Nurse Practitioner/Physician Assistant (1.0 FTE, Rotating) - MG-Peds-Intensive Care
Nursing Advance Practice
1.0 FTE, 10-Hour Rotating Shifts
At Stanford Children’s Health, we know world-renowned care begins with world-class caring. That's why we combine advanced technologies and breakthrough discoveries with family-centered care. It's why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Children's Hospital Stanford. And it's why we need caring, committed people on our team - like you. Join us on our mission to heal humanity, one child and family at a time.
The Pediatric Nurse Practitioner certified in Acute Care (CPNP-AC) is a career-based, dynamic role and includes clinical care, leadership, and education. The CPNP-AC is prepared with a graduate level education (Master’s or Doctorate) whose advanced degree allows for the diagnosis, management, and treatment of acute and acute on chronic disease whilst practicing under national and state licensure and certification. In collaboration with the attending physician, the role includes urgent and emergent life-saving interventions, procedural sedation or performance of invasive procedures, and coordination of long-term care needs. They provide compassionate and comprehensive care to patients and families, acting as liaison between nursing and medicine. In addition to direct patient care, the CPNP-AC collaborates with all team members in the PICU to coordinate unit flow, admissions and discharges, as well as determining and addressing the unique learning needs in an academic institution. The CPNP-AC is an educator to resident and fellow trainees and nurses through bedside teaching and formal didactic experiences, including bedside multidisciplinary education, weekly conference, and lectures for nursing staff. The CPNP-AC is an invested career-based member of the team and is engaged in divisional and institutional projects such as program development/management, research, QI, simulation, and education/training.
1) Clinical Responsibilities: (Daily: 3-7 patients, Nightly: 12-18 patients)
a) Prepare for morning/evening rounds: evaluate data, perform physical exam, develop and institute plan of care
b) Consult and coordinate appropriate services for specialized management needs
c) Provide serial evaluations of patients and adjust plan and update appropriate team members
d) Facilitate operating room, off-unit procedure or transportation hand-off for admissions
e) Formulate appropriate daily clinical documentation
f) Provide comprehensive sign-out to oncoming PICU team or transfer teams
g) Discharge patients, coordinating follow-up care, communication with primary care provider, and discharge instructions to family
h) Perform emergent/urgent interventions and escalate clinical care as necessary
i) Lead and attend transport unstable patients for off-unit procedures
j) Function as a clinical resource to medical and nursing staff and trainees
k) Lead weekly inter-disciplinary rounds for C team
L) Participate in or lead weekly sign-out
a) Perform invasive procedures, including arterial and central lines, lumbar punctures, chest tube insertion and airway intubation under general supervision
b) Perform on and off unit procedural sedation
c) Perform all elective intubations on C team patients
d) Prioritize procedural care over residents in training
e) Maintain procedural skills by entering the OR periodically as defined by group and practicing in simulation and on mannequins
a) Participate in daily multidisciplinary huddle for situational awareness, unit census, bed flow, and staffing limitations
b) Rounds: Act as clinical resource, manage time, facilitate discussion, and provide education
c) Participate in urgent/emergent situations such as rapid response team activation and code blue emergency events
d) Act as liaison between nursing and medicine to bridge relationship between specialties
e) Lead program development for advanced practice providers (APP), including hiring, training, and advancement of scope/role in the division and institution
f) Determine clinical assignments that meet the needs of the trainees and the APP/hospitalist team
g) Oversee medical students, APP students, and provide mentorship
h) Develop and foster relationships within the institution and specialty teams that improve patient care, divisional goals, and support professional development
i) Act as team leader at fellow level when fellow is absent
a) Provide timely clinical education to all members of the interdisciplinary team
b) Development case conference and present at weekly didactic conferences for physician peers and trainees
c) Provide clinical education to nursing staff via lectures, relevant articles and simulation training
d) Participate in and facilitate annual ECMO didactics and water drills biannually
5) Professional/Non-Clinical Development
a) Represent PICU frontline providers in specialty care teams
b) Participate in research and systematic reviews,
c) Develop best practice guidelines and quality improvement and implement institution-wide
d) Represent role at national level presenting research, teaching, and networking
e) Lead simulation experiences for multidisciplinary team
Nurse Practitioner (NP): The Nurse Practitioner functions under the general Nurse Practitioner Standardized Process Protocol approved by the Interdisciplinary Practice Committee (IDPC). The Nurse Practitioner provides routine care 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 Nurse Practitioner and the supervising physician(s), and approved by the appropriate medical and nursing administrators, the IDPC, and the Stanford Hospital and Clinics (SHC) Medical Executive Board and Board of Directors.
