Nurse Practitioner - Palliative Care - Casual/Prn

Why work for Nebraska Methodist Health System?
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care - a culture that has and will continue to set us apart. It's helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient's needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.
Job Summary:
Location: Nebraska Methodist Hospital
Address: 8303 Dodge Street Omaha NE
Work Shift: Weekends/holiday call rotation. Casual- weekdays 8AM-4:30PM
Provides quality of care and safety to our patients and employees.
Responsibilities:
Essential Functions
Perform primary health care for patients by utilizing the processes of assessment and diagnosis of health status.

• Obtain patient's medical and history information, data collection is prioritized according to immediate condition or needs.
• Perform physical exam and determine patient's mental status.
• Develop and implement treatment, follow-up and evaluation plans for patient outcomes.
• Collaborate with physicians and other disciplines as appropriate and provides regular and consistent feedback.
• Use appropriate assessment techniques & diagnostic information. Performs tests relevant to patient condition and record findings.
• Order appropriate ancillary tests.
• Derive diagnosis from the assessment data and diagnostic information as data becomes available.
• Use new or additional data to form a treatment plan.
• Perform telephone triage to determine patient condition and provides appropriate consultation scheduling appointments when needed.
• Incorporate research into clinical practice as appropriate.
• Provides timely initial patient and family assessments for Palliative Care consults.

Implement interventions consistent with the established plan of care in a safe and appropriate manner.

• Apply established therapeutic practices to patient's problem.
• Administer medications and immunizations using the appropriate method and with physician oversight if applicable.
  • The above performance measure is not applicable to this position.
• Prescribe medications according to Controlled Substance Registration Certificate issued by the DEA.
• Generate referrals to appropriate services as needed to further diagnose and/or progress of care.
• Prescribes medications and other non-pharmacologic interventions, including controlled substances, to promote comfort and symptom management.
• Safely selects and manages medications/dosages for ongoing treatment of symptoms.
  • Pain-oral, parenteral, IV, IM, subg, bolus, PCA
  • Nausea and vomiting
  • Constipation
  • Breathlessness
  • Delirium
  • Other
• Appropriately converts medications using equianlagesic/equipotency formulas (eg. opioids, steroids).
• Manages and preempts common side effects of pharmacologic intervention.
• Recommends and facilitates non-pharmacologic strategies into the plan of care.
• Consults other team experts as needed (eg. Chaplains, Behavioral Health).
• Collaborates with Palliative Care collaborating providers as needed, recognizing abilities and limitations.
• Conducts, leads and facilitates Palliative Care consultation meetings and decision making using theoretical principals, skills, and competencies of advanced nursing practice and Palliative Care.
• Communicates effectively with patient and family understanding of diagnosis, prognosis care and treatment options.

Evaluate patient care to determine response to care/interventions for optimal patient outcome.

• Evaluate the patient's capabilities and/or limitations related to nursing and medical interventions.
• Recognize and address patient and family capabilities and limitations (physical and mental).
  • Including assessment of capacity.
• Return patient telephone calls.
  • The above performance measure is not applicable to this position.
• Monitor outcomes and documents patient response to interventions.
• Seek out new treatment methods necessary to ensure patient progress.
• Discusses findings and recommendations for plan of care with attending and consulting physicians and other team members as needed to assure continuity of care.
• Implements actions and provides for communication that promote continuity of care and optimal transition within and outside the hospital setting.
• Collaborates with other disciplines for discharge planning inclusive of financial needs and functional status.

Provide patient and family teaching and education specific to the patient's health care.

• Proper use of medication and health/illness prevention to ensure adequate knowledge/awareness.
• Interview and advise specific to patient needs.
• Demonstrate sensitivity to family regarding need for patient information on a timely basis.
• Work collaboratively with physicians and other team members to provide appropriate patient education geared to the patient's needs and family's ability to provide care.
• Use adult learning principles for teaching purposes being careful to check for understanding and being available for follow-up questions.
• Recommend references and resources such as printed materials, online, community and other information sources to fulfill the family's need for education.

Maintain a professional behavior in attitudes, demeanor, and interactions to achieve organization's mission.

• Communicate effectively with physicians, staff and patients.
• Is approachable and professional in working with other health professionals, patients and their family.
• Maintain a professional appearance, behavior, and work environment.
• Initiate action to correct, prevent, and/or minimize risk(s) to the patient, family or hospital/clinic employees (i.e., falls, needle sticks, patient concerns).
• Communicate to appropriate personnel regarding unresolved issues.
• Serve as a role model in the provision of emerging care.
• Serve as a reliable/knowledgeable resource for staff.
• Participate in meetings, research on special projects and professional organizations.

Comply with the bylaws, rules and regulations of the organization as they pertain to Nurse Practitioners or Physician Assistants.

• Know and follow organization policy & procedures.
• Follow Medical Protocols for professional discipline.
• Maintain certification/licensure.
• Follow guidelines of regulatory bodies (FDA etc.).

Maintain complete patient records.

• Document data appropriately.
• Document treatment plan of care that is individualized, appropriate and reflects patient's needs.
• Document interventions.
• Document consultations with other practitioners/physicians.
• Completes accurate patient records in a timely manner.
• Documentation includes information to support sound medical/Nurse Practitioner practice.
• Completes timely documentation and dictations for new consults/follow up visits.
• Documents as needed to support billing and reimbursement for services provided.
• Initiates reimbursement billing for services rendered (submits billing).
• Completes adequate number (or %) of Palliative Care patient/family consults and follow up visits given team workload.

