Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 315-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus as well as at 10 Eskenazi Health Center sites located throughout Indianapolis.Interested Applicants should apply here:
The Advanced Practice RN (APRN) Nurse Practitioner in Emergency Care works as an educator, advocate and care provider and is responsible for the care and well-being of patients in the Michael and Susan Smith Emergency Department by functioning as a direct provider of emergency services.
The APRN plans, coordinates, and evaluates patient's health care at EMG venues. The APRN provides diagnostic as well as therapeutic intervention and evaluation, including diagnostic and pharmacologic intervention. Performs or orders and interprets diagnostic testing. Utilizes referrals to other providers as needed. Writes prescriptions when having appropriate approved prescriptive authority. Performs office procedures within the scope of practice. Collaborates with health care providers across the health care continuum.
Eskenazi Medical Group employees are expected to model PRIDE values (Professionalism, Respect, Innovation, Development, and Excellence) and be positive representatives of our organization on and off the job. This earns the trust and respect necessary to serve all our customers with excellence. Employees proactively contribute to EMG's mission and professional goals: Advocate, Care, Teach and Serve.ESSENTIAL FUNCTIONS AND GENERAL DUTIES:
Clinical Practice and Education
1. Provides a history and initial and ongoing physical assessment of patients: medical, physical and psychosocial status including data from all relevant sources:
a. Obtains relevant health and medical history from patients and/or caregivers,
b. Performs physical exam appropriate for age, history, and presentation, including comprehensive functional assessment when clinically indicated
c. Conducts preventive screening and diagnostic procedures based on age and history
d. Identifies patient's medical and health risks and needs
e. Updates and records changes in health status
f. Orders, conducts and interprets diagnostic tests
g. Maintains follow-up on patient labs and tests
h. Identifies the needs of the individual, family, or community as a result of the evaluation of the collected data
i. Selects treatment interventions to promote quality of care while considering safety, effectiveness and cost
j. Formulates the appropriate differential diagnosis based on history, physical exam, clinical findings and diagnostic test findings
k. Develops care plan and communicates the plan to patient, their care giver, or family
l. Evaluates patient responses in relation to care provided and the expected outcomes
m. Identifies non-pharmacologic interventions and prescribes non-pharmacologic therapies; identifies pharmacologic interventions and prescribes pharmacologic therapies within approved prescriptive authority from the State of Indiana
n. Provides patient education
o. Makes appropriate referrals to physicians and other health professionals and community agencies,
p. Determines the effectiveness of plans of care based on identifies, objective outcomes and reassesses and modifies the plan as necessary to achieve medical and health goals of the individual patient and communicates findings and plan of care to patient, their care giver or family
2. Participates in quality improvement review on a periodic basis, including systematic review of records and treatment plans, helps disseminate findings, and implements plans for improvement.
3. Serves as an educational resource for other EMG staff.
4. Serves as a member of various EMG committees dealing with healthcare and clinical practice
5. Completes and maintains written records in a timely fashion and in compliance with NCQA and Eskenazi Health standards.
6. Ensures documents are accurate, comprehensive and in a manner that is retrievable
7. Identifies patients whose illnesses are beyond the scope of practice and collaborates with department physicians or specialty consultants as needed
8. Strives for improved patient care focusing on positive outcomes and cost effectiveness through the five primary roles of expert clinician, consultant, educator, researcher and leader
9. Maintains clinical skills requirements based on area of practice and demonstrated competency as required by credentialing
10. Utilizes principles of performance improvement process to improve patient care
11. Maintains a flexible schedule to meet the needs of patients, staff and system
12. Utilizes prescriptive authority according to the Indiana statute and institutional guidelines
13. Contributes to professional literature
14. Impacts patient care by evaluating standards of care, clinical practice guidelines, and best practices to implement evidence based practice. Uses evidence based practice to develop policies and procedures and through involvement in practice committees.
