The Advanced Practice Nurse (APP) is a registered nurse with master’s preparation in an expanded role who will provide direct care to a variety of transgender and gender diverse individuals in the Transgender Health Program. The Transgender Health Program (THP) is a small multidisciplinary clinic in the MGH primary care network that provides both primary care and gender affirming consultative care to transgender and gender diverse patients of all ages. There is an opportunity for the APP will provide care to patients across the age range in the THP. Care in the THP includes general primary care visits, urgent care visits, ordering lab and imaging tests and appropriate consults, and prescribing medications. It may additionally include co-management of certain patients with physician colleagues, as well as provision of gender affirming services such as hormone therapy and surgical pre-assessment in line with APP experience and training in the group. Further, there are opportunities to provide care to meet population-based needs including PrEP and HIV care, and more in line with APP experience and training. There are also potential opportunities to teach APP and other students interested in gender affirming care/LGBTQ health as well as to participate in a variety of community engagement activities with other members of the clinic team, if interested.
In collaboration with the physician and other staff, the APN is responsible for the diagnoses, treatment, and provision of care for patients during all phases of wellness and illness. The APP holds their own outpatient sessions, and within the scope of practice is expected to initiate and arrange the patient’s outpatient care plan with the involvement and consideration of other health disciplines within and outside the hospital. They coordinate the care a patient may need in the community with Visiting Nurses or case managers. The APP will place a marked emphasis on patient teaching and education, and promote competent, compassionate care for patients and families.
The Primary Care APP understands the position is an important part of the care team.
The APP has appropriate knowledge of nursing, medical, and scientific principles, and appropriately applies those principles to practice of family care.
PROFESSIONAL CONDUCT:
I. Professionalism
• Treats patients with courtesy and respect.
• Is mindful of cultural beliefs and expectations.
• Uses patient and colleague chosen names and pronouns; attempts to use inclusive language as much as possible
• Determines priorities per patient’s needs.
• Understands all components of position and how job fits into overall mission of the practice.
• Contributes to favorable image of Practice.
• Dresses to support business/clinical image.
• Works collaboratively with peers and staff, fostering an environment of teamwork.
• Refrains from engaging in demeaning, discriminating or otherwise threatening behavior.
II. Citizenship
• Attends regular scheduled practice meetings.
• Is punctual, and plans ahead for scheduled time off by 2 months.
• Open and receptive to change and feedback.
• Assist in orienting new staff in like positions.
• Contributes to strengthen the practice community.
• Is present and focused at work.
• Effectively owns work they do to completion and resolves mistakes when made.
III. Quality
• Recognizes patient as ultimate consumer of services.
• Places patient concerns before self.
• Protects and maintains patient confidentiality.
• Consistently produces work that meets practice standards.
• Performs job accurately, in a timely fashion.
• Maintains proper documentation of information required for position.
• Is aware of practice goals and is a proactive participant in helping achieve them.
IV. Communication
• Provides and receives feedback in a tactful, positive, respectful manner.
• Responds to patients and colleagues in a timely manner.
• Uses agreed upon methods of practice communication as decided by individual practice guidelines.
• Communicates any unexpected tardiness, changes or adjustments in schedule as dictated by practice policy.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
CLINICAL PRACTICE
Participates in daily huddles and shares information with the team that is necessary to enhance the patient office experience, delivery and coordination of care and incorporates the patient as an active team member.
Provides independent, direct, and indirect care; performing physical examinations, ordering diagnostic studies, evaluating results and prescribing treatment as appropriate. Follows patients appropriately, within Advanced Practice Role as delineated within the state of Massachusetts and MGH.
Patient/Family Care
Establish the diagnosis (es) and determines a plan of care including; order laboratory and radiology test and treatments for
• Short term and chronic health problems
• Exacerbation of health problems
• Chronic disease and health promotion management
Discuss with patients or their delegates: end of life issues, chronic disease management, and educational materials regarding patient’s health
Refer patients to appropriate physicians, clinics, or other health care providers, including community providers for management or consultation.
