NP or PA - Post Op Cardiac Surgical Care - ICU EXP REQUIRED

GENERAL SUMMARY/ OVERVIEW STATEMENT FOR PHYSICIAN ASSISTANT: Under general supervision and direction of the Division Chief Cardiac Surgery Cardiac Surgical Intensive Care Unit (CSICU) Medical Director Cardiac Surgery Chief PA and Lead NP and in accordance with the rules and regulations of Massachusetts governing Physician Assistantspractice the Physician Assistant (PA)will be responsible for the care of patients on the Cardiac Surgical Service. Participates in daily rounds and multidisciplinary caregivers performs bedside diagnostic and therapeutic procedures coordinate tests and consultations implements treatment plans communicates with referring physicians performs patient education and prepares patients for discharge. Maintains open lines of communication between Cardiac Surgeons ICU Attendings Residents Fellows PAs NPs Nursing Staff Cardiologists border services and patients/families. Promotes a collaborative relationship and effort with all team members toward continuity of patient care and efficient use of resources. Serves as a role model for professional PA 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 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 supervising physician or designee. Performs medically delegated aspects of patient care as agreed upon by medical administrators according to practice and guidelines. Collaborates with 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 PA guidelines per state and hospital regulations. Provides consultation to physicians PAs NPs and nurses. 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 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 medical staff and clinical nurses and 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 over utilization 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 professional and health delivery problems for investigation. Evaluates current research findings for clinical specialty and determines applicability to service practice. Assists 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 division 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 or ICU attending executes a wide range of management plans for patients. Writes daily notes on assigned patients and discusses the care of each patient with the surgeon or ICU attending and other consult service(s) involved with the care of that patient. Maintains communication with referring physicians. Performs basic and advanced cardiac life support procedures as necessary and directs these efforts until the arrival of a surgical resident or attending physician. Rounds independently and attends daily rounds with Surgeons/Intensivist when available. Assists or performs procedures to include: Removal of chest tubes wound care removal of drains etc. as acceptable via the guidelines of the service. Bronchoscopies central and arterial line placement endotracheal intubation (in the CSICU). Obtains consultations from other services. 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 intensivist 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. Wound management and dressing changes when indicated Immediate support measures will be instituted. Familiarity with CVVH Mechanical Circulatory Support (intraaortic balloon pumps ventricular assist devices ECMO) pulmonary arterial catheters arterial catheters and mechanical ventilation support (in the CSICU). Completes Transfer notes for patients being transferred to another unit Completes all discharge paperwork for any patient discharged from unit. This includes discharge summary discharge orders and prescriptions. Liaison with other PA and NP staff on the service. Participates in patient billing as approved by the collaborating physician while adhering to hospital billing guidelines. May be involved with management of patients in the Outpatient Area. This may include wound management and patient followup. Assist staff with vein mapping. (remove) Preoperative evaluation and management: Performs thorough history and complete physical examination on any patient admitted to the Cardiac Surgical Service. With input form Attending Surgeon/Intensivist will develop a management plan for each patient. Adjusts medications and writes a daily progress note. Intraoperative Care: After a minimum period of time on the service 6 months to 1 year) there may be an opportunity to participate in the intraoperative care of patients Training would involve direct supervision with an experienced PA Aproval of Surgical Coordianting Committee is required prior to independent involvement in the OR. Operative care would include: Positioning patients in the operating room and prepping for surgery Vessel harvesting for CABG procedures first and second assisting for other procedures Transferring patients to the CSICU and giving signout to appropriate clinician. Filling out Brief Intraoperative Note for surgeon to review and sign. Once fully trained will be involved in rotating call schedule with other PAs. (remove) EDUCATIONAL Assist in the development of protocols and procedures for PAs NPs residents and nurses. 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 TRAINING/ORIENTATION There will be a minimum of a twomonth orientation to the Cardiac Surgical ICU on the Cardiac Surgical service. During this time PAs and NPs along with the surgical staff will give the appropriate orientation that includes patient care management diagnostic tests therapeutic modalities patient billing prescription writing discharge planning and patient education. REPORTINGPer 263 CMR Board of Registration of Physician Assistants in the Commonwealth of Massachusetts a PA shall be accountable to a designated supervisory physician.Physician supervision of the PA shall be continuous but shall not require the personal presence of the supervisory physician. In addition the physician is empowered to use his/her discretion in the delegation of functions appropriate to his skill as long as the PA retains legal responsibility and shares liability for competence.SCOPE OF PRESCRIPTIVE PRACTICESPrescriptive practices will conform to the regulations set forth by the Commonwealth of Massachusetts Board of Registration of Physician Assistants 263 CMR Board of Registration in Medicine 243 CMR and the Department of Public Health 105 CMR 700.00. This will include Schedule IIVI . Prescriptions will be written for a onemonth supply unless otherwise required by an insurance carrier or if a shorter course is necessary. A maximum of two refills will be issued. Schedule II will be written for a finite number of pills without a refill. If a refill is requested the patient will be instructed to discuss the need with his/her private physician.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 CSICU at the discretion of the collaborating physician. QUALIFICATIONS: A PA must graduate from an accredited program. He/she must then be certified by the National Commission on Certification of Physician Assistants after passing an exam developed by the National Board of Medical Examiners. Maintenance of this certificate requires completing 100 hours of Continuing Medical Education credits every two years. In addition a PA must demonstrate continued competence by passing a recertification exam every six years. Current licensure in the Commonwealth of Massachusetts as a Physician Assistant. Strong interest in Cardiac Surgery or related Cardiology program. Prior experience preferred. 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 CMS and other regulatory bodies standards. WORKING CONDITIONS: Direct patient care role that will include exposure to a hospital environment on a daily basis. Will come into physical contact with patients and may risk exposure to bodily fluids. Normal office conditions will be encountered as well as fast paced complex clinical settings.May require attendance at meetings outside of regularly scheduled hours.Rotating shifts including some weekends and holidays.SUPERVISORY RESPONSIBILITY: No direct supervisory responsibilitiesFISCAL RESPONSIBILITY: None Job Description GENERAL SUMMARY/ OVERVIEW STATEMENT FOR NURSE PRACTITIONER: Under general supervision and direction of the Division Chief Cardiac Surgery Cardiac Surgical Intensive Care Unit (CSICU) Medical Director Cardiac Surgery Chief PA and Lead NP and in accordance with the rules and regulations of Massachusetts governing Nurse Practitioners practice the Nurse Practitioner (NP) will be responsible for the care of patients on the Cardiac Surgical Service. Participates in daily rounds and multidisciplinary caregivers performs bedside diagnostic and therapeutic procedures coordinate tests and consultations implements treatment plans communicates with referring physicians performs patient education and prepares patients for discharge. Maintains open lines of communication between Cardiac Surgeons ICU Attendings Residents Fellows PAs NPs Nursing Staff CardiologistMassachusetts 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.