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

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

About Duke University Hospital

Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States and is the number one hospital in North Carolina, according to U.S. News and World Report for . Duke University Hospital is the largest of Duke Health's three hospitals and features 1048 patient beds, 65 operating rooms, as well as 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, as well as other units within Duke University Hospital including the OR, PACU, Step-down units, inpatient units, emergency department (ED), and hospital-based clinic settings 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 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…