Nocturnist Physician Assistant or Nurse Practitioner
Duke University Health System
Location: Durham, North Carolina
Internal Number: 181388
Duke University Hospital is consistently rated as one of the best in the United States and is known around the world for its outstanding care and groundbreaking research. Duke University Hospital has 957 inpatient beds and offers comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center; a major surgery suite containing 51 operating rooms; an endo-surgery center; an Ambulatory Surgery Center with nine operating rooms and an extensive diagnostic and interventional radiology area. In fiscal year 2018, Duke University Hospital admitted 42,916 patients and had 1,085,740 outpatient visits in fiscal year 2017.
U.S News & World Report named Duke University Hospital #1 in North Carolina and #1 in the Raleigh-Durham area in 2018-19.
Duke University Hospital is ranked in the top 20 nationally for seven adult specialties, including cardiology and heart surgery, nephrology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology.
In addition to its hospitals, Duke Health has an extensive, geographically dispersed network of outpatient facilities that include primary care offices, urgent care centers, multi-specialty clinics and outpatient surgery centers.
Duke Hospital (Durham, North Carolina)
Work Hours: Shifts will be primarily night shifts (9pm-7am or 11pm-7am). Each PA/NP nocturnist will work an equivalent of 40 hours/week with equitable weekend and holiday coverage. Schedule and hours may be modified by the clinical or leadership team to meet the needs of the program.
The Duke University Hospital Medicine Advanced Practice Provider (APP) provides direct patient care services for acutely ill inpatients in an intermediate level care or observation care setting, in collaboration with and under the supervision of the Duke University Hospital Medicine physicians. The duties of the Hospital Medicine APP will include admitting patients from the Emergency Department to the DUH Hospital Medicine service, transferring patients from the ICU to the DUH Hospital Medicine service, and performing cross cover for patients admitted to the DUH Hospital Medicine service. The Hospital Medicine APP elicits patient histories, performs physical exams, collects and documents data, conducts diagnostic and therapeutic procedures, orders and schedules laboratory studies and professional consultations, assesses and responds to changes in patients' clinical status, prescribes appropriate interventions and medications, coordinates the care during admission and discharge of patients, and provides direct patient care services. The Hospital Medicine APP contributes to excellence in patient care, research, quality improvement/patient safety, teaching, and provides leadership to the organization.
Specific Job Responsibilities and Standards
· In collaboration with attending physicians, assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of patient care.
· Provide and coordinate clinical care for service-specific patients through established protocols and under the hospital medicine supervising physician or back up physician who is either on site or available by pager.
· Collaborate with attending physicians, consultants, other APP colleagues, nurses, pharmacists, therapists, case managers, and hospital operations staff to formulate treatment plans, monitor patient progress, and efficiently and safely move patients through the inpatient or observation setting.
· Perform procedures specific to the work environment after demonstrated competency and within the guidelines of scope of practice and credentialing protocols.
· Assess patients for change in status and institute appropriate interventions. Initiate emergency interventions in an effort to stabilize the patient until physician support arrives.
· 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, case manager, home health agency, and other relevant healthcare providers.
· Document in the patients' medical record 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.
· Prescriptive authority for prescribing, ordering, and or administering drugs; including (but not limited to) schedule II, III, IV, and V drugs and necessary medical devices.
· Role model competence in all APP advanced skills.
· Prepare and communicate appropriate handoffs to physician and APP colleagues at the end of a shift or clinical block.
· Assess educational needs of the patients / families and provide culturally-sensitive patient/family education interventions as indicated. Use non-technical language when educating patients and families. Document all pre and post-op education in patients' medical record.
· Implement and evaluate appropriate educational programs for DUHS patient care staff and other healthcare providers as appropriate (e.g., journal club, morbidity and mortality, medical staff grand rounds, etc.).
· Role model and precept healthcare learners (e.g., PA students) through contractual agreements.
Research Utilization and Investigation:
· Utilize current research and evidence-based decision-making in all clinical practice.
· Incorporate clinical research findings in the development and implementation of standards of care.
· Support IRB approved clinical research/trials though a variety of activities including but not limited to: obtaining consent; ordering diagnostic tests; recording laboratory & diagnostic results; administering therapeutic interventions; and reporting patient outcomes including toxicities or adverse events.
· Participate in interdisciplinary quality improvement and/or research activities.
· Participate in measuring and documenting outcomes.
· Provide expertise and resource information to other healthcare providers, patients and families, related to medical conditions, procedures, interventions, and conditions.
· Develop, implement and evaluate standards of care/practice guidelines/policies and procedures/care maps/protocols within area of specialization.
· Develop programs and projects in areas of expertise to facilitate the attainment of the goals and objectives of the Duke University Hospital and Duke University Health System.
Professional Leadership and Development:
· Role model advanced practice professionalism through conduct, communication, dress, leadership, ethical decision-making, critical thinking and problem solving skills.
· Demonstrate responsibility for professional practice through active participation in at least one professional organization (ACP, SHM, etc.)
· Meet Continuing Education requirements as designated by the NC Medical Board and/or NC Nursing Board. Maintain professional certification.
· Enhance the body of knowledge in area of specialization through written publications, oral presentations, posters, continuing education, etc.
· Maintain all professional requirements for licensure and certification.
Knowledge, Skills & Abilities
Able to clearly articulate scope of practice, and practice within those guidelines as a Physician Assistant/Nurse Practitioner in the state of North Carolina and within the Duke University Health System.
· Able to demonstrate and maintain credentialing and licensing requirements of Duke University Hospital, including maintenance of state licensure and Federal DEA licensure.
-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.
Completion of an accredited Physician Assistant program. A Bachelor's degree required; Master's degree strongly preferred.
None required above education/training requirement. OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE/
Work requires completion of an accredited Nurse Practitioner program, with a Master's degree in Nursing.
Degrees, Licensures, Certifications
Must be licensed in the state of NC, and be certified as a Physician Assistant by the National Commission on Certification of Physician Assistants./Must have current or compact RN licensure in the state of North Carolina. BLS required. National certification as a NP required prior to or within 6 months of employment.
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.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.