**APP (NP/PA) - Hematology and Oncology

Principal Duties and Responsibilities

• Receive and triage telephone request for information, appointments and/or medication renewals. Make appropriate and timely decision regarding the patient's compliant and/or request utilizing clinical knowledge and skill to extract pertinent data.
• Identify, coordinate and delegate as necessary, appropriate health care professional to facilitate delivery of care.
• Provide appropriate and timely communication with the attending physician.
• Provides thorough and accurate documentation in the medical record by documentation of all pertinent data, therapeutic interventions, patient responses and any medical/surgical procedures.
• Perform routine bedside procedures and order tests and procedures as indicated.
• Communicate immediately to attending physicians any gross abnormalities in patient lab levels or test results.
• Round on Hepatobiliary and Liver Transplant patients on a daily basis as assigned by the attending surgeons and in coordination with the Transplant Fellow and Surgical resident.
• Admission history and physical exams; discharge summaries.
• Manages and communicates information through various processes which include but are not limited to the use of computers, telephone systems, direct and indirect observations and documents in the medical record.
• Actively involve the patient and family as appropriate in implementing the plan of care.
• Prioritize care needs and ensures the appropriate availability and accessibility of treatment for the patient.
• Develop and initiate the plan of care by collaborating with physician, other health care professionals and family members.
• Provides counseling and education to both the patient and the family.
• Ensures treatment plan is individualized based on the patient and family's level of understanding.
• Participates in grand rounds as necessary to assure continuity of quality care.
• Documents as indicated in the department database.
• Complete history and physicals, daily notes and discharges summaries on assigned inpatients.
• Differentiates normal results from abnormal findings.
• Obtain detailed history and performs baseline and interval health examinations.
• Completes medical histories, physical assessment and differentiates normal results from abnormal findings.
• Identify wellness and risk factors; communicating relevant data via dictation and/or provide complete, accurate written documentation in the patient's medical record.
• Collaboratively perform biopsies or line placements as indicated by the attending and the needs of the patients.
• During the admissions process, develop and initiate the plan of care by collaborating with physicians and other healthcare professionals and family members.
• Assist in the maintenance of the Cardiothoracic Computer Database by appropriate data entry.
• Perform routine health examinations through baseline histories, review of symptoms and complete medical histories and physical examinations.
• Completes a quarterly review with the supervising physician on a timely basis.
• Ensures summaries include complete examinations, office visits, telephone conversations and testing requests.
• Utilize physical assessment skills on an ongoing basis to identify, communicate and document patient problems.
• Recognizes changes in mental and physical condition. Implement appropriate action based on assessment to ensure patient safety, well being and satisfaction.
• Formulates desired outcomes specific to the individual patient problem/diagnosis and specifies interventions as appropriate.
• Prescribe, in collaboration with or at the direction of the attending physician, medications specific to the patients' diagnosis and level of medication tolerance and in accordance with Lahey Clinic policies and procedures.
• Obtains consents for total joint surgery and implements the study materials.
• Follow through on achievement or failure of obtaining the desired outcomes and provide timely communication to attending physician.
• Complies with all policies and procedures as set forth by Lahey Clinic and all state and federal regulations.
• Assist in the operating room as requested.
• Review of the plan of care on an ongoing basis and revise the plan as necessary per patients progress or lack thereof.
• In conjunction with the attending physician, research medical protocols to determine an appropriate change in care plan.
• Provides complete and accurate documentation in the patient's medical record.
• Anticipates potential emergency situations and perform appropriate treatment/intervention measures.
• Perform a variety of routine procedures to expedite patients' response to plan of care.
• All documentation is completed in a timely manner per Lahey Clinic policy.
• Determine and order necessary laboratory and diagnostic tests.
• Perform and interpret various diagnostic tests including blood tests, MRI, CT scans, EKGs etc.
• Assists patients in areas other than the primary specialty including, but not limited to, recognizing the patients' mental and physical conditions and initiates appropriate assistance from other health care professionals.
• Identify and manage specified acute illness i.e., URI, UTI, vaginitis, etc.
• Operating room participation, including: saphenous vein harvesting; wound closure; first and second assisting on cardiac; pulmonary; and esophageal procedures.
• Order and adjust medications in conjunction with attending physicians.
• Anticipate and intervene potential problems/complications before they occur and initiates protocols and therapeutic measures in collaboration with the physician and according to established standards of practice.
• Identify and manage urgent care i.e., superficial wounds and lacerations, burns, sprains, minor fractures, etc.
• Perioperative technical procedures, including but not limited to: changing of pulmonary artery, central venous pressure, triple lumen, and double lumen catheters; removal of chest tubes; insertion and changing of arterial lines; removal of intra aortic balloon pumps; removal of temporary epicardial pacing wires; insertion of nasogastric tubes; emergency endotracheal intubation.
• Meets all guidelines for continuing education/recertification for continued practice in the Orthopaedic Surgery Department.
• Postoperative patient care (ICU, Step-down unit, and floor) including: recognition of disturbance in the normal postoperative course recovery following open heart, pulmonary, and esophageal surgery; recognition and management of postoperative hemodynamic abnormalities including hypertension and hypotension, including the interpretation of hemodynamic data and the use of pressor and inotropic agents; recognition and management of arrhythmias, including the use of anti-arrhythmic drugs and the use of an external cardioverter/defibrillator; the use of an external pacemaker and epicardial pacing wires; acquisition of information for daily rounds, as determined by the attending surgical staff, and presentation of this data on each patient; writing of daily progress notes and orders, under supervision of Chief Resident and/or attending staff; arrange inter-service consultation; review test results and act in an expeditious manner to correct any abnormal findings.
• Monitor and manage stabilized patients with chronic diseases i.e., hypertension, diabetes, thyroid, etc.
• Respond to and assist in the treatment of patients requiring emergency care.
• Write prescriptions and medication orders; dispense sample medications and administer injections and immunizations under established guidelines.
• Initiates appropriate assistance from other healthcare professionals as required.
• Provide post operative and post procedure care by removing sutures as indicated and performing wound care.
• Make referrals to outside health care specialists and provide health care management for HMO and PPO members; initiate written referrals to insurance companies as necessary.
• Educate and actively involve patient and family members in post surgical care.
• Assist with completion and/or review completed forms i.e.; office visit and lab encounter forms, insurance and disability, worker's compensation, etc. and provide necessary signatures.
• Provide direction to medical records staff regarding completion of forms and APS release.
• Teach and counsel patients in preventive health care i.e.; basic nutrition, specialized diets, obesity, smoking, exercise, sexuality, etc.
• Assist discharged hospital patients with home treatment preparation and provide education to family members responsible for providing home patient care.
• Follow through on an achievement or lack thereof based on outcome evaluation.
• Perform minor surgical procedures and provide follow-care i.e.; suturing/suture removal, dressing changes, etc. in accordance with past training.
• Perform routine procedures i.e., collections of specimens for culture and vaginal or microscopic examination including PAP smears as well as blood, urine and stool specimens.
• Perform and interpret a variety of diagnostic tests including but not limited to timed vital capacity, audiograms, pulmonary function tests.