GENERAL SUMMARY: The Advanced Practice Registered Nurse (APRN)/Nurse Practitioner (NP) is responsible and accountable for the comprehensive direct medical and nursing care of the pediatric patient for delegated aspects of care, under the practice agreement with collaborating physician(s) to include: health promotion, health supervision, illness prevention and diagnosis, treatment and management of various health problems and conditions. The APRN/NP is a clinical expert, mentor and educator, leader, collaborator, and researcher. Schedule varies according to area of accountability needs.
% of Time
1. In collaboration with physicians, assesses patient, synthesizes and analyzes data, develops plan of care, orders diagnostic tests and therapeutic treatments and evaluates clinical outcomes according to individualized* patient needs/age specific standards.
(*Individualized refers to the patient’s developmental, cognitive, cultural, psychosocial, spiritual, and educational/family influences and physical/medical care needs.)
· Completes an accurate assessment of patients within assigned specialty.
· Identifies appropriate medical diagnoses, and documents plan of care in progress notes.
· Utilizes appropriate diagnostic tests related to patient condition, and demonstrates ability to interpret the diagnostic tests.
· Synthesizes and analyzes data obtained through assessment to develop a comprehensive plan of care that is individualized and reflects patient care needs including interventions and treatments to attain expected outcomes.
· Implements plan by writing appropriate medical orders in accordance with medical practice standards and/or jointly approved protocols.
· Evaluates and revises plan as indicated by changes in patient condition or needs.
· Communicates daily medical plan/updates to patients/parents, medical team involved, and other interdisciplinary team members.
· Demonstrates understanding of caregiver dynamics involved in providing care to the pediatric patient.
· Works in collaboration with nursing staff to integrate individualized nursing plans/ interdisciplinary goals in support of the medical plan of care.
· Assesses the educational needs of patients/caregivers and develops/implements the educational plan in collaboration with other healthcare professionals.
2. Prescribes therapeutic measures and medications according to the State of Nebraska APRN statutes and Children’s Hospital Policies. Performs select invasive procedures, as approved in his/her individual Scope of Service, according to Children’s Hospital policies.
· Demonstrates competency in principles of medication dosing and mechanism of action as it relates to specific diagnosis.
· Orders/administers medication according to Children’s Hospital policy, procedure and scope of practice.
· Maintains accurate log of credentialed procedures performed. Demonstrates knowledge and expertise when performing credentialed procedures/specialty skills, independently or with a physician to include: Chest Tube removal, Pacemaker Wire Removal and specialty skills such as Emergent Airway Management, Drain Removal, Suture Removal, and Infiltration/extravasation Antidote Administration.
3. Documentation reflects assessment/evaluation, modification, and patient’s response to therapy, changes in condition, and therapeutic interventions/procedures.
· Entries in the medical record follow hospital policy (i.e., date, time, use of appropriate abbreviations, and legibility).
· Facilitates written medical orders vs verbal orders, when appropriate.
· Documentation reflects timely notification of collaborating physician and/or appropriate health care team members.
· Documentation reflects communication with families/caregivers as appropriate (i.e., update on plan of care, teaching, etc.).
· Documentation notes are individualized to the clinical area and reflect assessment, plan of care, rationale for plan of care, care changes, and collaborative discussions, contains necessary components per hospital policy and standards. Notes include but are not limited to:
o History and Physical
o Consultation Notes
o Discharge/Transfer Summary
o Progress Note plan of Care and Procedure Notes
o Unplanned changes in patient condition which may/may not result in changes of plan of care
o Time Out process completed
o Documentation accurately reflects services provided in order to appropriately code for billing
4. Assumes leadership role in implementing and reinforcing medical/nursing standards of practice to promote quality patient care.
· Performs as a clinical content expert in integrating medical/nursing practice into unit/organizational systems under development/review.
· Collaborates with identified groups in the organization to define/clarify/improve practice while incorporating research findings, new knowledge and national standards to advance patient care throughout the organization.
· Proactively identifies educational needs related to patient care specialty and provides formal/informal professional education.
· Coordinates/participates in clinical project planning and program development for effective implementation and monitoring of outcomes.
· Identifies opportunities to acknowledge unit/organization for patient care best practices as seen through support of publication/research participation.
Regular attendance at work is an essential function of the job.
Perform physical requirements as described in the Physical Requirements section
· Performs other duties assigned.
· Participates in preceptorship/internship of nurse practitioner students, as assigned.
§ Promotes professionalism and leadership within service team, and through interactions with patients, families, staff, colleagues, others.
§ Professionally seeks opportunities to help unit team members/department, as needed.
§ Accepts assignments to share/teach knowledge and provide clinical support.
Achieves department/organization Outcomes
· Provides prompt, timely service that meets or exceeds expectations.
· Understands and anticipates the needs of patients, families, and/or customers and utilizes feedback to improve and reinforce satisfaction.
