NP-HOURLY ED/ED ANNEX - ER DOCTOR

Status : PRN - As Needed

Shift : Varies; 12-13 hours shifts depending on location; 1-2 full shifts per schedule (4 weeks) depending on staffing needs as determined by leadership. Includes weekend and holiday rotations; shifts may vary based on department needs. Includes all areas under Emergency Services, including Urgent Care Clinics and Occupational Health Clinic.

Exempt : No

Summary :

The Nurse Practitioner, also known as an Advanced Practice Provider (APP) is a healthcare provider who, working collaboratively within a multi-disciplinary health team, is responsible for providing comprehensive care to acutely ill patients in the hospital setting under the direction of a supervising physician. Provides care to patients within Emergency Department / Emergency Services service line as assigned, and under the direction of the Medical Director and other collaborative agreement physicians. Provides care according to established policies, protocols, bylaws, and rules and regulations of the medical center and medical staff. Seeks opportunities for professional growth through participation in continuing education, staff development and hospital committees.

Other information :

1.Previous Experience Required :

• Minimum of one (1) year prior experience as a Nurse Practitioner (NP) in Emergency Services OR five (5) years of experience as a Registered Nurse (RN) in Emergency Services is required.
• Must be credentialed and approved for privileges through the established Medical Staff Committees initially and on an ongoing basis.

2.Specialized or Technical Education Required :

1. Must haveactive DEA licensewithin in six months of

hire. Maintenance of DEA license is required once obtained.

2.Certification as a Medical Examiner from the National Registry of Certified Medical Examiners (NRCME)(as required by the Federal Motor Carrier Safety Administration to perform DOT / CDL Physicals) is preferred upon hire.

3. If NRCME not currently held, employee shall obtain within one (1) year of hire or notice of such requirement.

ii.Emergency Nurse Practitioner Certification (ENP-C)is preferred upon hire.

1. If ENP-C not currently held, employee shall obtain ENP-C within five (5) years of hire date. Each NP is independently responsible for meeting requirements for testing as well as requirements for maintaining ENP-C certification through accrediting board.

2. Once ENP-C obtained, employee shall maintain certification ongoing.

Manual or Physical Skill Required :

o Must be capable of performing all areas of skill required in the day-to-day management of assigned areas.

Physical Effort Required :

Strength : Light Push : Occasionally Pull : Occasionally

Carry : Occasionally Lift : Occasionally Sit : Frequently

Stand : Frequently Walk : Frequently

B. Work Complexities

1.Complexity and Difficulty of Work :

o Must be able to manage and organize staff, work, and workflow in an efficient and timely manner. Must be able to problem-solve, evaluate, and establish priorities, coordinate activities, multi-task, and communicate effectively with all persons, including patients, physicians, staff, other North Oaks employees and leadership, and the community.

o Must be able to work efficiently and cheerfully in a busy environment with a high level of patient contact. Must possess the maturity necessary for establishing and maintaining a good work relationship with patients, family, physicians, and other staff members.

2.Seriousness of Errors :

o Inaccuracies and / or errors may adversely affect patient care, efficiency of operations, expenses, revenue, morale, and / or public perception.

C. Working Conditions

1.Hazards :

o Sensitivity to appropriate precautions and procedures related to personal protective equipment and procedures. General knowledge and awareness of work-site and clinical safety and hazard precautions.

2.Adverse Working Conditions :

o Work is performed in a healthcare delivery environment and interaction with staff, physicians, and patients may be frequent and interruptive. Must have the ability to handle stress associated with meeting deadlines and concentrate of specific details of the job despite distractions.

o Must possess the ability to handle the stress associated with meeting deadlines and concentrate on specific details of infection control procedures. Must be able to maintain cheerful, positive attitude while performing duties in a high volume practice.

D. Contacts

o Contacts with Customers, the General Public or Other Companies : Frequent contact with patients and / or clients, physicians, staff, insurance providers, other healthcare agencies, public.

o Contacts with Other Departments : Frequent contact with hospital departments and personnel.

o Representative for hospital medicine program on various hospital committees and networking projects.

E. Responsibilities :

1.Responsibility for the safety of others :

o Responsible for the safety of all patients, visitors, physicians, and staff.

o Responsible for maintaining safety of facilities and equipment.

o Responsible for following all policy and procedures to assist in maintaining a safe environment.

