Nurse Practitioner or Physician Assistant — Pediatric Heart Center Fellowship

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About Duke University Hospital

Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States and is the number one hospital in North Carolina, according to U.S. News and World Report for 2023-2024. Duke University Hospital is the largest of Duke Health’s three hospitals and features 1048 patient beds, 65 operating rooms, as well as comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.

This opportunity will not start until July 1, 2025. Seeking PA or PNP-AC recent graduates or those that will graduate by May 2025.

Job Location – Duke University Hospital

Job Summary

The Duke Pediatric Heart Center Advanced Practice Provider (NP or PA-C) Fellowship rotates through clinical settings in the pediatric heart center, which includes inpatient and outpatient locations. There will be heavy emphasis in the pediatric cardiac intensive care unit (PCICU), PICU, and pediatric cardiac stepdown. The APP Heart Center fellow will work alongside APPs and MDs to provide direct patient care services for newborn congenital heart, surgical, and medically ill pediatric heart center patients from birth to young adults at Duke University Hospital or in the clinics in collaboration with APPs, cardiologists, and surgical physicians. The APP Fellow performs physical exams, collects and documents data, conducts diagnostic and therapeutic procedures, orders and schedules laboratory studies and professional consultations, prescribes appropriate interventions and medications, coordinates the care and discharge of patients, and provides direct patient care services. The APP Fellow contributes to excellence in patient care, research, teaching, and learns to provide leadership in the organization.

Goals of Pediatric Heart Center fellowship:

• Acquire a deep and broad knowledge base of the common congenital heart anomalies and disease

• processes for which patients are hospitalized, understanding the pathophysiology, various presenting
• clinical presentations and disease prognosis
• Develop a diverse differential diagnosis and respective diagnostic and treatment plan based upon the
• patient’s presenting symptoms along with evidence-based and cost-effective medical care
• Manage patients effectively throughout the whole hospital stay, including admission, daily rounds and
• continuing evaluation, and dismissal, while remaining cognizant of the patient’s or families emotional,
• physical and spiritual needs
• Learn practice management, including strategies in training APPs and APP students
• Develop keen verbal skills to effectively communicate with colleagues, physicians, patients and
• ancillary staff to ultimately become a key part of the inpatient health care delivery team

Job Duties and Responsibilities

Clinical Expert:

• In collaboration with cardiology attendings, PCICU attendings, surgeon(s) and/or APPs, round daily on patients to assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of patient care.
• Provide and coordinate clinical care for service specific patients through established protocols and under the hospitalist supervising physician or back up physician who is either on site or available by pager.
• Collaborate with the residents, fellows, attending other NP/PA colleague’s nurses, and patient resource managers to formulate treatment plans and monitor patient progress.
• Perform procedures specific to the work environment after demonstrated competency and within the guidelines of scope of practice and credentialing protocols.
• Assess patients for change in status and institute appropriate interventions. Initiate emergency interventions in an effort to stabilize the patient until physician support arrives.
• Postoperative stabilization and management.
• Develop patient care pathways, protocols and guidelines for the management of specific problems in conjunction with physicians and other members of the health care team.
• Analyze clinical practice patterns so as to provide the best medical care and to increase effectiveness and efficiency.
• Communicate verbally and in writing all pertinent patient information to supervising MD, nursing staff, patient resource manager, home health agency, and other relevant healthcare providers.
• Document in the patients’ medical record all relevant data including but not limited to results of diagnostic tests; laboratory results; patients’ condition and response to therapies/interventions; communications with supervising MD.
• Utilize prescriptive privileges only for identified patient population.
• Prescriptive authority for prescribing, ordering, and or administering drugs; including (but not limited to) schedule II, III, IV, and V drugs and necessary medical devices.
• Role model competence in all nurse practitioner / physician assistant advanced skills.
• Give daily handoff to appropriate APP, attending, resident and/or intern at the end of the shift

• Educator:
• Assess educational needs of the patient-care staff and provide one-on-one as well as formal education as needed.
• Assess educational needs of the patients / families and provide culturally-sensitive patient/family education interventions as indicated. Use non-technical language when educating patients and families. Document all pre and post-op/procedure education in patients’ medical record.
• Implement and evaluate appropriate educational programs for DUHS patient care staff and other healthcare providers as appropriate.
• Role model and precept healthcare learners through contractual agreements.

