Pediatric Cardiac Stepdown Advanced Practice Provider; APP

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Nurse Practitioner or Physician Assistant

Duke University Hospital

The Duke Hospital Pediatric Cardiac Stepdown Advanced Practice Provider (APP), including 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, and chronic illness across a variety of care settings. It is appropriate for the NP to provide care for an aging pediatric patient beyond the age of 21 with a pediatric condition for a limited period of time.

Utilizing acquired knowledge of physiology, pathophysiology and pharmacology, the Pediatric Cardiac Stepdown APP exercises independent decision making in the assessment, diagnosis and development of the plan of care for patients on the Pediatric Cardiac stepdown service. In collaboration and consultation with the supervising physician, the APP contributes to excellence in patient care. As an advanced practice provider, the APP is additionally involved in education, consultation, research and leadership throughout the Duke Health System, organization and profession.

• In collaboration with the attending of service 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 APP colleagues, nurses, and patient resource managers 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 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.
• 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 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, resident and/or intern at the end of the shift.

• Assess educational needs of the patient-care staff and provide one-on-one as well as formal education as needed.
• Assess educational needs ofthe 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.

• 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…