· Responds promptly and effectively to reverse negative service situations (service recovery).
· Takes positive action to meet department and organization satisfaction goals.
· Recommends and implements process improvements that improve quality, efficiency, safety, time and/or reduce cost.
· Makes appropriate use of own time.
· Anticipates and adjusts to changes in workload by organizing and prioritizing own work.
· Utilizes performance measurements to improve work quality and patient/customer outcomes.
· Performs work accurately and professionally.
· Uses quality review processes to identify and correct potential errors.
· Takes positive action to meet department/organization quality goals.
§ Is an available/visible medical/nursing resource for staff.
§ Is consistently a role model by facilitating, supporting, mentoring, taking initiative, and practicing proactive problem solving.
§ Assesses parent/patient questions and concerns and develops a plan to address needs. Communicates information to appropriate person(s) in appropriate time frames to meet parent/patient questions, concerns, and/or expectations.
§ Initiates/completes patient/parent concern reports, when issues arise.
§ Incorporates key concepts into communication with parents:
o Introduces self to parent/patient when enters room.
o Explains purpose of activity before touching the patient.
o Before leaving the room, asks “Is there anything else that I can do for you?”
§ Utilizes appropriate CPT codes to optimize the nurse practitioner billing system.
§ Follows policy for capturing patient charges (stickers on charge sheets).
§ Participates in unit specific cost saving activities.
§ Considers factors related to cost, safety and effectiveness in delivery of patient care.
§ Participates in the evaluation and implementation of new products, ensuring that the value analysis process is maintained.
§ Initiates/designs/participates in audits, and analyzes data with the leadership team to develop an action plan.
§ Coordinates and/or participates in data collection and analyzes databases specific to specialty (i.e. Vermont Oxford – NICU, PRISM – PICU, PICC data, CTS database)
§ Serves on performance improvement teams as needed.
§ Identifies opportunities to enhance clinical practice by evaluating current practices utilizing new/current research, and leads the integration of changes in care practices into related unit/hospital policies/procedures/CPGs/NDs and actual practice.
§ Seeks out and identifies opportunities for system improvements and takes action by providing leadership in strategy design/education.
Adherence to Policies, Procedures, Safety, and Compliance/Regulatory Requirements
· Understands and performs role in emergency situations (i.e., disruptive individuals, internal/external disaster, CPR for direct patient care providers, Code Adam).
· Understands and practices regulatory standards and department/organization policies and procedures as appropriate to employee’s position (e.g., Joint Commission, HIPAA, OSHA, Infection Control, Environment of Care, National Patient Safety Goals, Wage and Hour).
· Maintains confidentiality of patient/customer information.
· Addresses non-compliance with regulatory, department and organization standards.
· Meets mandatory department and organization job requirements within established time frames (i.e., physicals, annual mandatory reviews, licensure/certifications, and CPR).
· Participates in 75% of Town Hall and staff meetings.
· Understands, supports, and practices staff, visitor, patient, and vendor identification policy.
§ The following meetings qualify for requirement of 75% of staff meetings: CT Surgery – monthly house-wide NP meeting/Town Hall meetings and bi-monthly service line meetings
§ Seeks out and participates in educational activities, learning opportunities and networking to improve personal practice in support of their professional role in the organization.
§ Cares for patients according to credentialed scope of practice.
§ Works collaboratively with leadership team to ensure and facilitate unit’s clinical/ professional compliance regarding Joint Commission and Magnet standards.
§ Operationalizes the fundamental values of nursing into nurse practitioner role as defined in the nine ANA Code of Ethics into daily practice and teaching activities at Children’s including:
1-3: Establishing professional relationships with compassion and respect for human dignity, worth, and the uniqueness of individuals, while demonstrating a primary commitment to the patient in advocating for patient privacy, health, safety, and rights.
4-6: Identifying the boundaries of the profession by accepting responsibility and accountability for own actions, delegating tasks appropriately to optimize patient care. Maintenance of competence with continued pursuit of activities for personal/professional growth. Influencing the patient care/work environment with the values of nursing to promote respectful interactions, the promotion of safe practices, and creating a care setting that expects high quality, compassionate nursing care.
7-9: Collaborates with all disciplines/the community in promoting nursing excellence in meeting health care. Seeks opportunities beyond patient care to advance profession by involvement in developing, maintaining, implementing professional standards through practice/education, i.e. involvement with internship/preceptor programs, committees, awareness of broader heathcare issues such as JCAHO National Patient Safety Goals, integrating nursing values into daily practice (articulates and practices).
Communication, Team Work and Leadership.
· Actively listens to others with attentiveness and concern for what they are saying. Does not interrupt others while they are speaking.
· Tailors communications to the level and understanding of the audience.
· Organizes and expresses ideas clearly both orally and in writing.