• Research Utilization and Investigation:
• Utilize current research and evidence-based decision-making in all clinical practice.
• Incorporate clinical research findings in the development and implementation of standards of care.
• Support IRB approved clinical research/trials though a variety of activities including but not limited to obtaining consent, ordering diagnostic tests, recording laboratory & diagnostic results, administering therapeutic interventions, and reporting patient outcomes including toxicities or adverse events.
• Participate in interdisciplinary quality improvement and/or research activities.
• Participate in measuring and documenting outcomes.

• Consultant:
• Provide expertise and resource information to other healthcare providers, patients and families, and the community at large related to cardiothoracic diseases, procedures, interventions, and conditions.
• Implement and evaluate appropriate educational programs for referring MDs
• Develop, implement and evaluate standards of care/practice guidelines/policies and procedures/care maps/protocols within area of specialization.
• Develop programs and projects in areas of expertise to facilitate the attainment of the goals and objectives of the Duke University Hospital and Duke University Health System.

• Professional Leadership and Development:
• Role model advanced practice professionalism through conduct, communication, dress, leadership, ethical decision-making, critical thinking and problem solving skills.
• Participate in at least one professional organization.
• Demonstrate responsibility for professional practice through active participation in the Cardiology department, CAP Department, and professional organizations. Meet Continuing Education requirements as designated by the NC Medical Board and/or NC Nursing Board. Maintain professional certification.
• Enhance the body of knowledge in area of specialization through written publications, oral presentations, posters, continuing education, etc.
• Maintain all professional requirements for licensure and certification
• Attend educational conferences regularly, morbidity and mortality conferences, code reviews, NP monthly meetings and attend twice a year adult congenital sessions.
• When caring for adults with congenital heart disease, plan for situations beyond expertise, consult with and refer to other health care providers as appropriate.

Job Eligibility Requirements

Education (MUST GRADUATE BY May 31, 2025)

PA: Graduate of ARC accredited Physician Assistant Program, Masters or DMSc degree preferred

NP: Graduate of accredited MSN or DNP Pediatric Acute Care Nurse Practitioner Program

Certification

PA: PA-C

NP: PNP-AC

License

PA: Current unrestricted medical license issued by the NCMB with authorization to practice as PA

NP: Current unrestricted RN license issued or recognized by the NCBON with authorization to practice as NP

Experience:

New PA or PNP-AC grads welcome to apply, no APP experience required

Life support:

BLS (required)

PALS (required)

ACLS (recommended)

Physical and mental requirements:

• Able to clearly articulate scope of practice, and practices within those guidelines as a Nurse Practitioner / Physician Assistant
• Able to independently seek out resources and work collaboratively to solve complex problems
• Able to communicate clearly with patients, families, visitors, healthcare team, physicians, administrators, leadership, and others.
• Able to use sensory and cognitive functions to process and prioritize information, perform health assessments, treatment, and follow-up.
• Able to use fine motor skills

• Able to record activities, document assessments & interventions; prepare reports and presentations;
• Able to use computer and learn new software programs
• Able to provide leadership in clinical area of expertise and in meeting organizational goals
• Able to navigate the Hospital and DUHS to provide clinical expertise to specific patient populations

• Able to withstand prolonged standing and walking with the ability to move or lift at least fifty pounds
• Able to remain focused and organized
• Able to work collaboratively with all levels of personnel

Job Hours

Primary hours will be 14 shifts a month, 12-hour shifts, including days, nights, weekends and holidays. Flexibility is required to meet clinical needs of the service.

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual’s age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.