Nurse Practitioner Complex Continuing Care

The Complex Continuing Care and Complex Rehabilitation and Transition Care (CRTC) team is an in-patient service that provides care to clients from birth to age 18 with a variety of medically complex conditions that require intensive monitoring life sustaining technologies active re/habilitation needs and care coordination/navigation. The CCC team assists children and youth to acquire functional mobility movement and life skills and provides support services for families to care for their child and transition to their home and community.

The Nurse Practitioner (NP) as a member of the CCC team provides leadership and promotes excellence in pediatric client and family-centered nursing care through the key domains of practice (i.e. Clinical practice; Inter-professional Collaboration Consultation and Referral; Leadership and Scholarly Activities Research Education & Mentorship). The NP integrates in-depth knowledge of advanced nursing practice and theory health management health promotion disease/illness /injury prevention and other relevant biomedical and psychosocial theories to provide comprehensive health services.

The NP works in collaboration with their clients and families and other inter-professional health-care providers in the provision and coordination of high quality client and family-centred care. The NP provides autonomous direct care and clinical leadership for defined populations of children and youth. The specific population(s) will be determined in collaboration with the medical team (Canadian Nursing Association 2010). The NP will be registered as a Nurse Practitionerand work to full scope of practice within the current legislative framework.
Key Responsibilities
Clinical Practice:

• Provides direct care toclients and families within Complex Continuing Care who are transitioning to the community with medical complexity
• Provides comprehensive health assessment to diagnose health/illness conditions and to treat and manage acute and chronic illness within a holistic model of care
• Orders and interprets appropriate screening and diagnostic tests and performs therapeutic procedures
• Prescribes pharmacologic agents and therapeutic measures in accordance with federal/provincial legislation and policy
• Communicates effectively with clients and families and health care team members
• Coordinates care to ensure smooth transitions for clients and families between and across services
• Participates in and/or leads complex admission and transition planning processes
• Monitors evaluates and revises the plan of care and therapeutic interventions based on current evidence and on client goals preferences health status and outcomes
• Participates in systems improvement and innovations to ensure access and efficient use of clinical services

Inter-professional Collaboration/Consultation/Referral:

• Consults and collaborates with inter-professional team members clients and families as well as community healthcare providers and agencies to achieve the best health outcome for clients and families
• Consults with and/or refers clients to other health-care providers (e.g. physicians specialists) when appropriate and when the clients condition is not within the NP scope of practice
• Collaborates and participates in planning promoting implementing and evaluating new ideas concepts and interventions to facilitate care to clients and families
• Provides consultation to health care team regarding clinical situations within expertise area
• Build collaborative relationships with key partners (e.g. SickKids UHN - Toronto Rehab Institute)

Leadership:
The CCC team NP will use strength based leadership to develop themselves and engage others build partnerships and networks to achieve results and use systems/critical thinking to champion and orchestrate change.

• Provides leadership in the management of clinical care and is a resource person and role model
• Guides initiates and provides leadership in the development/revision of standards practice guidelines protocols policies and quality improvements education and research initiatives
• Participates in professional program and hospital-wide initiatives
• Actively promotes professional role through participation in external forums such as the Nurse Practitioner Association of Ontario Toronto Academic Health Science Network (TAHSN) NP community of practice
• Advocates to influence health care practice health services policy and outcomes
• Examines current processes identifies opportunities for change and provides recommendations for improvements
• Serves as a resource and consultant in strategic program planning decision-making and problem-solving within the program team and the organization

Research Education Mentorship & Scholarly Activities:

• Uses evidence in practice develops and uses clinical practice guidelines pathways and protocols in care provision
• Critically reviews analyses interprets and applies evidence to clinical practice
• Participates in the generation of new knowledge through active engagement in research initiatives and partnership with the Bloorview Research Institute and Centres for Leadership
• Acts as a change agent through knowledge translation and dissemination of new knowledge that may include formal presentations publication seminars and the development of clinical practice guidelines and policies.
• Functions as a content expert and resource person in their specialized field of practice and takes advantage of informal learning opportunities to educate the interprofessional team
• Participates in the academic community by providing education clinical supervision and mentorship through university cross-appointment
• Educates clients families members of the health care team referring facilities and other community providers
• Enhances personal and professional development through reflective practice and by attending educational opportunities and /or conferences in clinical specialty research & scholarship and/or leadership topics

Qualifications
Education

• Graduate degree from an approved and accredited Nurse Practitioner Program
• Current registration with the College of Nurses of Ontario Registered Nurse (Extended Class)
• Eligible for cross-appointment with the University of Toronto
• Basic Life Support (BLS) for Healthcare Providers

Experience

• Minimum 3 years pediatric and family nursing experience required
• NP experience within an Academic Health Science environment preferred
• NP preferred with experience in both acute care (inpatient/PICU/NICU) and post acute/chronic care (outpatient/community care/hospice) environments
• NP preferred with experience working as a member of a Complex Care team
• Evidence of active involvement/participation in scholarly activities

Skills

• Excellent conceptual and theoretical understanding of evidence-based practice and ability to articulate the concepts as they relate to advanced nursing practice
• Superior clinical decision-making ethical practice assessment diagnostic and therapeutic management skills
• Demonstrated problem-solving and critical thinking skills
• Effective communication and presentation skills (both verbal and written)
• Demonstrated leadership skills and effectiveness in collaborative relationship development
• Proven ability to work independently and as part of an interprofessional team
• Demonstrated ability to identify and meet own learning needs in pursuit of ongoing professional development
• Able to use computer software such as MS Office applications email and web applications