Advanced Practice Registered Nurses / Physician Assistants
Duke University Hospital is consistently rated as one of the best in the United States and is known around the world for its outstanding care and groundbreaking research. Duke University Hospital has 957 inpatient beds and offers comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center; a major surgery suite containing 51 operating rooms; an endo-surgery center; an Ambulatory Surgery Center with nine operating rooms and an extensive diagnostic and interventional radiology area. In fiscal year 2018, Duke University Hospital admitted 42,916 patients and had 1,085,740 outpatient visits in fiscal year 2017.
U.S News & World Report named Duke University Hospital #1 in North Carolina and #1 in the Raleigh-Durham area in 2018-19.
Duke University Hospital is ranked in the top 20 nationally for seven adult specialties, including cardiology and heart surgery, nephrology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology.
In addition to its hospitals, Duke Health has an extensive, geographically dispersed network of outpatient facilities that include primary care offices, urgent care centers, multi-specialty clinics and outpatient surgery centers.
Duke Nursing Highlights:
Duke University Health System is designated as a Magnet® organization
Nurses from each hospital are consistently recognizedeach year as North Carolina's Great 100 Nurses.
Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy for being strong advocates of specialty nursing certification.
Duke University Health System has 6000 + registered nurses
Quality of Life: Living in the Triangle!
Duke University Hospital
Center for Advanced Practice
Pediatric Critical Care Medicine (PCCM) Advanced Practice Provider (APP)
Pediatric Intensive Care, Pediatric Cardiac Intensive Care and Progressive Care Units
The Duke Hospital Pediatric Critical Care Medicine Advanced Practice Provider (APP), includes both Nurse Practitioner (NP) and/or Physician Assistant (PA), provides direct patient care services for critically ill pediatric patients aged 0-21 with acute, complex, critical, and chronic illness across a variety of care settings. It is appropriate for the APP to provide care for an aging pediatric patient beyond the age of 21 with a pediatric condition for a limited period of time. Pediatric Critical Care medicine APPs will care for patients in the Pediatric Intensive Care unit (PICU), Pediatric Cardiac Intensive Care unit (PCICU), and Pediatric Progressive Care Unit (PPCU). In addition, APPs will provide critical care management on the Rapid Response and Code blue teams.
Utilizing acquired knowledge of physiology, pathophysiology and pharmacology, the PCCM APP exercises independent decision making in the assessment, diagnosis and development of the plan of care for patients on the PCCM service. In collaboration and consultation with the supervising physician, the PCCM APP contributes to excellence in patient care. As an advanced practice provider, the PCCM APP is additionally involved in education, consultation, research and leadership throughout the Duke Health System, organization and profession.
NP: Work requires completion of accredited graduate level Pediatric Acute Care Nurse Practitioner
PA: Work requires graduation from a Physician Assistant program accredited by the Accreditation Review
Commission on Education for the Physician Assistant (ARC-PA) or its predecessor agencies.
NP: Current licensure as a Registered Nurse in the state of North Carolina and approval to practice as an
PA: Licensure as a Physician Assistant in the state of North Carolina.
NP: National certification as an NP (Pediatric Acute Care certification)
PA: National Commission on Certification of PAs (NCCPA) certification is required
Master's degree required for Nurse Practitioners and strongly preferred for Physician Assistants. Prior experience as a Nurse Practitioner/Physician Assistant in a pediatric acute care clinical setting strongly preferred. Registered Nurses with at least 2 years of ICU nursing experience preferred.
Rotating 12 hours shifts to provide 24hour/day 7 day a week coverage. Schedule may be modified by the clinical or leadership team.
The pediatric Critical Care Medicine Advanced Practice Provider will report directly to the Center for Advanced Practice Team Leader and Director, with input from Supervising Physician into clinical performance appraisal and expected job results.
Process of Evaluation
Evaluation will be ongoing and will encompass the six general areas of competency as defined by The Joint Commission (patient care, medical/clinical knowledge, practice-based learning & improvement, interpersonal & communication skills, professionalism and systems-based practice). Annual and midyear evaluations using the CAP PPR process will be conducted by the Center for Advanced Practice, in coordination with NP/PA's primary supervising physician. Ongoing Review of Care and Quality Improvement meetings with supervising physician will be conducted and documented monthly for the first six months, in accordance with Duke University's and the designated Board's standards, then at least once every six months in accordance with the NC Medical Board.
Specific Job Responsibilities and Standards
In collaboration with attending(s) and/or fellow/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 supervising physician or back up physician who is either on site or available by pager.
Collaborate with the residents, fellows, attending other APP colleague's, nurses, and other staff to formulate treatment plans and monitor patient progress.
Perform procedures specific to the work environment after demonstrated competency and within the guidelines of scope of practice and credentialing protocols.
Assess patients for change in status and institute appropriate interventions. Initiate emergency interventions in an effort to stabilize the patient
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 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' 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.
Utilize prescriptive privileges only for identified patient population.
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.
Role model competence in all nurse practitioner / physician assistant advanced skills.
Give daily handoff to appropriate attending, APP, fellow, resident and/or intern at the end of the shift.
