Public Health Clinic Nurse Practitioner

Are you interested in using your skills to address the opioid crisis in Pierce County? Are you looking for a position that will help you gain experience prescribing/ordering medications for the treatment of opioid use disorder? If this sounds like you, we invite you to apply for our new Advanced Registered Nurse Practitioner (ARNP) position with our treatment services public health clinic This is a Regular, Full-Time (1.0 FTE) position that offers the opportunity to participate in a learning and collaborative environment with the interdisciplinary team at the Public Health Clinic comprising of substance use disorder treatment services, street medicine, and sexual health teams.

This is an advanced professional classification that works in collaboration with other health care team members to deliver patient-centered, trauma-informed care for individuals, including those with substance use disorder. This position supervision of other nurses and clinical staff to ensure the delivery of quality health care and health education to those seeking services. In addition, the Advanced Registered Nurse Practitioner (ARNP) provides hands-on care, develops evidence-based treatment plans, performs a variety of diagnostic workups, and prescribes medications. Distinguishing Characteristics This is a single-level classification within the nursing services field that is supported by clinic physicians and/or a Medical Director. This role works independently, under the general supervision of a physician. Employees in this classification work with sensitive and confidential information requiring a high level of discretion.

Essential Functions

• Provide high-quality direct patient care for patients seeking substance use disorder treatment, primary care, sexual health services, or other care deemed appropriate by the Health Officer or Medical Director.
• Maintain appropriate clinical documentation and bill appropriately for clinical services in a time-sensitive manner.
• Consult with Medical Director as soon as possible in all scenarios listed in the operating procedures and when unable to independently arrive to a safe and effective care plan for a patient.
• Maintain compliance with all relevant laws, regulations, policies, and guidelines.

Examples of Key Duties The items in this section are the key duties and responsibilities for this job and do not represent an exhaustive list. Our organization is dynamic, and duties may change based on business needs. Any new duties will remain within the scope of the job.

• Act as a licensed Opioid Treatment Program (OTP) practitioner for outpatient substance use disorder treatment clinic working under indirect supervision of Medical Director. Obtain health and medical history, both general and specific, including but not limited to substance use history, sexual health history, family history, psychosocial/developmental histories and cultural information using patient centered, trauma informed care. Identify actual and potential health needs based on medical, behavioral, financial, and social factors.
• Perform comprehensive physical exams and focused physical exams depending on patients' needs. The ARNP may perform procedures within their scope of practice to include, but not limited to naloxone challenge testing, administration of long-acting buprenorphine, naltrexone, incision and drainage of abscess, placement of long-acting reversible contraception, removal of foreign body, sample collection, etc.
• Diagnose and manage substance use disorders, medical and psychiatric conditions with appropriate referrals.
• Develop and implement treatment plan; oversee the treatment plan throughout treatment. Longitudinal follow-up of patients. Obtain a collateral history. Consult with the Medical Director on complex cases and situations as noted in the operational procedures. Refer cases to physicians and allied health professionals for conditions outside the scope of practice to diagnose or treat. Confer directly with one or more physicians regarding diagnosis and care management problems as needed. Refers to community partners, collaborates with care teams, other health care providers and community resources, health promotion and education.
• Participate in weekly medical staffing meetings and weekly 1:1 meeting with the medical director.
• Perform and/or interpret appropriate ancillary testing including but not limited to basic blood work (CBC, CMP, etc.), sexually transmitted infection testing and monitoring, toxicology screening and confirmation testing, methadone trough level, electrocardiograms or other indicated testing.
• Prescribe medications based on current evidence. Educate patients on risks, benefits, interactions, and contraindications of use of medications in terms appropriate to the patients' level of health literacy.
• Conduct assessment for MOUD in pregnant women, educate patients on their medication options, provide referrals, and educate them on neonatal abstinence syndrome.
• Document in Electronic Health Record to collect, record, and analyze data. Report IT issues in a time-sensitive manner.
• Participate in daily clinic operations. Actively participate in the planning, implementation, and evaluation of quality improvement initiatives.
• Provide on-call phone consultation to dosing staff during 5 am 8:30 am on Saturdays (rotating schedule, alternate weekends.
• File exemption/exception requests on SAMHSA Extranet.
• Manage acute medical emergencies in the clinic.
• Provide leadership, guidance, and feedback to clinic staff to support a high-performance clinic that focuses on quality and safe patient care. Provide technical guidance to the nursing staff in diagnostic, counseling, and referral techniques to ensure quality of nursing care.
• Stay up to date on federal, state, and local laws, regulations, policies, and procedures
• Ensure quality professional practice by practicing within professional, legal, and ethical standards.
• Collaborate with other nurse practitioners, RNs, SUDPs, and LPNs in and across the teams to deliver safe and effective patient care.
• Provide compassionate care for patients who are stigmatized and/or discriminated against for substance use disorder
• Provide high-quality direct patient care for patients seeking substance use disorder treatment, primary care, sexual health services, or other care deemed appropriate by the Health Officer or Medical Director.
• Refers patients to community partners or other health professionals when necessary.
• Prescribes medications, including controlled substances, based on State and Federal regulations. Ensures each patient receives the appropriate level of education needed to understand the purpose and intended outcome of the use of medications.
• Assesses candidates and collaborates with the medical team to evaluate patients for Medication for Opioid Use Disorder (MOUD).
• The work you do might require you to participate in the Title XIX Medicaid Claiming Program.
• Performs other duties as assigned.

