Physician Assistant or Nurse Practitioner Acute Care - Cardiac Surgery Step Down Unit

GENERAL SUMMARY/ OVERVIEW STATEMENT: Under general supervision and direction of the Cardiac Surgeons and in accordance with the rules and regulations of Massachusetts governing Physician Assistant practice the Cardiac Surgery PA will be responsible for the care of patients on the Cardiac Surgical Service primarily those patients that are admitted to the Cardiac StepDown Unit (SDU). The PA will participate in daily rounds with nurses other PAs NPs residents and multidisciplinary caregivers. Performs bedside diagnostic and therapeutic procedures participates in the development and implementation of care plans coordinate tests and consultations implements treatment plans communicates with referring physicians performs patient education and prepares 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 Orbit 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. PRINCIPAL DUTIES AND RESPONSIBILITIES: UNIVERSAL DUTIES AND RESPONSIBILITIES: 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 PAs 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 unitbased 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 systemwide 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 researchbased 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. SERVICE SPECIFIC DUTIES AND RESPONSIBILITIES:Postoperative Hospitalization and Discharge: Assists with postoperative management of 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 with residents and PAs. Will also round independently. Assists with or performs procedures to include removal of chest tubes wound care removal of drains etc. as acceptable via the guidelines of the Cardiac SDU. Obtains consultations from other services. Reviews transfer patients from the CSICU to Ellison 8 (H&P orders). Renews medications transfer orders and general orders under supervision of physician. 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 preoperative and postoperative surgical patients shall include: Initiates pacing atrial and/or ventricular in patients with existing pacing wires for treatment of bradycardia hypotension or arrhythmia suppression Initiates pacing with external pacemaker system Skin wire insertion in patients who require pacing but in whom the existing bipolar wires do not function properly Change milliamp sensitivities polarities of the pacing system Remove pacing wires when appropriate Evaluation and treatment of medical events that might occur on the postoperative surgical patients (onset of arrhythmias respiratory distress alteration in neurological status wound care management etc. Immediate support measures will be instituted. Liaison with VAD Coordinator and SDU Nursing Director Participates in patient billing as approved by the collaborating physician while adhering to hospital billing guidelines. Educational: 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 followup of patients currently involved in clinical trials. Assists in current clinical research and pursues independent clinical research. Credentialed to practice as a Physician Assistant at MGH and attain recredentialing every two years Participate in precepting PAs NPs and/or medical students Training/Orientation:There will be a minimum of a twomonth orientation to the Cardiac Surgical service. During this time the advanced practice staff will give the appropriate orientation to the SDU that includes patient care management diagnostic tests therapeutic modalities prescription writing discharge planning and patient education.Other: Participates as requested in MGH and Partners quality initiatives. Participates in various hospital and system committees as assigned. May be required to participate in clinical coverage in areas outside of the SDU at the discretion of the collaborating physician. QUALIFICATIONS: Current licensure in the Commonwealth of Massachusetts as a Physician Assistant. Masters Degree in Physician Assistant Studies. National certification by NCCPA. SKILLS/ ABILITIES/ COMPETENCIES REQUIRED: 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. 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. Personnel Management: 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 JCAHO HIPAA and other regulatory bodies standards. WORKING CONDITIONS: Normal office conditions.May require attendance at meetings outside of regularly scheduled hours.Shifts are predominantly dayshifts which extend into evening hours in addition to covering weekends and holidays. May include night coverage as necessary. SUPERVISORY RESPONSIBILITY: No direct supervisory responsibilities. FISCAL RESPONSIBILITY: Cost effectively uses supplies and resources.Massachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills perspectives and ideas we choose to lead. Applications fromprotected veterans and individuals with disabilities are strongly encouraged.