Pediatric Nurse Practitioner or Physician Assistant - Pediatric Heart Center Fellowship

About the role

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Duke University Hospital in Durham, North Carolina is consistently ranked among the best in the United States. It is the largest of the four Duke Health hospitals with 1,062 patient beds and features comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo‑surgery center, and more. Duke University Health System is a Magnet organization; its nurses are regularly recognized as North Carolina's Great 100 Nurses and it has received the American Board of Nursing Specialties Award for Nursing Certification Advocacy. The system employs over 6,000 registered nurses. Living in the Triangle offers a high quality of life, and relocation assistance is available based on eligibility.

The Duke Pediatric Heart Center Advanced Practice Provider (NP or PA‑C) Fellowship rotates through clinical settings in the pediatric heart center, including inpatient and outpatient locations, with heavy emphasis in the pediatric cardiac intensive care unit (PCICU), PICU, and pediatric cardiac stepdown. The APP Heart Center fellow works alongside APPs and MDs to provide direct patient care services for newborn congenital heart, surgical, and medically ill pediatric heart center patients from birth to young adults at Duke University Hospital or in clinics, collaborating with APPs, cardiologists, and surgical physicians. Responsibilities include performing physical exams, collecting and documenting data, conducting diagnostic and therapeutic procedures, ordering and scheduling laboratory studies and professional consultations, prescribing appropriate interventions and medications, coordinating patient care and discharge, and providing direct patient care services. The fellow contributes to excellence in patient care, research, teaching, and learns to provide leadership in the organization.

Responsibilities

• In collaboration with cardiology attendings, PCICU attendings, surgeon(s) and/or APPs, round daily on patients to assess, diagnose, plan treatment, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of patient care.
• Provide and coordinate clinical care for service‑specific patients through established protocols and under the hospitalist supervising physician or back‑up physician who is either on site or available by pager.
• Collaborate with residents, fellows, attending other NP/PA colleagues, nurses, and patient resource managers to formulate treatment plans and monitor patient progress.
• Perform procedures specific to the work environment after demonstrated competency and within the guidelines of scope of practice and credentialing protocols.
• Assess patients for change in status and institute appropriate interventions; initiate emergency interventions to stabilize the patient until physician support arrives.
• Postoperative stabilization and management.
• Develop patient care pathways, protocols, and guidelines for the management of specific problems in conjunction with physicians and other members of the health care team.
• Analyze clinical practice patterns to provide the best medical care and to increase effectiveness and efficiency.
• Communicate verbally and in writing all pertinent patient information to supervising MD, nursing staff, patient resource manager, home health agency, and other relevant healthcare providers.
• Document in the patient’s medical record all relevant data including but not limited to results of diagnostic tests; laboratory results; patient’s condition and response to therapies/interventions; communications with supervising MD.
• Utilize prescriptive privileges only for the identified patient population; prescriptive authority for prescribing, ordering, and/or administering drugs (including schedule II, III, IV, and V drugs) and necessary medical devices.
• Role model competence in all nurse practitioner/physician assistant advanced skills.
• Give daily handoff to appropriate APP, attending, resident and/or intern at the end of the shift.
• Assess educational needs of the patient‑care staff and provide one‑on‑one as well as formal education as needed.
• Assess educational needs of patients/families and provide culturally sensitive patient/family education interventions as indicated; use non‑technical language when educating patients and families.
• Document all pre‑ and post‑op/procedure education in patients’ medical records.
• Implement and evaluate appropriate educational programs for DUHS patient care staff and other healthcare providers as appropriate.
• Role model and precept healthcare learners through contractual agreements.
• Utilize current research and evidence‑based decision‑making in all clinical practice.
• Incorporate clinical research findings in the development and implementation of standards of care.
• Support IRB‑approved clinical research/trials through activities such as obtaining consent, ordering diagnostic tests, recording laboratory & diagnostic results, administering therapeutic interventions, and reporting patient outcomes including toxicities or adverse events.
• Participate in interdisciplinary quality improvement and/or research activities.
• Participate in measuring and documenting outcomes.
• Provide expertise and resource information to other healthcare providers, patients, families, and the community related to cardiothoracic diseases, procedures, interventions, and conditions.
• Implement and evaluate appropriate educational programs for referring MDs.
• Develop, implement, and evaluate standards of care/practice guidelines/policies and procedures/care maps/protocols within the area of specialization.
• Develop programs and projects in areas of expertise to facilitate the attainment of the goals and objectives of Duke University Hospital and Duke University Health System.
• Role model advanced practice professionalism through conduct, communication, dress, leadership, ethical decision‑making, critical thinking, and problem‑solving skills.
• Participate in at least one professional organization.
• Demonstrate responsibility for professional practice through active participation in the Cardiology department, CAP Department, and professional organizations.
• Meet Continuing Education requirements as designated by the NC Medical Board and/or NC Nursing Board.
• Maintain professional certification.
• Enhance the body of knowledge in the area of specialization through written publications, oral presentations, posters, continuing education, etc.
• Maintain all professional requirements for licensure and certification.
• Attend educational conferences regularly, morbidity and mortality conferences, code reviews, NP monthly meetings, and attend twice‑a‑year adult congenital sessions.
• When caring for adult patients with congenital heart disease, plan for situations beyond expertise, consult with, and refer to other healthcare providers as appropriate.

Requirements

• Education: Must graduate by December 31, 2025. PA: Graduate of an ARC‑accredited Physician Assistant Program; Masters or DMSc degree preferred. NP: Graduate of an accredited MSN or DNP Pediatric Acute Care Nurse Practitioner Program.
• Certification: PA: PA‑C. NP: PNP‑AC.
• License: PA: Current unrestricted medical license issued by the NCMB with authorization to practice as PA. NP: Current unrestricted RN license issued or recognized by the NCBON with authorization to practice as NP.
• Both: Federal and State DEA with unrestrictive full prescriptive authority.
• Experience: New PA or PNP‑AC graduates welcome to apply; no APP experience required.
• Life Support: BLS (required), PALS (required), ACLS (recommended).
• Physical and Mental Requirements:
  • Able to clearly articulate scope of practice and practice within those guidelines as a Nurse Practitioner/Physician Assistant.