The nurse practitioner (NP) within the acute care hospital setting works in collaboration with, and is an integral member of, a multidisciplinary health care team. The NP functions primarily as a hospitalist in an inpatient setting, managing the care of acute/complex chronically ill patients. The NP is typically on a service aligned team managing the patient care from step down to discharge. The NP may have responsibilities for same patient population during follow up outpatient visits. The NP has a strong foundation in evidenced based practice/education and provides an environment of safe quality care. The NP demonstrates an advanced level of medical and nursing knowledge, clinical/technical competence, sound clinical judgment, professional communication skills, timely and compliant documentation, and is responsible for professional development and competency validation.
- Assessment of Health Status
- Performs and documents in the medical record a complete history and physical examination for acute and complex chronically ill patients.
- Orders and collects data using appropriate assessment techniques, relevant supporting diagnostic information and diagnostic procedures where indicated.
- The nurse practitioner may serve as the first responder for both nursing and house staff in the event of patient status changes, orders, and in situations requiring procedural and resuscitative interventions.
- Assesses for risks associated with the care of the acute and complex chronically ill patient including: medication side effects, immobility, impaired nutrition, fluid and electrolyte imbalance, immunocompetence, invasive interventions and diagnostic procedures.
- Coordinates daily rounds with the Attending physician teams, presents 24 hour patient report, collaborates in plan of care, and follows assigned patient population throughout the day.
- Collaborates with interdisciplinary health care team in making diagnoses of acute and complex chronic conditions.
- Manages diagnostic tests through ordering, interpretation, performance, and supervision.
- Formulates differential diagnoses by priority.
- Diagnoses complications and orders appropriate interventions
- Formulates Plan of Care
- Identifies expected outcomes from diagnosis, and formulates and documents a plan of care to address complex acute and chronic health care needs.
- Utilizes evidenced based practice guidelines or protocols in an individualized, dynamic plan of care that can be applied across the continuum.
- Implements and modifies plan of care
- Prescribes diagnostic strategies and therapeutic interventions both pharmacologic, non-pharmacologic and surgical, needed to achieve expected outcomes.
- Manages further diagnostic tests through ordering, interpretation, performance, and supervision.
- May perform advanced procedures consistent with privileges and competency validation including minor suturing, complex wound management, line and tube placements and removals.
- Communication and Collaboration
- Maintains ongoing communication and collaboration with interdisciplinary health care team .
- Facilitates and communicates with patient, family and staff to promote continuity of care across the inpatient and outpatient continuum of care.
- Documents/dictates key components of patient's progress via daily progress note, transfer, and discharge summary , and or clinic note where applicable. (h&p, daily progress notes, plan of care, problem lists, procedure notes, acute event note, discharge summaries, in medical record per specific patient unit or service, death summary)
- Documentation is timely, meets acute care compliance standards and captures patient acuity.
- Professional Practice
- Demonstrates Professional Practice behaviors including: preceptor/mentoring, education and instruction of students, nursing staff, nurses, graduate and novice nurse practitioners.
- Seeks opportunities for active engagement in research and the analysis of evidenced based practice.
- Actively participates in Grand Rounds, APN council meetings, faculty and unit meetings, M&M presentations.
- Maintains CEUs, and membership in a professional organization.
- Organizational Impact: Executes job responsibilities with the understanding of how output would affect and impact other areas related to own job area/team with occasional guidance.
- Problem Solving/ Complexity of work: Analyzes moderately complex problems using technical experience and judgment.
- Breadth of Knowledge: Has expanded knowledge gained through experience within a professional area.
- Team Interaction: Provides informal guidance and support to team members.
SUPPORTING COLLEAGUES (P2):
- - Develops Self and Others: Invests time, energy and enthusiasm in developing self/others to help improve performance and gain knowledge in new areas.
- - Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.
- - Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences.
DELIVERING EXCELLENT SERVICES (P2):
- - Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.
- - Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.
- - Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness.
ENSURING HIGH QUALITY (P2):
- - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.
- - Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them.
- - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring.
MANAGING RESOURCES EFFECTIVELY (P2):
- - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.
- - Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.
- - Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities.
FOSTERING INNOVATION (P2):
- - Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.
- - Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.
- - Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.