Write prescriptions according to Massachusetts Authority to Prescribe laws and consistent with the APPs scope of practice, and using institutional guidelines.
Use the Electronic Medical Record in timely and competent manner per practice guidelines
Diagnostic studies : Order, interpret and communicate results
• For health screening and monitoring purposes
• Monitor the effect of current therapy
• Needed to investigate a new problem
Perform therapeutic measures but not limited to, the following;
• Removal of cerumen impaction
• Order and apply skin and wound dressing
• Order and apply venous pressure dressing and compression stockings
• Suture removal
• Immunizations
Team Care
The NP will be an integral member of the team. They will:
• Within team care work to create and implement a system to manage the complex patients with the PCP
• Participate in team huddles and communicate on a regular basis with team members about patients
• Assist patients/families in management of their health
• Consult with the LICSW regarding psychological-social needs of the patient
• Communicate with case managers regarding disease management especially during transitions of care
• Answer clinical questions from support staff
• Educate support staff and families on health issues and behaviors that can affect patient interactions with staff and families
Transfer to MGH emergency department
• communicate with the ED triage staff
• identify pertinent information to be completed in EPIC for the ED transfer and coordinate with the staff who will organize and print information
• follow up on patient condition post ER visit
Urgent/emergent or complex patient problems – in office or phone
• Provide emergency care to stabilize patient’s condition as appropriate
• Seek input from onsite physician and work with them to diagnosis and treat the patient
Indirect Work Management
• Responsible to follow up on labs and imaging ordered by sending letters or calling patients if results are considered critical
• Carry a pager to receive results of a critical value
• W orks with all staff to ensure smooth patient flow through out the day to improve efficiency of provider workflow
• Follows guidelines of practice to respond to staff questions via Clinical Messaging in EPIC
• Monitors patient outcomes.
Academic Practice
Quality Initiatives
• The APP will be involved in practice quality improvement initiates
• Recommends changes in practice as needed
Preceptor
• The APP may precept APP students at a minimum of one semester every 2 years
Professional Development
• Fulfills professional role through involvement in professional organization activities, presentations, (publications, and research).
• Responds to changes in clinical practice by planning, designing, implementing, and evaluating scientific based practice.
• Develops new techniques, guidelines, protocols, and standards in collaboration with other staff.
• Applies problem solving approaches to teaching, guiding, and solving complex clinical problems.
• Identifies current trends in healthcare and their implications for nursing practice
SKILLS/ABILITIES/COMPETENCIES REQUIRED:
• Integrates theoretical knowledge base and clinical expertise in decision making.
• Advocates for patients, their significant others, coworkers, the community, and the nursing profession.
• Consistently demonstrates accountability.
• Champions collaborative practice with coworkers and other disciplines and departments.
• Consistently demonstrates compassion to internal and external customers.
• Dynamically represents the program and nursing profession in internal and external forums.
• Exemplifies a professional behavior.
• Provides clear and direct verbal and written communication.
• Effectively facilitates group processes of decision-making for patient, family, and staff.
• Is empathic and respectful.
• Manages conflict resolution between patient, family, and staff.
• Advocates for patient’s choices.
• Is HIPAA compliant.
• Is BLS certifiedLICENSES, CERTIFICATIONS, and/or REGISTRATIONS (if applicable): Specify minimum credentials and clearly indicate if preferred or required:
• Current Registered Nurse licensure in Massachusetts as Nurse Practitioner.
• Family/Adult/Pediatric Nurse Practitioner Certification Required
EDUCATION: Specify minimum education and clearly indicate if preferred or required:
• Master’s degree from an accredited school of nursing as Nurse Practitioner.
EXPERIENCE: Specify minimum creditable years of experience and clearly indicate if preferred or required:
Minimum of 2 years nursing experience required
Minimum of 1-year NP experience required
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