Nocturnal Endocrine Adv Pract Provider (APRN or PA)

Cancers of endocrine glands are rare, but their optimal treatment requires the same attentive diagnosis and therapy as more common malignancies. MD Anderson’s Endocrine Neoplasia and Hormonal Disorders department provides comprehensive diagnostic and treatment services for patients with endocrine system tumors, both malignant and benign. Here’s just a partial list of diseases treated by our physicians, nurses and other caregivers:

• Thyroid cancer and management of other thyroid disorders
• Cancers and benign tumors of the adrenal glands
• Hyperparathyroidism and parathyroid tumors
• Pituitary tumors
• Pancreatic neuroendocrine tumors
• Multiple endocrine neoplasia (MEN) I and II
• Inherited endocrine tumors, including childhood endocrine tumors

This position will work 3-12 hour shifts from 5:30pm-6:00am.

Specialized care is required when cancer affects the endocrine system. Disruptions to the body's delicate hormonal balance from cancer or the therapies used to treat it can have long-reaching effects, particularly in pediatric patients. Treating the tumor itself just isn't enough. Our mission includes anticipation and management of treatment-related side effects, including diabetes mellitus, pediatric growth disorders and metabolic bone diseases such as osteoporosis.

Our multidisciplinary approach offers patients the best possible outcome, so that successful treatment doesn't have to be a compromise. Our specialists work closely with teams of physicians from other departments to manage patients with these diseases. Our endocrinologists collaborate with our surgeons, oncologists, radiologists and pathologists to provide dedicated state-of-the-art patient care, while performing clinical research to evaluate how best to apply the most recent developments in cancer medicine.  As part of this approach we provide comprehensive services for patients who were diagnosed with diabetes mellitus as a result of their cancer treatment. Our Glycemic Management Program assists other providers with their patients with glycemic disorders.  

PROVIDE DIRECT MEDICAL SKILLS WITHIN SCOPE OF PRACTICE (40%) 

Provide medical skills within scope of practice, as assigned:
Has primary responsibility for working with department faculty physicians to assist in covering the inpatient clinical practice for the Endocrinology Service-Diabetes. Clinical aspects include but not limited to Manage endocrinopathies; Manage endocrine effects of chemotherapy agents; Assess glucose needs and lipid control; Manage multiple-dose insulin and insulin pumps; Manage recently discharged patients for insulin titration
Conduct comprehensive health assessments, identifies normal/abnormal health characteristics, develops treatment plans, initiates appropriate care and continuously evaluates care outcomes.
Use judgment to work autonomously as defined by the nurse practice act or to collaborate with the healthcare team to manage client care throughout the continuum of care and in a variety of settings.
Must be able to independently initiate assignments without supervision.  He/she must be able to understand and respond to telephone conversations with physicians and other members of the health care team, both within and outside of the institution.  He/she must be able to clearly write and/or clearly communicate verbally person-to-person or over the phone.
Attend Diabetes Services Meetings
Attend Division of Internal Medicine Grand Rounds
Share responsibility with other department advanced practice professionals for coverage of inpatient services, triage new patients and consultations, and coordination of the scheduling of these patients
Primary area of assignment varies based upon the needs of the clinical practice and available staff. The primary assignment of this position is:

Inpatient Night Shift Endocrinology—Diabetes:

Provides initial assessment and management of urgent issues related to complex, critical endocrinology--diabetes needs at night across the institution; oversight by Endocrinology—Diabetes Attending on Service
Provides post-admission assessment for night-time admissions of patients with diabetes; oversight by Endocrinology—Diabetes Attending on Service
Perform inpatient consultations and follow-up visits, as assigned by Endocrine and/or Diabetes Attending on Service
Perform follow-up of inpatients who have undergone surgery, admitted for observation, and previously seen by department faculty physicians and/or advanced practice providers
Manage care of high-risk Diabetes inpatients previously seen by department faculty physicians and/or advanced practice providers, e.g. insulin pump, Type 1 Diabetes, and those on concentrated insulin
Review endocrine discharge instructions on patients pending discharge. Assist with test claims for inpatients pending discharge to ensure patients have appropriate diabetes medications
Retrieve and review labs, glucose monitoring results on all patients followed by inpatient Diabetes Service
Round on patients not seen by day team to ensure glycemic control 
Titrate insulin on patients that have blood sugar outside of target values
Facilitate communication with faculty and day shift APP team
Update IPASS (handoff) information and indicate follow up items needed
Respond to overnight call from patients or clinical team members
Respond to requests from askMDAnderson on patient care concerns who have been recently discharged
Dictate notes on consult and follow-up patients

