Advanced Practice Registered Nurse - Medicine, Nephrology - Full Time

University of Miami•Miami, FL

51d

About The Position

The Advanced Practice Registered Nurse ("APRN") delivers patient-family centered care in a culturally competent and compassionate manner, utilizing and promoting evidence-based standards of quality, safety, and service while ensuring population-specific patient care. The APRN provides and directs hands-on care to patients, practicing within the Scope of Practice of the Florida Board of Nursing requirements, standards of care, and institutional policies and procedures. Within this role, the APRN performs all steps of the care process and monitors the quality of care provided. The APRN demonstrates expertise and mastery towards patient care, providing care within the philosophy, mission, and objectives of the health system. The APRN delivers care that supports the UHealth mission to be a state-of-the-art academic medical center by participating in transforming patient care through innovative research. The APRN is responsible for assessing physical and psychosocial status of patients in an outpatient clinic setting by means of interview, health history, physical examination, and diagnostic studies. Assist physicians in performing and documenting medical procedures, up to and including blood drawing, vital signs, nursing assessments, and history and physicals. The incumbent will spend up to 8 half days per week in outpatient Nephrology clinics. APRN will manage ambulatory patients with chronic kidney disease, create and carry out treatment plans, educate about medication use, diet restrictions, and renal replacement choices, and collaborate with consultants. APRN will be expected to cover outpatient dialysis service, as needed. In addition, the APRN will rotate as necessary in our UHealth Tower and Jackson Memorial Hospital inpatient dialysis units managing patients with end-stage kidney disease who are supported with hemodialysis, report findings to and discuss management with the supervising physician until deemed independent and provide education to patients. Seeking an Advanced Practice Provider (Nurse Practitioner or Physician Assistant) to join the Nephrology team providing care primarily in the outpatient hemodialysis setting, with flexibility to assist with inpatient nephrology coverage at Jackson Memorial Hospital or UMH as needed. This role supports seamless continuity of care between the dialysis unit, CKD clinic, and hospital, maintaining a balanced and collaborative workflow. APRN inpatient job description The APRN will see alone all ESRD consultsâ¯with the exception ofâ¯PD patients Fellow and APRN should sign out guarded status patients every day at 5pm to the night float fellow via text or phone call. APRN to cover fellow when at clinic, if needed. The APRN will carry an APRN ESRD phone from 8am to 5pm. Inpatient job description is based on service needs; APRNs are exempt staff, not hourly. For inpatient daily responsibilities, APRN is to arrive no later than 8am and leave at 5pm or unless service dictates otherwise. Fellows on the consult service, will forward their phones from 11:45am to 1 pm on Monday, Thursday and Fridays to the APRN of the hospitals they are assigned to. Either Jackson Memorial or UHT/ Daily huddle at 11:30am between APRN and fellow to bring up to date about calls/new consults/follow upâ¯questions via text or phone call. Whoever is holding phone should text the other teams if they get a new consult. It is the responsibility of the ARNP to find coverage when going on vacation or absent leaves by another APRN for both inpatient and outpatient activities, ex. answer calls from patients followed in outpatient clinics, covering inpatient services, and covering outpatient dialysis services APRN should declare vacations 2 or 3? months ahead of time and assigned coverage and cancel their PM clinic. APRN inpatient coverage during sick days, the APRN should email the APRN lead (MD supervisor and Elias Fernandez, APRN, and Sr. Clinical Practice Manager) and the faculty on service to have the teams find coverage. It is expected that APRNs will have at least 75% participation in our noon teaching conferences. APRNs will be evaluated by their clinic patients using the Ganey consumer experience survey; group and individual data will be shared monthly. APRNs are expected to see consults until 5 PM even during clinic days.

