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Duke Raleigh Hospital offers the latest in care and technology in a patient-friendly setting. It has been an important part of Duke Health since 1998 and has served Wake County for more than 35 years, employing more than 2,000 team members. The hospital provides 186 inpatient beds and a comprehensive array of services, including the Duke Raleigh Cancer Center, Duke Raleigh Orthopedic and Spine Center, cardiovascular services, neurosciences including the Duke Raleigh Skull Base and Cerebrovascular Center,advanced digestive care, disease management and prevention, wound healing, outpatient imaging, intensive and progressive care, pain clinic, same-day surgery, emergency department and community outreach and education programs. U.S. News & World Report ranked Duke Raleigh Hospital as high performing in orthopaedics and five adult procedures/conditions: chronic obstructive pulmonary disease (COPD), heart failure, kidney failure, lung cancer surgery, and stroke.

 

Cardiology Hospitalist APP

Nurse Practitioner or Physician Assistant

   

 

JOB LOCATION

Duke Raleigh Hospital

 

JOB SUMMARY

The Advanced Practice Provider, (APP) is a Nurse Practitioner (NP) or Physician Assistant (PA) who provides direct patient care services and performs medical acts as an NP or PA, under the supervision of the supervisory physician to patients on the cardiology service. This position will work with cardiology patients in the Cardiology Service including general cardiology, Electrophysiology (EP), and Heart Failure (HF) patients. Areas of clinical work include Duke Raleigh inpatient units and Emergency Department, Observation units, and Cath lab.  The Cardiology APP performs admissions, and physical exams, collects and documents data, conducts diagnostic and therapeutic procedures within scope, 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. The Cardiology APP contributes to excellence in patient care, research, and teaching, and provides leadership to the organization.

 

JOB DUTIES and RESPONSIBLITIES

 

The APP is responsible for providing/coordinating direct clinical care to adult cardiovascular patients on the designated unit, short stay unit and is also responsible for maintaining the practice consistent with the rules and regulations of the North Carolina Board of Nursing and Medical Board and the PDC and Duke Raleigh Bylaws. Duties include:

• Evaluate new patients, consults, and established patients on the cardiovascular service as well as diagnose, treat and manage common conditions in the cardiovascular patient population.
• Perform an appropriate history and physical exam on all assigned patients. The NP/PA will write progress notes; and prepare patient workups and summaries noting pertinent positive and negative findings; a psychosocial history will be obtained relevant to patient care. The APP will assume responsibility for developing therapeutic relationships with patients.
• Facilitate and order diagnostic studies including echocardiograms, cardiolite stress test, magnetic resonance imaging, and cardiac catheterization if indicated, review with attending MD
• Order and schedule laboratory studies and diagnostic procedures. Explain the necessity, preparation, nature, and anticipated effects of scheduled diagnostic and therapeutic procedures to the patient and family.
• Work closely with the inpatient rounding teams including attending, APP's, residents, and fellows to appropriately allocate workload based on daily census, clinical, and operational needs
• Assist in the training of new employees, students, and fellow trainees, to the limits of competence, and actively participate in educational conferences
• Participate in evaluations with the primary supervising physician weekly for the first month after initial hire then monthly for the first six months of a new practice engagement, and a minimum of every six months thereafter.  Any complications will be monitored on a monthly basis through routine quality assurance conferences.
• Discharge all assigned admitted/procedural/surgical patients, as directed by the Attending physician, including, but not limited to, completing discharge summary, patient education, patient wound care instructions, and performing medication reconciliation including prescriptions and entering discharge orders and follow-up
• The APP may order and/or perform the following procedures:
  • Patient history and perform physical exam
  • Laboratory, radiology, and/or diagnostic procedures/tests
  • Interpretation of laboratory, radiographic, and diagnostic tests
  • Interpretation of PA, CVL, SG, VS interpretation and critical thinking skills
  • EKG interpretation
  • Suture / Staple removal
  • Application of dressings, bandages, negative pressure wound therapy
  • Manage and insert nasogastric, gastric  tubes, jejunostomy tubes
  • Manage support devices, including (but not limited to) hemovac, bulb drains
  • Removal of superficial foreign bodies
  • Venipuncture for blood sampling
  • Capillary blood sampling
  • Perform/Supervise stress testing
  • Blood sampling via central venous lines, including:
    • Temporary central catheters
    • Tunneled catheters
    • Implantable vascular access devices
  • Order/Administer infusion therapy/ oral medications including:
    • IV fluids
    • Anticoagulants
    • Analgesics, Narcotics, including Patient Controlled Analgesia
    • Antibiotics
    • Antifungals
    • Antivirals
    • Antiarrhythmic
    • Antihypertensive
    • Inotropes
    • Electrolytes
    • Benzodiazepines
    • Muscle relaxants
    • Local anesthetics
    • Blood products - Packed Red Blood Cells and/or Platelets
    • Total parenteral nutrition
    • Enteral nutrition
  • Application of dressings and bandages.
  • Inhalation therapy or medications to alleviate the distress of dyspnea or shortness of breath. 
  • Pacemaker, ICD, interrogation, and change settings appropriately (only if/when competency documented)
• Assess patients for change in status and institute appropriate interventions.  Initiate emergency interventions in an effort to stabilize the patient until physician support arrives.
• Communicate verbally and in writing all pertinent patient information to the supervising MD, referring MD, nursing staff, home health, hospice agency, and other relevant healthcare providers.
• Analyze clinical practice patterns so as to provide the best medical care and to increase effectiveness and efficiency
• Document in patients' chart all relevant data including but not limited to results of diagnostic tests; laboratory results; patients' condition and response to therapies/interventions; and communications with the supervising MD.  
• Provide leadership and coordination of care and services for the Cardiology Division.
• Utilize prescriptive privileges for the identified patient population in accordance with the DHIP and NC Board of Nursing/NC Medical Board regulations.
• Other related duties and responsibilities as listed in full job description

 

JOB ELIGIBILITY REQUIREMENTS

Education

PA:         Graduate of ARC accredited Master's Degree or DMSc Physician Assistant program.

NP:         Graduate of accredited MSN or DNP Acute Care Nurse Practitioner program for adult care

 

Licensure  

PA:           Current unrestricted medical license issued by NCMB to practice as PA.

NP:           Current unrestricted RN licensure issued by or recognized by the NCBON with approval to practice as an NP.

 

Certification

PA:         PA-C

NP:         ACNP or AGACNP only

 

Experience

Strongly prefer candidate with at least one year of provider experience in cardiology setting, but willing also consider a new PA or AGACNP graduate with relevant clinical experience during training.

 

Physical and mental requirements:

• Able to clearly articulate scope of practice, and practices within those guidelines as a Nurse Practitioner / Physician Assistant in the state of North Carolina and within the Duke University Health System. 

• 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 & 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

 

JOB HOURS

This is a full-time salaried position, working a 40 hour work week. 5 shifts per week.  Shifts are staggered dayshift hours covering all 7 days of the week, including holidays, 7am - 3:30pm or 9am - 5:30pm.  Variations in hours and days of the week covered may be changed by Heart Center Leadership in consultation with the clinical service line leadership based on service needs.

    

 

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

 

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

 

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

 

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