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Nurse Practitioner/Physician Assistant - Internal Medicine (Acute NP/PA) - VUMC-1603411

**Please note this is a NOCTURNIST position; employee will be expected to work overnight.
The Advanced Practice Professional, APP, (including either PA or NP) within the acute care hospital setting works in collaboration with, and is an integral member of, a multidisciplinary health care team. The APP functions as a Hospitalist in an inpatient setting, managing the care of acute/complex chronically ill patients. The APP typically cross-covers and manages patient care from step down to discharge. With appropriate experience, up to 25% of time will be devoted to an admission only service. The ideal candidate has a strong foundation in evidenced based practice/education and provides an environment of safe quality care. The APP should demonstrate an advanced level of medical and nursing knowledge, clinical and technical competence, sound clinical judgment, professional communication skills, timely and compliant documentation. This role is responsible for continued professional development and competency validation.

Key Functions and Expected Performances:

1. Assessment of Health Status
   1. Performs and documents in the medical record a complete history and physical examination for acute and complex chronically ill patients.
   2. Orders and collects data using appropriate assessment techniques, relevant supporting diagnostic information and diagnostic procedures where indicated.
   3. The APP 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.
   4. 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.
   5. Coordinates daily rounds with the Attending physician teams, presents 24 hour patient report, collaborates in plan of care, and cross-covers assigned patient population throughout the night.
2. Diagnosis
   1. Collaborates with interdisciplinary health care team in making diagnoses of acute and complex chronic conditions.
   2. Manages diagnostic tests through ordering, interpretation, performance, and supervision.
   3. Formulates differential diagnoses by priority.
   4. Diagnoses complications and orders appropriate interventions
3. Formulates Plan of Care
   1. Identifies expected outcomes from diagnosis, and formulates and documents a plan of care to address complex acute and chronic health care needs.
   2. Utilizes evidenced based practice guidelines or protocols in an individualized, dynamic plan of care that can be applied across the continuum.
4. Implements and modifies plan of care
   1. Prescribes diagnostic strategies and therapeutic interventions including pharmacologic, non-pharmacologic and surgical, needed to achieve expected outcomes.
   2. Manages further diagnostic tests through ordering, interpretation, performance, and supervision.
   3. May perform advanced procedures consistent with privileges and competency validation including minor suturing, complex wound management, line and tube placements and removals.
5. Communication and Collaboration
   1. Maintains ongoing communication and collaboration with interdisciplinary health care team.
   2. Facilitates and communicates with patient, family and staff to promote continuity of care across the inpatient and outpatient continuum of care.
6. Documentation
   1. 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)
   2. Documentation is timely, meets acute care compliance standards and captures patient acuity.
7. Professional Practice
   1. Demonstrates Professional Practice behaviors including: preceptor/mentoring, education and instruction of students, nursing staff, nurses, graduates and novice APPs.
   2. Seeks opportunities for active engagement in research and the analysis of evidenced based practice.
   3. Actively participates in Grand Rounds, APN council meetings, faculty and unit meetings, MM&I presentations.
   4. Maintains CEUs, and membership in a professional organization.

Department Summary:

The Division of General Internal Medicine and Public Health is committed to caring well for those who entrust their care to us and to improving community health. A large and diverse Division within the Department of Medicine, we are aligned along ten Sections that include Ambulatory Medicine, Hospital Medicine, Medicine-Pediatrics, Palliative Care, Occupational Health, Student Health, Veterans' Health, Concierge and Executive Health, Walk-in-Clinics, and Professional Health and Wellness. Collectively the sections support our tripartite pursuit of compassionate, patient-centered health care, rigorous training of the next generation of physicians and impactful discoveries.

View how Vanderbilt Health employees celebrate the difference they make every day:

Discover Vanderbilt University Medical Center:

Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded and your abilities challenged. It is a place where your diversity -- of culture, thinking, learning and leading -- is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt's mission is to advance health and wellness through preeminent programs in patient care, education, and research.

VUMC Recent Accomplishments

Because we are committed to providing the best in patient care, education and research, we are proud of our recent accomplishments:

* US News & World Report: #1 Adult Hospital in Tennessee and metropolitan Nashville, named to the Best Hospitals Honor Roll of the top 20 adult hospitals, 10 nationally ranked adult specialty programs, with 3 specialties rated in the top 10 nationally, Monroe Carell Jr. Children's Hospital at Vanderbilt named as one of the Best Children's Hospital in the nation, with 10 out of 10 pediatric specialties nationally ranked.

* Healthcare's Most Wired: Among the nation's 100 "most-wired" hospitals and health systems for its efforts in innovative medical technology.

* Becker's Hospital Review: named as one of the "100 Great Hospitals in America", in the roster of 100 Hospitals and Health Systems with Great Oncology Programs and to its list of the 100 Hospitals with Great Heart Programs.

* The Leapfrog Group: One of only 10 children's hospitals in the to be named at Leapfrog Top Hospital.

* American Association for the Advancement of Science: The School of Medicine has 112 elected fellows

* Magnet Recognition Program: Received our third consecutive Magnet designations.

* National Academy of Medicine: 22 members, elected by their peers in recognition of outstanding achievement

* Human Rights Campaign Healthcare Equality Index: 6^th year in a row that Vanderbilt University Medical Center was a Leader in LGBTQ Healthcare Equality.

Master's Degree (or equivalent experience) and < 1 year experience. 12 months of nursing experience preferred; Inpatient acute care advanced practice nursing experience desirable.

Licensure, Certification, and/or Registration (LCR):

• Registered Nurse Required

Additional Qualification Information:

• Prefer National Specialty Board Certification, TN APN certificate/certificate of fitness to prescribe, eligible for DEA

Physical Requirements/Strengths needed & Physical Demands:

Movement

• Occasional: Sitting: Remaining in seated position
• Occasional: Standing: Remaining on one's feet without moving.
• Occasional: Walking: Moving about on foot.
• Occasional: Lifting under 35 lbs: Raising and lowering objects under 35 lbs from one level to another
• Occasional: Push/Pull: Exerting force to move objects away from or toward.
• Occasional: Bending/Stooping: Trunk bending downward and forward by bending spine at waist requiring full use of lower extremities and back muscles
• Occasional: Crawling:Moving about on hands and knees or hands and feet.
• Occasional: Reaching below shoulders: Extending arms in any direction below shoulders.
• Occasional: Handling: Seizing, holding, grasping, turning or otherwise working with hand or hands.

Sensory

• Occasional: Vision: Clarity of near vision at 20 inches or less and far vision at 20 feet or more with depth perception, peripheral vision, color vision.
• Frequent: Noise: May include exposure to occupational noise levels which equal or exceed an 8-hr time-weighted average of 85 decibels, requiring enrollment in VUMC's Hearing Conservation Program which includes training, use of hearing protection, and periodic audiometry.
• Continuous: Communication: Expressing or exchanging written/verbal/electronic information.

Environmental Conditions

• Occasional: Chemicals and Gasses: Medications, cleaning chemicals, oxygen, other medical gases used in work area.
• Occasional: Pathogens: Risk of exposure to bloodborne pathogens and other contagious illnesses.
• Occasional: Radiation: May be exposed to occupational radiation, requiring enrollment in VUMC's Radiation Safety Program which includes training, use of personal protective equipment with lead shielding, and personal dose monitoring.
• Occasional: Climate: Ability to withstand exposure to atmospheric extremes including heat, cold, humidity, and barometric pressure changes.

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