ED Pscyh Physician Assistant or Nurse Practitioner - DRH

Duke Regional Hospital Duke Regional Hospital offers the personal touch and hometown feel of a community hospital while serving as an essential arm of internationally recognized Duke University Health System. Duke Regional has served Durham, Orange, Person, Granville and Alamance counties for more than 45 years. To be successful at caring for our community and have a strong reputation among patients who seek our care, we have 3,500 team members who work together to provide exceptional, compassionate and equitable healthcare 24/7. We are a place of learning and acceptance for team members just starting their careers, as well as an institution of family culture and professional development for employees who have served for decades in our hospital units.Duke Regional has 388 inpatient beds and offers a comprehensive range of medical, surgical and diagnostic services, including orthopedics, weight-loss surgery, women's services, and heart and vascular services. We also offer care at our Duke Rehabilitation Institute, Davis Ambulatory Surgical Center, Duke Ambulatory Surgery Center Arringdon, Health Services Center, and Duke Behavioral Health Center North Durham. In fiscal year 2021, Duke Regional Hospital admitted 16,422 patients, performed 18,152 surgeries and welcomed 2,673 babies into the world. U.S. News & World Report ranked Duke Regional Hospital as #9 in North Carolina and #4 in the Raleigh-Durham area for 2021-22. The Human Rights Campaign consistently names us a Healthcare Equality Leader, and we are a Joint Commission-accredited and Magnet-designated hospital.
 

Emergency Behavioral health SERVICES Advanced Practice Provider (APP)

Nurse Practitioner or Physician Assistant

Job Location:  Duke University Hospital Emergency Room

Job Summary

The Emergency Behavioral Health Services Advanced Practice Provider (APP) provides direct patient care services and performs medical acts as either a Nurse Practitioner (NP) or Physician Assistant (PA) under the supervision of the supervisory physician to patients requiring psychiatric evaluation and management in the Emergency Departments at Duke University Hospital and Duke Regional Hospital.  The APP performs physical and mental health exams, collects and documents data, conducts diagnostic and therapeutic procedures, orders and schedules laboratory studies and professional consultations, prescribes appropriate interventions and medications, and provides direct patient care services. The APP contributes to excellence in patient care, research, teaching, and provides leadership in the organization.

Job Duties and Responsibilities

Clinical Expert

• Collaborate with Emergency Department attending physicians and residents, Psychiatry attending physicians and residents, and healthcare team to assess, diagnose, plan, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of patient care.
• Provide /coordinate clinical practice for psychiatric patients at Duke Hospital and Duke Regional Hospital being followed in the Emergency Department  through established protocols and under the supervision of the supervising physician who is either on site or available by pager
• In collaboration with attending,  round daily on patients to assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of patient care:
• Provide evidence-based clinical care
• May order and/or perform the following procedures: 
• Patient history and perform physical exam
• Laboratory, radiology, and/or diagnostic procedures/tests
• Interpretation of laboratory, radiographic and diagnostic tests
• Removal of superficial foreign bodies
• Venipuncture for blood sampling
• Prescribing Authority for the following: 
  • Antidepressants
  • Antipsychotics, typical and atypical
  • Benzodiazepines
  • Non-benzodiazepine anxiolytics
  • Hypnotics
  • Mood stabilizers
  • Psychostimulants
  • Antiparkinsonian drugs
  • IV and oral antibiotics
  • Analgesics, to include both narcotic and narcotic agents
  • Antiepileptic agents
  • Oral antifungal agents
  • Muscle relaxants
  • Antiasthmatics
  • Antihistamines
  • Antitussives, expectorants
  • Anticoagulants
  • Antidiarrheals
  • Oral antidiabetics/insulin
  • Antiemetics
  • Antihypertensives
  • Antipyretics
  • Cardiovascular Drugs
  • Cholesterol lowering agents
  • Diuretics
  • Electrolyte replacements/Vitamins/IV fluids
  • Gastrointestinal drugs
  • Antiretroviral medications
  • Hormones and synthetic substitutes/oral contraceptives
  • Muscle relaxants
  • Osteoporosis meds
  • Smoking cessation meds
  • Thyroid meds
  • Tuberculosis meds (in latent TB/already established med regimen)
• Assess patients for change in status and institute appropriate interventions.  Initiate emergency interventions in an effort to stabilize the patient until physician support arrives.
• Communicate verbally and in writing all pertinent patient information to supervising MD, referring MD, nursing staff, transfer facility, home health, and other relevant healthcare providers.
• Document in patients’ medical records all relevant data including but not limited to results of diagnostic tests; laboratory results; patients’ condition and response to therapies/interventions; communications with supervising MD.
• Provide leadership and coordination of care and services for psychiatric patients in the Emergency Department.
• Utilize prescriptive privileges for identified patient population and in accordance with DUH and NC Board of Nursing/NC Medical Board regulations.
• Role model competence in advance nursing skills.

