Advanced Practitioner - NICU Putnam Hospital

Completes focused and increasingly comprehensive evaluations of newborn patients while developing toward independent practice. Gathers and uses relevant maternal/perinatal, delivery, newborn history; performs appropriate physical examinations; develops differential diagnoses; and interprets diagnostic study results with guidance as needed.

Provides routine newborn care and evaluates common neonatal conditions within established scope of practice, clinical privileges, institutional policies, and the individual's demonstrated level of competency. During orientation and development, practices with preceptor and/or supervising neonatologist support, progressing toward independent site coverage once required competencies have been established.

Attends deliveries and participates in neonatal resuscitation and stabilization consistent with Neonatal Resuscitation Program (NRP) standards, initially with preceptor support until competency and independence are established.

Recognizes changes in clinical status, initiates appropriate evaluation and stabilization within demonstrated competency, and promptly seeks physician or additional clinical support when patient acuity or complexity exceeds current experience, privileges, or site capabilities.

Medical knowledge

• Clinical knowledge. Applies foundational neonatal and newborn medical knowledge to routine and common clinical presentations. Expands clinical knowledge through active learning, review of available evidence, feedback, and clinical experience. Recognizes personal knowledge limitations and seeks guidance appropriately.
• Diagnostic evaluation. Performs focused diagnostic evaluation for common newborn presentations. Develops an increasingly prioritized differential diagnosis, recommends appropriate diagnostic testing, and interprets clinically significant findings with guidance as needed.

Patient history. Gathers relevant maternal, perinatal, delivery, newborn, family, and medical history using established frameworks. With increasing experience, filters and prioritizes pertinent findings to support clinical assessment and differential diagnosis.

Patient care

• Clinical reasoning. Organizes history, examination findings, diagnostic studies, clinical trends, and available consultation to develop differential diagnoses and management strategies. Presents relevant clinical information clearly to the preceptor and/or supervising neonatologist and incorporates guidance into the plan of care.
• Organize and prioritize patient care. Completes assigned newborn care responsibilities safely and efficiently. Progresses toward organizing and prioritizing the simultaneous care of multiple newborn patients, including routine care, acute clinical concerns, and delivery attendance.
• Patient management. Participates in the development and implementation of management plans for routine newborn care and common neonatal conditions. With increasing competency, assumes greater responsibility for independent management within scope of practice and privileges. Recognizes clinical deterioration or an unexpected neonatal presentation and promptly engages the preceptor and/or supervising neonatologist/physician. Initiates appropriate evaluation and stabilization within demonstrated competency while additional support is obtained. Participates in coordination of escalation or transfer to a higher level of neonatal care when clinically indicated.

Delivery room. Attends deliveries with a preceptor or other designated clinical support until required competency and independence in delivery attendance and neonatal resuscitation have been established.

Performs initial newborn assessment and participates in neonatal resuscitation and stabilization consistent with current NRP standards, institutional policies, individual clinical privileges, and demonstrated competency.

Recognizes newborns requiring intervention beyond routine stabilization and promptly obtains additional support while initiating appropriate measures within demonstrated competency.

Progresses toward independent delivery attendance and neonatal resuscitation as competency is validated through the department's orientation, credentialing, and privileging processes.

Procedures as defined by clinical department. Performs neonatal procedures consistent with departmental expectations, institutional policy, individual clinical privileges, and demonstrated competency. Initially performs new or developing procedures with appropriate supervision or guidance and progresses toward independent performance once competency is established.

May provide neonatal/newborn-specific procedural or clinical support in the Emergency Department or other areas of the facility when requested, provided such care remains within the APP's neonatal scope of practice, privileges, and demonstrated competency.

Please reference the “APP Procedures Listing” for those relevant to the Medical Specialty.

Interpersonal and communication

• Patient and family centered communications. Works to establish rapport with patients/families. Develops therapeutic relationship in straightforward encounters. Seeks guidance when adjusting communication strategies in order to mitigate barriers and meet patient/family expectations.
• Interpersonal and team communication. Participates within the inter-professional team. With guidance, clearly and appropriately requests consultation, presenting relevant patient information to supervising physician.
• Communication within the Health Care System. Accurately and timely records information in the patient record. Responds in a timely fashion and in appropriate form (e.g., in-person, HER, telephone, email) to requests. Seeks guidance on best mode of communicating when uncertain.

Practice-based learning and improvement

• Evidence-based and informed practice. Develops and articulates clinical questions. Accesses available evidence with appropriate guidance.
• Reflective practice and commitment to personal growth. Participates in feedback sessions. With guidance from lead/manager, develops professional goals and a learning plan, incorporating feedback and performance data.

Professionalism

• Performs responsibilities in a thorough and timely manner. Proactively seeks guidance in new, complex and/or stressful situations.
• Participates in creating, promoting and sustaining a healthy and productive team and work environment. Familiarizes self with institutional resources that are meant to promote well-being.

System-based practice

• System navigation for patient centered care-coordination of care. Increasingly involved in coordinating care of patients in routine clinical situations. Identifies the need for and engages inter-professional team based on patient and family needs.
• Population and community health. Incorporates awareness of population and community health needs and disparities and knowledge of local resources to inform understanding of patient/family health concerns.

Supervisory Duties (if applicable)

N/A

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). Prior APP neonatal experience is not required. Relevant neonatal, newborn, pediatric, or acute-care experience is preferred. Candidates must successfully complete the department's orientation and competency validation process before assuming independent community-site coverage.
KSAs required upon hire or transfer. (Please reference the KSA section below)

License and/or Certification

Required: 

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

• Provider licensing: 
  • Current Neonatal Nurse Practitioner licensure in the State of Connecticut or New York, as appropriate. OR…
  • Certified by the National Commission on Certification of Physician Assistants, Inc. (NCCPA). Current Physician Assistant licensure in the State of Connecticut or New York, as appropriate.
• Neonatal Resuscitation Provider (NRP) certification required within 3 months of hire. 

Additionally:

• Depending on privileges for role, federal DEA and CT controlled substance registration may be required. 
• Please reference the document: “APP: Certifications by Specialty.”

Preferred:

n/a                                                                                                                         

Knowledge, Skills, and Abilities

• Medical knowledge and procedures: 
  • Medical knowledge sufficient to recognize patterns, trends and disease traits and to fully engage in APP learning opportunities, effectively applying such knowledge to basic clinical evaluations and patient care.
• Communication: 
  • Exemplary written and verbal communication.
• Interpersonal: 
  • Respectful and compassionate in interactions with staff, patients, and families.
• Professionalism, organizational view:
  • Demonstrates accountability for assigned work and the extent of one’s involvement in patient care. 

  • Demonstrates openness to feedback. Ability to incorporate feedback and learnings into work effort.