Family Nurse Practitioner

Position Summary :

Provides direct patient care services by independently and interdependently scheduling, supervising, and / or conducting complex diagnostic and therapeutic procedures. This position independently participates 1n the delivery of direct patient care within the scope of individual authority granted by the North Carolina State Boards of Medical Examiners and Nursing.

Job Responsibilities :

• Performs complete physical exams, obtains medical history; interprets and records findings.
• Orders / obtains appropriate laboratory and diagnostic studies / tests to assist with patient evaluations, as needed.
• Interprets and integrates data to determine preliminary diagnosis and appropriate therapeutic plan.
• Administers medications, immunizations, and injections in compliance with state law and clinic guidelines.
• Performs direct patient care services, which may include instruction, education, counseling, recommendation of medications and treatments, health and illness prevention, and / or community resources to meet specific needs to patient and family.
• Coordinates and schedules laboratory studies and diagnostic procedures. Explains the necessity, preparation, nature and anticipated effects of scheduled diagnostic and therapeutic procedures to patients.
• Reviews, writes, and renews medication prescriptions, which corresponds to the written standing orders, and / or, to the consultation advice of the supervising physician.
• Documents, updates, and maintains patient records.
• Carries out patient care services under indirect physician supervision, such as suture removal, catheterization, burn and wound debridement, simple head injuries, dressing changes, pelvic exams, removal of foreign bodies from orifice or tissue, etc.
• Collaborates with physician in the management of acute or long-term patient needs : monitors / maintains a record of patient progression, and consults with supervising physician when patient progress does not meet anticipated and / or predetermined criteria.
• Collaborates with the designated Triage Nurse to address phone calls from patient seeking advice, answers to health questions, determination of being seen in the clinic, etc., home health nurses, teachers, inpatient medical team, PT 's, OT's, and physicians.
• Collaborates with Community Liaisons and Wraparound staff to coordinate patient complex caie, follow-ups, and continuity of care.
• Revlews school reports, psychological evaluations, DEC evaluations, IEP's, Early Intervention Reports, etc. with regaids patient care plan.
• Summarizes records and prepares referral letters.
• Communicates / confers with various outside agencies and resources regarding medical advice / information of clinic patients, such as dentist, social services, speech and hearing, etc., as needed.
• Refers patients to specialist, such as ENT, Pediatric Surgeon, Dermatologist, Neurologist, Asthma, etc., as needed.
• Participates in clinical research projects and prepares analyses / consensus report, when requested.
• Confers with other health professionals regarding patient condition, if necessary.
• Attends staff meeting once monthly.
• Attends Ground Rounds and continuing education meetings, as required.
• Promotes team, system, and organizational goals; maintains patient confidentiality and provides superior customer service.
• Disposes all disposable, contaminated, and used items into designated waste containers.
• Abides by all company policies regarding safety / health rules and regulations.
• Adapts to various situations and adjusts to shifting priorities.
• Performs other duties as assigned.

Preparation and Training :

Job duties require a broad knowledge of advanced nursing skills and comparable studies not available in undergraduate schools. Requires completion of a Master's Degree Nurse Practitioner program and certification as an FNP or PNP. Must have a working knowledge of data processing equipment, computers, telephones, and such typical office machines and equipment. Must maintain effective written and oral communication and English skills. Must maintain current North Carolina RN and NP License, with a letter of approval from the NC Medical Board. CPR certification, and a NC driver's license are also necessary.

Experience :

With the above skills, education, at least three years of previous clinical experience (preferably in ambulatory pediatric care), and with an additional two years of experience as a Nurse Practitioner, it would take approximately 3-5 years to become proficient with the policies, procedures, and protocol utilized by Triad Adult and Pediatric Medicine.

Analytical Ability :

Works on highly technical or complicated projects or problems presenting a variety of new or constantly changing variables or considerations. Duties require outstanding judgment, creativity, initiative, and the ability to deal with complex factors and abstract concepts not easily evaluated; to apply logical or scientific thought processes to a wide range of issues and problems, and to make decisions based on conclusions for which there is little precedent.

Independent Judgment :

Under general direction, works from company policies and general objectives with little functional guidance. Rarely refers specific cases to supervisor unless clarification or interpretation of company policies is involved.