Integrity and Professionalism
1. Adheres to the Code of Ethics for Advanced Practice Registered Nurses and works within a APRN's scope of practice
2. Demonstrates a high level of confidentiality and trustworthiness
3. Acts in a way that promotes a positive, respectful, and supportive environment for patients, families, and coworkers
4. Takes responsibility for quality of own work
5. Continually strives to increase knowledge and skills and is responsible for maintaining continued competence in the APRN role
6. Maintains appropriate and up to date licensing, certifications, and continuing education
7. Uses resources efficiently, conservatively, and is cost conscious
8. Follows organization's policies and procedures
9. Presents self in a professional manner
10. Regularly attends and participates in staff meetings
11. Supports the organizational goals and objectives
12. Fosters a team environment among coworkers
13. May provide feedback regarding clinic staff on performance and clinical competencies to the individual and management as neededSUPPLEMENTAL JOB FUNCTIONS:
- Assess and triages a patient's condition by obtaining a focused and pertinent history, identifying risk factors, performing an appropriate focused/complete physical examination, and by ordering and/or providing preventive or diagnostic procedures.
- Develops a differential diagnosis and/or diagnoses of both life threatening and non-life threatening conditions by utilizing critical thinking while simultaneously synthesizing and analyzing patient data. ENPs establish a differential diagnosis based on the patient's medical history, physical exam findings, interpretation of diagnostic studies, while continually establishing priorities to meet the needs of the patient, their family, and or the community.
- Utilize critical thinking during medical screenings and diagnostic processes by synthesizing and analyzing the data to execute a plan of care including stabilization, resuscitation of unstable conditions and the transfer of care when appropriate.
- Provides medical screening evaluations in accordance with the EMTALA. This includes:
o Documentation of the chief complaint and pertinent history incorporating health risk factors
o Physical exam findings
o Interpretation of diagnostic data including the rationale for the medical necessity of tests
o Medical decision making with differential diagnosis
o On-going evaluation of patient progress and response to treatment to determine the plan of care.
- Collaborates with staff of affiliated institutional facilities to provide care for patients receiving care in the Michael and Susan Smith Emergency Department
- Collaborates with transitional support team, inpatient teams, physical therapy and other health care providers to ensure a seamless transition to inpatient units or care within the community.
- Determines most appropriate patient disposition
- Confers with patient's primary care provider as needed
- Communicates via Epic outstanding patient problems and issues requiring follow up care
- Management of patient health/illness status
o Triages patients' health needs/problems
o Completes EMTALA-specified medical screening examinations
o Responds to the rapidly changing physiological status of emergency care for the assessment, treatment, and disposition of acute and chronically ill and injured emergency patients.
o Specifically assesses and initiates appropriate interventions for violence, neglect and abuse.
o Specifically assess and initiates appropriate interventions and disposition for suicide risk
o Participates in internal and external emergencies, disasters, and pandemics.
o Maintains awareness of known causes of mass casualty incidents and treatment modalities required for emergency care.
- The following may be done independently based on scope of practice and credentialing or in partnership with the ER staff physician:
o Assess and manages a patient in cardiopulmonary arrest
o Assess and obtain advanced circulatory access o Ultraviolet examination of skin and secretions o Treat skin lesions
o Injects local anesthetics
o Nail trephination o Toe nail removal o Nail bed closure
o Wound revision for closure
o Debridement of wounds/ minor burns
o Incision, drainage, irrigation of wounds and packing.
o Eye dilatation
o Tonometry to asses intraocular pressure
o Slit lamp examination
o Cerumen impaction curettage
o Control epistaxis
o Needle thoracotomy for life threatening conditions in emergency situations.
