Description

Division: Neurology, Outpatient. Multi-disciplinary Clinic.

Expected Starting Salary Range: 45.39 - 57.98

SUBFUNCTION DEFINITION: Advanced Practice Providers (APPs) are Advanced Practice Registered Nurse (APRN), Physician Assistant (PA), Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS) or Certified Nurse Midwife (CNM) providing clinical services including diagnosis of illness, development and management of treatment plans, prescription of medication. APPs may see patients independently or as part of the health care team.

The CCHMC Tuberous Sclerosis Complex (TSC) clinic is multi-disciplinary team including Neurology (advanced practice providers, neurologists, nurses, researchers, and clinic coordinators), Genetics, Psychology, Psychiatry, Nephrology, Pulmonary, Cardiology and Ophthalmology.

Tuberous sclerosis complex (TSC) is a genetic disorder that can affect every organ system in the body throughout the lifespan. TSC is associated with epilepsy, autism, kidney and lung comorbidities, and neurocognitive and behavioral disabilities. The TSC Clinic treats children and adults (no age limit).

Excellent critical thinking skills and ability to assess the "whole patient" beyond their neurological symptoms is necessary in the overall management of this patient population.

Excellent and effective communication skills and collaboration with all members of the multi-disciplinary team and external resources are required in the effective management of TSC patients seen in TSC Clinic.

Scope: Scope for subspecialty role will not exceed the scope of the collaborating or supervising MD

Advanced Practice Provider Role in the TSC multi-disciplinary Clinic

APRN will see follow up patients (children and adults) in TSC clinic in Neurology and perform a comprehensive history, physical and neurological examinations, order tests, review and interpret labs and other test results, and order tests, labs, medications, and other treatments. The APRN will collaborate and communicate with other multi-disciplinary team members involved in the care of the patient during the clinic visit.

The APRN will provide care for TSC patients between office visits who contact the office with concerns. The APRN will review patient labs, test results, and other reports to monitor patient safety and effectiveness of treatments. It may be necessary to make adjustments to current treatment plans or initiate new treatments as a result based on these results and the clinical presentation of the patient (how the patient is doing overall at this time.

The APRN will actively participate in weekly TSC Team meetings to address patient concerns and discuss patients to be seen at upcoming clinics. The APRN coordinates care with the subspecialties: assistance in scheduling TSC clinic follow up visits with various subspecialty clinics when needed; contacting subspecialists in and outside of Neurology to discuss and collaborate about patient concerns or abnormal test results to determine or modify the treatment plan; gives an update to subspecialty providers on patients seen in clinic after the APRN sees the patient and before the subspecialist sees the patient.

The APRN will manage and prescribe treatments and medications for neurological conditions such as seizures and headaches. The APRN will also manage and prescribe treatments and medications for non-neurological conditions such as mouth sore prevention, ADHD, aggression, insomnia and other TSC associated neuropsychiatric disorders (TAND) such as ADHD, aggression, irritability and insomnia. APRN will provide education on treatments, medications, possible side effects, risks vs benefits, anticipate and mitigate possible drug interactions, and make adjustments to medications and treatment plans as needed.

REPRESENTATIVE RESPONSIBILITIES

-Patient Care
Perform history and/or physical exams on patients presenting for care in area of expertise. Assess and diagnose illnesses, including chronic and acute conditions. Formulate, document and monitor a treatment plan. Order and monitor therapeutic interventions including but not limited to diets, laboratory, radiological and diagnostic tests as deemed necessary by patient history and/or physical exam. Provide clinical consultation, order interdisciplinary consults. Professional practice including but not limited to prescription of medications in accordance with Federal and State Law & Rules and CCHMC policy. Attains and maintains competency in subspecialty practice, skills and procedures in accordance with Joint Commission standards for focused (FPPE) and ongoing (OPPE) professional practice evaluation.

Outcomes Identification and Planning
Develops outcomes as measurable goals that provide direction for continuity of care & continuity of care & consistency among providers. Develops, prioritizes, evaluates & modifies an individualized comprehensive plan of care. Addresses each diagnosis or issue, as appropriate. Derives outcomes & plans of care that involve the patient/family/caregiver when possible & are realistic to the patient/family/caregiver capabilities & resources. Considers risks/benefits, costs, clinical effectiveness, current scientific evidence/clinical guidelines & clinical expertise to formulate interventions, treatments & outcomes. Incorporates new knowledge & strategies to initiate change in practice if desired outcomes not achieved. Maintains documentation & updates accordingly outcomes, goals & the plan of care.

