NP or PA - Cardiac Surgery Step Down Unit (nights only) at Massachusetts General Hospital(MGH)

Posted in Other 8 days ago.

Location: Boston, Massachusetts





Job Description:

GENERAL SUMMARY/ OVERVIEW STATEMENT: Summarize the nature and level of work performed.


Under general supervision and direction of the Cardiac Surgeons, and in accordance with the rules and regulations of Massachusetts governing Nurse Practitioner's practice, the Nurse Practitioner (NP) will be responsible for the care of patients on the Cardiac Surgical Service, primarily those patients that are admitted to the Cardiac Surgery Service. The NP will participate in daily rounds with nurses, other Advanced Practice staff, residents and multidisciplinary caregivers; perform bedside diagnostic and therapeutic procedures, participate in the development and implementation of care plans, coordinate tests and consultations, implement treatment plans, communicate with referring physicians, perform patient education, and prepare patients for discharge, all while keeping Surgeons updated as required. Maintains open lines of communication between Cardiac Surgeons, Residents, Fellows, PAs, Nursing Staff, Cardiologists, VAD NP Coordinator, and patients/families. Promotes a collaborative relationship and effort between the medical staff and professional nurses toward continuity of patient care and efficient use of resources. Serves as a role model for professional nursing practice.



UNIVERSAL DUTIES AND RESPONSIBILITIES: Indicate key areas of responsibility, major job duties, special projects and key objectives for this position. These items should be evaluated throughout the year and included in the written annual evaluation.



  • Provides direct care to a select patient population in collaboration with the physician.
  • Performs and records the patient history and physical exam and discusses findings with the physician.

  • Utilizes advanced nursing knowledge to identify, prevent or solve complex and/or recurring patient care problems.

  • Follows and manages patients (in collaboration with MD) enhancing continuity of care.

  • Performs (oversees/assures completion of) specialized procedures particular to the select population mutually agreed upon with collaborating physician.

  • Performs medically delegated aspects of patient care as agreed upon by nursing and medical administrators according to practice guidelines.

  • Collaborates with unit staff and physicians to facilitate a comprehensive plan of care and coordinate resources.

  • Writes orders which are in accordance with current guidelines.

  • Maintains and practices in accordance with practitioner guidelines per state and hospital regulations

  • Provides consultation to Nurses, Advanced Practice staff and Physicians.
  • Serves as a resource to staff in area(s) of expertise.

  • Serves on appropriate intra and interdepartmental committees.

  • Participates in the development of formal and informal educational programs for the unit-based nursing staff.
  • Develops educational programs within area of expertise.

  • Collaborates with unit staff, Clinical Educators, Clinical Nurse Specialists, Staff Specialists and other health care professionals to meet staff and patient educational needs.

  • Monitors patient outcomes in accordance with defined standards of patient care.
  • Collaborates with nurse managers, clinical nurses and medical staff to plan, implement and evaluate pertinent change in practice and health care delivery.

  • Identifies system-wide factors contributing to undesirable outcomes, such as complications, increased length of stay and overutilization of services.

  • Facilitates patient movement through the system and efficient use of resources through interdepartmental collaboration.

  • Supports research efforts to advance knowledge and to promote research-based practice.
  • Evaluates own practice and program effectiveness.

  • Identifies pertinent nursing and health delivery problems for investigation.

  • Evaluates current research findings for clinical specialty and determines applicability to unit practice.

  • Assists nursing and medical colleagues in research efforts.

  • Conducts own research.

  • Responsible for own professional growth and maintenance of required credentials.
  • Maintains the standards and educational requirements specific to the position and licensure.

  • Identifies own learning needs and goals.

  • Takes responsibilities for leadership and participation on committees and task forces of the DON and the hospital.

  • Maintains and updates clinical knowledge and skills based on current health care practice/research.

  • Participates in MGH and Partners quality initiatives and/or hospital committees as assigned





  • ROLE-SPECIFIC DUTIES AND RESPONSIBILITIES: Indicate areas of responsibility pertinent to specific role, major job duties, special projects and key objectives for this position. These items should be evaluated throughout the year and included in the written annual evaluation.



    Step Down Unit:




  • Assists with postoperative management of Cardiac Surgery patients. Under the direction of the surgeons, executes a wide range of management plans for patients.

  • Writes daily notes on all patients and discusses the care of each patient with surgeon or resident and other consult service(s) involved with the care of that patient.

  • Performs basic and advanced cardiac life support procedures as necessary and directs these efforts until the arrival of a surgical resident or attending physician.

  • Attends daily rounds. Will also round independently.

