We have an exciting opportunity to join our team as a Nurse Practitioner with the Enteral Access Team.
The Nurse Practitioner will work collaboratively with Gastrointestinal Attending physicians responding to GI consults, assessing patients and making clinical decisions about feeding modalities. Additionally, you will have the opportunity to train and become competent in performing GI procedures. In this role, the successful candidate will be responsible for the provision, coordination, and assurance of comprehensive nursing care using nursing process and pertinent standards of care, the diagnosis of illness and physical conditions, and performance of therapeutic, corrective, and prescriptive measures of the designated patient population.
CLINICAL. Performs complete health history, physical examination and psychosocial assessment of patients within the designated practice or clinical unit. Completes histories, physicals, and assessments within 24 hours of admission on selected patients, per regulatory guidelines. Considers clinical presentation, cultural and religious influences, individual experiences, environmental factors, available resources and health behaviors/practices in assessment and re-assessment. Documents histories, physicals and patient care progress notes to reflect daily assessment, reassessment and treatment plan.
Orders customary laboratory, radiological and diagnostic studies per practice protocols, differentiates between normal/abnormal findings and follows protocols for abnormal findings, which may include referral to consulting physicians per customary pattern of the attending MD or with the collaborating physician. Quarterly medical records review reflects appropriate ordering patterns and resource utilization. Follows through on medical plan, revises plan and orders appropriate tests. Patient care progress notes reflect orders, evaluation of diagnostic studies, and plan for abnormal findings. Executes appropriate consults based on patient assessment to ensure timely delivery of care.
Formulates the plan of care, along with the attending physician, patient and family based on expected goals of care and length of stay. Develops a plan of care that is individualized to the patient's condition or needs. Formulates orders and plan with the patient, family and interdisciplinary team in a way that promotes each member's contribution toward achieving outcomes. Plans care that reflects knowledge of NYUHC Patient and Nursing Care Standards, evidence based practice and principles of safety. Develops a plan that provides for continuity of care. Coordinates care based on expected goals and length of stay. Documents plan of care with appropriate consideration given to patient confidentiality.
Works collaboratively with the attending physician, consulting physician(s), and other disciplines to identify, develop, and implement an appropriate plan of care that maximizes individual patient/family preference and enhances quality, access, and cost effective outcomes. Intervenes as an advanced practice nurse in a manner that is consistent with the established plan of care. Implements care that reflects knowledge of NYUHC Patient and Nursing Care Standards with incorporate current evidence-based practice and principles of safety. Prescribes and facilitates interventions. Implements interventions in a safe, timely and appropriate manner. Collaborates with the interdisciplinary team to implement an individualized plan of care. Documents interventions with appropriate consideration of patient confidentiality.
Prescribes in-patient and discharge medications according to New York State law including controlled substances with DEA authorization. Prescribes relevant medications to treat patient's admitting diagnosis, in consultation with the attending physician. Prescribes maintenance medications per patient's history or in consultation with attending physician. Adjusts medication doses and/or therapies based on a thorough review of patient history and reassessment. Evaluates patient's overall health status and prescribes appropriate preventive care, i.e., vitamins, inoculations, etc. Considers barriers related to patient compliance with medication regimen.
Prescribes medical equipment, devices, physical and occupational therapy, and home health services per practice protocol. Prescribes equipment and services as appropriate to patient need.
Evaluates treatment and health care plans for effectiveness and modifies per clinical standards and practice protocols. Monitors test results, patient responses to interventions, health status, and makes revisions to treatment plan based on patient need and responses. Communicates with attending physician, patient and staff regarding alteration in plan. Informs and discusses treatment plan with patient and family, and facilitates patient/family education process to reflect individualized learning needs. Participates as a member of interdisciplinary team rounds to ensure communication and delivery of prescribed treatment plan. Evaluates and communicates urgent and emergent needs within the time on duty. Documents medical plan of care and reflects patient's progress in meeting prescribed plan. Completes discharge summaries accurately and on a timely basis.
Educates patient and family to facilitate and promote healthy adjustment to new or changed health patterns. Collects and analyzes assessment data to identify patient/family learning needs and barriers to learning. Develops and implements an educational plan that reflects patient and family learning needs and barriers to learning at an expert level. Collaborates with the interdisciplinary team to evaluate and modify patient/family education plan based on readiness to learn and expected outcomes. Documents learning outcomes and revisions to patient/family education plan.
