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Birthing Center Advanced Practice Provider with Leadership Responsibilities

Certified Nurse Midwife, Physician Assistant or Nurse Practitioner

Job Location - Duke University Hospital, Center for Advanced Practice

Job Summary

The Certified Nurse Midwife (CNM) / Women's Health Nurse Practitioner (WHNP) / Physician Assistant (PA) is an advanced practice provider (APP) who provides direct patient care services for antepartum, intrapartum (CNM only), postpartum and gynecology patients.

This practice includes primary as well as specialized care provided in multiple locations including inpatient units and OB triage in the Duke Birthing Center, Duke Regional and outpatient clinics.

The APP performs physical exams, collects and documents data, conducts diagnostic and therapeutic procedures, orders and schedules laboratory studies and professional consultations, prescribes appropriate interventions and medications and coordinates the care and discharge of patients.

The APP contributes to excellence in patient care, research, teaching and provides leadership to the organization.

Provide overall direction and leadership for activities and operations associated with the provision of advanced clinical practice services in accordance with the hospital and health system strategic plan and objectives, internal and external credentialing and regulatory requirements, and evidence based practice standards on a 24 hour basis.

The Director of Advanced Practice is responsible for 24 / 7 management of all aspects of those advanced practice positions within a Clinical Service Unit (CSU) or Units.

In addition the director is responsible for maintaining productive working relationships with medical staff and hospital / health system leadership.

The Director also serves as an expert resource for requirements related to licensure, regulatory, and practice issues for advanced practice nursing positions to include Nurse Clinicians (NC), Clinical Nurse Specialists (CNS), Nurse Practitioners (NP), Critical Care Nurse Practitioners (CCNP) and Certified Nurse Midwives (CNM);

Critical Care Physician Assistants (CCPA), and for Physician Assistants (PA).

Job Duties and Responsibilities

Clinical Expert

• Collaborate with attending physician(s) 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 patients at Duke Hospital and Duke Regional Hospital being followed on the OB service through established protocols.
• Round daily on patients to assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of obstetrical patient care;
• Provide evidence-based clinical care by actively engaging in review of literature
• 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, home health, and other relevant healthcare providers.
• Document in patients' chart 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 the OB-GYN Service.
• Utilize prescriptive privileges for identified patient population and in accordance with Duke and NC Board of Nursing regulations.
• Role model competence in advance nursing skills and provides evidence-based practice.
• May order and / or perform the following procedures :
• Order Laboratory and or diagnostic procedures for
• Term labor
• Preterm labor
• Cesarean delivery
• Postpartum care (including insertion and removal of intrauterine devices and Nexplanon)
• Gynecological care / Primary care including pap smears and STD testing
• Insertion and interpretation of external and internal fetal monitoring (CNM only)
• Insertion and interpretation of tocodynamotor and intrauterine pressure catheter (CNM only)
• Identification of vaginal and perineal lacerations including degree of tear. (CNM only)
• Identify common vaginal infections using microscopy
• Neonatal circumcision
• Assist attending in the OR
• Limited obstetrical ultrasound

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 maternal and fetal diseases, procedures, interventions, and conditions.
• Implement and evaluate appropriate educational programs for referring MDs
• 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 and Duke University Health System.

Professional Leadership and Development :

• Role model Advanced Practice Nursing 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 OB / Gyn Department, 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

CNM : Graduate of MSN or DNP accredited MSN or DNP Nurse Midwifery Program

PA : Graduate of a Masters or Doctoral ARC accredited Physician Assistant Program

NP : Graduated of MSN or DNP Womens Health Nurse Practitioner Program (WHNP) or Family Nurse Practitoner (FNP) Program

Certification

CNM : National certification as a CNM.

PA : PA-C

NP : WHNP or FNP

License

CNM : RN license issued by or recognized by NCBON with authorization to practice as CNM.

PA : Medical License issued by the NCMB with authorization to practice as a PA.

NP : RN license issued by or recognized by the NCBON with authorization to practice as WHNP.

Experience

PA and FNP applicants must have Women's Health Birthing Cetner Experience

Life support

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 Hospital 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 Hours

APPs will work an average of 40 hours each week inpatient and / or outpatient. Outpatient : Monday through Friday 4 or 8 hour days in the clinics.

Inpatient : Sunday through Saturday 8 or 12 hour days / nights rotating in the hospital. This schedule may be modified by CAP leadership to meet the hospital and clinical needs.

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.

Last updated : 2024-03-03