POPULATION HEALTH NURSE-DPC SAGE ROAD PEDIATRICS-FT-IBLC Certified
Duke University Health System
Location: Durham, North Carolina
Internal Number: 143755
Duke Primary Care is the largest primary care network in the greater Triangle area with family medicine and internal medicine providers, and pediatricians in 34 locations throughout the Triangle.
Duke Nursing Highlights:
Duke University Health System is designated as a MagnetÂ® organization
Nurses from each hospital are consistently recognized each year as North Carolinaâ€™s Great 100 Nurses.
Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy for being strong advocates of specialty nursing certification.
Duke University Health System has 6000 + registered nurses
Quality of Life: Living in the Triangle!
Pediatric Population Health Nurse-DPC SAGE ROAD PEDIATRICS (Candidate must be certified in Lactation-IBLC; position is located in the clinic).
The Population Health Nurse is responsible and accountable for clinical expertise for specific complex patient populations. This role will perform disease management, assessment of disease states and utilization, care plan development and facilitation, referral to appropriate levels of care, etc. The Population Health Nurse functions as an integral part of an interdisciplinary team, ensuring excellence in patient care, in an effort to achieve optimal clinical outcomes through a seamless model of access and care. Focus on improving transitions in care for patients, physicians, family and community.
Provide specialized nursing treatment, development of care plans, and education to patients while exercising discretion and independent judgment; following established policies and procedures.
Assess the educational needs of the patient/caregiver as it relates to the disease process, alterations in function, and assimilation back into the home and community.
Monitor system access to care, services, and treatment including linkage to the medical home.
Address the total individual, inclusive of medical, psychosocial, behavioral, and spiritual needs. Involve the patient and their support systems (i.e. caregiver, family, etc.) in the decision-making process.
Use a patient-centric, collaborative partnership approach to assist the patient with improved self-management. Utilizing proven processes to measure a patient's understanding and acceptance of the proposed plan(s), his/her willingness to change, and his/her support to maintain health behavior change.
Apply teaching and learning theories to assist patients and families with physical and emotional impact of body changes and chronic illness.
Communicating and coordinating with all provider(s) and member(s) of the care team as needed to minimize fragmented care. This will include navigating transitions of care generally from hospital to home or community facilities.
Monitor quality and effectiveness of interventions to the population by setting long term and/or short-term specific, measurable goal(s).
Accessing and systematically using data from multiple sources such as patient medical records, claims, and program metric reports to target recipient(s) and provider(s) for outreach, education, and intervention.
Advocate for patient(s) and supporting provider(s) to ensure delivery of appropriate, evidence based care.
Facilitate Quality Improvement activities that educate, support, and monitor provider(s), regarding evidence based care for best practice/National Standards of Care (Adapted from CMSA, 2010).
Utilize innovative nursing and population management tactics to support health throughout the continuum of care in order to promote quality, cost-effective outcome.
Participate in quality/performance improvement programs and projects, product evaluation, outcomes evaluation studies and/or clinical research.
Provide clinical experience in a preceptor role for students attending institutions that have contractual agreements with DUHS. Participates in the orientation of new nursing staff and provides expert coaching and guidance through both formal and informal one-on-one teaching with nursing staff.
Serves as an expert resource to the network
This position may require home visits however; position specific details and duties are available upon request.
The work activity and patient acuity levels can create a stressful atmosphere.
Knowledge Skills and Abilities
BSN is required for this position
Current RN licensure in the state of North Carolina required.
AHA BLS required
3 years of nursing experience required
Organized and motivated by a fast-paced environment
Able to manage multiple tasks/projects simultaneously
Proficient in review and assess needs quickly
Strong with the use of computer software tools and data files
Comfortable with continuous change and self-initiating
Able to complete documentation in a quick and efficient manner (will be in legal medical record and other software systems developed for care management and population based program metrics)
Additional job expectations include the ability to:
Maintain strict confidentiality
Promote programs and services to community
Build effective and trusting relationships with patient/peers
Use motivational interviewing and active-listening skills when assessing patient conditions, problems and interests
Use conflict-resolution skills when reaching consensus about plans of care and treatment decisions
Demonstrate confidence, compassion, political savvy, as well as attention to detail to apply these skills as decisions dictate
Use data to analyze trends and to verify data
Self-directed and able to organize and manage multiple tasks/projects simultaneously
Ability to promote programs and services to community
Proficient in review of medical records and other patient care information
Pediatric Specific Description of Role and Responsibilities
Coordinate care for high acuity, medically complex patients including post NICU/PICU patients, management and administration of Synagis to qualifying infants throughout RSV season (October through March). Inclusive of participating in clinical visits and injections that must be administered by an LPN or RN.
Work with providers with management of patients with asthma- complete spirometry, provide asthma education and teach children/parents on proper use of devices, and management of asthma and asthma symptoms.
Assist providers with coaching, teaching and follow up of patients with elevated BMIs.
Assist providers with patient follow up via phone calls- medical concerns- acute and chronic, patients with anxiety, depression, ADHD, behavior concerns, etc.
Provide coverage for timely management of Newborn Screening results.
May round at Duke Regional on newborns. Coordinates continuity of care for newborns by ensuring appointments are scheduled, any necessary referrals are placed. Collect and incorporate maternal and infant appropriate clinical data to assist in provider progress notes.
Support providers throughout the day with management of newborns at Duke Regional Hospital. This includes, but is not limited to, follow up of labs and management of hospital communication.
Works with parents to conduct weight checks, color checks, lactation consultations, patient education issues, feeding problems, and behavioral issues such as sleep or daily schedules.
Schedules prenatal visits with providers at request of parents.
Provides office lactation counseling or referral to patients according to evidence-based practices, including phone advice. In addition, provide lactation consultation support and education to providers and staff.
Administrators for NCIR. Maintains continuing education for vaccines per state guidelines. Educates staff about changes in state vaccine program, assist with introducing new vaccines in office/clinical staff and is a resource to clinical staff/providers as vaccine questions arise
Will provide education on other health topics, as well as execute other clinical roles and responsibilities as identified.
Knowledge Skills and Abilities
Lactation Certification Preferred
Pediatric experience Preferred
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