Advanced Practice Provider - Critical Care

St. Charles Health System•Bend, OR

1d•Onsite

About The Position

The Advanced Practice Providers (APPs) work as part of the Critical Care team. They work under the direction and supervision of the attending intensivist and facilitate care of ICU patients from admission to discharge, in collaboration with the attending physician. The APP will discuss and update the Intensivist on duty with significant changes in the patient’s condition, new test results, and will attend Team rounds daily. New admissions will be discussed collaboratively with the Intensivist to develop a Plan of Care. This is NOT an independent practice model for APPs and at all times a patient’s plan of care and actual care should reflect the informed judgment of the Attending Intensivist. Each APP should have a strong foundation in evidenced based practice and ensuring an environment of safe, quality care. They should also demonstrate an advanced level of medical knowledge, clinical/technical competence, solid clinical decision making, critical thinking skills, professional communication skills, timely and complete documentation, and are responsible for personal and professional development with competency validation. APPs provide quality patient and family centered care as a member of the health care team in accordance with SCHS mission, philosophy, policies, and procedures; They provide specialty medical care within defined scope of practice under the supervision of a licensed physician, are responsible for daily patient flow in the ICU setting, and use critical skills to make appropriate patient health assessments and that should align with the physician’s plan of care. APPs do not directly manage any other caregivers. Work schedule: APP will work at least one hundred fifty-six (156) shifts per reconciliation year for a full-time exempt employee and will be prorated for any FTE that is established below a full-time status. Provider Practice Location: Provider will render the Professional Services at such SCHS Facilities as may be directed by St. Charles Health System, and at such other facilities and locations as may be established by SCHS from time to time. It is anticipated that the primary work locations will be as follows: Practice Locations: St. Charles ICU - 2500 NE Neff RD Bend, OR

Requirements

Graduation from an accredited Physician Assistant or Nurse Practitioner program
Physician Assistant requires NCCPA certification
Nurse Practitioner requires AANC certification
Complete annual fire/safety, etc. education in-services as required
Attend mandatory educational offerings as described in SCHS policies/procedures and/or as required by other regulatory bodies
Complete annual CME as required to maintain license and appropriate Board certification
Complete by assigned due date Computer Based Learning modules
Unrestricted Physician Assistant and/or Nurse Practitioner licensure
Physician Assistant requires NCCPA certification
Nurse Practitioner requires AANC, NCC or AANP, AMCB certification
Unrestricted Federal DEA number
Unrestricted ability to participate in Medicare / Medicaid, or other federal or state governmental health care programs
Valid driver’s license and the ability to meet SCHS driving requirements
Current BLS certification required
Current ACLS certification required
Current ATLS certification required
Additional certifications may be required based on privileges granted to provider by Medical Staff Services at SCHS Inpatient locations
Two years’ experience as an Advance Practice Provider of which at least one year should be in the practice specialty
Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely
Must have excellent communication skills and ability to interact with a diverse population and professionally represent SCHS
Strong team working and collaborative skills
Ability to multi-task and work independently
Attention to detail
Excellent organizational skills, written and oral communication and customer service skills, particularly in dealing with stressful personal interactions
Intermediate to advanced proficiency with Electronic Medical Record systems
Intermediate in Microsoft applications (Word, Excel)
Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level
Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation
Occasionally (25%): Bending, climbing stairs, reaching overhead, carrying/pushing or pulling 1-10 pounds, grasping/squeezing
Rarely (10%): Stooping/kneeling/crouching, lifting, carrying, pushing or pulling 11-25 pounds, operation of a motor vehicle
Never (0%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 25-50 pounds, ability to hear whispered speech level