Provide evidence base clinical care to pediatric patients cared for by the division of PCCM
Gather pertinent information systematically and skillfully from all sources: History, diagnostic tests, comprehensive physical exams, behavioral and developmental assessments.
Bill appropriately for all APP services.
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 education in patients' medical record.
Implement and evaluate appropriate educational programs for DUHS patient care staff and other healthcare providers as appropriate.
Role model and precept healthcare learners through contractual agreements.
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.
Participate in interdisciplinary quality improvement and/or research activities.
Participate in measuring and documenting outcomes.
Identify potential areas for research
Provide expertise and resource information to other healthcare providers, patients and families, and the community at large related to pediatric diseases, procedures, interventions, and conditions.
Implement and evaluate appropriate educational programs for referring MDs
Develop, implement and evaluate standards of care/practice guidelines/policies and procedures/care maps/protocols within area of specialization.
Develop programs and projects in areas of expertise to facilitate the attainment of the goals and objectives of the Duke University Hospital and Duke University Health System.
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.
Demonstrate responsibility for professional practice through active participation in the CAP, and professional organizations. Meet Continuing Education requirements as designated by the NC Medical Board and/or NC Nursing Board. Maintain professional certification.
Enhance the body of knowledge in area of specialization through written publications, oral presentations, posters, continuing education, etc.
Maintain all professional requirements for licensure and certification
Attend educational conferences regularly, morbidity and mortality conferences, code reviews, NP monthly meetings and attend twice a year adult congenital sessions.
When caring for adult congenitals plan for situations beyond expertise, consult with and refer to other health care providers as appropriate.
Excellence – We strive to achieve excellence in all that we do.
Acts – and makes decisions – in the best interests of patients and their loved ones, and willingly accepts accountability for outcomes.
Improves performance that enhances patient care and advances individual, team and organizational goals.
Effectively uses DUHS resources (time, budget and property) to support optional patient care and operational performance while adhering to organizational policies and procedures.
Seeks opportunities to improve service provided to patients and their loved ones related to clinical care and support.
Safety – We hold each other accountable to constantly improve a culture that ensures the safety and welfare of all patients, visitors and staff.
Strictly adheres to all established patient, staff and faculty safety procedures.
Contributes to an environment of safety and security for patients and staff through individual actions.
Speaks up about all risk of harm; reports patient, staff safety or injury events within twenty-four hours of incident or awareness of incident.
Actively participates in all mandatory patient and staff safety training.
Integrity – Our decisions, actions, and behaviors are based are based on honesty, trust, fairness, and the highest ethical standards.
Is truthful and honest with patients, their loved ones, and co-workers, and consistently exhibits actions that reflect our values.
Is accountable for actions and decisions involving patient care or other operational activities, and strives to learn and improve from experience.
Follows through on commitments made to patients, visitors, co-workers, and others.
Conducts work positively while doing so in full compliance with all organizational policies, procedures, expectations and patient-centered values.
Diversity – We embrace differences among people.
Applies cultural understandings and sensitivities to enhance patient care, and improves interactions with people of diverse backgrounds.
Treats all individuals – patients, visitors and co-workers – with courtesy, dignity and respect.
Contributes to a work environment that is welcoming to all – whether patients, visitors, staff or faculty.
Demonstrates a sensitivity and awareness of the needs of a diverse workforce and patient population.
Teamwork – We have to depend on each other and work well together with mutual respect to achieve common goals.
Willingly shares expertise and information with others to improve patient care, unit or departmental performance without compromising individual responsibilities.
Celebrates the accomplishments of others in making a difference in the lives of patients and the success of the organization.
Takes ownership of decisions made by specific patient care or project teams, and team leaders, and the individual role needed to support them.
Manages multiple demands while maintaining quality and courtesy; acknowledges and resolves patient or visitor issues.
Contributes to a positive team by acting positively and discouraging gossip and negative talk
Communicates openly and respectfully
Helps to resolve conflict with in the team.
Volunteers for internal and external committees and works collaboratively.
APP Procedures and Devices
The APP is able to perform procedures pertinent to the PICU/PCICU within the Duke Health System. These procedures are reviewed and validated through skills labs, procedure QI, and direct supervision on a yearly basis.
The work environment involves risk discomforts that are typical of an acute care setting to include working with patients under isolation and universal precautions. It requires safety precautions, ongoing education and health risk monitoring. Contact with specimens, chemicals, sharps, radiation, technical equipment and fumes are possible. Employees are required to wear personal protective attire according to hospital policies and OSHA guidelines. The work activity and patient acuity levels can create a stressful atmosphere.
In case of an emergency, it is imperative for the APP to act immediately. The on-call attending physician is always available by phone, pager, or is on site. The APP will utilize in-house resources such as other members of the PCCM service (ie. Fellows other APPs, the Pediatric Rapid Response Team, Code Blue Team) and the Emergency Airway Team as needed. The APP will implement Basic Life Support (BLS), Pediatric Advanced Life Support (PALS), Advanced Cardiac Life Support (ACLS) resuscitation measures as needed and call the on-call attending physician.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel classified in this position.
Duke is an Affirmative Action/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, sexual orientation, or veteran 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 essentialjob 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.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.