Educator:

• Assess educational needs of the Duke nursing staff and healthcare team members and provide one-on-one as well as formal education as needed
• Implement and evaluate appropriate educational programs for nursing staff, MDs, and other healthcare providers as appropriate.
• Role model and precept healthcare learners through contractual agreements.
• Assess educational needs of patients/families and provide culturally sensitive patient/family interventions as indicated. Use non-technical language when educating patients/families. Document educational interventions in the patient’s medical record.

Research Utilization and Investigation:

• Utilize current research and evidence-based decision-making in all clinical practice.
• Incorporate clinical research finding in the development and implementation of standards of care.
• Support IRB approved clinical research/trials though a variety of activities including but not limited to: obtaining consent; ordering diagnostic tests; recording laboratory & diagnostic results; administering therapeutic interventions; and reporting patient outcomes including toxicities or adverse events.
• Participate in interdisciplinary quality improvement and/or research activities.
• Participate in measuring and documenting outcomes.

Consultant:

• Provide expertise and resource information to other healthcare providers, patients and families, and the community at large related to psychiatric/mental health diseases, recognition and management.
• Develop, implement and evaluate standards of care/practice guidelines/policies and procedures/care maps/protocols within area of specialization.
• Develop programs and projects in areas of expertise to facilitate the attainment of the goals and objectives of the Duke University Hospital, Duke Regional Hospital, and Duke University Health System.

Professional Leadership and Development :

• Role model Advanced Clinical Practice through conduct, communication, dress, leadership, ethical decision-making, critical thinking and problem solving skills.
• Participate in at least one professional organization.
• Demonstrate responsibility for professional practice through active participation in Emergency Department, Behavioral Health Services, CAP Department, and professional organizations.
• Share clinical expertise, program accomplishments, and research findings with other professionals through written publications, oral presentations, posters, continuing education, etc.
• Maintain all professional requirements for licensure and certification.

Job Eligibility Requirements

Education

NP:       Graduate of MSN or DNP Adult Psychiatric and Mental Health Nurse Practitioner Program

PA:       Graduate of ARC accredited Master’s or Doctoral Degree Physician Assistant program

Licensure

NP:        Current unrestricted RN license issued by or recognized by NCBON with approval to practice as an NP.

PA:       Current unrestricted medical license issued by the NCMB with approval to practice as PA.

Certification

NP:       Adult Psychiatric Mental Health Nurse Practitioner - PMHNP

PA:       PA-C, with added qualifications (CAQ) in Psychiatry is preferred.

Experience

One (1) year experience as a NP/PA in a psychiatric capacity is strongly preferred.

Physical and mental requirements :

• Able to clearly articulate scope of practice, and practices within those guidelines as a Nurse Practitioner / Physician Assistant in the state of North Carolina and within the Duke University Health System. 

• Able to independently seek out resources and work collaboratively to solve complex problems

• Able to communicate clearly with patients, families, visitors, healthcare team, physicians, administrators, leadership, and others.

• Able to use sensory and cognitive functions to process and prioritize information, perform health assessments, treatment, and follow-up.

• Able to use fine motor skills

• Able to record activities, document assessments & interventions; prepare reports and presentations;
• Able to use computer and learn new software programs
• Able to provide leadership in clinical area of expertise and in meeting organizational goals
• Able to navigate the Hospitals and DUHS to provide clinical expertise to specific patient populations

• Able to withstand prolonged standing and walking with the ability to move or lift at least fifty pounds
• Able to remain focused and organized
• Able to work collaboratively with all levels of personnel

Job Schedule

The Emergency Behavioral Health Services APPs provide coverage 24 hours a day, 7 days per week, including rotating days, nights, holidays, and weekend coverage at Duke University Hospital, and 7am-7pm, 7 days per week, including rotating days, nights, holidays, and weekend coverage at Duke Regional Hospital. Coverage model must be flexible to meet clinical needs.  14-shifts per month is considered FULL-TIME.

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.