Critical Care Nurse Practitioner or Physician Assistant - Cardiothoracic Surgery ICU, CTICU

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The largest of the four Duke Healthhospitals with 1062 patient beds, it features comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.

Job Location

Duke University Hospital

Job Summary

The Duke Hospital Cardiothoracic Intensive Care Unit (CTICU) Advanced Practice Provider (APP) provides direct patient care services for complex critically ill cardiothoracic surgery and Advanced Heart Failure patients, predominately in an intensive care setting in collaboration with cardiac anesthesiology and under the supervision of the cardiothoracic surgeon(s) and the Medical Director of the CTICU. The APP 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, and provides direct patient care services.

Job Duties and Responsibilities

Provide /coordinate clinical care for cardiothoracic surgery patients at Duke Hospital being followed primarily in the Cardiothoracic Intensive Care setting through established protocols and under the supervision of the cardiothoracic surgeon or back-up supervising physician who is either on site or available by pager

Patient rounding in collaboration with attending cardiothoracic surgeon(s), cardiac anesthesiologist(s), CTICU intensivists, and Medical Director of the CTICU,  round daily on patients to assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of cardiothoracic patient care;

Perform procedures when indicated: (Partial listing…full list will be shared upon request or at time of interview)

• Intubation / Extubation and/or airway management
• Flexible bronchoscopy for non-biopsy purposes in patients with an artificial airway
• Ventilator Management
• Tracheostomy tube changes
• Removal of diaphragm sutures
• Chest tube insertion / management / removal
• Paracentesis

Thoracentisis

• Blood sampling via central venous lines (CVLs) including temporary central catheters, tunneled catheters, implantable vascular access devices
• Arterial and Venous sticks
• Arterial line placement and removal
• Intraortic balloon pump (IABP) removal
• Venous line placement/central line including PA catheter placement, temporary dialysis catheter, temporary transvenous pacemaker
• Venous line removal including temporary dialysis catheters
• Place gastric or post-pyloric feeding tubes
• Management of peripherally placed central and peripheral venous catheters (PICC/C)
• Peripheral intravenous catheter placement (PIV)
• Wound management including wound vac, application of dressings and bandages, simple debridements, suture removal/placement, local cauterization, staple removal/placement
• ECG Interpretation including atrial ECG
• Defibrillation/Cardioversion
• Temporary pacemaker wire removal and clipping as well as programing
• Transcutaneous pacing
• Assisting with ECMO cannulation/decannulation
• Manage acute cardio and/or respiratory decompensation, including rapid response and/or code
• Management of Mechanical Circulatory Support Device devices

Collaborate with the chief resident, residents and fellows to formulate treatment plans and monitor patient progress

Assess patients for change in status and institute appropriate interventions.  Initiates emergency interventions in an effort to stabilize the patient until physician support arrives.

Preoperative evaluation; including (but not limited to) establishing diagnosis, and baseline status

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.

Analyze clinical practice patterns so as to provide the best medical care and to increase effectiveness and efficiency.

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’ chart 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.

Utilize prescriptive privileges only for identified patient population.

Role models competence in all nurse practitioner / physician assistant advanced skills.

Job Eligibility Requirements

Education

• NP:       Graduate of accredited MSN or DNP Acute Care Nurse Practitioner Program for adult care.
• PA:       Graduate of accredited Masters or Doctorate Degree Physician Assistant Program

License

• NP:       Current and unrestricted RN license issued by or recognized by the NCBON with authorization to practice as a NP
• PA:       Current and unrestricted medical license issued by the NCMB with authorization to practice as a PA
• Both:    Federal and State DEA with prescriptive authority

Certification

NP:       ACNP, AGACNP (no other APRN certifications will be considered)

PA:       PA-C

• Experience
• NP:       1 year experience in high acuity adult CTICU/ICU strongly preferred

will consider new grads with CTICU RN experience and/or CTICU rotation as NP student

PA       1-year experience as PA in an adult high acuity critical care/CTICU setting OR a one-year Critical Care Fellowship

Will consider new grad PA with CTICU rotation while in PA school

Physical and mental requirements:

Able to clearly articulate scope of practice and practices within those guidelines as an NP/PA in the state of North Carolina and within the Duke University Health System (DUHS)

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, and 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

Job Hours

Primary hours will be 12-hour rotational shifts / 7 days per week including holidays.

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes.

To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

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.