 

PROVIDE QUALITY PATIENT CARE (40%)

Provide quality patient care in relation to the patient's prescribed diagnosis, treatment, age group, development and other identified needs:
Have access to all medical records that would normally be available to the physician.  Perform and record histories, physical assessments and progress notes within 24 hours. For patients co-managed, sign off and forward to the supervising physician for co-signature within ten days.
Order routine tests appropriate to the services provided under such orders.  Access biopsy and laboratory reports.  He/she must also be able to perform simple mathematical computations with and without the assistance of calculators including addition, subtraction, multiplication, and division. 
Order patient medications and treatments within authorized limited prescriptive authority consistent with institutional delegated prescriptive authority policies and procedures.
Perform routine admission procedures.  Input patient information into the computer by typing on a keyboard all information as required.  Must be able to visually read information on a video screen and/or on hard copy and prepare printouts of patient information using a computer and printer.
Interview patients for symptoms, side-effects, toxicities, and determine their status pertaining to the investigational aspects of protocols.  Calculate drug doses when appropriate.  Chart notes.  Measure films to monitor disease response.  Assess toxicity, grade and make handwritten entries onto flow sheet or database.  Assure protocol compliance and assist physicians as necessary.  Requires the ability to walk from his/her office to clinic and/or hospital nursing stations and then return to the office.
Schedule and perform delegated medical procedures as required.
 

EDUCATION/RESEARCH/COLLABORATION (10%)  

Provide patient and trainee education. Participate in clinical protocol clinical tasks as needed. Commit to collaborative relationships with co-workers, patients, faculty, physicians and all members of the health care team.
Deliver education to patients and their families.  Conduct in-service training for clinic and in-house nursing personnel regarding protocol requirements.  Act as liaison with patients, families, physicians, and other personnel.
Participate in trainee education, i.e. student Advanced Practice Nurses, house officers and medical students. Instruct coworkers in allied positions in recording patient information and/or data entry.  May supervise personnel in related activities. 
Participate and collaborate on clinical research protocols, under direct supervision of faculty physicians.  Interview patients and review the eligibility criteria to identify potential patients for protocol studies.  Schedule and conduct follow-up appointments.

Demonstrates a service attitude by:
a. Identifying new ways to provide better service to supervisors, peers, external employees, visitors, etc.
b. Maintain pleasant demeanor.
c. Following up to make sure that the problem is solved.

Exhibit professional behavior by:
a. Not showing disapproval or dislike of others or their opinions or ideas expressed.
b. Being perceived by others as one who works well with others and who does their job well.
c. Staying outwardly calm, even in unpleasant situations.
d. Maintaining usual demeanor in spite of personal problems or the behavior of others

Demonstrate excellent oral and written communication skills as observed by supervisor.  Demonstrate excellent interpersonal skills as observed by supervisor.  Work effectively with all employees and departments. 
After first year in position, serve as Team Leader for advanced practice professionals in rotation schedule, as assigned.


PROVIDE OTHER SERVICES TO FACILITATE DIRECT MEDICAL SERVICES (10%)

Demonstrate an awareness of and responsiveness to the larger system of healthcare to provide patient care that is cost effective and demonstrates resource allocation that does not compromise quality of care.
Advocates for quality patient care and assist patients in dealing with system complexities.
Accepts responsibility for promoting a safe environment for patient care and recognizes and participates in the correction of system-based factors that negatively impact patient care.
Assist with various projects as assigned.