Nurse Practitioner (NP) or Physician Assistant 9PA) - Heart Failure Hybrid- MGH

Provides direct care to a select population in collaboration with the physician.

• Performs and records the patient history and physical exam and discusses findings with the physician.
• Utilizes advanced provider knowledge to identify, prevent or solve complex and/or recurring patient care problems that negatively impact the health outcomes of patients with heart failure.
• Follows and manages patients (in collaboration with MD) enhancing continuity of care.
• Performs medically delegated aspects of patient care according to practice guidelines.

Provides consultation to both nurses and physicians.

• Serves as resource to health care professionals in area(s) of expertise.
• Serves on appropriate intra and interdepartmental committees.

Participates in the development of formal and informal educational programs for appropriate health care professionals

Monitors patient outcomes in accordance with defined standards of patient care.

• Collaborates with administrative, nursing and medical staffs to plan, implement and evaluate pertinent change in practice and health care delivery.
• Identifies system-wide factors contributing to undesirable outcomes, such as complications, readmission and overutilization.
• Facilitates patient movement through the health-care system and efficient use of resources through intrasystem collaboration, as well as interaction with outpatient care providers within and outside our healthcare system.

Supports research efforts to advance knowledge and to promote research-based practice.

Responsible for own professional growth and maintenance of required credentials.

• Maintains the standards and educational requirements specific to the position and licensure.
• Maintains and updates clinical knowledge and skills based on current health care practice/research.

Specific Responsibilities in Heart Failure Patient Management:

• Performs patient evaluations as part of a rapid response team that evaluated patients in the emergency department, inpatient setting, and post-hospital discharge
• Orders/obtains routine laboratory and related studies
• Discusses with the collaborating physicians and orders diagnostic studies related to identifying the etiology of heart failure and/or the complications of heart failure, including renal dysfunction, hepatic dysfunction, malnourishment, and metabolic derangements.
• Continues previous medication as appropriate
• Discusses needed change in medications/orders with collaborating physician
• Educates patients regarding positive health behaviors that promote optimal clinical outcomes. This includes compliance with medication, the use of a flexible diuretic program, and adherence to a diet appropriate for the avoidance of fluid overload.
• Assists with the development and deployment of practices, including patient education, that avoid hospitalizations and readmissions.
• Collaborates with physician, case manager, and where appropriate, clinical nurses, social work and nutritionists for needed health care services.
• Assists in the development of the MGH heart failure program.
• Promotes a customer service orientation in relationships with outside health care providers.

Specific Responsibilities in Heart Failure/Cardiac Transplant Patient Management:

• Performs patient history and physical exam

• Orders/obtains routine laboratory and related studies
• Discusses with the collaborating physicians and orders diagnostic studies related to the management of immunosuppression, the control of infections that occur in the immunocompromised host, and the assessment and management of accelerated graft vascular disease.
• Collaborates with physician, case manager, and where appropriate, clinical nurses for needed health care services.
• Assists in the development of the MGH cardiac transplant program. This may include educating healthcare providers at referring institutions as to the indications for and benefits from cardiac transplantation.
• Identifies patients appropriate for ongoing research programs within the heart failure program

Specific Responsibilities in Evaluation of Cardiac Disease in non-Cardiac Transplant Recipients:

• Performs patient history and physical exam
• Orders/obtains routine laboratory and related studies
• Discusses with the collaborating physicians and orders diagnostic studies related to the identification of risk factors for the presence of cardiac disease or the management of known cardiac disease in patients with severe pulmonary, hepatic, renal, or hematologic disease.
• Designs diagnostic and treatment plans for these patients that consider both the risk of transplant surgery and the need for subsequent immunosuppression.
• Collaborates with physician, case manager, and where appropriate, clinical nurses for needed health care services.
• Maintains and promotes relationships with transplant health care providers, both within the institution and outside of it, regarding the care of heart transplant recipients and candidates.

Outpatient APP Role:

• The APP works collaboratively with Heart failure Program Leadership, Physicians, RNs and PSCs as a provider in the HF outpatient clinic. The APP practices in accord with practitioner guidelines per state and hospital regulations
  • Manages follow up patients in collaboration with the Collaborating MD enhancing continuity of care.
  • Ensures timely appointments and facilitates access to care for patients
  • Performs and records the patient history and physical exam
  • Utilizes knowledge & training to identify, prevent or solve complex and/or recurring patient care problems.
  • Orders appropriate procedures and testing particular to the select patient population according to guidelines.
  • Performs medically delegated aspects of patient care according to practice guidelines.
  • Collaborates with health care professionals within other cardiology sub specialties and outside of cardiology to facilitate a comprehensive plan of care and coordinate resources.
  • Monitors patient outcomes in accordance with defined standards of patient care.

Clinical Responsibilities:

• The APP will perform independent patient visits both planned follow up care and urgent care as well
  • This will include Virtual Telemedicine visits in addition to in person follow up and urgent visits. .
  • The schedule will include 5 sessions with possible additional follow up or urgent patients as needed to meet the needs of patients and the clinic. With allotted administrative time including (but not limited to) in basket follow up, returning patient phone calls, completing documentation, Rx refills.
  • The APP participates in cross coverage of clinics and in basket when colleagues are away

Education
Master's Degree Nursing required

Can this role accept experience in lieu of a degree?
No

Licenses and Credentials
Class D Passenger Vehicle Driver's License [State License] - Generic - HR Only preferred Registered Nurse [RN - State License] - Generic - HR Only preferred Basic Life Support [BLS Certification] - Data Conversion - Various Issuers preferred Nurse Practitioner [NP] / Advanced Practice Registered Nurse [APRN] [State License] - Generic - HR Only preferred Nurse Practitioner [NP] / Advanced Practice Registered Nurse [APRN] [State License] - Generic - HR Only preferred

Experience
2 years of licensed nurse practitioner experience required

Knowledge, Skills and Abilities
- Skilled in taking medical histories to assess medical condition and interpret findings.
- Ability to maintain quality control standards.
- Ability to react calmly and effectively in emergency situations.
- Ability to interpret, adapt and apply guidelines and procedures.
- Ability to communicate clearly and establish/maintain effective working relationships with patients, medical staff and the public.

Physical Requirements

• Standing Frequently (34-66%)
• Walking Frequently (34-66%)
• Sitting Occasionally (3-33%)
• Lifting Frequently (34-66%) 35lbs (w/assisted device)
• Carrying Frequently (34-66%) 20lbs - 35lbs
• Pushing Occasionally (3-33%)
• Pulling Occasionally (3-33%)
• Climbing Rarely (Less than 2%)
• Balancing Frequently (34-66%)
• Stooping Occasionally (3-33%)
• Kneeling Occasionally (3-33%)
• Crouching Occasionally (3-33%)
• Crawling Rarely (Less than 2%)
• Reaching Frequently (34-66%)
• Gross Manipulation (Handling) Frequently (34-66%)
• Fine Manipulation (Fingering) Frequently (34-66%)
• Feeling Constantly (67-100%)
• Foot Use Rarely (Less than 2%)
• Vision - Far Constantly (67-100%)
• Vision - Near Constantly (67-100%)
• Talking Constantly (67-100%)
• Hearing Constantly (67-100%)