The Cardiac Surgery Critical Care APN II provides clinical oversight and management of the patients in the cardiac surgery intensive care unit delivering care for complex, critically ill patients in the CT ICU.

Evidence-based Practice (Direct Clinical Practice): The Cardiac Surgery Critical Care APN provides comprehensive management of critically ill cardiothoracic surgery patients.

1. Provide care for critically ill, complex cardiac surgery patients in a 14 bed ICU in an autonomous manner, in collaboration with the attending surgeon.

2. Manage and serve as a hospital resource for artificial cardiac devices (LVAD, pVAD, ECMO)

3. Conducts complex, standardized patient care procedures which require experience and specialized training.

4. Conducts independent rounding on the unit

5. Performs relevant patient evaluations, assessments, and appropriate treatment

6. Coordinates, directs, and implements the patients plan of care.

7. Orders appropriate laboratory, diagnostic, and radiographic tests and interprets the results

8. Monitors the treatment program of the patient to inform the attending surgeon of pertinent medical information

9. Responds to, coordinates, and provides management of emergent life-threatening situations

10. Possesses surgical expertise/training necessary to perform emergent re-sternotomy (reopening of the sternum at the bedside), cardiac massage, evacuation of hematoma, and achieving temporary hemostasis

11. Demonstrates proficiency in invasive procedures such as a. Chest tube insertion b. Placement of central venous, dialysis, and Swan Ganz catheters c. Placement of arterial lines d. Intubation e. Thoracentesis f. DC Cardioversion g. Impella device repositioning using echocardiogram guidance

12. Exhibits extensive knowledge of vasoactive/inotropic drugs, ventilator management, pacemaker management, and artificial cardiac devices

13. Through accepted departmental guidelines, expedites and executes down grading and transferring of CT ICU patients to stepdown

14. Acts as a resource to cardiac step down mid-level providers

15. Regularly interacts and serves as a medical liaison between our Cardiac Surgeons and the patients and their families, providing appropriate, knowledgeable updates

on their status and plan of care. Works to empower the patients and their families in becoming involved in their daily plan of care, engaging them as a force and factor in the patients postoperative course.

16. Serves as a mentor for nursing staff across the Cardiac Surgery service line, providing consistent education of newer, as well as novice staff nurses, helping them expand their knowledge base of Cardiac Surgery pre and postsurgical nursing care.

Leadership:

1. Participates in decisions affecting APN practice and in opportunities to advance nursing practice within the institution.

2. Seeks opportunities to promote HUMC APN practice recognition locally, nationally, and internationally at conferences, round table discussions, manuscript publications in journals and texts, and conference presentations (poster and podium).

3. Provides excellence in the patient experience through modeling Service Excellence Standards.

4. Communicates a shared vision with the department of patient care and the department of specialty practice.

5. Participates in APN interviewing, credentialing, and peer review process as requested.

6. Participates in a minimum of one professional specialty organization.

7. Supports the nursing blueprint by providing evidence of practice outcomes.

8. Displays support of the institutional pillars through systems management, change management, and scholarly practices.

9. Ensures consistency with HUMC nursing protocols, standards of care, and accomplishment of disease specific quality indicators.

Consultation/Collaboration:

1. Evaluates current protocols and standards of care for translation of best practice into clinical practice.

2. Provides culturally diverse and educationally appropriate health management education.

3. Supports organizational and department of patient care strategies through annual professional cascading goals.

4. Identifies practice gaps and initiates practice changes supportive of evidence-based practice best practices with nursing staff within area of practice and population.

5. Participates in policy/procedure reviews for updating with current evidence-based and value-based practices.

6. Acts as a resource to staff for addressing clinical, process, and system opportunities for improvement that promote excellence in care and clinical outcomes.

7. Serves as a member of organizational and departmental meetings, work-groups, and committees as requested representing APNs and/or the department of patient care.

8. Builds credibility with medical staff as nursing experts for patient care, quality of care, and the profession of nursing.

9. Collaborates with medical staff leaders to support nursing-led protocols to enhance the nurses ability to function at their highest level of education and skill applying lean system and change management principles.

10. Acts as a mentor for APN and graduate students of other disciplines. 11. Acts as a clinical resource for evidence-based practice. Research

1. Utilizes and disseminates relevant research findings through clinical practice, education or consultation.

2. Promotes innovation within clinical practice by seeking opportunities to bring new clinical knowledge into practice.

3. Actively engages in research as a primary investigator or co- investigator.

4. Acts as a mentor and or reviewer for research proposals.

5. Disseminates research findings to enhance the practice of nursing by participating as presenters at conferences locally, nationally, and internationally and through publications.

Ethical decision-making

1. Identifies ethical care issues and coordinates interdisciplinary collaborative meetings to resolve those issues.

Education, Knowledge, Skills and Abilities Required:

1. Masters degree.

2. Graduate of an NLN/AACN accredited program in nursing.

3. 2 years experience as an APN in the critical care setting

4. Maintains clinical competencies through participating in continuing educational programs (contact hours per years), and clinical practice as mandated by Board of Nursing and national certification body.

5. Competency in the skills listed above.

6. In collaborative agreement with physicians on staff- fulfills terms of collaborative agreement.

Licenses and Certifications Required:

1. NJ State Professional Registered Nurse License.

2. Advance Practice Nurse License.

3. AHA Basic Health Care Life Support HCP Certification.

4. Advanced Cardiac Life Support Certification.

5. Maintains National or Board Certification as appropriate in area of specialty.