Acute Care Nurse Practitioner: Surgical Intensive Care Unit (SICU) - UMMS Providers/Physicians

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The Surgical Intensive Care Unit (SICU) is a 24-bed unit. Our patient population spans several surgical services including transplant, vascular, oral maxillary facial, emergency, orthopedic, oncology, gynecologic, and thoracic surgery. The SICU Advanced Practice Provider (APP) team consists of 11 APPs. In collaboration with and under the direction of the attending physician and the Department Director, the Advance Practice Provider (APP) provides day to day organizational and clinical direction of the healthcare provider team serving surgical intensive care unit patients to ensure continuity of patient care by facilitating and coordinating communication between the health care team, patient and patient’s family and the coordination of care to ensure quality, cost effectiveness; appropriate length of stay; and patient safety. The AAP participates in the development and advancement of evidenced-based best practices and supports formal and informal educational programs for other members of the health care team.

Clinical Responsibilities

1. Demonstrates competence in clinical assessment and decision -making including diagnostic reasoning and problem solving.
2. Performs comprehensive history and physical assessment for patients admitted/scheduled to service/practice setting.
3. Orders, obtains and interprets appropriate diagnostic tests.
4. Establishes medical diagnosis based on history, assessment, and diagnostic findings.
5. Designs, orders and documents appropriate treatment plans/plans of care including prescriptions of medications based on a comprehensive review of HPI and diagnostic results.
6. Initiates protocols/clinical pathways, evaluates the plan of care ensuring timely intervention.
7. Performs invasive procedures. Central, Arterial, Hemodialysis, Pulmonary Artery Catheter line, insertion / pulling chest tubes, Thoracentesis,
8. Collaborates with attending physicians and clinicians regarding admission, discharge and transfer decisions.
9. Presents patients in the Advanced Practice Provider’s caseload on rounds.
10. Communicates plan of care with the interdisciplinary team.
11. Incorporates the patient and family in their healthcare plan; communicates plan of care with the patients and family members. Provides patient and family instruction related to the plan of care, disease process, new treatment plans, and medication regimens.
12. Counsels and educates patients and family members in disease process, health maintenance and health promotion activities. Provides primary, secondary, and tertiary preventive care services.
13. Initiates appropriate referrals and specialty consultations or other agency involvement as needed.
14. Facilitates patient flow. Collaborates with the multidisciplinary team including case management ensuring appropriate and timely discharge.
15. Provides specialty consultation.
16. Advocates for patients ensuring patient/family participation in care, knowledge of treatment options, and understanding of patient rights.
17. Considers the holistic needs of patients and orchestrates resources (i.e. Pain service, palliative care).
18. Demonstrates ethical decision-making incorporating other healthcare team members as appropriate.
19. Uses evidenced based interventions and best practice guidelines in planning patient care.
20. Provides safe patient care through compliance with National Patient Safety Goals (NPSG).
21. Serves as a role model and educator for nurses and other healthcare personnel.
22. Collects and completes STS documentation of clinical variables in a complete, accurate and timely manner

Educational and Developmental Responsibilities

1. Promotes understanding of disease processes in area of specialty/program.
2. Functions as a clinical resource for other team members including but not limited to interns, residents, fellows, nurses, and medical students.
3. Assists with providing community education, health promotion and outreach, as requested. Acts as a community health resource for specialty disease entity.
4. Participates in educational strategies that help APPs improve clinical outcomes.
5. Participates in educational development in the following:
   • Staff development,
   • Health related community service activity,
   • Orientation of new employees, and/or
   • Orientation of house staff rotating through the clinical area.

Clinical Leadership/Outcomes

1. Participates in quality improvement initiatives in area of practice.
2. Serves as interdisciplinary team member or committee member focused on improving patient outcomes, safety, quality or cost effectiveness.
3. Participates in development of evidence -based practices for a specific population.
4. Actively participates and contributes to various department and division meetings and organizational initiatives.
5. As requested, maintains compliance and regulatory documentation for administrative purposes and reimbursement for services.
6. Participates in accreditation readiness.

Professional Development and Organizational Leadership

1. Maintains professional licensure, certification, and attestation as required by the Maryland State Board of Nursing and national certifying organizations
2. Pursues educational opportunities for professional growth (i.e. CEUs, CMEs, conferences).
3. Promotes the organization to all customers. Acts as a loyal and supportive informed spokesperson for the hospital.
4. Serves as APN/PA Council or Privileging Committee member or member on another shared governance council.
5. Participates on a professional organization or PAC.
6. Participates in shared governance in specialty.
7. Serves as an advisor to a committee or work group in work area.
8. Speaks out on local, regional, national, international policy issues.

Patient Safety

1. Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.
2. Takes action to correct observed risks to patient safety.
3. Reports adverse events and near misses to appropriate management authority.
4. Implements policies, procedure, and standards consistently in the performance of assigned duties.
5. Develops effective working relationships and maintains good communication with other team members. 48. Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.

Performs related work as assigned.

Customer Service: 
1. Greets customers in courteous, friendly, respectful and professional manner at all times, including maintaining eye contact when appropriate.
2. Follows communication protocols to both internal and external customers, including introducing him/herself with job title and experience, asking open ended questions, such as “How may I be of help to you?” Using the customer’s name as soon as it is learned.
3. Responds promptly and appropriately to customer questions/concerns/complaints and attempts immediate resolution.
4. Keeps customer’s information confidential, including public places such as elevators or the cafeteria.
5. Provides assistance and offers help immediately, including finding someone else to meet the request, if unable to do so him/herself. Introduce other staff to customers when a hand-off occurs and explain that the person will provide excellent service.
6. Demonstrates commitment to excellent service recovery when a customer’s expectations have not been met. 

