Part-Time Nurse Practitioner (Np)

GENERAL SUMMARY/ OVERVIEW STATEMENT:

The Advanced Practice Provider (APP) is a registered nurse with master's preparation in an expanded role who will provide direct care to individuals, families, and/or groups in a Primary Care Practice. The APP as PCP functions as an independent Primary Care Provider (PCP), responsible for a discrete panel of patients. The APP will act independently outlined above. This includes primary responsibility of said panel, including all primary care visits, communication (with help of practice support staff (RN/MA/PSC) such as patient GW, telephone, results, review of consults, admissions, and outside records; all prescriptions and renewals, The PCP is also expected to meet certain Population Health standards as outlined by the department. Citizenship includes participation in practice provider meetings. The AP PCP is expected to carry a pager, and signs out during the weeknights and weekends to the covering NSPG AHC program.

The APP primary care provider (APP/PCP) at MGH must be actively board certified in adult or family practice and hold an active license (from the ANCC/XXX/XXX. The APP/PCP must be capable to provide direct patient care for 4-8 hours per day, 1 to 5 days per week, and in addition, to attend to about 2-3 hours of electronic health record chart work and telephone calls per 4 hours of direct patient care. The target patient panel size is 300-1200 per PCP, depending on how many hours of direct patient care to which they are committed. These patients typically are a mix of adult patients aged 18 to over 100 years seeking wellness examination and advice as well as complex patients with multiple medical, social, and psychological problems. In addition, the APP/PCPs may also choose to round on their patients who have been admitted to MGH, providing continuity visits (optional).

In collaboration with the physician and other staff, they are responsible for the diagnoses, treatment, and provision of care for patients during all phases of wellness and illness. They hold their own outpatient sessions, and within the scope of practice is expected to initiate and arrange the patient's outpatient care plan with the involvement and consideration of other health disciplines within and outside the hospital. They coordinate the care a patient may need in the community with Visiting Nurses or case managers. Advanced Practice Nurses place a marked emphasis on patient teaching and education, and promote competent, compassionate nursing care for patients and families.

The Primary Care NP understands the position is an important part of the care team and promotes partnership between patient, family and team.

The APN has appropriate knowledge of nursing, medical, and scientific principles, and appropriately applies those principles to practice of family care.

PROFESSIONAL CONDUCT

I. Professionalism

• Treats patients with courtesy and respect.

• Is mindful of cultural beliefs and expectations.

• Determines priorities per patient's needs.

• Understands all components of position and how job fits into overall mission of the practice.

• Contributes to favorable image of Practice.

• Dresses to support business/clinical image.

• Works collaboratively with peers and staff, fostering an environment of teamwork.

• Refrains from engaging in demeaning, discriminating or otherwise threatening behavior.

II. Citizenship

• Attends regular scheduled practice meetings.

• Is punctual, plans ahead for scheduled time off by 2 months.

• Open and receptive to change and feedback.

• Assist in orienting new staff in like positions.

• Contributes to strengthen the practice community.

• Is present and focused at work.

• Effectively owns work they do to completion and resolves mistakes when made.

III. Quality

• Recognizes patient as ultimate consumer of services.

• Places patient concerns before self.

• Protects and maintains patient confidentiality.

• Consistently produces work that meets practice standards.

• Performs job accurately, in a timely fashion.

• Maintains proper documentation of information required for position.

• Is aware of practice goals and is a proactive participant in helping achieve them.

IV. Communication

• Provides and receives feedback in a tactful, positive, respectful manner.

• Responds to patients and colleagues in a timely manner.

• Uses agreed upon methods of practice communication as decided by individual practice guidelines.

• Communicates any unexpected tardiness, changes or adjustments in schedule as dictated by practice policy.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

CLINICAL PRACTICE

Participates in daily huddles and shares information with the team that is necessary to enhance the patient office experience, delivery and coordination of care and incorporates the patient as an active team member.

Provides independent, direct, and indirect nursing care; performing physical examinations, ordering diagnostic studies, evaluating results and prescribing treatment as appropriate. Follows patients appropriately, within Advanced Practice Role as delineated within the state of Massachusetts and MGH.

