Title: Nurse Practitioner- Interstitial Lung Disease and Pulmonary Hypertension

Department: JM4 Med Surg Clinics (ILD and PH)

Pay Band: $63.68-$72.44

Hours of Work: Full-Time Position; Days

Union: ONA

Location: Hotel Dieu Hospital Site

PRIMARY FUNCTION

The Nurse Practitioner (NP) is aRegistered Nurse (RN) in the Extended Class with additional educational preparation and experience, who possesses and demonstrates the competencies to autonomously diagnose, order and interpret diagnostic tests, prescribe pharmaceuticals and perform specific procedures within their legislated scope of practice.

The NP must know and practice in accordance with the standards relevant to the practice area as well as the legislation and regulations applicable to an NP practice:

• Regulated Health Professions Act, 1991;

• Nursing Act, 1991;

• Laboratory and Specimen Collection Centre Licensing Act;

• Healing Arts Radiation Protection Act, 1990;

• Public Hospitals Act, 1990;

• Health Protection and Promotion Act, 1990.

Reporting to the Program Manager, the NP works in an extended nursing role demonstrating a high level of autonomy and expert skill in order to formulate clinical decisions, appropriately manage acute illness and promote wellness within their area of specialty, in this case Interstitial Lung Diseases (ILD) and Pulmonary Hypertension (PH), and other relevant respiratory diagnosis.

The NP explicitly consults the interprofessional team where care is required outside of the NP scope of practice, level of competency and/or where not covered by a Medical Directive.

The NP works within the framework of advanced nursing practice and in collaboration with other members of the interprofessional team to provide and enhance holistic care for these specific patient populations. The full NP scope of advanced nursing practice, including clinical, administrative, education and research competencies (see next page), will be utilized to meet patient-and-family-centered health care needs across the continuum of care in the ambulatory setting.

The NP improves patient outcomes through the use of best practice guidelines, standards, policies and procedures; interprofessional collaboration; participation in research; provision of leadership through committee membership, role modeling professional practice and consultation on issues related to professional practice; facilitation of educational opportunities for patients, staff, and others, and continuous quality improvement processes. Promotion of leadership and excellence in nursing practice is a key component of the NP role.

The NP participates in resolving patient and family situations and clinical events that are complex and that require a depth and breadth of knowledge sufficient to meet the complex, and rapidly changing needs of patients and families.

Within this role, the NP is accountable for contributing to the delivery of the Kingston Health Sciences Centre strategy and must demonstrate an awareness of and be responsible for actively promoting and supporting patient-and-family-centered care and engagement.

RESPONSIBILITIES & DUTIES INCLUDE:

Clinical Domain:

The provision and coordination of care to patients with PH/ILD and their families in the ambulatory and inpatient/acute setting are the primary (but not exclusive) components of this role. At times, duties may extend to the broader Division of Respirology in consultation with the primary physician partners and Program Manager. The NP will be responsible for:

• performing preliminary nursing assessments and preparing a risk assessment form based on recent test results

• ensuring the proper completion and review of standardized clinical questionnaires filled out by patients at home at each clinic appointment.

• ensuring the proper recording of the clinically relevant information required in the ILD clinic data collection sheet.

• facilitating/ ensuring required blood work is ordered/ completed prior to clinic appointments (e.g. liver function, creatinine, electrolytes, CBC, INR etc.)

• arranging diagnostic and surveillance testing to assess liver and/or respiratory function (e.g. bronchoscopy, chest X-ray, CT scan, PFTs, specialized blood work, etc.) and other testing to monitor disease status and/or adverse effects of medications, for example antifibrotic and immunosuppressive drugs

• following-up on test results ordered by the NP or where the NP is copied, reviewing other results ordered by the team or primary care providers as applicable, and consulting with medical team as required

• prescribing and managing medications and therapy including (but not limited to):

• prescribing and managing home oxygen therapy

• prescribing medications commonly used in the treatment of ILD and/or PH patients including: antibiotics, systemic corticosteroids and/or immunosuppressants; osteoporosis preventive medications (calcium, Vitamin D, bisphophonates); proton pump inhibitors or H2 blockers for gastric protection in patients on steroids or management of GERD; pneumocystis carinii prevention and treatment

• consulting with physician team as required

• managing fluid status including the prescription of diuretics, with the appropriate monitoring of renal and electrolyte status

• prescribing nicotine replacement therapies, other smoking cessation medications and referral to smoking cessation programming

• triaging patient phone calls related to medications, management of adverse medication side effects and incurrent medical issues, and initiating/ coordinating follow-up including responding to all urgent clinical issues and discussing them with the medical team as appropriate and coordinating care across multiple specialties

• facilitating the initiation of appropriate palliative care measures and/or palliative care consultation and co-managing with the palliative care team opioids and other appropriate drugs to improve quality of life of patients.

• documenting all patient interactions per KHSC Policy with copies sent to the office chart

• instructing and facilitating patients to attend the emergency room (or hospital) when appropriate, and liaising with the corresponding physicians to ensure proper continuity of care.