Requirements

Masters or Doctorate in Nursing (APRN) or Masters in Physician Assistant Studies from an accredited program.
Current board certification as an Acute Care nurse practitioner by an accredited APRN certifying body required
Valid State of Florida required
BLS - Basic Life Support certification required
Must have a National Provider Identifier (NPI), or obtain an NPI, prior to employment start date and meet current Medicare requirements for billing
Minimum of 1 year of relevant experience.
Strong, effective communication skills with patients, families, and clinical team for innovative patient care and trust
Ability to collaborate with peers in the best interest of the patient to provide consistent quality of care
Ability to adapt and exhibit flexibility to handle new, different, or changing environments
Demonstrates strong time management skills to prioritize, triage, and act proactivity
Ability to uphold professional ethics and maintain patient confidentiality
Knowledgeable on all aspects of patient care including assessing, planning, coordinating, monitoring and evaluating the patients' progress through continuum of care

Responsibilities

Provides overall care with loving kindness.
Uses creative problem-solving to meet the individual needs and requests of patients.
Helps support the hope and faith of patients cared for.
Is responsive to patient readiness to learn when they are taught something new.
Is respectful of individual patient spiritual beliefs and practices.
Creates an environment for the patient that helps them heal physically and spiritually.
Establishes a helping-trusting relationship with the patients during their treatment period.
Responds to each patient as a whole person, helping to care for their needs and concerns.
Encourages patients to speak honestly about their feelings, no matter what their feelings are.
Contributes concise, constructive feedback in the provision of care to other staff and leadership.
Assumes responsibility and delegates to appropriate personnel and follows up to ensure completion.
Serves as a clinical role model, mentor, and/or preceptor.
Teaches others, suggests process improvements, provides evidence-based practice suggestions, coaches others to improve, support changes, and recognizes contribution of others.
Participates and/or leads committees and task forces as they advance in expertise.
Creates and maintains a climate conducive to healing through being present to the patient and family.
Leads and collaborates with the care team in identifying and managing discomforts; providing emotional support and information; guiding the patient and family through phases of illness and recovery/passage to death in accordance with the patient's goals and culture.
Mobilizes the patient's strengths and abilities towards participation in recovery and control over plan of care.
Obtains accurate and relevant assessment data and interprets the data as normal vs. abnormal.
Determines diagnosis.
Modifies patient treatment plans as indicated by patients' responses and conditions and collaborates with physicians and other team members.
Collaborates with the patient, family, and members of health care team to develop an individualized plan of care including discharge planning.
Implements medical interventions safely.
Performs appropriate patient tests and safely administers medications within the scope of practice.
Administers and maintains accurate records related to medications and treatments as per regulatory bodies, policies, and procedures.
Evaluates effectiveness of interventions and monitors patient for adverse responses and side effects.
Utilizes available technology platforms for telehealth encounters.
Initiates and leads the development of policies, procedures, protocols standards of care; examines and questions treatment to determine if they are within best practice.
Assesses a patient's and family's learning needs and readiness to learn.
Teaches needed information for self-care and illness management and prevention.
Adjusts information and expectations based on responses from patient, developmental levels, physiological and psychological condition, and cultural variations while addressing and meeting the needs of any language barriers that may be present.
Rapidly grasps problem situations and responds quickly and appropriately.
Identifies the need for and activates emergency protocols.
Serves as a transformational leader in assisting others to adapt to changing work demands and environment.
Anticipates possible problems and assists leadership in the development of contingency plans.
Monitors own practices and assists in monitoring and evaluating others for practices related to patient and employee safety and compliance to standards and policies.
Looks for opportunities for continual improvement in patient care and the work environment.
Adheres to University, departmental and unit-level policies and procedures and safeguards University assets.
Participates in activities such as, leading an Evidence-based Practice/Performance Improvement project and/or a nursing theory-based, methodologic approach to develop/submit a research proposal for Institutional Review Board (IRB).
Integrates multiple requests and work expectations by setting priorities, delegating tasks appropriately, and seeking assistance as needed.
Contributes to team building through participation in unit programs and meetings.
Contributes to positive morale, using constructive and effective conflict resolution skills.
Learns and utilizes the available technology for communication, documentation, and locating information regarding unusual clinical situations, diagnosis, and treatments.
