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

Duke Careers•Durham, NC

7d•Onsite

About The Position

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 2023-2024. 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. Candidates with 2 years related experience are eligible for a $20,000 commitment bonus. 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 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.

Requirements

NP: Graduate of accredited MSN or DNP Acute Care Nurse Practitioner Program for adult care.
PA: Graduate of accredited Masters or Doctorate Degree Physician Assistant Program
NP: Current and unrestricted RN license issued by or recognized by the NCBON with authorization to practice as a NP
PA: Current and unrestricted medical license issued by the NCMB with authorization to practice as a PA
Both: Federal and State DEA with prescriptive authority
NP: ACNP, AGACNP (no other APRN certifications will be considered)
PA: PA-C
NP: 1 year experience in high acuity adult CTICU/ICU strongly preferred
PA 1-year experience as PA in an adult high acuity critical care/CTICU setting OR a one-year Critical Care Fellowship
Able to clearly articulate scope of practice and practices within those guidelines as an NP/PA in the state of North Carolina and within the Duke University Health System (DUHS)
Able to independently seek out resources and work collaboratively to solve complex problems
Able to communicate clearly with patients, families, visitors, healthcare team, physicians, administrators, leadership, and others
Able to use sensory and cognitive functions to process and prioritize information, perform health assessments, treatment, and follow-up
Able to use fine motor skills
Able to record activities, document assessments, and interventions; prepare reports and presentations.
Able to use computer and learn new software programs
Able to provide leadership in clinical area of expertise and in meeting organizational goals
Able to navigate the Hospital and DUHS to provide clinical expertise to specific patient populations
Able to withstand prolonged standing and walking with the ability to move or lift at least fifty pounds
Able to remain focused and organized
Able to work collaboratively with all levels of personnel

Nice To Haves

will consider new grads with CTICU RN experience and/or CTICU rotation as NP student
Will consider new grad PA with CTICU rotation while in PA school

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 response to therapies/interventions; communications with supervising MD.
Utilize prescriptive privileges only for identified patient population.
Role models competence in all nurse practitioner / physician assistant advanced skills.