Physician Assistant (PA): The Physician Assistant functions under the general Physician Assistant Role Description approved by the Interdisciplinary Practice Committee (IDPC). Specific functions pertaining to the Service, Clinic or Department are established by the Physician Assistant and his or her supervising physician(s), and approved by the appropriate medical and nursing administrators, the IDPC, and the Stanford Hospital and Clinics (SHC) Medical Board and Board of Directors.
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.
Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
Must perform all duties and responsibilities in accordance with the Service Standards of the Hospital(s).
A. An NP/PA may provide only those medical services which he/she is competent to perform, which are consistent with the NP/PA's education, training and experience, and which are performed in collaboration with a physician.
B. An NP/PA shall consult with a physician regarding any task, procedure or diagnostic problem which the NP/PA determines exceeds his/her level of competence or shall refer such cases to a collaborating physician.
C. Scope of Practice of the NP/PA:
- Evaluates and treats patients with acute, chronic complaints and health maintenance concerns related to specialty, according to written standardized procedures.
- Obtains complete histories and performs pertinent physical exams with assessment of normal and abnormal findings on new and return patients.
- Performs or requests and evaluates diagnostic studies as indicated upon evaluation of the patient.
- Administers, orders, furnishes and prescribes medications.
- 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.
- 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 iNP/PAatient 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.
- Supervision is provided by the supervising/sponsoring physician with clinical privileges at LPCH, or designated attending physicians in the Clinic, Service or Department. Standardized procedures, approved by the supervising physician(s) and the IDPC, are a mandatory mechanism of supervision. Other mechanisms of supervision used may be:
- Direct on-site, electronic or phone supervision by a supervising physician. A physician cannot supervise more than four (4) NP/PAs at one time.
- Chart screens on random charts by the supervising physician or designee.
- Chart audits on random charts as an integral part of selected quality improvement programs.
- Ongoing Professional Practice Evaluation (OPPE) through tracking of performance indicators.
- The NP/PA will receive a formal annual performance evaluation by the Lead Advanced Practice Provider (Lead APP), Director of Advanced Practice or supervising manager/director with iNP/PAut from the Lead APP, supervising physician(s) and/or physician delegates, APP peers and the supervising manager/director. Ongoing Professional Practice Evaluation (OPPE) also occurs through tracking of performance indicators.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
Physician Assistant (PA):
- Bachelor’s degree or above from an accredited college or university.
- Graduate of a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant, Inc.
Nurse Practitioner (NP):
- Master’s or doctoral degree in nursing from an accredited college or university.
- Graduate of an NP program accredited by the National League of Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE).
Physician Assistant (PA):
- Licensure as a Physician Assistant (PA) in the State of California.
- Certification as a Physician Assistant (PA) by the National Commission on Certification of Physician Assistants (NCCPA)
- Certification in Basic Life Support (BLS) from the American Heart Association (AHA)
- An individual Drug Enforcement Agency (DEA) license issued by the United States DEA for Schedule II-V controlled substances, required only if prescribing controlled substances to outpatients
- Additional board certification(s) may be required by certain services/departments.
Nurse Practitioner (NP):
- Licensure as a Registered Nurse (RN) in the State of California
- Certification as a Nurse Practitioner (NP) in the State of California
- National Board Certification as a Nurse Practitioner (NP) from an agency accredited by the American Board of Nursing Specialties (ABNS).
Note: New graduate NPs will be allotted six (6) months from their graduation date to obtain national board certification.
- Certification in Basic Life Support (BLS) from the American Heart Association (AHA).
- Furnishing license issued by the Board of Registered Nursing (BRN), required only if furnishing medications
- An individual Drug Enforcement Agency (DEA) license issued by the United States DEA for Schedule II-V controlled substances, required only if prescribing controlled substances to outpatients.
- Additional board certification(s) may be required by certain specialties/departments.
Licensure/Certification: Additional board certification(s) may be required by certain specialties/departments.
The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job.
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