Advanced Practice Provider (NP/PA), Cardiac Surgery Heart-Lung Transplant & Mechanical Circulatory Support (MCS)

1.0 FTE Full time Rotating – 12 Hour R2546084 Onsite 107860004 Organ Acq Heart Transplant Multi Site Other PALO ALTO, 500 Pasteur Dr, California

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Rotating – 12 Hour (United States of America)

A. Coordinates the management of Adult Heart Transplant, Adult Lung Transplant and Mechanical Circulatory Support Device (MCS) patients. Responsibility begins at the time of first encounter of patient, transplant/implant and continues throughout the hospital stay, including post-op visits. The NP/PA may also see pre-operative and post-operative patients in the clinic or inpatient setting. Tasks include (but are not limited to) the assessment and management of:

1. Physical examination, hemodynamic parameters, lab values, diagnostic tests (x-ray, echo, etc.), device parameters.

2. Medical and surgical complications, rejection, medication side effects, long term complications

3. Immunosuppression and prophylaxis and assure that protocols are followed

B. Demonstrates knowledge of and identifies:

1. Transplant/MCS associated complications and has knowledge of interventions to treat the complications

2. Immunosuppressants, prophylactic agents, and other medications common for heart transplant recipients

3. Initiates appropriate interventions and orders appropriate diagnostic tests

4. Identifies educational and psychosocial needs of the patient/family/caregiver after transplant

C. Assists in coordinating aspects of outpatient care for transplant and MCS recipients, including post-operative management, outpatient follow-up, scheduling of procedures, and discharge planning. May participates in coverage of inpatient service.

D. Primary shift will be Monday-Sunday, 12-hour days/nights. Shift subject to change based on program needs.

E. Responsible for working ONE to TWO weekends a month. Weekend shifts subject to change based on program needs.

F. Willingness to develop professional education programs/seminars regarding Heart Transplantation for the staff and medical specialty units of SHC.

Provides outreach education to meet the needs of referring physicians, patient support groups and lay community throughout Northern and Central California.

G. Exposure Risk to Blood-Borne Pathogens

• Category 1: Tasks regularly involve exposure to blood, body fluids or tissues. The potential for spills or splashes of blood, body fluids or tissues exists in job-related tasks.

H. Physical Demands and Work Environment

1. The work involves considerable physical exertion such as frequent lifting of patients and equipment, bending and stooping, and walking. The work environment involves moderate risks or discomforts which require special safety precautions, e.g., working with risk of exposure to contagious disease, radiation or infection, or working with emotionally disturbed patients. Precautions are routine for nearly all situations. The employee may be required to use protective clothing or gear.

2. Requires an individual who is able to function at off-hours for on-call duties, and continue to report to work the following day.

I. Outpatient / Clinic:

1. Review clinic charts, pre clinic, and order any additional test and studies needed to properly evaluate patient in clinic.

2. See Clinic patients; Obtain complete history and performs comprehensive physical exam with assessment of normal and abnormal findings on new and return patients post op patients.

3. Write a full H&P on patient to be signed by the end of clinic day.

4. Performs and/or requests and evaluates diagnostic studies, follow up on any needed studies post clinic; update note and team as needed.

5. Preform all risk scores on patients and trial paperwork as needed for studies.

6. Communication with patient, family and cardiology regarding bridging anticoagulation when needed.

7. Communication, teaching and follow up with any questions with patient and family. Provides and coordinates patient teaching and counseling.

8. Ability to evaluate and treat post op surgical debridement and wound care in clinic

9. Administers, orders and/or prescribes medications as needed in Epic.

10. Obtains informed consent (blood and procedure).

11. Initiates arrangements or helps facilitate hospital admissions, transfers and discharges.

12. Maintains communication between attending physicians, Lead, co-workers and staff to facilitate patient care and the plan of surgery for the patient.

13. Effectively communicates and interacts with patients, families, staff and members of the community from diverse backgrounds

14. Facilitates the coordination of inpatient and outpatient care and services

15. Orders, interprets and follow up on any echo’s, CTA, caths, scans as needed for attending/patient.

16. Recognizes situations which require the immediate attention of a physician, and initiates life-saving procedures when necessary

17. Provides and coordinates patient teaching and counseling.

K. Inpatient

1. Obtain objective information from patient’s chart

2. Assess and obtain subjective information from your patient

3. Present pertinent information to a physician led team.

4. Participate in the development of a plan for the patient

5. Call consults as appropriate and communicate information to the consulting physician in a concise manner to summarize the concern adequately to the consulting physician.