· Practices first party face-to-face communication to address issues and concerns.
· Proactively keeps patients, families, customers, managers and coworkers informed—what to expect, status, changes, outcomes and time frames.
· Willingly participates in group work activities.
· Takes a lead role in challenging others to work collaboratively both within and outside of work group.
· Shares knowledge and offers assistance to others.
§ Fosters the development of an effective working relationship between interdisciplinary team.
§ Effectively communicates as a liaison among healthcare team members, and between family and healthcare team members.
§ Professionally communicates identified patient/system information/issues/ideas to appropriate individuals who have accountability/responsibility for response/direction/solution.
§ Promptly initiates the chain of command appropriately as a patient advocate for patient care and system issues.
§ Demonstrates personal ownership of scheduling process/coverage for position. Communicates to appropriate individuals changes in coverage plan.
§ Communicates a comprehensive picture of medical/nursing plan of care, to oncoming nurse practitioner/resident/ physician, promoting seamless care delivery system
§ Incorporates Joint Commission National Patient Safety Goals into patient care practices.
§ Facilitates meeting processes in collaboration with team members in the promotion of clinical standards and professionalism throughout the unit and organization, as appropriate.
o Participates in Area Action Council and related housewide Shared Governance councils to provide clinical expertise.
o Participates in monthly housewide NP meetings.
o Attends Town Hall meetings.
o Participates in organization committees as assigned i.e. Allied Health Credentialing committee, Subcommittee of the Credentials committee.
o Attends unit meetings specific to specialty, i.e. CTS meetings
Collaborates with unit management team to analyze, develop, implement and evaluate unit goals, education needs and equipment planning, and ensures processes/systems support patient and staff safety.
BEHAVIORS and the 5-I’s
Respect for Human Dignity (Treats others with compassion, fairness, courtesy and respect while honoring their uniqueness.)
Positive Attitudes and Behaviors (Enthusiastically approaches their role and displays pride in the organization)
I-countability (Owning behaviors, decisions, and outcomes; working within your Circle of Influence)
Pick One or more of the Following
Initiative (Being creative and resourceful)
Innovation (Using new and original methods)
Ingenuity (Applying creativity and imagination)
Immediacy (Responding quickly)
KNOWLEDGE, SKILLS AND ABILITIES:
Satisfy all relevant criteria and qualifications outlined in the Medical Staff Policy on Allied Health Professional, required to be credentialed.
Maintains practice agreement with service of specialty, and practices within framework of respective scope of practice.
Must be knowledgeable in billing regulation practices to include documentation requirements/CPT coding regulations.
Must be able to perform a variety of duties, often changing from one task to another of a different nature, without loss of efficiency or composure, and be able to perform under stressful conditions when confronted with multiple requests, demonstrating prioritizing skills.
Strong interpersonal and communication skills with the ability to work effectively with multiple disciplines.
Legible handwriting skills.
Ability to be self-directed, with minimum supervision, and detail oriented.
EDUCATION AND EXPERIENCE:
Education as required by Department of Health and Human Services-Regulation and Licensure Credentialing Division as represented by APRN licensure in the State of Nebraska.
An Advanced Practice Registered Nurse who does not have a master’s degree or two-thousand (2,000) hours of supervised practice will be required to furnish proof of jointly approved protocols with a collaborating physician, which shall guide the nurse practitioner’s practice.
Prefer APRN/nursing experience in specialty assigned.
Current and valid Basic Life Support (BLS) certification required.
Current and valid Pediatric Advanced Life Support (PALS) required, within 6 months of hire.
Current and valid PALS Instructor certification preferred.
Possess an unrestricted license as a registered nurse, and as an Advanced Practice Registered Nurse/Nurse Practitioner in the State of Nebraska required
REQUIRED TRAINING & EMPLOYEE HEALTH REQUIREMENTS
Annual Mandatory Review
Color Blind Test
TB Mask Fit
PHYSICAL REQUIREMENTS/WORKING CONDITIONS:
Less than 10%
11% to 49%
Greater than 50%
Less than 10%
11% to 49%
Greater than 50%
Blood and body fluid exposure*
Sharps, needles, etc.
Wet, humid conditions (non-weather)
Talk or hear
Work near moving mechanical parts
Displays manual dexterity
Fumes or airborne particles
Climb or balance
Toxic or caustic chemicals
Stoop, kneel, crouch or crawl
Outdoor weather conditions
Reach with hands and arms
Extreme cold (non-weather)
Taste or smell
Extreme hot (non-weather)
Risk of electrical shock63
Visual: Looking at computer screen
Risk of radiation
Up to 10 lbs.
Up to 20 lbs.
Up to 40 lbs.
Up to 100 lbs.
More than 100 pounds
* Refer to the Infection Control Manual for a listing of job classifications which may be at risk of occupational exposure.