MAJOR DUTIES:

The Nurse Practitioner (Cardiology) performs in a variety of duties involving the full range of activities including treatment rendered, tests or procedures ordered, and notation of prescriptions and drugs dispensed or administered. The Nurse Practitioner responsibilities include counseling, teaching, coordination of services, and participating with other disciplines. The function of the Cardiology Service is to provide highly specialized diagnostic and treatment plans for cardiovascular diseases. The purpose of this position is to serve as Cardiology Nurse Practitioner in San Antonio Military Medical Center (SAMMC) Cardiology Service, Department of Medicine. Duties include population based disease management in cardiology, heart failure disease management, ischemic heart disease management, arrhythmia management and anticoagulation management as well as, other general nurse practitioner duties. Provides comprehensive care for adolescents, adults, and geriatric patients within the Cardiology Service. Performs physical and psychosocial assessments and initiates appropriate Licensed Independent Provider (LIP) and medical interventions based on the health care protocols of practice (including patient education, diagnostic studies, and use of approved therapeutic agents).

1. Serves as a specialty care provider in the capacity of a Credentialed Nurse Practitioner to provide Cardiology Services to patients within the community. Performs comprehensive and problem focused histories and physical examinations. Examines, diagnoses, and treats walk-in and clinic appointment patients. Recognizes more complicated cases and emergency medical problems and refers to a higher level of medical expertise for diagnosis and treatment. Provides follow-up care on patients previously seen in the clinic. Uses tact, diplomacy, and advanced clinical assessment skills to assess and triage patients. Systematically collects data through interviews, observation, physical examination, and review of medical records. Evaluates information provided and makes a professional assessment of patient’s physical, developmental, social, spiritual, emotional, and mental status. Collects demographic and other data. Documents the health assessment in the medical records. Interprets and reports abnormal diagnostic data and changes in signs or symptoms; identifies need for follow-up. Identifies recurring problems and anticipates possible crises for patients. Identifies situations in which the physician should be notified immediately. Initiates emergency treatment when necessary. Coordinates with other health care providers as required. Orders the collection of laboratory specimens in collaboration with physicians and in accordance with established procedures. Plans, schedules, directs, coordinates, and implements diagnostic treatments (including but not limited to echocardiogram, dobutamine exercise stress test, trans-esophageal echocardiograms, cardiac catheterizations, and pacemaker insertions) to meet patients' healthcare needs. Ensures cost efficient, timely, and quality services throughout the continuum of care assuring that patients receive an appropriate level of care according to pre-established standards. Coordinates administration of medications by all routes and documents effectiveness. As a subject matter expert, actively participates in discharge planning teams, clinical pathways, and cardiac rehabilitation. Reviews and updates clinical protocols, with physician guidance, according to nationally established guidelines. Provides specialized management of hyperlipidemia patients with established heart disease by coordinating, monitoring, and administering outpatient care. Assesses and evaluates treatment programs in accordance with national standards and extensive knowledge of the National Cholesterol Education Program recommendations regarding lipid lowering medications and management. Provides specialized management of patients identified with - heart failure -by coordinating, monitoring, and administering outpatient care. Assesses and evaluates treatment programs in accordance with national standards and extensive knowledge of the American College of Cardiology, the American Heart Association,the Heart Rhythm Society and other nationally recognized authorities. - Provides care of patients with arrhythmias to include interrogation of implantable devices, stress and cardiopulmonary exercise testing and supervision of tilt table testing. Provides specialized management of patients in the anticoagulation therapy program by coordinating, monitoring, teaching and providing -patient care. Assesses and evaluates treatment programs in accordance with national standards and extensive knowledge of the American College of Chest Physicians recommendations regarding medication and management of anticoagulation. Using protocol, instructs anticoagulation patients in preparation for special procedures including but not limited to cardioversion, dental procedures, colonoscopies, minor surgeries, and other invasive procedures related to interruptions in anticoagulation therapy. Also ensures continuity, timeliness, and appropriateness of care as they relate to the dynamics of treatment rendered by other health care providers and their effects on anticoagulation. Provides group, individual and/or family teaching and counseling and/or initiates coordination of health care needs. Coordinates and presents anticoagulation, heart disease, and hyperlipidemia education classes with follow-up examinations. Instructs patients in preparation for special procedures (including but not limited to echocardiogram, dobutamine exercise stress test, transesophageal echocardiograms, cardiac catheterizations, and pacemaker insertions). Counsels and teaches patients about modification of risk factors, lifestyle changes, and medication management. Educates and counsels patients and family members regarding procedures to be performed and treatments provided. Reviews and updates patient education materials in accordance with hospital standards and current medical treatment practices. Assesses the appropriateness of patient education materials to include websites, teaching materials, and general media to stay current with recent developments. Receives and acts upon patient complaints. Provides a full range of emergency services or crises interventions in the absence of the physician, including lifesaving emergency procedures in order to stabilize a patient within the scope of practice and approved protocols.

2. Serves as a patient and family advocate. Facilitates the expeditious scheduling of patients appointments. Increases access to care for patients by frequent phone contacts and assisting patients in recognizing early symptoms of exacerbation and coordinating necessary interventions. Collaborates with cardiologists, oncologists, orthopedists, vascular surgeons, endocrinologists, hematologists, dietitians, internists, pulmonologists, referring physicians and other health care providers to ensure optimal patient outcomes. Collaborates with other healthcare providers to identify the most cost-effective options or alternatives for the provisions of treatment. Performs healthcare delivery systems analysis and provides recommendations to healthcare providers and/or case managers regarding diagnosis and specific clinical pathway events to facilitate efficient, effective, and quality patient care. Explores methods and processes to reduce resource consumption as appropriate ensuring that the patient receives quality care at the most appropriate level. Makes appropriate referrals to healthcare resources within BAMC and the community. Referrals include but are not limited to the cardiac rehabilitation program, nutrition counseling, home health and hospice services in consultation with a physician. Facilitates communication between external healthcare providers and BAMC Healthcare providers. Maintains continuity of care through case management. Evaluates the effects of case management on target populations to improve health care delivery. Serves as consultant for inpatients. Refers inquiries to appropriate agencies when the situation is determined to be outside the domain of the medical treatment.

3. Participates and presents outcomes in professional conferences and boards at national or local levels as required. Evaluates current practice in light of research findings to develop evidence-based procedures/protocols. Reports process improvement issues. Participates in team conference meetings. Has the ability to communicate effectively both orally and in writing and maintaining accurate and thorough documentation. Skills for working effectively in an interdisciplinary healthcare environment are required. Generates statistical reports regarding access to, and outcomes of care provided for the purposes of process improvement and to meet the requirements of federal accrediting agencies. This involves computation, analysis, tracing/trending, graphing and preparation of summary management reports. Attends and participates in assigned committees, projects, and programs.. Oversees, teaches, and provides consultation to other health care providers (Registered Nurses, physician's assistants residents, therapists, medical students, interns, and other clinical staff). Serves as a leader of a health care team comprised of other physicians, non-physician providers, and ancillary staff.

Performs other duties as assigned.

US Citizenship required

At least one year of clinical experience AFTER finishing APRN program

Applicants must have passed the National Council Licensure Examination and possess a current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.