2.Responsibility for Company Funds or Property

o Responsible for inventory, supplies, minor equipment, and both movable and fixed assets.

o Maintain all equipment in the department in a conscientious manner thereby ensuring that all equipment is in proper working order.

3.Responsibility for Confidential Information :

o Direct access to protected health information, financial data, proprietary organizational processes, procedures or strategy, employee financial and demographic information. Must always safeguard and preserve confidentiality of all such confidential or proprietary information in accordance with applicable hospital policies, laws, rules, and regulations. Must ensure employees also strictly maintain such confidentiality standards. Follow HIPAA privacy standards.

4.Responsibility for Performance of Work without immediate supervisor :

o Must work independently, take initiative, and perform responsibilities timely to ensure great outcomes and program quality without direct supervision - yet stay within the parameters of the organization's policies and procedures and within the scope of authority. The Medical Director will be available for instruction and advice as needed.

o Must be highly motivated self-starter able to perform well without direct supervision. Must be able to function productively as part of the overall clinical health care team. Must be able to consistently meet established work deadlines. May perform some job duties independently during temporary absence of supervising physician, but only to the extent approved by supervising physician and allowed by North Oaks privileges, and applicable law and regulations. A supervisor / coordinator / director will be available to give advice, or instructions as needed. Work is subject to review at any time.

5.Responsibility for the Supervision of staff :

o Provides clinical direction to nursing and ancillary personnel in the care of patients.

Responsibilities :

DESCRIPTION OF DUTIES :

1. Conducts a comprehensive physical health assessment of patients with acute health problems which may include the psychosocial, cognitive, and personal assets and limitations of the patient / family.

2. Obtain patient histories and perform physical examinations.

3. Dictate history and physical examination results.

11. Performs admissions, discharges, and triage of patients as needed, in collaboration with medical staff, and as defined in the allied health standards of practice.

12. Interfaces with family and interdisciplinary team members as needed. Educates patients and / or their

families to promote wellness, prevent health problems, and intervene in acute illness.

15. Demonstrates skills and knowledge necessary to provide care to acute patients including knowledge of growth and development, the ability to obtain and interpret information, to identify patient needs and to provide care needed.

16. Provides formal and informal acute care related in-services and educational programs in which expert knowledge base is shared with staff.

17. Complete all ongoing education required to maintain North Oaks privileges and required certifications as governed by certification authority and / or the State Board of Medical Examiners or LSBN

19. Can demonstrate competency in age specific criteria as applicable to job scope.

20. Performs approved procedures competently, per credentialing approval.

21. Documents in the medical record according to policy and medical staff rules and regulations, with regards to content, notes, orders, security, and confidentiality.

22. Consistently attend meetings as assigned, including monthly staff meetings

23. Communicate following appropriate channel of communication.

24. Interpret and correlate subjective and objective data to formulate a differential diagnosis and establish a working diagnosis.

Suture wounds; Removal of sutures, staples, and casts.

b. Inject local anesthetic agents subcutaneously.

incision and drainage

26. Adheres to medical staff bylaws as applicable to advanced practice nursing under allied health policies.

27. Follows North Oaks Health System's Compliance Program and Federal and State Regulatory guidelines.

COMPETENCIES / SKILLS

Nurse Practitioners within the Emergency Services departments provide healthcare within an ethical framework, through assessment, diagnosis, and management of health / illness status, to persons of all ages who seek emergency care for acute episodic illness or injury and acute exacerbations of chronic illnesses.

Scope of practice for an advanced practice registered nurse within a particular state is regulated by their state board of nursing. Although competencies provide a model for entry-level practice, competencies in and of themselves do not stipulate a scope of practice.

Nurse practitioners are responsible for understanding their scope and authorized practice and must recognize if they have the expertise and proper depth of knowledge to evaluate and treat a patient fully and appropriately. APRNs are expected to practice within established standards and are accountable for the quality care rendered, for recognizing limits of knowledge and experience, planning for the management of situations beyond one's expertise; and for consulting with or referring patients to other health care providers as appropriate.

Each patient and situation will present varied and individual clinical situations requiring professional judgement and adaptation. Policies set forth for clinical caregivers, and associated support personnel, are a resource for guiding and assisting the caregiver in his / her patient care decisions and actions. By themselves, however, the recommendations and steps found in policies, procedures, protocols, and guidelines may not allow the caregiver to effectively adapt to the unique characteristics and challenges a patient or situation can present, or to other potential extenuating circumstances. Policies, procedures, protocols, and guidelines and not intended to replace or supersede the responsibility of the caregiver to exercise critical judgement skills gained from training and experience to best serve the patient and the situation effectively. Nor are they intended to alone define the standard of care for all patient and clinical situations a caregiver will confront.