Safety & Emergency Preparedness

• Adheres to all workplace and trade safety laws, regulations, standards, and practices.
• Understands and properly follows established procedures in preventing and responding to unsafe or emergency situations. Identifies and reports potentially unsafe practices or conditions.
• Operates equipment, tools, machinery, and vehicles safely and understands processes for reporting an accident or injury.
• Understands and applies knowledge and skills necessary to successfully perform assigned emergency response role during an emergency.

• Intermediate knowledge of standard Microsoft Office programs and Electronic Medical Records software.
• Knowledge of professional and public health nursing principles, practices, and techniques including trauma-informed and patient-centered care, community health problems, preventative measures, and community resources.
• Knowledge of both motivational interviewing and trauma-informed care to provide individualized support for clients navigating behavior change.
• Skill in analyzing, compiling, recording, and assessing data, i.e., medical decision making, shared decision making, informed consent, mental status assessment, mental capacity evaluation, review of medical records, etc.
• Ability to synthesize and assimilate complex information from variety of sources including internal and external medical records, collateral history from family members/peers/staff, history from patient, objective data from testing and examination.
• Ability to apply evidence-based knowledge to formulate an individualized assessment and plan for each patient based on their unique presenting medical and biopsychosocial conditions.
• Understanding of systems-based quality improvement. Ability to stay up to date with advances in clinical medicine.
• Familiarity with community, professional, and educational resources for referral services.
• Knowledge of medication administration, drug interactions, dosages, and effects.
• Understanding of ethical and legal standards of medical practice and patient confidentiality.
• Ability to apply crisis intervention skills.
• Ability to apply diagnostic reasoning and clinical decision-making skills to make educated and timely decisions regarding patient care.
• Skill in maintaining sensitive and confidential data and using discretion when sharing information.
• Skills in communication:
  • Listens to others and communicates in an effective manner.
  • Asks questions in ways that enhance the clarity, quality, and reliability of information.
  • Understands and learns from what others say, attends to nonverbal cues, and responds appropriately.
  • Grasps the meaning of written information and applies it to work situations.
  • Conveys ideas and facts using language the audience will best understand, taking into consideration the audience and nature of the information.
  • Writes in a clear, concise, and organized manner for the intended audience.

• Knowledge of neurobiology of addiction, pathophysiology of substance use disorders, pharmacology of medications for opioid use disorder (MOUD) and medications for treatment of alcohol use disorder, contingency management for stimulant use disorder, common medication interactions and contraindications, mental status assessment, medical decision making capacity assessment, management of sexually transmitted infections, screening of co-occurring medical and psychiatric conditions like ADHD, withdrawal management, toxicology, screening and diagnostic tests, EKG interpretation, basic life support, and motivational interviewing.
• Ability to work daily with patients who often have extremely difficult life circumstances and experience stigma, discrimination, and marginalization
• Ability to work harmoniously with patients and other health professionals. Exercise independent clinical judgment in determining when to consult other resources for diagnosis and case management; make clear explanations of technical conditions to professionals and laymen.
• History taking, physical examination, diagnostic reasoning, and clinical decision-making.
• Knowledge of harm reduction, relapse prevention, health promotion, and risk assessment.
• Awareness of community, professional, and educational resources and the ability to direct patients to the appropriate resource.
• Crisis intervention skills.