Patient/Family Care

Establish the diagnosis(es) and determines a plan of care including; order laboratory and radiology test and treatments for

• Short term and chronic health problems

• Exacerbation of health problems

• Chronic disease and health promotion management

Discuss with patients or their delegates: end of life issues, chronic disease management, and educational materials regarding patient's health

Refer patients to appropriate physicians, clinics, or other health care providers, including community providers for management or consultation.

Write prescriptions according to Massachusetts Authority to Prescribe laws and consistent with the NP's and supervising physician's scope of practice.

Use the Electronic Medical Record in timely and competent manner per practice guidelines

Diagnostic studies: Order, interpret and communicate results

• For health screening and monitoring purposes

• Monitor the effect of current therapy

• Needed to investigate a new problem

Perform therapeutic measures but not limited to, the following;

• Removal of cerumen impaction

• Order and apply skin and wound dressing

• Order and apply venous pressure dressing and compression stockings

• Suture removal

• Immunizations

Team Care

The NP will be an integral member of the team. He/She will:

• Within team care work to create and implement a system to manage the complex patients with the PCP

• Participate in team huddles and communicate on a regular basis with team members about patients

• Assist patients/families in management of their health

• Consult with the LICSW regarding psychological-social needs of the patient

• Communicate with case managers regarding disease management especially during transitions of care

• Answer clinical questions from support staff

• Educate support staff and families on health issues and behaviors that can affect patient interactions with staff and families

Transfer to MGH emergency department

• communicate with the ED triage staff
• identify pertinent information to be completed in EPIC for the ED transfer and coordinate with the staff who will organize and print information
• follow up on patient condition post ER visit

Urgent/emergent or complex patient problems - in office or phone

• Provide emergency care to stabilize patient's condition as appropriate

• Seek input from onsite physician and work with them to diagnosis and treat the patient

Indirect Work Management

• Responsible to follow up on labs and imaging ordered by sending letters or calling patients if results are considered critical

• Carry a pager to receive results of a critical value

• Works with all staff to ensure smooth patient flow through out the day to improve efficiency of provider workflow

• Follows guidelines of practice to respond to staff questions via Clinical Messaging in EPIC

• Monitors patient outcomes.

Academic Practice

Quality Initiatives

• The NP will be involved in practice quality improvement initiates

• Recommends changes in practice as needed

Preceptor

• The NP may precept NP students at a minimum of one semester every 2 years

Professional Development

• Maintains and updates knowledge and skills based on current education, nursing, and health care practices.

• Attend bi-weekly staff meeting

• Fulfills professional role through involvement in professional organization activities, presentations, (publications, and research).

• Responds to changes in clinical practice by planning, designing, implementing, and evaluating scientific based practice.

• Develops new techniques, guidelines, protocols, and standards in collaboration with other staff.

• Applies problem solving approaches to teaching, guiding, and solving complex clinical problems.

• Identifies current trends in healthcare and their implications for nursing practice

FISCAL RESPONSIBILITY (if applicable):

Responsible billing per MGH Billing Compliance, Federal and State billing regulations

SKILLS/ABILITIES/COMPETENCIES REQUIRED:

• Integrates theoretical knowledge base and clinical expertise in decision making.

• Advocates for patients, their significant others, coworkers, the community, and the nursing profession.

• Consistently demonstrates accountability.

• Champions collaborative practice with coworkers and other disciplines and departments.

• Consistently demonstrates compassion to internal and external customers.

• Dynamically represents the program and nursing profession in internal and external forums.

• Exemplifies a professional behavior.

• Provides clear and direct verbal and written communication.

• Effectively facilitates group processes of decision-making for patient, family, and staff.

• Is empathic and respectful.

• Manages conflict resolution between patient, family, and staff.

• Advocates for patient's choices.

• Is HIPAA compliant.

• Is BLS certified

WORKING CONDITIONS:

Patient care primarily at MGH outpatient setting

The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities, or skills of personnel so classified.

LICENSES, CERTIFICATIONS, and/or REGISTRATIONS (if applicable):

• Current Registered Nurse licensure in Massachusetts as Nurse Practitioner.

EDUCATION:

• Master's degree from an accredited school of nursing as Nurse Practitioner.

EXPERIENCE:

Minimum of 2 years nursing experience required

Minimum of 1-year NP experience required