Job Summary

The Cardiothoracic Surgery team at VA St. Louis Health Care System seeks an experienced NP with full practice authority to provide outpatient, inpatient, operative and ICU care. Duties include ordering and titrating cardiac medications, first assist, hemodynamic surveillance, chest tube management, VAD implantation support, and transplant evaluation. Coordinate perioperative, intra-operative and post-operative care with cardiac surgeons and intensivists under VA APRN privileging guidelines.

Job Description

Advanced Practice Nurse (Nurse Practitioner) Basic Requirements Education: A post-master's certificate or master's or doctoral degree as a Nurse Practitioner. (Applicants pending the completion of educational requirements may be referred and tentatively selected but may not be hired until the education requirements are met.) Must be a graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE). NOTE: Foreign Education. Graduates of foreign schools of professional nursing programs, the nurse practitioner degree equivalency must be validated through an Agency recognized degree equivalency evaluation agency, such as the International Consultants of Delaware (ICD). Candidates with equivalent nurse practitioner masters or doctorate level degrees who possess current, full, active, and unrestricted registration and certification will meet the requirement of graduation from an approved school of professional nursing to warrant appointment. License - All APN (NPs) must possess and maintain an active, current, full, and unrestricted APN license to practice as an NP in a State, Territory or Commonwealth of the United States, or in the District of Columbia. Basic Board Certification - All APN (NPs) must maintain full and current basic board certification in one of the following: Board Certification as Adult- Gerontology - Acute Care Must Obtain and maintain independent license and privileges for controlled substance prescriptive authority. NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and an APN (NP) assignment that are also performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification. The following Scope, Education and Experience, and Dimension criteria must be met to qualify for Advanced Practice Nurse (Nurse Practitioner) II: Exception to Licensure for Graduate Nurse Technicians. Candidates who otherwise meet the basic requirements, but do not possess the required licensure and/or certification, may be appointed at the entry step of the Nurse II, as a Graduate Nurse Technician - Nurse Practitioner on a temporary appointment up to any period not-to-exceed one year and a day under the authority of 38 U.S.C. § 405(c)(2)(B). Scope: Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others Education and Experience Requirement: Meets basic education requirement for APN (NP). Nurse II is considered the entry grade level for APN (NPs); no experience is required. Dimension Requirement: APNs (NPs) at level II are expected to meet the following dimension requirements: Clinical Practice. Delivers evidence-based health care, demonstrating proficiency in the ability to manage a patient panel, population, or program. Outcome Focus. Utilizes research and evidence-based practice to evaluate the patient care delivery system within a patient panel or program, presents findings and contributes to changes that enhance the quality and timeliness of veteran/patient care. Leadership. Works effectively as a leader within a team/unit/group and seeks interdisciplinary collaboration as appropriate to enhance patient care. Professional Development. Acquires knowledge and skills to develop expertise in area of practice. Professionalism/Collegiality. Demonstrates effective communication skills and professional behavior, promoting cooperation and teamwork. Participates in interdisciplinary teams and processes that positively impact patient outcomes. The following Scope, Education and Experience, and Dimension criteria must be met to qualify for Advanced Practice Nurse (Nurse Practitioner) III: Scope: Executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex client care. Education and Experience Requirement: Meets basic education requirement for an APN (NP) AND one year of specialized APN (NP) experience equivalent to the Nurse II grade level. Dimension Requirement: APN (Nurse Practitioners) at grade III are expected to meet the following dimension requirements: Clinical Practice. Influences and models the delivery of evidence- based health care, demonstrating expertise in the ability to manage a patient panel, population, or program. Outcome Focus. Leads and implements changes that enhance the quality and timeliness of Veteran/patient care applying research and evidence in the delivery of healthcare for patient populations. Leadership. Initiates and leads interdisciplinary teams informed by structured approaches and processes to improve outcomes that positively impact care for a patient panel, population, or program. Professional Development. Acquires knowledge and skills, then disseminates acquired information within and/or outside the medical facility. Professionalism/Collegiality. Initiates and leads interdisciplinary teams developing systems that positively impact outcomes at the panel, population, or program level. Demonstrates effective communication skills and professional behavior, promoting cooperation and teamwork Preferred Experience: Conducts detailed assessments, including hemodynamic and volume status evaluation, assists in surgical interventions specific to heart failure (e.g., ventricular assist device implantation, transplant evaluation), and coordinates intra- and postoperative care with cardiac surgeons and intensivists. Provides comprehensive preoperative care by obtaining medical histories, performing focused and comprehensive physical examinations, and ordering and interpreting diagnostic tests (e.g., ECGs, laboratory studies, and imaging) to optimize patients for cardiothoracic surgery. Functions as an intraoperative first assist, including surgical exposure, tissue handling, suturing, hemostasis, and closure; performs conduit harvesting during CABG; participates in chest closure, cannulation, valve placement, decannulation, and chest tube placement within granted privileges. Provides comprehensive postoperative care, including entering and managing orders, participating in ICU/PACU transfers, conducting postoperative rounds, performing wound care and pacing wire removal, and coordinating discharge planning. Manages immediate ICU care for post-cardiac surgery patients, including oversight of intubated and ventilated patients, ventilator weaning, and interpretation of arterial blood gases. Monitors and manages chest tubes and hemodynamics, including surveillance and documentation of chest tube output, early recognition of complications such as hemorrhage, tamponade, or low cardiac output, and adjustment of therapy. Minimum of two (2) years of recent cardiothoracic perioperative experience (operating room and ICU), demonstrating independent titration of cardiac medications, ventilator weaning, chest tube and hemodynamic surveillance, and rapid recognition of life-threatening complications. Demonstrated prescriptive authority consistent with APRN scope and institutional privileging, using a formulary that includes inotropes, antiarrhythmics, anticoagulants, diuretics, and analgesics/controlled substances, consistent with VA APRN practice authority and local privileging. Physical Requirements: This is a direct patient care position and may require long hours of standing, walking, stooping, bending, lifting and positioning patients for examinations. There may also be extended periods of time sitting at a computer entering patient data