• following inpatients with ILD/PH in the Emergency Department and/or throughout their hospital stay

• following up on patients post hospital admissions or Emergency/ Urgent Care Department visits with the objective of preventing unnecessary recurrent Emergency/ Urgent Care visits or hospital admissions related to heart failure or respiratory causes

• obtaining up-to-date drug lists for patients and doing medication reconciliation as appropriate

• tracking and ordering monthly lab results for patients on high risk medications

• educating patients (and families) regarding their disease, drugs/ advanced medical therapies/ parenteral therapies, diet restrictions, exercise and other self-management strategies (e.g. PH or ILD Clinic Recommendations, GERD preventive measures, bronchiectasis exacerbation preventive measures, smoking cessation counselling/aids, etc.)

• providing patients with verbal, written and virtual information about self-management strategies including information about their disease, potential side effects of medications such as inhaled and system corticosteroids, immunosuppressants and antifibrotics; how to identify disease exacerbations and progression and providing patients with an appropriate action plan; how to use and interpret home monitoring devices such as pulse oximeter and peak flow meter

• providing patients with verbal and/or written information regarding rationale and preparation for bronchoscopic procedures and right heart catheterization including instructions on holding and restarting medications before and after the procedure

• assisting with right heart catheterizations and other diagnostic or procedural activities (e.g. cryobiopsy and bronchoscopy)

• triaging calls from patient support programs

• interacting with government agencies and patient support groups to obtain limited use medications

• requesting, processing and tracking prior authorization requests for life-sustaining parenteral and oral medications

• enrolling patients in patient assistance programs for life sustaining therapy for those with inadequate insurance coverage

• acting as the liaison for external physicians, home nursing, specialty pharmacy and patients

• communicating effectively with the medical team, referring services, primary care provider and other interprofessional providers to support the care of the patient.

• obtaining and maintaining necessary clinical competencies and skills to deliver evidence-based, quality care in accordance with the College of Nurses of Ontario

• engaging with industry as needed to identify new products/ medications that would benefit patients and obtaining samples, brochures, and other resources.

The proportion of time spent in the various domains of practice will be identified by the program and the population it serves.

NOTE - The above duties are representative but are not to be construed as all-inclusive. A complete job description is available from People Services on Watkins 4.

BASIC QUALIFICATIONS:

• Current registration with the College of Nurses of Ontario as Registered Nurses in the Extended Class with one of the following specialty classes: Adult, or Primary Health Care (Adult preferred)

• Masters of Science (Nursing) or Master of Nursing or a Masters in a relevant discipline

• Membership with a professional organization such as CNA, RNAO or NPAO (an asset)

• Participation in the College of Nurses of Ontario’s Quality Assurance requirements

• Respirology or Critical Care or Cardiac experience is required. NP experience in required areas is preferred over RN experience

• CNA Specialty in area of primary focus (an asset)

• Professional liability insurance

• Impeccable attendance record

• Demonstrated ability to problem solve and make evidence based decisions

• Demonstrated critical thinking and decision making skills

• Outstanding interpersonal, communication, team building, presentation and documentation skills

• Demonstrated ability to work both independently and collaboratively with all team members

• Demonstrated ability to educate staff, patients and families

• Demonstrated leadership skills within the interprofessional care team

• Evidence of strong mentoring, teaching, team building, change leadership, organizational and prioritization skills, with the ability to work well in stressful situations

• Demonstrated ability to effectively deal with conflict situations and proactively and effectively resolve issues impacting on quality and continuity of care

• Exceptional time management, organizational and prioritization skills

• Excellent patient advocacy skills

• Demonstrated ability to interpret/participate in research

• Demonstrated knowledge of computer database, data analysis and presentation packages required

• This job posting is subject to the provisions of the Attendance Management Policies. Please refer to the Attendance Management policies for more information (policies can be found on the KHSC Intranet site)

• Satisfactory criminal reference check required

PHYSICAL REQUIREMENTS:

The applicant must be able to meet the physical demands of this position.

KHSC is located on the ancestral lands and waters of the Anishinaabeg and Haudenosaunee and serves a wider geographical area that encompasses many Indigenous communities including Tyendinaga, Katarokwi, as well as communities within the Weeneebayko Area Health Authority. As we partner in care, discovery, and learning to achieve better health outcomes for our communities, KHSC is committed to actively advocating for and acting upon the Truth and Reconciliation Committee’s Calls to Action on Health.

KHSC is committed to recruitment practices that support and contribute to building a respectful, diverse and inclusive workplace. We welcome all applications from women, racialized persons, persons with disabilities, Indigenous Peoples, persons in the 2SLGBTQIA+ community, and members of other equity deserving groups.

We thank all applicants, but only those selected for an interview will be contacted. Kingston Health Sciences Centre is committed to inclusive and accessible employment practices. If you require an accommodation to fully participate in the hiring process, please notify the Recruitment Team.