Nurse Practitioner or Physician Assisant

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

About Duke University Hospital

Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States and is the number one hospital in North Carolina, according to U.S. News and World Report for 2023-2024. Duke University Hospital is the largest of Duke Health's three hospitals and features 1048 patient beds, 65 operating rooms, as well as comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.

The Duke Hospital Pulmonary Medicine/Transplant Advanced Practice Provider (APP) provides direct inpatient care services for seriously ill complex (multi-organ) patients on the pulmonary medicine/transplant service under the supervision of the pulmonary transplant attending physician.   The APP performs physical exams, collects and documents data, conducts diagnostic and therapeutic procedures, orders and schedules laboratory studies and professional consultations, prescribes appropriate interventions and medications, coordinates the care and discharge of patients, assist in the bronchoscopy suite, and provides direct patient care services. This position does not include operating room responsibilities. Outpatient clinic responsibilities may grow over time. The Nurse Practitioner / Physician Assistant contributes to excellence in patient care, research, teaching, and provides leadership to the organization.

Job Duties and Responsibilities

• Provide /coordinate clinical practice for pulmonary medicine/transplant patients at Duke Hospital being followed by the pulmonary medicine transplant service through established protocols and under the supervision of the pulmonologist who is either on site or available by phone.
• In collaboration with attending pulmonologist, round daily on patients to assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of the pulmonary medicine/transplant patient care
• Collaborate with the chief resident, residents and fellows to formulate treatment plans and monitor patient progress
• May order and/or perform the following procedures:
  • Patient history and perform physical exam
  • Laboratory, radiology, and/or diagnostic procedures/tests
  • Interpretation of laboratory, basic radiographic and diagnostic tests
  • Chest tube management and removal
  • Evaluation of pleurovacs (chest tube drainage systems)
  • Blood sampling via central venous lines (CVLs) including:
    • Temporary central catheters
    • Tunneled catheters
    • Implantable vascular access devices
    • Line placement for peripheral venous access
    • Suture / Staple removal
    • Application of dressings, bandages, wound vacs
    • Simple debridement
    • Manage cantor tubes, NG tubes, G tubes, J tubes including insertion of postpyloric and nasogastric tubes/cortrak placement.
    • Manage support devices, including (but not limited to) hemovac, JP drains,  wound vac
    • Management of acute decompensation of the patient
    • Bedside bronchoscopy
    • Peripheral intravenous catheter placement (PIV)
    • Administration of infusion therapy
• Assess patients for change in status and institute appropriate interventions.  Initiates emergency interventions in an effort to stabilize the patient until physician support arrives.
• Preoperative evaluation; including (but not limited to) establishing diagnosis, and baseline status
• Postoperative stabilization and management.
• Develop patient care pathways, protocols and guidelines for the management of specific problems in conjunction with physicians and other members of the health care team.
• Analyze clinical practice patterns so as to provide the best medical care and to increase effectiveness and efficiency.
• Communicate verbally and in writing all pertinent patient information to supervising MD, nursing staff, patient resource manager, home health agency, and other relevant healthcare providers.
• Document in the patients' chart all relevant data including but not limited to results of diagnostic tests; laboratory results; patients' condition and response to therapies/interventions; communications with supervising MD.
• Utilize prescriptive privileges only for identified patient population.
• Prescriptive authority for prescribing, ordering, and or administering drugs; including (but not limited to) schedule II, III, IV, and V drugs and necessary medical devices.
• Model competence in all nurse practitioner / physician assistant advanced skills.
• Assess educational needs of the inpatient pulmonary transplant service areas' patient-care staff and provide one-on-one as well as formal in-service education as need.
• Assess educational needs of the inpatient pulmonary transplant service's patients / families and provide patient/family education interventions as indicated.  Document all pre and post-op education in pts medical record.
• Implement and evaluate appropriate educational programs for referring MDs, DUHS patient care staff, and other healthcare providers as appropriate.
• Role model and precept healthcare learners through contractual agreements.
• Utilize current research and evidence-based decision-making in all clinical practice.
• Incorporate clinical research findings in the development and implementation of standards of care.
• Support IRB approved clinical research/trials though a variety of activities including but not limited to: obtaining consent; ordering diagnostic tests; recording laboratory & diagnostic results; administering therapeutic interventions; and reporting patient outcomes including toxicities or adverse events.
• Participate in interdisciplinary quality improvement and/or research activities.
• Participate in measuring and documenting outcomes.
• Provide expertise and resource information to other healthcare providers, patients and families, and the community at large related to pulmonary medicine and pulmonary transplant diseases, procedures, interventions, and conditions.
• Develop, implement and evaluate standards of care/practice guidelines/policies and procedures/care maps/protocols within area of specialization.
• Develop programs and projects in areas of expertise to facilitate the attainment of the goals and objectives of the inpatient pulmonary medicine/transplant unit at Duke University Hospital and Duke University Health System.

Job Eligibility Requirements

Education

PA:         Graduate of ARC accredited Physician Assistant Program, Master's or Doctoral Degree preferred

NP:         Graduate of accredited MSN or DNP Nurse Practitioner program for adult care

Licensure

PA:         Current unrestricted medical license issued by NCMB with authorization to practice as PA

NP:         Current unrestricted RN license issued by or recognized by the NCBON with authorization to practice as an NP.

Certification

PA:         PA-C

NP:         National NP certification in the care of adults, i.e., AGACNP, ACNP, AGNP, FNP

Experience

Prefer 1-2 years of APP experience in a similar setting, but not required.

Physical and mental requirements:

• Able to clearly articulate scope of practice, and practices within those guidelines as a  Nurse Practitioner / Physician Assistant in the state of North Carolina and within the Duke University Health System.
• Able to communicate clearly with patients, families, visitors, healthcare team, physicians, administrators, leadership, and others.
• Able to use sensory and cognitive functions to process and prioritize information, perform health assessments, treatment, and follow-up.
• Able to use fine motor skills.
• Able to record activities, document assessments & interventions; prepare reports and presentations.
• Able to use computer and learn new software programs.
• Able to provide leadership in clinical area of expertise and in meeting organizational goals.
• Able to navigate the Hospital and DUHS to provide clinical expertise to specific patient populations.
• Able to withstand prolonged standing and walking with the ability to move or lift at least fifty pounds.
• Able to remain focused and organized.

Job Hours           

Primary work hours will be rotating 12 hour shifts (7 days a week, 7am – 7pm) to equal 14 shifts per month which will include holiday coverage at times. Hours of coverage may be changed by administration to meet service needs.

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.