• Knowing and managing oneself: Understands that all equity, trauma-informed, and restorative practices start with oneself. Exercises a high degree of self-reflection, personal accountability, resilience, flexibility, and adaptability. Is willing to learn, apply, and model agency values and ethical standards.
• Restorative practices and conflict resolution: Articulates through words and actions authentic commitment to create an environment in which all people are treated with dignity and respect. Applies trauma informed and restorative practices to achieve and maintain collaboration and teamwork and to effectively work with historically underrepresented and/or underserved populations to advance community health. Utilizes restorative practices to address harm and promote healing to strengthen relationships between individuals and social connections within communities.
• Collaboration and engagement: Provides balanced and objective information to help teammates, partners, and the public understand problems, alternatives, opportunities, and solutions. Works directly with partners within the department, in the community, and members of the public affected by the work to obtain feedback and understand diverse points of view, concerns, and aspirations. Identifies preferred solutions together, incorporating advice and recommendations to the maximum extent possible.
• Evidence informed practices and decision-making: Applies evidence informed practices and methodologies to achieve the greatest impact in delivery of services to internal and external customers and partners. Incorporates the social determinants of health into public health work. Integrates research and evidence into the decision-making process. Seeks to systematically identify and eliminate inequities resulting in differences in health and in overall living conditions. Utilizes evidence informed practices to increase equity in systems and policy. Creates a robust culture of assessment and evaluation and continuous process improvement.
• Cross cultural communication and Engagement: Understands that cultural awareness, appreciation, and humility can only occur when you practice curiosity and open-mindedness. Operates with a high level of humility and cultural agility to achieve effective intercultural communication, engagement, and collaboration in the workplace and in the community. Is open to feedback and continuously self-reflects on one's own actions and responses. Centers personal accountability on the Department's mission, values, and ethical standards.

The items below are the requirements for the job and are relevant to this position. The organization values work experience, lived experience, and education and realizes that people take different paths to acquire knowledge.

• Bachelor of Science in Nursing from an accredited school of Nursing.
• Masters or Doctorate of Science in Nursing from a school accredited by the Commission on Collegiate Nursing Education.
• One year of experience working in a public or community health setting.

Preferred Experience:

• 6 months of clinical experience in an OTP/addiction medicine as an ARNP.
• Previous experience in primary care settings or outpatient psychiatry or emergency department as an ARNP.
• MOUD training completion through PCSS, APNA, AACN, ASAM.
• Certified Professional in Patient safety (CPSS) certification.

• Current unrestricted Washington State Advanced Registered Nurse Practitioner (ARNP) License and Washington State Registered Nurse (RN) License.
• DEA registered practitioner.
• Basic Life Support (BLS) for Health Care Providers required within 90 days of hire.
• Immunizations and immunization screening required at hire and annually based on program area.

Work Environment

• Work is performed in a clinical office environment or in the community as part of clinic outreach efforts.
• Exposure to communicable diseases, bloodborne pathogens, and biohazardous materials and waste.
• Environmental conditions may entail a stressful work climate due to the nature of the job, i.e., working with individuals that have experienced traumas such as sexual abuse, physical and mental abuse, being unhoused; and providing services such as sexual health counseling, substance use disorder counseling, etc.
• The potential for dealing with dissatisfied or angry customers exists, requiring skills in conflict resolution.
• Clinic hours may start earlier than regular business hours.
• Occasional on-call work required.
• Work is 100% in person.

• Regularly required to sit or stand continuously.
• Time-management skills and boundary setting skills for management of clinical work hours. Many patients are walk-ins and acute evaluations.
• Ability to adapt to new technologies like Electronic Health Record updates, process updates etc.
• Regularly communicate clearly in-person, over the phone, and via written communication, including communicating with dissatisfied or angry individuals.
• Capable of reading physical and electronic documents and working for prolonged periods on a computer monitor.
• Fine motor skills to grip and manipulate paper and operate a telephone, a computer mouse and keyboard, and use standard medical equipment.
• Reaching and gross manipulation capabilities sufficient to pick up and use standard office supplies and medical equipment.
• Frequently move throughout the clinic.
• This position may require lifting, carrying, pulling, or moving objects up to 10 pounds consistently, 20 pounds frequently, and exerting up to 50 pounds of force occasionally.
• Learn, recall, and apply specialized information.
• Work effectively when exposed to workplace stressors, such as emotional and/or confrontational individuals.
• Regularly work effectively in the presence of visual, auditory, or other distractions.

• Duties require the use of standard office furniture and equipment (e.g., desk , filing cabinet, computer, printer, telephone, copy machine, etc.).
• Standard medical office equipment (e.g., stethoscope, otoscope, blood pressure cuff, scale, speculum, scalpel, suture, etc.).

• Occasional travel may be required, and is typically local or regional, to meet with clients, conduct business, or attend training.