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Duke University Hospital

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The Duke Abdominal Transplant Surgery Hospitalist Advanced Practice Provider (NP or PA-C) provides direct patient care services for surgically ill adult, adolescent and pediatric patients on an intermediate and/or step-down unit or in the clinic in collaboration with residents and surgeons. The NP or PA 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, may assist in the operating room and provides direct patient care services. The Nurse Practitioner or Physician Assistant contributes to excellence in patient care, research, teaching and provides leadership in the organization.

Primary hours will be fourteen 12 hour shifts 7 days a week covering days, night, weekends and holidays. Flexibility is required to meet clinical needs of the service.

Specific Job Responsibilities and Standards
Clinical Expert:
– In collaboration with attending surgeon(s) and/or residents, round daily on patients to assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of patient care.
– Provide and coordinate clinical care for service specific patients through established protocols and under the hospitalist supervising physician or back up physician who is either on site or available by pager.
– Collaborate with the chief resident, residents, fellows, attending other NP/PA colleague’s nurses, and patient resource managers to formulate treatment plans and monitor patient progress.
– Assess patients for change in status and institute appropriate interventions. Initiate emergency interventions in an effort to stabilize the patient until physician support arrives.
– 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.
– 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’ medical record 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.
– Prescriptive authority for prescribing, ordering, and or administering drugs; including (but not limited to) schedule II, III, IV, and V drugs and necessary medical devices.
– Give daily handoff to appropriate attending, resident and/or intern at the end of the shift

– The NP/PA may order and/or perform the following procedures:
a. Patient history and perform physical exam
b. Laboratory, radiology, and/or diagnostic procedures/tests
c. Interpretation of laboratory, radiographic and diagnostic tests
d. Chest tube insertion / removal (per service requirements)
e. Exchange Transfusion
f. Line placement for venous or arterial access:
• Percutaneous arterial line placement
• Percutaneous central line placement
g. Interpretation of PA, CVL, SG, VS interpretation and critical thinking skills
h. EKG interpretation
i. Suture / Staple removal
j. Application of dressings, bandages, NPWT
k. Simple debridement
l. Manage and insert cantor tubes, NG tubes, G tubes, J tubes
m. Manage support devices, including (but not limited to) hemovac, JP drains, arterial lines, NPWT
n. Removal of superficial foreign bodies
o. Venipuncture for blood sampling
p. Capillary blood sampling
q. Blood sampling via central venous lines, including:
• Temporary central catheters
• Tunneled catheters
r. Administration of infusion therapy/ oral medications including: but not limited to
• Anticoagulants
• Analgesics, Narcotics, including Patient Controlled Analgesia
• Antibiotics
• Antifungals
• Antivirals
• Antiarrhythmic
• Antihypertensives
• Inotropes
• IV Fluids
• Electrolytes
• Benzodiazepines
• Muscle relaxants
• Local anesthetics
• Blood products – Packed Red Blood Cells and / or Platelets
• Total parenteral nutrition
• Enteral nutrition
v. Application of dressings and bandages.
w. Inhalation therapy or medications to alleviate the distress of dyspnea or shortness of breath.

– Assess educational needs of the patient-care staff and provide one-on-one as well as formal education as needed.
– Assess educational needs of the patients / families and provide culturally-sensitive patient/family education interventions as indicated. Use non-technical language when educating patients and families. Document all pre and post-op/procedure education in patients’ medical record.
– Implement and evaluate appropriate educational programs for DUHS patient care staff and other healthcare providers as appropriate.

Research Utilization and Investigation:
– Utilize current research and evidence-based decision-making in all clinical practice.
– Incorporate clinical research findings in the development and implementation of standards of care.
– Support IRB approved clinical research/trials though a variety of activities including but not limited to: obtaining consent; ordering diagnostic tests; recording laboratory & diagnostic results; administering therapeutic interventions; and reporting patient outcomes including toxicities or adverse events.

– Provide expertise and resource information to other healthcare providers, patients and families, and the community at large related to cardiothoracic diseases, procedures, interventions, and conditions.
– Implement and evaluate appropriate educational programs for referring MDs

Professional Leadership and Development:
– Role model advanced practice professionalism through conduct, communication, dress, leadership, ethical decision-making, critical thinking and problem solving skills.
– Participate in at least one professional organization.
– Maintain all professional requirements for licensure and certification

Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual’s race, color, religion, age, gender, sexual orientation, national origin, genetic information, veteran status, or disability.

Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

Work requires completion of accredited Nurse Practitioner or Physicians Assistant Program.

3 years of nursing experience for NP’s. None required for PA’s

Degrees, Licensures, Certifications
Must have current or compact RN licensure in the state of North Carolina. BLS required. National certification as a NP required prior to or within 6 months of employment. PA’s must be licensed in the state of North Carolina, and be certified as a Physician Assistant by the National Commission on Certification of Physician Assistants. Must demonstrate and maintain credentialing and licensing requirements of Duke University Medical Center and The North Carolina Medical Board.

Physical and mental requirements:
– Able to clearly articulate scope of practice, and practices within those guidelines as a Nurse Practitioner / Physician Assistant
– 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 & 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

Lines of Responsibility
Primary supervising physician and back-up physicians and the Medical Director for the department of surgery, and to the Duke Hospital Department of Advanced Clinical Practice Team Leader and Director. In addition, s/he will be accountable to the surgery department for clinical outcomes, defined quality indicators and to the standards set forth by the Department of Advanced Clinical Practice (ACP).

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