The incumbent performs in a variety of duties involving the full range of activities including progress notes, treatment rendered, tests or procedures ordered, and notation of prescriptions and drugs dispensed or administered. The incumbent responsibilities include counseling, teaching, coordination of services, and participating with other disciplines in evaluating and managing complex Traumatic Brain Injury (TBI) conditions and Neurological disorders. The work, in consultation with the Chief of Neurology Service and the Chief of Traumatic Brain Injury Service, requires the development of new techniques and revisions of criteria of care. The incumbent is a primary consultant for the Neurology Service and TBI Clinic in the medical community.
1. Serves as a primary care provider to provide Traumatic Brain Injury services to patients within the community. Performs comprehensive and problem focused histories and physical examinations. Examines, diagnoses, and treats walk-in and clinic appointment patients with Neurology Disorders and Traumatic Brain Injuries. Recognizes more complicated cases and emergency medical problems and refers to a higher level of medical expertise for diagnosis and treatment. Provides follow-up care on patients previously seen in the clinic. Applies the Medical Fitness and Profiling Standard. Evaluates soldiers for retention and admission in accordance with Army regulations. Prescribe medication for minor illness or disease. In the event of emergencies (for patients with life-threatening situations), performs cardiopulmonary resuscitation (CPR). Interprets and correlates 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 problems 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 or other health care professionals. Orders, collects, and performs appropriate laboratory or diagnostic procedures and studies including, but not limited to, blood and tissue specimens. Orders and performs diagnostic studies such as, but not limited to, EMGs, electrocardiograms, compartment pressure measurements, and examinations including special x-ray examinations, CT, MRI, ultrasound, and bone scans. Writes or dictates physical profiles, medical evaluation boards, fitness for duty evaluations, or other related documentation appropriately.
Obtains medical histories, performs examinations and procedures, diagnose conditions, prescribes medication, interprets diagnostic tests, refers patients to specialists when appropriate, develops a treatment plan that enhances recovery and outcome after TBI, and provides education and counseling to patients and family members on treatments and expected course of recovery. Care includes complex and standardized procedures along with performing administrative duties within the context of ensuring world class healthcare for patients with Neurology injuries and/or Traumatic Brain Injuries.
Treats acute and chronic illnesses; provides preventive care and health education for all ages and both sexes. Makes decisions on patient dispositions and assists in transfer or admission of patients.
Screens all consults to ensure they are in compliance with the Clinical Practice guidelines and are accurately placed with the appropriate specialty providers.
Refers patients with complex or unresolved conditions to supervising physician or specialty/subspecialty clinics as applicable. Provides telephone consultation with primary care providers regarding management of Neurological conditions. Maintains a thorough working knowledge of the performance improvement process outlined by the Joint Commission and stays current with their guidelines.
Conducts consultations in person and over the phone with non-TBI physicians, physician assistants, or other health care providers, making recommendations and giving guidance for treatment options and providing links between the Neurology Service and the Traumatic Brain Injury service and outlying clinics.
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 Neurology and Traumatic Brain Injury rotations.
Provides direct patient care to patients to include the following: evaluation, examination, diagnosis, and treatment of medical disorders. Incumbent is assigned the full range of cases including the most difficult and is responsible for determining when to seek advice and guidance. Examines patients and performs initial patient work-up and assessment of patients' care and treatment; and determines the need for and orders laboratory tests, X-rays and other diagnostic tests; interprets the total medical evidence, incorporating information into an accurate diagnosis or appraisal; and institutes proper treatment and patient care. In the event of emergencies, performs CPR. Maintains BCLS and ACLS certification. Provides surveillance of adherence to medical and primary care practices and procedures to stabilize acutely and chronically ill patients; adjusts regimens within established protocols recognizing when to refer the patient to the physician or other primary care members. Writes prescriptions, orders the administration of medications, dispenses medications and prescribes controlled substance in accordance with scope of practice for Middle Level Providers (MLP).
2. Records entries into patients' records using CHCS/AHLTA or handwritten as appropriate, including examination, treatments rendered, tests or procedures ordered, and notations of prescriptions or orders, and drugs dispensed or administered in accordance with approved protocols. Provides consultation, teaching, and coordination with patients and their family members regarding treatment and medical care. Evaluates the urgent or emergent care aspects of patient care recognizing when reassessment by a physician or other staff professionals is required. Participates with the attending physician and other medical staff in interpreting and evaluating continuing changes in direct patient care, conflicting requirements, or technological development in the medical field. Plans with other professionals, and agencies involved in providing primary care services to patients and their family members, and coordinates the primary care provided. Develops and recommends new approaches for providing improved, quality primary care for military and their family members and other clients of CRDAMC.
3. Evaluates soldiers for retention in accordance with Chapters 2 and 3, AR 40-501. Determines physical profile status in accordance with professional guidelines outlined in AR 40-48. Initiates, writes, and dictates medical summaries for the medical retention boards.
Ability to identify neurological and physical medicine problems and determine appropriate actions to be taken, recognizing emergency conditions and knowing when to refer patients to the neurologist, physiatrist, psychiatrist, or appropriate subspecialty clinic or clinic in other specialty.
Knowledge of the anatomy and physiology of the neurologic, pulmonary, cardiovascular, gastrointestinal, endocrine, renal, hematologic, and musculoskeletal systems. Knowledge of trauma management through the entire continuum of care: pre-hospital, resuscitation, stabilization, supportive care, rehabilitation, social re-integration, and prevention. Utilizes this knowledge to evaluate care, develop performance improvement processes and identify opportunities for quality improvement and cost reduction.
Ability to work responsibly with physicians and other members of the TBI Clinic and deal effectively with patients.
Knowledge of pharmacology and ability to prescribe in accordance with approved treatment protocols, practical knowledge of all Pharmacy and Therapeutics Committee (P&T) approved medications.
Possesses skills to communicate orally and in writing clear, concise, and well-organized medical data and information.
Ability to interpret and apply AR 40-501 which provides information on medical fitness standards and profiles for active duty members, and be able to identify soldiers for physical evaluation board and proceed with medical summaries.
Professional knowledge of a wide range of nursing principles, practices, and processes including physical and emotional assessment, establishment of health and nursing care goals, construction and implementation of the care programs, evaluation of the results and extended clinical experience and training to perform assignments of advanced nature and considerable difficulty requiring extended training and experience and serve as a role model.