Consequences of Error :

Incorrect assessments or treatments (including incorrect prescribing / administering prescriptions) during patient care could present possible long-term consequences, permanent disabilities, or even death for the patient. Errors resulting in potential lawsuits / OSHA fines would present excessive costs or losses to TAPM. Duties may involve the effective recommendation of company policies and protocols or the preparation and presentation of data on which top management bases major decisions.

Materials or Products : Errors with the incorrect storage of certain medications could go undetected and could result in some or total loss of medication, which would be costly to TAPM, as well as affect patient goodwill / care (if err or is not caught). Misuse of biohazard materials could mean OSHA fines and / or penalties.

Equipment : Limited - makes minor adjustments to equipment, testing, and measuring devices; however, equipment is not "sensitive" and damages are unlikely under normal use and care.

Testing / measuring equipment includes crash cart, oxygen tanks, stethoscope, otoscope, ophthalmoscope, reflex hammer, tympanogram, stadiometer, glucometer, strep test kit, scales, thermometer, pulse oximeter, nebulizer, hemoglobin machine, dinocap, nebulizer, tape measure, accuchecks, hemmocues, snelling charts, bulb suctions, IV starts, etc.

Interpersonal Contacts :

Outside and / or inside contacts with supervising and other clinic / hospital physicians, employees of TAPM, patients, families of patients, outside community agencies, community nurses, schools, etc. These contacts involve an exercise of influence, tactful judgment, and proper conduct in order to negotiate matters, and carry out policies and programs for the best interests of the company / patient. This position also deals with persons of substantially higher rank on matters requiring explanation, discussion, persuasion, and obtaining approvals, whereby improper handling could have a marked effect on operating results. Considerable tact is required.

Confidential Information :

Works with some confidential data of major importance, such as patient records, and patient / family salary / personal information, which, if disclosed, may be detrimental to the company's interests.

Working Conditions :

Patient care setting where working conditions can be stressful and fast-paced. Must be able to work and deal effectively with changing situations, varying workloads, interuptions, etc. Frequently exposed to communicable diseases, biohazard substances, medicinal preparations, and other conditions conducive to a clinical environment.

Mental Attention or Visual Demand :

Continuous mental and visual attention and manual dexterity when attending to patient care and medical record keeping; usually repetitive work or diversified operations requiring close application of thought processes for sustained periods of time and constant alertness. May involve problems of correlation or application of reports, statistics, or other data. Must have acute visual perception for patient care and record keeping requirements and be able to distinguish colors. Must be able to

communicate via telephone and other automation vehicles. Normal or corrected vision is needed in order to visualize computer screens, medical record forms, and equipment screens. Normal or corrected hearing is required for hearing blood pressures and other diagnostic equipment, monitor alarms, and building alarms, etc.

Physical Demand :

Position requires frequent standing / walking for extended periods of time. Must be able to touch / feel, and grip / grasp equipment / tools, and testing devices. Position also requires stooping, bending, stretching, reaching, and twisting. Must lift / carry young children weighing approximately 25-40 pounds, four or more times per hour, and occasionally push / pull occupied wheelchairs weighing approximately 15-60 pounds.

Hazards :

If precautionary measures are not adhered to, this position could be susceptible to contact with infectious / communicable diseases, biohazard waste materials, needle pricks, etc.

Safety :

Triad Adult & Pediatric require that all employee work in a safe manner with regards to themselves and their co-workers. Any unsafe acts or conditions are to be reported immediately.

Quality Improvement

Must understand and help enforce the meaning of quality improvement : " The combined and unceasing efforts of everyone-healthcare professionals, patients, and their families, researchers, payers, planners and educators- to make the change that will lead to better patient outcomes, better system performance and better professional development." (Batalden, 2007). Committed to promoting TAPM as a medical home and incorporating the core components of a Patient Centered Medical Home into your position on a daily basis.

Loan Repayment Opportunities

As a Federally Qualified Health Center (FQHC), Triad Adult and Pediatric Medicine, Inc. has access to resources to assist with the repayment of federal loans if the recipient practices within one of the following disciplines :

National Health Service Corp program at http : / / nhsc.hrsa.gov / loanrepayment /