  • Assists with or performs procedures to include removal of chest tubes, wound care, removal of drains, epicardial wire removal, & thoracentesis as acceptable via division clinical guidelines.

  • Obtains consultations from other services.

  • Admits patients from outside hospitals, ED, clinic, or other hospital units as necessary

  • Reviews transfer patients from the CSICU to Ellison 8 (H&P, orders).

  • Renews medications, transfer orders and general orders.

  • Performs appropriate evaluation of all patients on a daily basis. Medications, treatments, labs and consults will be ordered as needed. Discussion of the care of the individual patient will be made directly with the Attending Surgeon or resident, Cardiologist or other consult service that is involved with the care of that patient.

  • Cardiac Care of the postoperative surgical patients in the SDU shall include:
  • Initiating pacing with external pacemaker systems, atrial and/or ventricular, in patients with existing pacing wires for treatment of bradycardia, hypotension or arrhythmia suppression

  • Skin wire insertion in patients who require pacing but in whom the existing bipolar wires do not function properly

  • Changing milliamp output, sensitivities, and/or polarities of the pacing system

  • Removal of chest tubes, drains, epicardial pacing wires, central lines

  • Applying and/or changing wound VAC

  • Management of VAD and Cardiac transplant patients

  • Evaluation and treatment of medical events that might occur on the post-operative surgical patients (eg. onset of arrhythmias, respiratory distress, alteration in neurological status, wound care management, etc.)

  • Liaison with VAD Coordinator, Transplant Coordinator SDU Nursing Director, and Heart Failure team

  • Develops and implements routine instructions for patient discharge.

  • Participates in Cardiac Surgery Service and Department of Surgery educational meetings with students and residents assigned to the surgical services.

  • Assists with ongoing clinical research through follow-up of patients currently involved in clinical trials.

  • Assists in current clinical research and pursues independent clinical research.





  • QUALIFICATIONS: MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.



  • Current licensure in the Commonwealth of Massachusetts as a registered nurse in the expanded role.

  • Master's Degree in Nursing.

  • National certification in acute care advanced practice nursing.





  • SKILLS/ ABILITIES/ COMPETENCIES REQUIRED: MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.



  • Professional knowledge: Clinical, healthcare management with knowledge to enable effective interactions and communication with clinicians, administrators and other professionals.

  • Time Management: Exceptional organizational skills and ability to prioritize effectively and complete tasks; Flexibility to handle multiple tasks and deadline pressures.

  • Clinical leadership: Highly motivated, independent and capable of performing in a complex environment; Strong sense of initiative and perseverance to carry through to completion of tasks; Demonstrates forthrightness and integrity.

  • Interpersonal/communication: Excellent interpersonal, written and oral communication, and public speaking skills; Good command of English language, including medical and scientific terminology.

  • Information Systems/Technology Skills: Exceptional computer skills (including Windows operating systems, word processing, database, electronic mail, Internet, spreadsheets, and other office management systems).

  • Quality Assurance: Skills to work efficiently and effectively and strive to do so in all aspects of position; Effective project management skills and attention to detail.

  • Critical Thinking/Decision Making: Ability to appropriately evaluate all aspects of a situation and to independently make appropriate and timely decisions.

  • Collaboration: Ability to coordinate among diverse constituents, both inside MGH and in the community.

  • Discretion and Confidentiality: Ability to handle sensitive and confidential matters discreetly and to ensure confidentiality guidelines are maintained by staff.

  • Safety/Compliance: Knowledge in aspects of safety applicable to position; Knowledge of and compliance with institutional, Joint Commision, HIPAA, and other regulatory bodies' standards.





  • TRAINING & ORIENTATION



    1.0 Training will be tailored to the individuals experience level but will include a minimum of two months orientation.


    2.0 Orientation will be provided primarily by the Advanced Practice staff and will include all necessary aspects of patient care specific to area of practice.



    WORKING CONDITIONS: Describe the conditions in which the work is performed.


    Normal clinical conditions in a variety of hospital settings to include inpatient, clinic, and operating room.


    May require attendance at meetings outside of regularly scheduled hours.


    Rotating work schedule assigned by work location. Position may includes night, weekend, & holiday coverage for inpatient responsibilities.



    SUPERVISORY RESPONSIBILITY: List the number of FTEs supervised.


    No direct supervisory responsibilities



    Qualifications

  • Current licensure in the Commonwealth of Massachusetts as a registered nurse in the expanded role.

  • Master's Degree in Nursing.

  • National certification in acute care advanced practice nursing.





  • EEO Statement

    Massachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. Applications from protected veterans and individuals with disabilities are strongly encouraged.
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