The caregiver should consider the recommended actions outlined in a policy, procedure, protocol, and / or guideline in exercising professional judgement. Staff must then evaluate the circumstances presented, and responsibly modify or supplement these recommendations when necessary to meet the individual, unique needs of a patient or situation.

The following are competencies / skills identified :

A)Management of Patient Health / Illness Status

1) Triages patients' health needs / problems.

2) Completes EMTALA-specified medical screening examination.

3) Responds to the rapidly changing physiological status of emergency care patients.

4) Uses current evidence-based knowledge and skills in emergency care for the assessment,

treatment, and disposition of acute and chronically ill and injured (e.g., physiologic,

psychological, socio-economic, cultural) emergency patients.

5) Specifically assesses and initiates appropriate interventions for violence, neglect, and abuse (e.g., physical, psychological, sexual, substance).

6) Specifically assesses and initiates appropriate interventions and disposition for suicide risk.

7) Assesses patient and family for levels of comfort (e.g., pain, palliative care, end of life, bad

news) and initiates appropriate interventions.

8) Recognizes, collects, and preserves evidence as indicated (e.g., forensic evidence).

9) Orders and interprets diagnostic tests.

10) Orders pharmacologic and non-pharmacologic therapies.

11) Orders and interprets electrocardiograms.

12) Orders and interprets radiographs.

13) Assesses response to therapeutic interventions.

14) Documents assessment, treatment, and disposition.

B)Professional Role

15) Functions as a direct provider of emergency care services.

16) Collaborates with nurses and other health care providers.

17) Directs the care of licensed practical nurses and unlicensed personnel.

18) Participates in internal and external emergencies, disasters, and pandemics.

19) Maintains awareness of known causes of mass casualty incidents and the treatment modalities required for emergency care.

20) Acts in accordance with legal and ethical professional responsibilities (e.g., patient management, documentation, advance directives).

D)Skin and Wound Care Procedures

24) Performs ultraviolet examination of skin and secretions (e.g., Woods Lamp).

25) Treats skin lesions (e.g., foot callus, skin tag, plantar lesion, decubitus care).

26) Injects local anesthetics.

27) Performs nail trephination.

28) Removes toenail(s) (e.g., partial or complete removal for ingrown toe nail).

29) Performs a nail bed closure.

30) Performs closures (such as a single layer and multiple layer suturing, staple, and adhesive).

31) Debrides minor burns (e.g., no adhering blister).

32) The incision and drainage of simple and complex abscesses, including irrigation and insertion of packing or drains (Word catheter).

E)Head, Eye, Ear, Nose, and Throat Procedures

34) Performs fluorescein staining.

35) Performs tonometry to assess intraocular pressure.

36) Performs Slit lamp examination.

37) Performs cerumen impaction curettage.

38) Controls epistaxis.

39) Removes foreign body through irrigation or by use of cotton swab applicator.

F)Chest and Abdomen

40) Replaces a gastrostomy tube.

G)Neck, Back, and Spine Procedures

41) Clinically assesses and manages cervical spine.

H)Gynecologic, Genitourinary, and Rectal Procedures

42) Perform pelvic exam.

43) Obtain cervical swabs.

44) Removal of vaginal foreign body

45) Incises and drains a Bartholin's cyst, insertion of packing or Word catheter.

46) Assists with imminent childbirth and post-delivery maternal care.

47) Removes fecal impactions.

48) Incises thrombosed hemorrhoids.

I)Extremity Procedures

49) Performs digital nerve block.

50) Reduces fractures of small bones (e.g., fingers, toes).

51) Reduces dislocations of large and small bones.

52) Applies immobilization devices (e.g., splint, traction).

53) Bivalves / removes casts.

54) Performs knee arthrocentesis.

J)Other

55) Performs communication with prehospital units.

56) Interprets patient diagnostics (e.g., vital signs, 12-lead ECGs) as communicated by

prehospital personnel.

57) Removes foreign bodies (e.g., from orifices and soft tissue) including, but not limited to cerumen impaction, removal of foreign body from external auditory canal, removal of nasal foreign body, removal of ocular foreign body, removal of foreign body located in superficial skin layers.