Contributes to the knowledge and skill of other members of Advanced practice through one or more activities such as formal or informal teaching, participation in Shared Governance groups, professional publications and/or presentations.
Attains and maintains knowledge and competence that reflects current advanced nursing practice for assigned patient population through professional development activities.
Demonstrates an advanced level of competency in practice.
Engages in activities such as membership or leadership of a workshop or specialty continuing education course; serving as resource/super-user/specialist/support; teaches specialty competency development and proctor skill validation
Communicates plan of care in a timely manner to patient and family, as well as the appropriate team members, ensuring compliance with all regulatory guidelines (i.e., HIPAA).
Uses best practices for transition of patient care.
Meets diverse communication needs of patients with Limited English Proficiency (LEP).
Evaluates Advanced practice in relation to professional practice standards and guidelines, relevant statues, rules, and regulations.
Provides focused constructive feedback and guidance with loving kindness to peers in a manner that provides growth and maintains self-esteem.
Participates in shared governance, following the ANA Code of Ethics to elevate the professional, integrating the professional practice model and relationship- based care, delivery model into their practice.
Integrates the Magnet Model components into practice.
Incorporates protocols and standards of care into daily practice.
Uses sound judgement, decision making criteria, and available resources for drawing conclusions and taking required action.
Applies evidence-based practices, approaches and solves problems with a global perspective using creativity and flexibility.
Manage outpatient dialysis patients (minimum 3 visits per patient per month) and collaborate with the multidisciplinary dialysis team.
Conduct a ½-day CKD clinic weekly for chronic kidney disease management.
Assess and manage volume status, vascular access, anemia, bone-mineral balance, and medication adjustments.
Provide inpatient nephrology week and weekend coverage at JMH/UMH as needed
Recognizes deviations from normal in the physical assessment. Works in collaboration with a physician in formulating treatment plans for health problems and follow-up.
Writes prescriptions for medication, blood products based upon laboratory results, routine diagnostic and follow-up studies, therapeutic measures, diet, and post-discharge care in accordance with written practice protocols.
Participates in and facilitates clinical research protocols and coordinates patient care with research staff.
Obtains complete medical history and physical examinations without supervision by the physician.
See patients in follow up in between dialysis treatments and post procedure as necessary
Initiate and Maintain orders as per protocol
Orders appropriate laboratory tests according to practice guidelines.
Develops, implements, and evaluates a plan of care that is appropriate for the patient and family.
Actively participates in quality assurance programs and peer review activities.
Responsible for providing assistance to physicians in the care and treatment of patients.
Provides medical support to staff, triaging and implementing care in a knowledgeable and skillful manner, as evidenced by team feedback and documentation in medical records.
Assess severity of patient's condition, determining and directing patients to appropriate medical providers.
Requests prior authorizations and provides peer-to-peer reviews with insurance carriers in support of patients' medications
Consents patients for procedures, and places orders for procedures
Maintain EMR inbox and close encounters in a timely fashion according to UMMG guidelines.
The APRN will see alone all ESRD consultsâ¯with the exception ofâ¯PD patients
Fellow and APRN should sign out guarded status patients every day at 5pm to the night float fellow via text or phone call.
APRN to cover fellow when at clinic, if needed.
The APRN will carry an APRN ESRD phone from 8am to 5pm.
Fellows on the consult service, will forward their phones from 11:45am to 1 pm on Monday, Thursday and Fridays to the APRN of the hospitals they are assigned to. Either Jackson Memorial or UHT/
Daily huddle at 11:30am between APRN and fellow to bring up to date about calls/new consults/follow upâ¯questions via text or phone call.
Whoever is holding phone should text the other teams if they get a new consult.
It is the responsibility of the ARNP to find coverage when going on vacation or absent leaves by another APRN for both inpatient and outpatient activities, ex. answer calls from patients followed in outpatient clinics, covering inpatient services, and covering outpatient dialysis services APRN should declare vacations 2 or 3? months ahead of time and assigned coverage and cancel their PM clinic.
APRN inpatient coverage during sick days, the APRN should email the APRN lead (MD supervisor and Elias Fernandez, APRN, and Sr. Clinical Practice Manager) and the faculty on service to have the teams find coverage.
It is expected that APRNs will have at least 75% participation in our noon teaching conferences.
APRNs will be evaluated by their clinic patients using the Ganey consumer experience survey; group and individual data will be shared monthly.
APRNs are expected to see consults until 5 PM even during clinic days.