Nurse Practitioner/ Physician Assistant, Pulmonology

Job Description Department Description Inpatient Acute Care Pulmonary APP: Stanford Technology Assisted Respiratory (STAR) Program The Advanced Practice Provider (APP) position is part of a collaborative team model of care consisting of Attending Physicians, Fellows, and a team of APPs made up NP’s and PA’s who provide care to patients with chronic pulmonary care needs, specifically tracheostomy patients requiring chronic mechanical ventilation. Common Diagnosis include: Pediatric patients admitted to the hospital with tracheostomies requiring chronic mechanical ventilation, known as “trach/vent” patients. These patients include those awaiting transition to home or a long-term care facility, admitted for other medical concerns not related to their chronic respiratory condition, or for an overnight stay after a procedure. In many facilities due to their chronic respiratory status these patients would require hospitalization within the ICU (PICU/NICU). Here at LPCH the technology dependent patients with tracheostomies on portable ventilators, who do not require an ICU level of care, are eligible for admission to this highly specialized program. Specific roles/ responsibilities include: The APP is an integral part of the provider team and active in the management and clinical decision making for all patients on the service. The APP role will be the backbone of the program, providing continuity of care among providers 7 days a week. The APP will cover patients within the STAR program and acute care pulmonology patients. The APP functions to full scope of practice including ordering and prescribing of medical interventions/devices and perform procedures in accordance with medical staff privileging. The APP works collaboratively with an Attending Physician/ Pulmonologist and supports fellow and resident education within this unique population. JOB SUMMARY This paragraph summarizes the general nature, level and purpose of the job. The Advanced Practice Provider (APP) positions are part of a collaborative team consisting of Attending Physicians, Fellows, and a team of advanced practice providers both NPs and PAs. The APP team is highly respected, we are seen as the go to team for the attendings. We actively participate in the education of fellows and visiting residents. Responsibilities for this role include: receiving sign-out from overnight team. Pre-rounding on assigned patients, developing a plan of care for the day for that patient, present patients on rounds, write a daily note, you will be responsible for implementing the plan agreed upon on during rounds and responding to any issues raised by the nurses during the course of the day. The advanced practice provider is credentialed to perform the following procedures: intubation, central line placement, arterial line placement, chest tube insertion, PD drain placement, chest tube removal, pacing wire removal. Nurse Practitioner (NP): The Nurse Practitioner functions under the general Nurse Practitioner Standardized Process Protocol approved by the Interdisciplinary Practice Committee (IDPC). The Nurse Practitioner provides routine care and management of the patient with acute and chronic complaints, in collaboration with the supervising physician and through implementation of standardized procedures. Specific functions pertaining to the Service, Clinic or Department are established by the Nurse Practitioner and the supervising physician(s), and approved by the appropriate medical and nursing administrators, the IDPC, and the Stanford Hospital and Clinics (SHC) Medical Executive Board and Board of Directors. Physician Assistant (PA): The Physician Assistant functions under the general Physician Assistant Role Description approved by the Interdisciplinary Practice Committee (IDPC). Specific functions pertaining to the Service, Clinic or Department are established by the Physician Assistant and his or her supervising physician(s), and approved by the appropriate medical and nursing administrators, the IDPC, and the Stanford Hospital and Clinics (SHC) Medical Board and Board of Directors. ESSENTIAL FUNCTIONS The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned. Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings. Must perform all duties and responsibilities in accordance with the Service Standards of the Hospital (s). A. An NP/PA may provide only those medical services which he/she is competent to perform, which are consistent with the NP/PA’s education, training and experience, and which are performed in collaboration with a physician. B. An NP/PA shall consult with a physician regarding any task, procedure or diagnostic problem which the NP/PA determines exceeds his/her level of competence or shall refer such cases to a collaborating physician. C. Scope of Practice of the NP/PA:

• Evaluates and treats patients with acute, chronic complaints and health maintenance concerns related to specialty, according to written standardized procedures.
• Obtains complete histories and performs pertinent physical exams with assessment of normal and abnormal findings on new and return patients.
• Performs or requests and evaluates diagnostic studies as indicated upon evaluation of the patient.
• Administers, orders, furnishes and prescribes medications.
• Orders and collects specimens for routine laboratory tests, screening procedures and therapeutic procedures, including blood and blood products.
• Orders physical therapy, occupational therapy, respiratory therapy, radiology examinations and nursing services.
• Performs designated procedures after demonstrated competency, according to written standardized procedures where applicable.
• Obtains informed consent, as indicated.
• Initiates arrangements for hospital admissions and discharges and completes appropriate paperwork.
• As directed by the supervising physician, enrolls patients in investigational studies approved by the Investigational Review Board (IRB), and orders the necessary tests and medications.
• After appropriate training, assists the supervising physician in the operating room. The RN First Assistant directly assists the surgeon and practices under the supervision of the surgeon during the intraoperative phase. The RN First Assistant must adhere to standardized procedures and not concurrently function as a scrub nurse.
• Recognizes and considers age-specific needs of patients.
• Effectively communicates and interacts with patients, families, staff and members of the community from diverse backgrounds.
• Recognizes situations which require the immediate attention of a physician, and initiates life-saving procedures when necessary.
• Facilitates the coordination of inpatient and outpatient care and services as needed.
• Facilitates collaboration between providers and coordination of community resources.
• Ensures compliance with legal, regulatory and clinical policies and procedures.
• Participates in quality improvement initiatives.
• Provides and coordinates patient teaching and counseling.
• Other duties as assigned.

D. Supervision:

• Supervision is provided by the supervising/sponsoring physician with clinical privileges at LPCH, or designated attending physicians in the Clinic, Service or Department. Standardized procedures, approved by the supervising physician(s) and the IDPC, are a mandatory mechanism of supervision. Other mechanisms of supervision used may be:
• Direct on-site, electronic or phone supervision by a supervising physician. A physician cannot supervise more than four (4) NP/PAs at one time.
• Chart screens on random charts by the supervising physician or designee.
• Chart audits on random charts as an integral part of selected quality improvement programs.
• Ongoing Professional Practice Evaluation (OPPE) through tracking of performance indicators.
• The NP/PA will receive a formal annual performance evaluation by the Lead Advanced Practice Provider (Lead APP), Director of Advanced Practice or supervising manager/director with input from the Lead APP, supervising physician(s) and/or physician delegates, APP peers and the supervising manager/director. Ongoing Professional Practice Evaluation (OPPE) also occurs through tracking of performance indicators.

Qualifications MINIMUM QUALIFICATIONS Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying. Education: Physician Assistant (PA):

• Bachelor’s degree or above from an accredited college or university.
• Graduate of a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant, Inc.

Nurse Practitioner (NP):

• Master’s or doctoral degree in nursing from an accredited college or university.
• Graduate of an NP program accredited by the National League of Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE).

Licensure/Certification: Physician Assistant (PA):

• Licensure as a Physician Assistant (PA) in the State of California.
• Certification as a Physician Assistant (PA) by the National Commission on Certification of Physician Assistants (NCCPA)
• Certification in Basic Life Support (BLS) from the American Heart Association (AHA)
• An individual Drug Enforcement Agency (DEA) license issued by the United States DEA for Schedule II-V controlled substances, required only if prescribing controlled substances to outpatients
• Additional board certification(s) may be required by certain services/departments.

Nurse Practitioner (NP):

• Licensure as a Registered Nurse (RN) in the State of California
• Certification as a Nurse Practitioner (NP) in the State of California
• National Board Certification as a Nurse Practitioner (NP) from an agency accredited by the American Board of Nursing Specialties (ABNS).

Note: New graduate NPs will be allotted six (6) months from their graduation date to obtain national board certification.

• Certification in Basic Life Support (BLS) from the American Heart Association (AHA).
• Furnishing license issued by the Board of Registered Nursing (BRN), required only if furnishing medications
• An individual Drug Enforcement Agency (DEA) license issued by the United States DEA for Schedule II-V controlled substances, required only if prescribing controlled substances to outpatients .
• Additional board certification(s) may be required by certain specialties/departments.

Physical Requirements and Working Conditions The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job. Additional Information Pay Range Compensation is based on the level and requirements of the role. Salary within our ranges may also be determined by your education, experience, knowledge, skills, location, and abilities, as required by the role, as well as internal equity and alignment with market data. Typically, new team members join at the minimum to mid salary range. Minimum to Midpoint Range (Hourly): $89.80 to $109.44 Stanford Medicine Children’s Health (SMCH) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SMCH does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements, and where applicable, in compliance with the San Francisco Fair Chance Ordinance.