o Replace gastrostomy tube
o Assess and manage cervical spine injuries
o Lumbar puncture
o Incise and drain Bartholin's cyst
o Assist with imminent childbirth and post-delivery maternal care
o Fecal impaction removal
o Incision of thrombosed hemorrhoids
o Digital nerve block
o Reduction of fractures of small bones
o Reduction of fractures of large bones with vascular compromise (ie. traction splint)
o Application of immobilization devices
o Remove casts
o Arthrocentesis (knee/elbow)SKILLS AND KNOWLEDGE REQUIRED:
MINIMUM QUALIFICATIONS, TRAINING, AND EXPERIENCE:
- Ability to assess system and patients' needs and function autonomously to develop and implement programs to improve patient care
- Ability to collaborate with other health care team members to enhance patient care across the continuum
- Demonstrates leadership abilities by serving as a mentor to influence patient outcomes
- Ability to conduct product, program and/or process value analysis including complete financial implications involved in implementation of the product or program
- Ability to review/critique pertinent research literature related to specialty areas and promotes evidence based practices to improve patient care
- Demonstrates excellent communication skills related to team development, group process, conflict management and negotiations
- Possesses knowledge and skills necessary to provide care appropriate to the age of patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data/interpret appropriate information needed to identify each patient's requirements relative to age-specific needs
- Ability to use age-appropriate and cognitive skills detailed in the department/area/unit job specific/age specific competencies
- Graduation from an accredited school of nursing with a Master of Science degree
- Current Indiana license as a Registered Nurse or current registration with another State Board of Nursing followed by immediate registration with the Indiana Board of Nurse Examiners for license endorsement
- Collaborative agreement with affiliated physician group
- Current Indiana Controlled Substance and Drug Enforcement Registration
SPECIAL EFFORT REQUIRED:
- Maintains patient confidentiality
- Maintains protected health information in accordance with HIPAA privacy guidelines and regulations
- Performs other related duties as assigned
- Collaborates with staff of affiliated institutional facilities to provide appropriate care for patients
- Confers with the patient's physician as needed
- Maintains competency in area of expertise
- Able to perform duties and effectively respond in stressful environment/situations, mentally and physically
- Care or effort to avoid injury and infection
- Must be mentally capable of processing information quickly
- Demonstrates flexibility in response to changing situation, workload and/or patient assignments
- Must be able to respond immediately to/move quickly in emergency situations in unit and hospital
- May not work with devices that limit ability to perform duties or impede hand washing
- Must be able to arrive at work during severe weather conditions (snow, wind, hail, thunderstorms, dust, and extreme heat/cold)
- Patient care areas, clinics, nursing offices
- May be required to attend meetings or perform work remote from clinic or hospital campus
- Maintains clean and uncluttered work environment
- Follows universal precautions in cleaning up or disposing of any blood or body fluids
- Returns all resources back to original place
- Exposure to communicable diseases and infections.
- Risk of injury from lifting/moving patients and/or equipment
- An individual in this position may be exposed to:
Adverse indoor and outdoor environmental conditions
Physical and chemical hazardsADDITIONAL QUALIFICATIONS:
- ACLS certification
- Additional privileging as requested to perform procedures independently:
o Arterial line placement
o Nerve block
o Fracture reduction o Lumbar puncture. o Cast and splint
o Chest tube placement/removal
o Chest x-ray review
o Digital, hematoma, and intraarticular blocks
o Central and femoral venous catheter placement/removal
o Joint aspirationo Joint injection:
tendon sheaths, ligaments, trigger points, ganglion cysts, bursa
o Taping and bracing
o Fracture reduction
Eskenazi Health system commitment:
- Maintains competency in area of expertise
- Specialty certification if available/eligible
Expect collegial and multidisciplinary approaches to problem solving from all providers working in our system.
Respect clinician autonomy where evidence for a standard of care has yet to be developed. Different approaches should be evaluated to determine the optimal ones, which should then be adopted broadly. Care pathways will be assessed based on quality/outcomes, effects on workflow, and costs.
Commit ourselves to improvement in quality, processes, and the work environment.
Share information openly regarding vision, mission, and strategy, and the progress towards meeting those targets.
Provide timely reporting on quality, volume, financial, and other operations metrics to providers.
Improve chains of communication between providers and administration to make decision making and problem solving as transparent as possible.
Promote Eskenazi Health as a superior learning environment for undergraduate, graduate, and practitioner education in medicine, nursing, pharmacy and other clinical specialties, and provider opportunities for clinical research with our patients.
Seek the input of providers to develop novel services for our patient populations.
Be a leader in promoting wellness among our providers, staff, and patients.
Support career development of providers through inclusion of them in project teams, research projects, and leadership development activities, including coaching and training in improved patient satisfaction.
Recruit and retain superior providers and staff (including those employed by EMG and IUHP) through actions that recognize successes, address provider engagement, and address low performance among staff and providers in a timely fashion.
Eskenazi Health has been named to Becker's Hospital Review's 2018 list of "150 Great Places to Work In Health Care." This is the 3rd year in a row now that EH has received this honor.
Accredited by The Joint Commission and named one of the nation's 150 best places to work by Becker's Hospital Review for three consecutive years and Forbes list of best places to work for women, and Forbes list of America's best midsize employers' Eskenazi Health's programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city's primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the only verified adult burn center in Indiana, the first community mental health center in Indiana and the Eskenazi Health Center Primary Care - Center of Excellence in Women's Health, just to name a few.