Acts as a professional role model to all levels of staff by incorporating expertise and related experience into all aspects of patient care. Wears professional attire, including name badge visible, facing outward, above the waist. Supports environment of respect and privacy for patients and staff via confidentiality standards, content and place of discussion. Demonstrates advanced competence in at least one area of clinical expertise. Contributes expertise to emergency situations in an organized, effective manner. Uses all sensory and technological resources to assess, monitor, intervene, and evaluate patient conditions. Adjusts working hours as indicated to support patient care management and fulfillment of role.
Considers needs and behaviors of specific patient age and cultural groups in all patient care activities. Age Specific Competencies (check all patient populations served). Neonate/Infant 0-12 months. Adult 19-64 years Pediatric 1-18 years Geriatric 65 and older. Provides care in a manner that demonstrates knowledge of physical, behavioral and emotional characteristics typical for the age group. Recognizes that patient of various ages or developmental stages react differently to same situations and modifies approaches accordingly. Identifies safety hazards and unsafe situations for the age-group and addresses them appropriately. Prescribes, prepares and administers medications with consideration of age-specific doses and methods of administration. Uses communication techniques that are age appropriate. Orders and adapts equipment used in care to age and size of patient. Identifies and reports sign of abuse or neglect.
Cultural Competencies. Recognizes that all patients may not share the values and practices of the US health system. Develops questions and identifies resources to learn about patients values, beliefs and practices. Views patients as well as other employees as individuals with unique, values, beliefs and practices. Identifies common health related views of the major cultural and religious groups served. Communicates with each patient and family in a culturally sensitive way.
Supports the mission, philosophy, standards, goals and objectives of the institution department and service line. Contributes to the development of goals and objectives of advanced nursing practice consistent with the overall departments of nursing, office of medical affairs and service line. Mentors others to maintain privacy and confidentiality for patients and hospital personnel. Assists leadership to create a participative environment in unit/service based meetings and other activities. Initiates projects for improving cost effectiveness in delivery of patient care. Analyzes and develops systems to prevent unexpected events and outcomes in collaboration with leadership.
Plans and organizes care to meet individual patient needs and to ensure appropriate clinical resource utilization per protocols, pathways, and other means. Utilizes protocols, pathways and order sets to formulate communicate and ensure implementation of the patient plan of care. Establishes realistic goals for patient to achieve milestones activities within appropriate timeframes. Demonstrates flexibility to meet patient care needs. Utilizes multidisciplinary colleagues to address individualized patient needs. Medical records reflect presence and usage of appropriate clinical pathway. Medical records reflect presence and usage of appropriate clinical pathway/protocol.
Works collaboratively with the interdisciplinary team including the attending physician to develop and implement the therapeutic plan of care for a group of patients and ensure communication with family members. Initiates appropriate referrals and documents in HIS. Follows up on referrals, tests and procedures to ensure timely implementation of plan. Participates and contributes as a regular member of interdisciplinary rounds to communicate pertinent information to support staff. Conducts family conferences to communicate plan of care and identify needs.
Participates in the development and revision of interdisciplinary and nursing standards, patient and family education materials as relevant to area of practice and expertise. Serves as a clinical expert for interdisciplinary pathway development or other performance improvement teams, as requested Uses Departmental, Service, and Unit Structure and Process Standards to guide practice. Identifies need for additional standards participates in development and/or revision, and evaluates effectiveness. Reviews patient education materials and clinical pathways on a biannual basis, for specific patient population served. Initiates development of additional materials through Care Management and/or Patient/Family Education Council.
Works collaboratively with the attending physician to maintain timely and appropriate communication with family members, house staff, other disciplines and ancillary services. Communicates directly with the attending physician to formulate and implement the plan of care. Collaborates with physician regarding patient's achievement of therapeutic regimen. Establishes discharge plan and contingencies with the attending physician upon admission and reassessment. Utilizes interdisciplinary rounds to communicate pertinent information to the interdisciplinary team.
Works collaboratively with nursing leadership to ensure timely communications with the nursing staff. Offers constructive assistance to nursing staff regarding their clinical performance, and communicates such information in regular meetings with Nurse Manager and unit leadership. Provides formal feedback to Nurse Manager prior to nursing staff's performance appraisals through verbal and/or written communication.