6. Carry out the plan for the patient for the day including reassessments as needed.

7. Interpret lab results, chest x-ray results, and communicate with radiology for interpretation of radiological studies to answer pertinent clinical questions that arise about patients.

8. Create professional notes including progress, history and physical, procedure notes, etc.

9. Communicate effectively to your colleagues both MD and other APP via email, text, or in person communication as necessary.

10. Other duties as necessary to care for patients on service including but not limited to covering pagers, maintaining patient list,

11. Recognizes situations which require the immediate attention of a physician, and initiates life-saving procedures when necessary.

12. Obtain and maintain certifications and performance competencies, and privileges as necessary including ACLS, BLS, DEA license, NP/PA license, privileges including but not limited to chest tube removal, direct current cardioversion, incision and debridement, and pacing wire removal.

13. Will to work with residents, and assist in their training and educational process.

14. Ability to be motivated, flexible and willing to be part of a passionate, growing, dynamic and integrated team. Passion to be part of a rapidly growing cardiac surgery patient population and team. Needs to have passion and patience in teaching and training other new PA’s.

15. Will to work under attending surgeons, see clinic patients and participate in surgical cases as needed.

16. Experience and willingness to train other new NP/PA’s in cardiac surgery

17. Cover and help with co-APPs call time, vacation time and leave.

J. Operating Room

1. Maintain and address current surgeons OR list, update as needed, order any additional studies or tests needed pre-op.

2. See patients in SAU that are over 30 days since clinic visit for new H&P.

3. Preform 24 hour update morning of surgery by 6:30 am.

4. Recognizes situations which require the immediate attention of a physician, and initiates life-saving procedures when necessary.

5. Ability to work as a team with the other APP’s and cover all cases when needed.

6. First assist in adult cardiac surgery preferred, Minimum 3 years experience preferred.

7. Ability to assist anesthesia and nursing with any surgical questions and surgical plan.

8. Help position and prep patients for surgery; for incision goal time of 8:00am.

9. Will to work with residents, and assist in their training and educational process.

10. Ability to be motivated, flexible and willing to be part of a passionate, growing, dynamic and integrated team. Passion to be part of a rapidly growing cardiac surgery patient population and team. Needs to have passion and patience in teaching and training other new PA’s.

11. Will to work under attending surgeons, see clinic patients and participate in surgical cases as needed.

12. Ability to evaluate and treat post op surgical debridement and wound care.

13. Experience and willingness to train other new NP/PA’s in cardiac surgery

14. Cover and help with co-APPs call time, vacation time and leave.

Acute Patient Disorders:

Management of common acute disorders in Surgical Heart and Lung Transplant/MCS recipients, including but not limited to rejection, viral infection, bacterial infection, medication side effects, device malfunction, acute organ failure, etc.

Chronic Patient Disorders:

Assessment and management of chronic disorders in Surgical Heart and Lung Transplant/MCS candidates and recipients, including but not limited to routine anticipated problems for specific chronic Heart disease, Lung disease, and diabetes mellitus.

Disease Management (Primary Care Conditions):

Common acute conditions, including but not limited to pain, dysphagia, tachy or bradycardia, tachypnea, respiratory failure, nausea, diarrhea, constipation, weight loss, dizziness, fever, skin problems secondary to medications or immunosuppression (e.g., rash, surgical wound dehiscence, poor healing), sexual dysfunction, urinary dysfunction, change in vision, change in hearing, etc, or chronic stable conditions including diabetes, thyroid dysfunction, hypertension, depression, malnutrition, family dysfunction, review of established medication regimens, bowel regimens, etc.

All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, protected veteran status or on the basis of disability.

This is a Stanford Health Care job.