Professional Practice
Maintain professional behaviors aligned with core values and care standards, participate in quality improvement activities or research to improve the care delivery process & patient care outcomes. Participate in lifelong learning and professional development activities that improves skills & competence in clinical practice/role performance. Serve as preceptor, role model, or mentor; Contribute to the professional development of peers/colleagues to improve pediatric health care & to foster the professions growth. Integrate ethical considerations & research findings into practice; Provide leadership by participating on committees or in professional organizations, or writing/publishing/presenting. Advocate for the pediatric patient/family/caregiver. Serve as a leader, influencing both healthcare/APRN practice & policy.

Care Management
Maintains competency in skills/procedures; Promotes self-management & family centered care; Employs diverse & complex strategies, interventions, & teaching to promote health & a safe environment; Provides leadership in care management to achieve optimal quality, cost-effective care; Documents & communicates with healthcare team members to achieve an integrated delivery of pediatric care services; Delegates appropriate monitoring, assessment, & interventions according to the patient and scope of practice of the caregiver; Provides consultation to influence the identified plan of care, to enhance the abilities of others to provide health care, and to effect change in the healthcare system; Makes appropriate referrals and discusses recommendations with patient/family/caregiver; Orders and/or performs appropriate treatments, therapies, & procedures that are based on current knowledge, research, & practice; Provides patient/family/caregiver with diagnostic & laboratory results as well as actual/potential benefits, limitations, & adverse effects of proposed therapies.

Evaluation
Uses a systematic, ongoing evaluation of the assessment data & outcomes to revise or resolve the diagnoses, outcomes, the plan of care, & the implementation as needed; Evaluates the accuracy of the diagnosis, effectiveness of the interventions & the plan of care strategies in relation to attainment of expected outcomes; Includes the patient/family/caregiver & other healthcare providers; Bases the evaluation process on advanced knowledge, practice, research, & documents appropriately; Utilizes the results of the evaluation to determine the impact on the patient/family/caregiver, organization, & system to make/recommend process or structural changes including policy, procedure, or protocols as appropriate.

Qualifications

EDUCATION/EXPERIENCE

• Experienced APRN is required with over three years' experience.
• Prefer 5 years or more of experience as an APRN. Prefer that experience to be as a family practice nurse practitioner in the outpatient primary care setting (family practice).
• Prefer Neurology experience as an APRN and/or as a nurse in an outpatient Neurology setting.

Required:

Masters degree in related field. May require clinical license, certification or training OR Doctorate of Nursing Practice degree

No directly related experience

Licensure and certification in accordance with CCHMC Delineation of Privileges

Multi-state licensure in addition to Ohio licensure may be required base on subspeciality

Require an APRN, Family Practice Nurse Practitioner (primary care), only due to the need to provide comprehensive care (neurology, primary care conditions, and neuropsychiatric disorders) to children and adults of all ages.

Unique Skills:

Certification-FNP, Acute Care, Primary Care, etc.

• Certified FNP, primary care, is required due to the need to provide comprehensive care (neurology, primary care conditions, and neuropsychiatric disorders) to children and adults of all ages.

Specialty experience preferred (ED experience, Surgical experience, etc.)

• Experienced APRN is required with over three years' experience.
• Prefer 5 years or more of experience as an APRN. Prefer that experience to be as a family practice nurse practitioner in the outpatient primary care setting (family practice).
• Prefer Neurology experience as an APRN and/or as a nurse in an outpatient Neurology setting

Schedule:

Shift length (8,10,12 hours):

• Dayshift Monday through Friday.

This is a salary position, hours typically are from 8 am to 5 pm (do not clock in/out), but the hours can vary and be longer depending on patient care and clinics each day. Salary position expectation is that will typically work 40+ hours per week due to being in a professional clinical provider role in an outpatient specialty.

Straight or rotating shifts:

• Straight shift, not rotating (there is the potential for evening clinics in the future depending on the needs of patients and hospital policy).
• Holidays: no
• Weekends: not at this time (potential in the future depending on patient needs and hospital policy).
• Call: not at this time (potential in the future).

Other Information:

• The Division of Neurology currently provides reimbursement for APP national recertification fees, OH RN/APRN licenses, and OH DEA license fee. If there is a business need to obtain an out of state license as part of the job requirements to see certain patients (KY satellite location or Telehealth visits), the division/hospital will provide reimbursement.
• Travel and Education fund: there is not a specific amount provided to each APRN individually. APRN must submit a request to the division for review and consider for possible reimbursement.

Cincinnati Children's is proud to be an Equal Opportunity Employer that values and treasures Diversity, Equity, and Inclusion. We are committed to creating an environment of dignity and respect for all our employees, patients, and families (EEO/AA).

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