Provides consultation about the therapeutic regimen to the nursing staff responsible for the patient's care in the hospital setting. Uses opportunities to provide bedside teaching for nursing staff. Conducts and participates in unit / service rounds.
Facilitates the continuity of care across the continuum of services, e.g. home care, other facilities, appointments with MD's etc. Writes prescriptions for patients being discharged home in a timely manner. Communicates discharge plan to interdisciplinary team, home health agency staff, outside pharmacies and other facilities, such as skilled nursing facilities, through written summaries or discussion.
Participates in designated activities related to professional nursing standards and regulations of relevant outside agencies. Ensures the updating development and implementation of patient care and professional nursing standards. Demonstrates knowledge of JCAHO, CMS, and DOH standards pertinent to hospital. Ensures practice compliance with regulations and standards.
Promotes own professional growth and development in clinical and managerial role. Annually earns ~hours of continuing education and completes required programs for maintaining clinical competency. (See attached Education Record of CEDs). Assesses personal learning needs to enhance performance. Accurately completes quarterly chart reviews with collaborating physician. Participate in and utilizes peer review to identify areas for improvement in practice and leadership. Achieves previously established personal and professional goals. Completes annual performance evaluation.
Maintains current expertise in area of practice. Regularly attends offsite educational programs and professional offerings. Maintains membership in professional organizations (ANAC, NYSCOMP, ONS, etc.). Regularly participates in Advanced Nursing. Practice Council meetings. Attends Grand Rounds or other clinical presentations on a quarterly basis, or when pertinent topics are presented. Consults quarterly with collaborating physician on additional recommendations for clinical growth. Maintains annual mandatory education requirements and biannual credentialing requirements. Earns and maintains ANCC board certification.
Serves as a clinical expert and resource for the education of peers and other health professionals. Role models expert professional nursing practice. Precepts / mentors undergraduate and graduate students in nursing or other professions as requested. Supports a constructive environment of learning and development of mutual respect with medical students, house staff, and other disciplines. Facilitates staff access to outside educational opportunities through sharing of program announcements, etc. Prepares and provides informal and/or formal education to staff on clinically appropriate topics.
Participates in the development and monitoring of patient outcomes per established practice protocols for purposes of quality and performance improvement. Identifies desired outcomes and participates in development of measurement tools and data collection with Care Management and Service Line. Systematically engages in a review of patient outcomes and evaluates progress toward outcomes.
Uses evidence-based health care literature to advise and support appropriate practice changes within the designated service. Utilizes current literature to provide evidence based care to patients and family. Serves as a resource to promote evidence-based practice among nursing staff through dissemination of pertinent information from journals, web-sites, conferences/lectures and other resources.
Works collaboratively with nursing and other disciplines in the development and implementation of clinical studies within the area of expertise. Identifies areas requiring further study. Serves as clinical expert/preceptor for graduate students and/or faculty researcher, as required. Collaborates with physicians in research projects, as needed.
Assists in the preparation, implementation, and evaluation of research protocols when applicable. May serve as a member of a Nursing Research Council subcommittee. Serves as a resource for staff regarding the research process at NYYHC.
Monitors and trends the cost effectiveness of the position, particularly as it relates to the efficiency and performance indicators established for the service. Establishes performance indicators quarterly that review caseload, length of stay, and resource utilization. Reviews and analyzes resource utilization data and develops mechanisms for improvement.
To qualify you must have
Licensure: Current registration as a Nurse Practitioner and Registered Professional Nurse in New York State
Education: Master's Degree in Nursing; Board Certification as an Adult or Family Nurse Practitioner; BLS and ACLS
Competence: Relevant nursing practice in the care of the patient population served; GI nursing experience is preferred; ability to apply nursing process toward achievement of specific outcomes in an organized fashion, which addresses patient/family safety and satisfaction. Previous experience as a nurse practitioner is preferred. Evidence of excellent interpersonal skills, effective communication skills, creative problem solving and excellent critical thinking and leadership; Previously demonstrated ability to facilitate group processes and work cohesively and collaboratively as member of the interdisciplinary team; Effective change agent.
Preferred Qualifications: Membership in pertinent professional organizations preferred
Qualified candidates must be able to effectively communicate with all levels of the organization.
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