions, allergies and idiosyncratic reactions.
• Attempts to use interpreter via hospital policy to gather data when needed.
• Utilizes patients' charts, hospital charts, and emergency room records to gather background when needed.
• Organizes and demonstrates ability to arrange data in a problem-oriented fashion when recording.
• Demonstrates knowledge of laboratory reports, x-ray reports, and is able to interpret their effect and influence upon patient care management.
• Discusses unusual data or reports with physician and reviews data with physician if needed.
• Demonstrates good interviewing techniques.

Patient Assessment:

• Completes thorough physical exam on patients from birth to advanced age and understands normal variations.
• Assesses social, economic, spiritual, and mental needs which impact optimal health and documents these findings clearly and concisely in charts demonstrating a knowledge of normal growth and development and how different stages of life affect patients' abilities.
• Evaluates and reviews assessments with physician when needed to optimize care and change the plan of care as needs change.
• Develops and maintains a problem list for each patient in his/her clinic chart.
• Documents assessed problems clearly and objectively.

Patient Care Plans:

• Plans care which is comprehensive and problem specific based upon established protocols.
• Follows established protocols and initiates changes to protocols on an as needed basis.
• Utilizes physicians, specialists, and special resources as needed to assist patients to move towards higher levels of wellness.
• Initiates referrals when needed and keeps physician aware of referrals as needed.

Patient Care:

• Provides instruction to patients or patients' families for specific care, i.e., medication use and dosage, side effects, insulin administration as needed, and documents this education and intervention in patients' clinic charts.
• Initiates referrals; completes appropriate referrals.
• Reports unresolved problems to the Clinic Medical Director or CNO and assists in working towards resolution of problems.
• Provides needed educational materials and demonstrates self-care techniques when needed.

Evaluation:

• Takes responsibility for referring and deferring to physician when patients are not responding to care in an expected manner.
• Evaluates patients' responses to care and makes any needed changes.
• Discusses and reviews cases which are "problematic" with physician to assure that care is always up to established medical standards.
• Documents in patients' charts each consult with on-call physician.
• Quality Assurance: Quality Assurance (QA) is in keeping with established review standards for Seneca Healthcare District. Statements of concern are filed when needed and these are reviewed quarterly.
• Refers any problems associated with the smooth functioning of the Clinic to the Primary Care Clinic Practice Manager.
• Assists in developing new protocols as needed to correct identified QA problems.

Billing and Financial Planning:

• Completes billing forms and causes patient information pertinent to accurate billing.
• Diagnoses are problem related and clearly documented.
• Works closely with the Primary Care Clinic Practice Manager to correct any errors on bills and uses appropriate billing codes and amounts when needed.
• Communicates clearly with Administration and/or Primary Care Clinic Practice Manager with ample lead time for any needed equipment or supplies.

Other Functions:

• Assists in in-service education and orientation of nursing personnel as requested.
• Assists in evaluating clinical capabilities of Licensed Vocational Nurses and Medical Assistants in conjunction with the Primary Care Clinic Practice Manager, CNO, and physicians
• Attends Medical Staff meetings as able.
• Reviews all Advanced Practice Provider protocols with the Clinical Medical Director annually.
• Keeps CNO and Primary Care Clinic Practice Manager appraised of changes, needs, or concerns which affect clinical nursing aspects of care.
• Assists in arranging nursing staff training in conjunction with the CNO and the Primary Care Clinic Practice Manager.
• Keeps lines of communication open between local physicians and their patients, referring patients back to their care providers and keeping their care providers informed of episodic care provided in the Clinic.
• Follows all general and Clinic safety, security, and health policies and procedures. Utilizes all safe work practices recommended for the Clinic.
• Maintains CONFIDENTIALITY of all patient care information to assure patients' rights are protected.
• Other duties that become necessary or as directed by supervisor.

Physical Requirements, Safety, and Environmental Conditions

• Follows safe work practices, takes an active interest in preventing injury or illness and promoting a safe and healthful environment for self and others, and complies with Hospital and governmental safety regulations.
• Must function independently, have personal integrity, have flexibility and the ability to work effectively with other personnel, clients, and support agencies
• Sits, stands, bends, lifts, walks, and moves intermittently during working hours and ability to lift up to 20 lbs.

Compliance

• Assumes personal responsibility to comply with all Federal, State and local laws