Participate in performance improvement and outcome management.

• Meet regularly with medical director for chart reviews.
  • The above performance measure is not applicable to this position.
• Identify concerns in patient care & follows up according to hospital policy.
• Participate in patient satisfaction and other quality improvement initiatives.
• Participate in tracking of variances in care.
• Develops and maintains knowledge of current research related to clinical practice specialty.
• Uses knowledge of research review to analyze research findings.
• Contributes to PI data collection for the specialty area.
• Assists in analyzing PI data to determine opportunities for improvement.
• Initiates and/or contributes to changes in protocols, standards, policies and practices based on current research and PI data.
• Conducts research as needed based on hospital clinical priorities.
• Completes manuscript for publication on periodic basis

Provide appropriate care specific to the age of the patient to ensure understanding and comfort level of treatment as outlined in the "Age Specific Criteria".

• Demonstrates ability to identify opportunities for and give individualized customer service/patient care according to customer/patient needs.
• Right Task
• Right Person
• Right Communication (clear, concise, correct, complete)
• Right Feedback

Staff/Multidisciplinary Team Resource

• Serves as a resource for staff within expertise area on content for clinical patient care and outcomes.
• Demonstrates knowledge of EBP and research as it applies to area of expertise.
• Participates in the evaluation and development of evidence-based patient education.
• Contributes to education of staff relevant to clinical area of expertise.
• Assists in the development of clinical practice guidelines/standards that support implementation of EBP and current research in the specialty area.
• Serves in leadership roles that promote continued improvement of services for Palliative Care patients (e.g. chairs committee, develops standards, policies, etc.).

Patient Care - Care and Consultation

• Provides timely initial patient and family assessments for Palliative Care consults.
• Conducts, leads and facilitates Palliative Care consultation meetings and decision making using theoretical principals, skills and competencies of advanced nursing practice and Palliative Care.
• Collaborates with other team members as appropriate in patient/family conferences.
• Communicates effectively with patient and family for understanding of diagnosis, prognosis, care options and treatment plans.
• Discusses assessment data, diagnostic and prognostic information with other team members and includes content as needed in goal setting discussions and care planning.
• Performs relevant assessments, develops plans, assists in implementation and evaluates Palliative Care interventions.
• Collaborates with other team members in the development and implementation of individualized plans of care.
• Discusses findings and recommendations for plan of care with attending and consulting physicians and other team members as needed for continuity of care.
• Consults with Palliative Care collaborating physician as needed, recognizing abilities and limitations.
• Collaborates with other disciplines for discharge planning inclusive of financial needs and functional status.
• Implements actions and provides for communication that promote continuity of care and optimum transition within and outside the hospital.
• Assesses, documents and provides for education needs for the patient and family in a collaborative manner with other team members.

Schedule:
Weekend/holiday call rotation. 1 weekend/month. 1-2 holidays/year. On-call Friday at 4PM- Monday at 8AM. Round on Saturday & Sunday. Casual, weekdays 8AM - 4:30 PM
Job Description:
Job Requirements
Education

• Graduate of Masters of Science in Nursing (MSN) or Doctorate of Nursing Practice (DNP) program.
  • With licensure as Nurse Practitioner required.
• Satisfactory completion of annual mandatory education requirements.

Experience

• Minimum of 5 years nursing experience.
• Minimum of 3 years previous experience in a related clinical area required.

License/Certifications

• Current valid Registered Nurse (RN) License, valid compact multi-state license , or a temporary permit while awaiting licensure required.
• Current Nurse Practitioner (APRN.NP.NE or ARNP.IA) licensure for work state required.
• Current American Heart Association or American Red Cross Basic Life Support (BLS) strongly preferred at time of hire, required within 3 months of hire.

Skills/Knowledge/Abilities

• Strong leadership, problem-solving and medical judgement skills required.
• Strong interpersonal skills necessary to effectively communicate and interact with patients, family members and hospital personnel/co-workers.
• Ability to perform numerous tasks at once.

Physical Requirements
Weight Demands

• Medium Work - Exerting up to 50 pounds of force.

Physical Activity

• Occasionally Performed (1%-33%):
  • Climbing
  • Crawling
  • Kneeling
  • Sitting
• Frequently Performed (34%-66%):
  • Balancing
  • Carrying
  • Crouching
  • Distinguish colors
  • Keyboarding/typing
  • Lifting
  • Pulling/Pushing
  • Repetitive Motions
  • Stooping/bending
  • Twisting
• Constantly Performed (67%-100%):
  • Grasping
  • Hearing
  • Reaching
  • Seeing/Visual
  • Speaking/talking
  • Walking

Job Hazards

• Not Related:
  • Electrical Shock/Static
  • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
• Rare (1-33%): - Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
• Occasionally (34%-66%):
  • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
  • Equipment/Machinery/Tools
  • Explosives (pressurized gas)
• Frequent (67%-100%):
  • Chemical agents (Toxic, Corrosive, Flammable, Latex)
  • Biological agents (primary air...