Nice To Haves

One year in Critical Care medicine

Responsibilities

Round on every patient in ICU with the ICU care team (ICU physician, pharmacy, RNs, dietitian, etc)
Document a comprehensive list of changes to each day’s plan of care
Update hospital course progression/daily and significant events in the “Care Coordination Note”
Keep “Problem List” updated (only have current problems in active problem list)
Ensure labs/imaging ordered for that day or the future (i.e. next morning’s labs) when appropriate
Place orders while on rounds (i.e. medications, labs, imaging, communication orders)
Consult specialists
Be able to answer critical and non-critical patient questions from RN/RT/staff and place orders when necessary
Teach staff and families about treatment plans
Facilitate family meetings and goals of care, in collaboration with the attending physician
Participate in multidisciplinary rounds
Take Histories and Review of Systems from ICU patients/families, performs physical exams
Review outside records, completes full H&P’s, orders appropriate diagnostic studies and coordinates among providers
Write H&Ps, Consults, progress notes, discharge summaries on ICU patients
Sign death certificates
Evaluate each emergency department consults for admission and place admission orders with each admission to ICU, in collaboration with attending physician
Perform procedures (i.e. central lines, arterial lines, etc) that are consistent with medical staff privileges and individual capabilities
Discharge patients from ICU while providing discharge orders, summary, medications and prescriptions, proper follow up
Transfer patients and call “sign out” to hospitalists when a patient transfers out of ICU to the medical floor, PCU, etc
Update sign out patient list daily under “Pulmonary sign outs” drive → “ICU sign out” and print for night ICU physician
Call patient families daily with updates on patient care and answer family questions
Clinical preceptor for PA and NP students rotating through the ICU
Provide targeted assessment and evaluation, including diagnostic impression and functional status on presenting problem(s)
Examine, diagnose, and treat acute and chronic medical conditions.in collaboration with the Attending Intensivist
Effectively utilize team-based care model, leveraging expertise of all members of multi-disciplinary team
Share knowledge with other team members and patients both formally (in-services, consult responses) and informally (hallway conversations)
Collaborate in education with residents and medical students
Monitor effectiveness of plan of care
Educate patients and families on diagnoses and treatment plans
Collaborate and/or consults with physicians and other health care providers as appropriate
Help to provide ICU care in collaboration with the attending Critical Care Physician Intensivist: including daily rounds, fielding post-operative patients/admits/transfers, and continuous medical management
Document all patient care within the Electronic Medical Record (EMR) and complete all necessary tasks in compliance with health system policies and regulatory agencies to ensure timely and accurate billing
Be familiar with the SCHS organization structure
Participate in provider meetings and assist in policy formation for SCMG and Physician’s practice
Keep medical knowledge and skills current through regular CME activity
Must attest to having adequate (CME) to meet maintenance of board certification and compliance with MSO rules and continuing privileges without restriction
Keep all licenses and appropriate certifications current and unrestricted
Maintain active privileges at a St. Charles Health System hospital sufficient to permit performance of job duties
Participate in creating a healing environment that supports all aspects of the care environment and the wholeness of each individual, patient and caregiver
Provide and maintain a safe environment for caregivers, patients and guests
Conduct all activities with the highest standards of professionalism and confidentiality
Deliver first-rate patient care in a manner that promotes goodwill, and is timely, efficient and accurate, and courteous
Educate, counsel, and assist patients and families regarding current health problems, health maintenance activities and preventive behaviors
Provide a therapeutic presence in service to others by purposefully responding to the needs of patients/customers in a caring way
Comply with all applicable laws, regulations, policies and procedures, supporting the health system’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violations of applicable rules, and cooperating fully with all health system’s investigations and proceeding
It is expected that the APP will develop a plan of care in collaboration with the attending physician and will be responsible for updating the attending physician regarding a patient’s progress and any anticipated change in that plan of care
This collaboration specifically includes updating the Attending Intensivist regarding changes in a patient’s condition; new lab and imaging studies that result; and any communications from consultants
All admissions done by the APP should be staffed with the attending physician as soon as possible and all admitting orders should be reviewed at that time
Likewise, any changes in a patient’s condition, diagnoses or orders should be communicated to the attending physician in a timely manner
The APP should have a deep understanding of feasible goals of care relative to any patient before engaging any patient or his/her family in conversations that address goals of care
These conversations should be cleared with the attending physician before they occur, allowing the attending physician to provide input, direct participation in, and/or opportunity to lead in those discussions