Nurse Practitioner/Physician Assistant-Primary Care

Independently completes thorough evaluations of pediatric patients (from neonates to adolescents and young adults). Develops and implements informed management plans encompassing complicated and atypical diagnoses, with the ability to modify plans as necessary. Anticipates and triages urgent and emergent issues. Collaborates care and facilitates communication with the supervising physician and the inter-professional team. Coordinates recommendations to optimize patient care and foster collaborative practice. Incorporates a broader organization awareness into decision-making and interpersonal relationships. 

Primary Care. Serves as the PCP for a panel of patients, emphasizing comprehensive care and continuity of care in a PCMH model. Routinely incorporates quality metrics and reports from CT Children’s and payers. Reviews reports and consults from other care providers and independently generates a plan of care, including for those with complex or uncommon conditions and proactive outreach. Supports less experienced APPs and trainees in panel management skills.

Medical knowledge

• Clinical knowledge. Integrates a breadth of medical knowledge that includes complicated and atypical conditions to guide patient care, incorporating evidence-based practice and current literature to support care.
• Diagnostic Evaluation. Prioritizes and optimizes evaluation based on risks, benefits, indications, and alternatives to clarify the diagnosis(es). Interprets clinical significance of diagnostic study results while considering study limitations.

Patient History. Gathers, filters, prioritizes, and synthesizes patient history to develop a differential diagnosis in real-time for complicated or atypical presentations in addition to the uncomplicated or typical.

Patient care

• Clinical reasoning. Integrates clinical facts (e.g., history, exam, tests, consultations, etc.) into a unifying diagnosis(es); reappraises in real time to avoid diagnostic error.
• Organize and prioritize patient care. Organizes, prioritizes, and collaborates with others on patient care responsibilities even when patient volume approaches the capacity of the individual or facility; anticipates and triages urgent and emergent issues.
• Patient management. Develops and implements informed management plans for complicated and atypical diagnoses, in addition to common and typical diagnoses, with the ability to modify plans as necessary.

Procedures as defined by clinical department. Applies full competency in core procedures. May assist in mentoring less experienced APPs in the performance of procedures. Please reference the “APP Procedures Listing” for those relevant to the Medical Specialty.

Interpersonal and Communication

• Patient and family centered communication. Establishes a culturally competent and therapeutic relationship in straightforward and complex encounters with patients/families, including those with ambiguity and/or conflict. Elicits patient/family values and incorporates awareness of these in communications with patient/family and in patient care. Uses shared decision making with patient/family to make a personalized care plan.
• Interpersonal and team communication. Facilitates and maintains communication with supervising physician and inter-professional team. Coordinates recommendations to optimize patient care and foster collaborative practice.
• Communication within Health Care System. Concisely documents updated, prioritized, diagnostic and therapeutic reasoning, including anticipatory (preventive) guidance, in the patient record. Applies increased ability to identify areas for preventive counseling. Aligns type of communication with message to be delivered (e.g., direct and indirect) based on urgency and complexity.

Practice–based learning and improvement

• Evidence-based and informed practice. Critically appraises data and applies evidence, even in the face of uncertainty and conflicting evidence, to guide care tailored to the individual patient, including integrating patient preference. Contributes to evidence-based practice based on program needs.
• Reflective practice and commitment to personal growth. Proactively seeks feedback. Designs and implements a learning plan, incorporating feedback and performance data. 

Professionalism

• Models professional behavior and maintains composure in all circumstances. Proactively seeks guidance in new or unusually difficult circumstances.
• Constructively highlights to lead/manager concerns that impact the cohesiveness and well-being of the team. Proactively presents viable solutions for discussion.

System-based practice

• System navigation for patient centered care-coordination of care. Coordinates inter-professional patient-centered care among different disciplines and specialties actively assisting families in navigating the health care system.
• Population and community health. Adapts practice to provide for the needs of and reduce health disparities of a specific patient population.
• Organizational View. Considers divisional impact of own decisions, especially in relation to improving patient care, systems and processes, and the overall culture and well-being of the organization. Constructively and proactively addresses considerations of others related to the same.

Minimum Education and Experience Required

Minimum education (degree/type of degree). 

• Advanced Practice Nurse Practitioner: Graduate degree in nursing accredited by one of the national certifying bodies in nursing. (Or, on or before December 31, 2004, completion of an advanced nurse practitioner program recognized by a national certifying body for certification as a nurse practitioner.) 

Or…

• Physician Assistant: Graduation from a physician assistant program accredited, at the time of graduation, by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).

Minimum experience (minimum years & type of experience): At least 5 years of APP experience.
Preferred education & experience: n/a

                                                                                     License and/or Certification

Required:

At time of hire and maintenance at time of appointment or privilege approval:

• Current State of Connecticut (Pediatric) Advanced Practice Registered Nurse (APRN) licensure.

OR

• Certified by the National Commission on Certification of Physician Assistants, Inc. (NCCPA). Current State of Connecticut Physician Assistant licensure.

Additionally:

• Depending on privileges for role, Basic Life Support (BLS) and/or Pediatric Advanced Life Support (PALS) certification may be required.
• Depending on privileges for role, federal DEA and CT controlled substance registration may be required. 
• Certain specialties may require additional certifications.
• Please reference the document: “APP: Certifications by Specialty”                                                                                                             

                                                                                  Knowledge, Skills, and Abilities

• Medical knowledge and procedures: 
  • A breadth of medical knowledge sufficient to independently develop a differential diagnosis and management plan for a range of presentations – through uncommon or atypical presentations and/or where clinical evidence is not straightforward. 
  • Ability to evaluate patient outcomes and implement new procedures and policies, as needed. 
  • Fully competent in performing the core procedures of the department.
• Communication: 
  • Exemplary written and verbal communication skills with the ability to modify communication strategy/method for the audience and circumstance. 
  • Highly organized in the presentation of essential information. 
  • Ability to tactfully and proactively address concerns and propose solutions.
• Interpersonal: 
  • Ability to maintain composure in complex and stressful situations and in the midst of ambiguity or uncertainty. 
  • Skilled at effectively and proactively engaging patients/families in developing a care plan. 
  • Ability to facilitate and coordinate care across all levels of professionals and specialties.
• Professionalism, Organizational view:
  • Understands and demonstrates in one’s decision-making and interrelationships a sensitivity to the considerations of the broader team