A Brief Overview

The Nurse Practitioner (NP) functions under this Nurse Practitioner Job Description approved by the Interdisciplinary Practice Committee (IDPC). The NP provides routine are and management of the patient with acute and chronic complaints, in collaboration with the supervising physician, and through implementation of standardized procedures. Specific functions pertaining to the Service, Clinic or Department are established by the NP and his/her supervising physician(s), and approved by the appropriate medical and nursing administrators, the IDPC, the Credentials & Privileges Committee, the Stanford Hospital and Clinics (SHC) Medical Executive Committee and the SHC Board Credentials, Policies and Procedures Committee. This job description covers all classifications for NPs within the organization. All NPs must meet all elements of the Essential Functions, Qualifications, and Supervision. There is a voluntary Career Ladder for NPs who are interested in promotions for clinical expertise and contributions to the institution as well as the profession. Promotion is determined based on the Center for Advanced Practice Career Ladder Handbook. Here is a description of the various levels: Job Attributes: LEVEL I LEVEL II LEVEL III FLSA Status: Exempt Exempt Exempt Job Code: 400077 400169 400170 Requirement: LEVEL I: Entry level LEVEL II: Meets Career Ladder criteria for NP II LEVEL III: Meets Career Ladder criteria for NP III

Locations

Stanford Health Care

What you will do

• A. An NP may provide only those medical services which he/she is competent to perform, which are consistent with the NP’s education, training and experience, and which are performed under the supervision of a physician who is responsible for the patients cared for by that NP.
• B. An NP shall consult with a physician regarding any task, procedure or diagnostic problem which the NP determines exceeds his/her level of competence or shall refer such cases to a collaborating physician.
• C. Scope of Practice of the NP:
• Evaluates and treats patients with acute, chronic complaints and health maintenance concerns related to specialty, according to written standardized procedures. [see Appendix A: Assessment & Management of Patients]
• Obtains complete histories and performs pertinent physical exams with assessment of normal and abnormal findings on new and return patients, according to written standardized procedures. [see Appendix A Assessment & Management of Patients]
• Performs or requests and evaluates diagnostic studies as indicated upon evaluation of the patient, according to written standardized procedures. [see Appendix A: Assessment & Management of Patients]
• Administers, orders, furnishes and prescribes medications, according to written standardized procedures. [see Appendix B : Administering, Ordering, Furnishing or Prescribing of Drugs; Formulary Protocol]
• Orders and collects specimens for routine laboratory tests, screening procedures and therapeutic procedures, including blood and blood products.
• Orders physical therapy, occupational therapy, respiratory therapy, radiology examinations and nursing services.
• Performs designated procedures after demonstrated competency, according to written standardized procedures where applicable.
• Obtains informed consent, as indicated.
• Initiates arrangements for hospital admissions and discharges and completes appropriate paperwork.
• As directed by the supervising physician, enrolls patients in investigational studies approved by the Investigational Review Board (IRB), and orders the necessary tests and medications. [see Appendix B: Administering, Ordering, Furnishing or Prescribing of Drugs; Formulary Protocol] Medications that are not FDA-approved or are used for a non-FDA-approved indication (off-label use) require a patient-specific order in advance from the supervising physician.
• After appropriate training, assists the supervising physician in the operating room. The RN First Assistant directly assists the surgeon and practices under the supervision of the surgeon during the intraoperative phase. The RN First Assistant must adhere to standardized procedures and not concurrently function as a scrub nurse.
• Recognizes and considers age-specific needs of patients.
• Effectively communicates and interacts with patients, families, staff and members of the community from diverse backgrounds.
• Recognizes situations which require the immediate attention of a physician, and initiates life-saving procedures when necessary.
• Facilitates the coordination of inpatient and outpatient care and services as needed.
• Facilitates collaboration between providers and coordination of community resources.
• Ensures compliance with legal, regulatory and clinical policies and procedures.
• Participates in quality improvement initiatives.
• Provides and coordinates patient teaching and counseling.
• Other duties as assigned.

Education Qualifications

• Master’s or Doctoral degree in nursing from an accredited college or university. (Note: NPs hired prior to March 1, 2012 are not subject to this educational requirement.)
• Graduate of an NP program accredited by the National League of Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE).

Licenses and Certifications

• NursingRN – Registered Nurse – State Licensure And/Or Compact State Licensure and
• NP – Nurse Practitioner and
• NPF – NP Furnishing Number and
• BLS – Basic Life Support and

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $86.41 – $114.50 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

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