Commitment to Co-Workers:
1. Offers assistance to colleagues and other departments when needed.
2. Takes responsibility for solving problems regardless of origin; completes assignments, and respects deadlines.
3. Resolves conflict directly with colleagues and seeks assistance from others if the issue cannot be resolved. Refrains from criticism in public.
4. Mindful and respectful of others’ time and schedules. Attends meetings on time and communicates any absences. 
5. Provides co-workers with a status report for continuity of workflow when planning to be out of the office, off the unit, or away from the department.

Communication Etiquette: 
1. Respectful, courteous and professional in all forms of communication and follows facility’s service communication protocol in all interactions.
2. Refrains from use of personal cell phone in patient care areas and keeps usage to a minimum at all other times while on duty.
3. Does not text or use e-mail during meetings (except for exigent or emergency situations).
4. Limits use of business cell phone during meetings (remain on vibrate and/or calls go to voicemail).
5. Makes every effort to answer telephone calls within three rings, introducing him/her, department and title (if appropriate). Asks permission before placing the caller on hold or using the speakerphone. If caller is transferred, gives the caller the extension number of the person he or she is being transferred to. Offers further assistance to the caller upon completing the conversation.
6. Maintains an appropriate voicemail message and when away from the office has an out-of-office email message that is brief, current, and includes name and department and offers the caller options if possible.
7. Returns email and voicemail messages promptly but no later than within one business day (24 hours).
8. Always mindful of voice and language in public.

Self-Management:
1. Reports to work appropriately groomed and in compliance with the Hospital’s dress code. Wears identification badge at all times at chest level and facing outwards so identification is clearly visible.
2. Complete all assignments within deadlines or negotiates alternative actions and time frames in order to achieve desired outcomes. 
3. Completes mandatory, annual education and competency requirements. 
4. Follows CRH safety, infection control and employee health standards. 
5. Demonstrates responsibility for personal growth, development and professional knowledge and competency.
6. Adhere to all CRH and department policies and procedures, including Code of Conduct and professional behavior standards. Does not exceed Hospital guidelines in reference to attendance, punctuality, and use of sick and unplanned absences. Provides notification of absences, lateness and vacation requests according to department guidelines. Respects length of time for lunch and break times. 
7. Reviews, signs, and adheres to CRH and/or departmental confidentiality statement.

This position supervises jobs that are:

• Admin. Support
• Technical 

Supervisory responsibilities typically include:

• Evaluating Job Performance
• Scheduling – Work/Time Off
• Coaching/Mentoring
• Directing/Assigning/Reviewing Work
• Training/Developing

Licensure/Certification/Registration

• Required: Current Maryland license in good standing as a Nurse Practitioner or Physician Assistant.
• Preferred: National Certification within respective area of responsibility
• Other: NPI, DEA and CDS required

Life Support Certification:

• Basic Life Support-Health Care Provider(BLS-HCP)
• Advanced Cardiac Life Support(ACLS)

Education/Knowledge

• Attained Level: Advanced Professional
• Preferred: Master's of Science in Nursing

Completed Course Work/Program:

• Completion of an approved Nurse Practitioner or Physician’s Assistant program and appropriate certification including approved attestation on file at the appropriate Maryland Board.

Applicable Experience

• Experience (describe required & preferred): 2 years of experience as a Nurse Practitioner or Physician Assistant providing direct care to patients preferably in a surgical program setting.

Other Required Attributes
1. Demonstrated ability to promote professionalism through involvement in professional 
organizations, teaching, research, publishing, and/or certification in area of specialty.
2. Ability to demonstrate competency in knowledge and skills necessary to provide care 
appropriate to the patient population(s) served. Ability to demonstrate knowledge of the 
principles of growth and development over the life span and possesses the ability to 
assess data reflective of the patient's requirements relative to his or her population specific and age specific needs. 
3. Highly effective verbal and written communication skills are required to interact with 
patient families, departmental units, medical and nursing staff on all essential matters. 
Demonstrated/documented effective interpersonal skills.
4. Maintains updated hospital safety and other mandatory training.
5. Maintains updated immunizations as recommended per practice area.
6. Maintains all licensure, certification and credentialing and competencies required to 
perform the job and maintain clinical appointment. 

Technical/Clinical Skills
Microsoft Office Suite Skill Level

• Word: Basic
• Excel: Basic
• PowerPoint: Basic
• Access: Not applicable

Working knowledge of ICD-9 (Medical Coding)
Basic knowledge and working experience with Medical Terminology

Problem Solving/Analytical Skills & Abilities:
Professional/Supervisory

Level of Supervision Required
Works Independently

Contacts Inside & Outside Facility/Corporation
Within/Outside Company with Tact and Discretion

Working Conditions

• Lifting and/or carrying objects weighing 11 to 20 pounds
• Pushing and/or pulling non-motorized equipment (e.g., stretchers, supply carts, mops) weighing over 50 pounds
• Stooping and bending
• Grasping and fine manipulation with hands
• Using a keyboard to interact with computer system
• Proofreading and/or reviewing documents
• Walking for extended periods of time
• Ability to communicate verbally
• Ability to hear
• Exposure to hazardous materials requiring the use of protective dress

.