Acute Care Nurse Practitioner or Physician Assistant: CSICU

This position is working in our Cardiac Surgery ICU department.

In this position the APP will Round with a multidisciplinary team and create a plan for assigned patients. The APP will execute plans and follow up, as well as communicate with ICU attending and Surgical Teams. The APP will be involved with procedures as needed.

The primary procedures in the CSICU p include Central line, Chest tube, ALine, Pulmonary Artery Catheter, Bonchoscopy, Balloon Pump Removal, moderate sedation.

Summary Under general supervision, responsible for diagnosing and treating patients in collaboration with physician colleagues. Provide continuity of patient care by facilitating and coordinating communication between the health care team, patient and patient's family. Coordinate care to ensure quality, cost effective care; appropriate length of stay; and patient safety. Serves as link integrating relevant research and best practices.

Principal Responsibilities

The following statements are designed to describe the general nature and level of work being performed by the provider assigned to this classification. This description is not intended to be an exhaustive list of all job responsibilities performed by this individual.

A detailed description specific to performance functions will be described in the Nurse Practitioner's collaborative written agreement.

1. Clinical Responsibilities
   • In collaboration with the attending physician, provides day to day organizational and clinical direction and leadership of the healthcare provider team.
   • Performs comprehensive history and physical assessment for patients admitted/scheduled to service/practice setting.
   • Orders, obtains and interprets appropriate diagnostic tests.
   • Establishes medical diagnosis based on history, assessment, and diagnostic findings.
   • Designs, orders and documents appropriate treatment plans/plans of care including prescriptions of medications based on a comprehensive review of HPI and diagnostic results.
   • Initiates protocols/clinical pathways, evaluates the plan of care ensuring timely intervention.
   • Performs invasive procedures.
   • Collaborates with attendings and residents regarding admission, discharge and transfer decisions.
   • Presents patients in the nurse practitioner's caseload on rounds.
   • Communicates plan of care with appropriate providers including the collaborative physician, the primary care provider, the referring provider, the nursing staff, and the case manager.
   • 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.
   • Counsels and educates patients and family members in disease process, health maintenance and health promotion activities. Provides primary, secondary, and tertiary preventive care services.
   • Initiates appropriate referrals and specialty consultations or other agency involvement as needed.
   • Facilitates patient flow. Collaborates with the multidisciplinary team including case management ensuring appropriate and timely discharge.
   • Provides specialty consultation.
   • Advocates for patients ensuring patient/family participation in care, knowledge of treatment options, and understanding of patient rights.
   • Considers the holistic needs of patients and orchestrates resources (i.e. Pain service, palliative care)
   • Performs other activities as delineated in individual nurse practitioner written agreements.
2. Education Responsibilities
   • Provides formal and informal educational programs for other members of the health care team consistent with evidence-based practice standards.
   • Participates in mentoring activities. Precepts students.
   • Promotes understanding of disease processes in area of specialty/program.
   • Functions as a clinical resource for other team members including but not limited to interns, residents, fellows, nurses, and medical students.
   • Provides community education, health promotion and outreach.
   • Acts as a community health resource for specialty disease entity.
3. Clinical Leadership/Outcomes
   • Is responsible for coordinating adequate nurse practitioner coverage on their service. Works with the physician and nurse practitioner staff to assure this coverage.
   • Works with physician leaders and hospital administration to achieve service specific outcome targets for key metrics including clinical outcomes, LOS, cost of care and patient satisfaction.
   • Participates in performance improvement activities aimed at improving clinical outcomes and minimizing variation.
   • In collaboration with physician leadership and the multidisciplinary team, develops clinical pathways.
   • Participates in and leads quality assurance activities (i.e., chart reviews, peer review) and establishes standard of practice.
   • Advances the patient care delivery process through the application of research, evidence-based practice standards, and industry best practices.
   • Advises and influences hospital level policy and procedure that improves the delivery of care.
   • Introduces and evaluates new patient care delivery systems, models of care and therapeutic and preventive interventions that target patient needs not met by current care delivery strategies.
   • Actively participates and contributes to various department and division meetings and organizational initiatives.
   • Maintains compliance and regulatory documentation for administrative purposes and reimbursement for services.
   • Participates in accreditation readiness.
   • Supervises ancillary staff including completing annual reviews.
4. Customer Service
   • Models and upholds a customer service focus to all internal and external customers.
   • Demonstrates respect for all people in the work environment.
   • Ensures confidentiality of patient information.
5. Professional Development and Organizational Leadership
   • Serves on department, hospital and community committees.
   • Maintains professional licensure, certification, and collaborative agreement as required by the Maryland State Board of Nursing and national certifying organizations
   • Participates in department educational opportunities (i.e. journal clubs, grand rounds, etc.).
   • Participates in and presents at local, regional, and national professional organizations.
   • Pursues educational opportunities for professional growth (i.e. CEUs, update conferences).
   • Promotes the organization to all customers. Acts as a loyal and supportive informed spokesperson for the hospital.
6. Research Responsibilities
   • Serves as a clinical trial sub investigator participating in or coordinating all phases of industry sponsored research.
   • Doctorally prepared nurse practitioners are expected to conduct nursing research as the principle investigator adding to the body of knowledge in the nursing domain.

The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state's future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System's anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org .

1. Master of Science Degree with completion of an Acute Care Nurse Practitioner program. Registered and currently recorded with the Maryland Board of Examiners of Nurses and Certified as an Acute Care Nurse Practitioner in the State of Maryland. Certified in area of specialty. (DEA and CDS eligible).
2. CPR required
3. ACLS/BCLS as required for inpatient work.
4. A minimum of one (1) year experience as a Registered Nurse is required.
5. Demonstrated ability to promote professionalism through involvement in professional organizations, teaching, research, publishing, and/or certification in area of specialty.
6. Ability to demonstrate 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.
7. 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.
8. Maintains updated hospital safety and other mandatory training.
9. Updated immunizations as recommended per practice area.

Working Conditions

1. Weekend, shift work, holiday, on-call and overtime may be required.
2. There is potential for regular exposure to patients possessing infectious diseases in the work environment; requires observance of "Universal Precautions" by wearing gloves, goggles, and mask, is required.

Patient Safety

Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.

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

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