Serves as Nurse Practitioner (APRN), assigned to the Critical Care Service, Department of Medicine, Carl R Darnall Army Medical Center, (CRDAMC). Duties are performed in collaboration with the physicians of the Critical Care Service and other members of the health care team. Establishes treatment regimens and initiates interdisciplinary consultation, collaboration and referrals. Documents all therapeutic, diagnostic, assessment activities, patient care plans, and patient status thoroughly and accurately.
Serves as an active member of the ICU Service performing comprehensive and problem focused histories and physicals, daily progress notes, discharge & transfer summaries, and coordinating the entire spectrum of care for intensive care and progressive ward admissions. Performs initial critical care and rapid response team consultation on all medical wards and the emergency department. Develops and initiates treatment plans. Incumbent provides advanced and complex multidisciplinary treatment to critically injured active duty soldiers, reserve soldiers, military beneficiaries and civilian trauma patients. Incumbent is a subject matter expert on surgical/medical critical illness and disease process diagnosis and treatment. Serves as the Nurse Practitioner on the critical care team and critical care service providing diagnosis, acute lifesaving interventions, therapeutic decisions and management of complex patients with critical injuries under the direction of a board eligible or Certified Critical Care Intensivist. Serves as a subspecialist consultant to other departments, services, and health-care providers for a variety of diseases and conditions marked by acute injuries and chronic diseases resulting in Neurologic impairment. Examines, diagnoses, and treats patients admitted to the intensive care unit and Medical/Surgical wards resulting from wide variety of injuries. Recognizes complicated cases and emergency medical problems and manages these or consults a higher level medical specialist for diagnosis and treatment. Incumbent practices in the hospital setting, the clinic and the operating room assisting with routine and emergency cases affecting Wounded Warriors. Interprets and correlates radiologic, laboratory and diagnostic procedures. Interprets and correlates subjective and objective data to formulate a differential diagnosis and establish a working diagnosis. Formulates treatment plans for complex pathophysiology and critical illness within the scope of practice.
Implements therapeutic interventions for specific conditions when appropriate. Exercises judgment on problems requiring consultations, referrals, or evaluations by the supervising physician. Orders, collects, and performs appropriate radiologic, laboratory or diagnostic procedures and studies including, but not limited to, blood and tissue specimens. Performs diagnostic studies and procedures such as, but not limited to, Ventriculostomy drains, ICP monitors, lumbar drains, cervical spine stabilization devices, electrocardiograms examinations including special x-ray examinations, CT, MRI, ultrasound, and nuclear medicine scans. Writes or dictates history and physical as well as daily progress notes or other related documentation appropriately. Incumbent must maintain accurate, legible, and complete records for all patients treated, given the complex nature of the patients medical and surgical therapies. A frequent component of the treatment regimen for critically ill patients with complex neurosurgical diseases is interventional hemodynamic procedures, advanced airway management techniques, central line placement, and lumbar puncture, etc. These advanced interventional techniques are performed with ultrasound, or in some cases under fluoroscopic guidance.
Makes interdisciplinary referrals, e.g. Social Work service, Community Health, Chaplain, etc as needed. Participates in staff development, in-service and professional continuing education program. Becomes an educational resource for nursing and paraprofessional staff; caring for patients with complex disease. Conducts continuing educational conferences for these staff concerning the clinical nature of selected topics in critical care. Makes decisions on patient dispositions and assists in transfer or admission of patients with physician supervisor. Refers patients with complex or unresolved conditions to supervising physician or specialty/subspecialty physician teams as applicable. Conducts consultations in person and over the phone with physicians, physician assistants, or other health care providers, making recommendations and giving guidance for treatment options and providing links between the Intensive care unit teams, Trauma service, Anesthesia and other consulting services and primary teams.
Calculates dosages and mixes potent and potentially lethal drugs prior to the arrival of physician and administers these drugs upon the physician's directive. Prepares patients for endotracheal intubations, administering oxygen therapy, defibrillating the patients, regulating and monitoring the infusion of intravenous fluids, blood volume expanders, and blood transfusions to maintain blood pressure, and preparing the patient as need arises for surgical intervention. Continually observes, monitors, and assesses patient's condition. Interprets signs and symptoms of deterioration and takes corrective actions. Consults with physician regarding medical and nursing management. Maintains and enforces infection control policies in accordance with unit and department operating instructions. Administers oral and/or intravenous sedation medications closely monitoring for level of sedation and adverse drug reactions.
Educates internal staff, nurses, paraprofessional staff, patients and caregivers about medications and treatment regimens, their complex mechanisms of actions and potentially dangerous side effects. Assists in the development of guidelines, policies and procedures to improve patient care on the critical care service. Develops and maintains standard protocols and procedures for care on the intensive care and progressive care units. Assesses the appropriateness of patient education materials to include websites, teaching materials, and general media to stay current with recent developments in intensive care and research.
Attends all morning conferences, continuing medical education classes, in-services, and required short courses to maintain certification and license as a Nurse Practitioner. Learns new techniques and methods of patient care. Supervises and assists in training paraprofessionals during their critical care rotations. The Nurse Practitioner must maintain a rigorous continuing medical education curriculum, focused on the areas of critical illness, surgery, pain medicine, physical medicine, orthopedics, neurology, neurosurgery, and obstetrics.
PERFORMS OTHER DUTIES AS ASSIGNED