Advanced Practice Nurse (Nurse Practitioner) - Medicine Service

This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific eligibility requirements per VHA policy and submit your EDRP application within four months of appointment. Program Approval, award amount (up to $200,000) & eligibility period (one to five years) are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible.

This position is the Advanced Practice Registered Nurse (APRN) Nocturnist for Direct Care. The APRN provides independent overnight medical management for all admitted and residential patients at North Little Rock (NLR) and /or Little Rock campus, including but not limited to acute rehab, subacute rehab, dementia unit, geriatric psychiatry, acute psychiatry, residential rehabilitation, domiciliary, and Community Living Center in NLR and Inpatient services at JLM. Duties include but are not limited to:

• Independently manages a panel of patients with acute and chronic health conditions with an emphasis on health promotion and disease prevention using evidence-based practice.
• Develops and implements an individualized plan to achieve optimal population health and disease management.
• Orders and interprets labs, tests, and diagnostic studies.
• Prescribes pharmacologic and non-pharmacologic interventions.
• Initiates referrals and consults to specialty services.
• Provides education to patients and their families.
• Assesses and adjusts the plan of care as needed to achieve optimal patient outcomes.
• Provide NLR facility wide medical oversight after hours, serving as the primary medical decision maker for urgent and emergent issues across inpatient, residential, and designated outpatient areas.
• Promptly respond to requests from nursing staff for evaluation and treatment of patient care concerns, including reviewing electronic medical records, in-person assessment of patients, entry appropriate orders and documentation, and closed loop communication with nursing staff.
• Promptly respond to all code blue events. In NLR serve as the code team leader. coordinate resuscitative care; direct team roles; and collaborate with NOD on EMS activation and transfers.
• Collaborate with NOD to resolve any escalated issues involving nursing staff or patient care, and to arrange transportation to Emergency Department (ED) for patients that require work-up or stabilization beyond NLR facility capabilities.
• Understand limitations of evaluation and management at NLR after hours and how to expeditiously arrange for transport of appropriate patients to ED.
• Provide warm handoff to providers on patients transferring to ED and MICU.
• Provide call coverage of other VHA policy mandated duties including but not limited to handling of after-hours critical lab values for patients.
• Provide call coverage for VHA mandated duties, including follow up on critical after-hours laboratory values for clinic or inpatient Veterans.
• Evaluate patients that wish to discharge for safety of their discharge plan, and facilitate plan for those patients with capacity to include medication fills and discharge summary with alert to primary team. Patients that lack capacity may be held either by surrogate decision maker authorization or by 72 hour hold per VHA policy, in which case provider facilitates implementing these holds per VHA policy.
• Perform history & physicals and write admission orders as needed for patients admitting to services where after hours admissions are permitted.
• Rapidly evaluate all reported falls and document accordingly as per VHA fall policy.
• Provide admission-related orders where orders have been lost due to user error or system limitation.
• Meaningfully participate in Joint Patient Safety Review reporting processes, Peer Review reporting processes and Root Cause Analysis as appropriate.
• Participate in facility peer review process, OPPE review process, and other assigned chart review processes.
• Duties may require extended periods of walking, standing, bending, lifting/carrying light items, donning PPE, and rapid mobility during emergent responses.

VA offers a comprehensive total rewards package: VA Nurse Total Rewards

Pay: Competitive salary, regular salary increases, potential for performance awards
Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year)
Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA
Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement)
Licensure: 1 full and unrestricted license from any US State or territory

Work Schedule: 7 days on / 7 days off. Wednesday - Monday, 7:00pm to 7:00am, and Tuesday, 11:00pm -7:00am. Schedule subject to change based on the needs of the service.
Compressed/Flexible: Available
Telework: Not Available
Virtual: This is not a virtual position.
Relocation/Recruitment Incentives: Not Authorized
EDRP Authorized: Former EDRP participants ineligible to apply for incentive. Contact lashala.goodman@va.gov, the EDRP Coordinator for questions/assistance. Learn more
Permanent Change of Station (PCS): Not Authorized

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: Family Nurse Practitioner (FNP), Adult Nurse Practitioner (ANP), Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP), Acute Care Nurse Practitioner (ACNP), Adult-Gerontology Acute Care Nurse Practitioner (AGACNP), or Gerontology Nurse Practitioner (GNP) from one of the following: the American Nurses Credentialing Center (ANCC), American Academy of Nurse Practitioners Certification Board (AANPCB), or other nationally recognized certifying body in the area in which the Nurse Practitioner is academically prepared.

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:

• At least 2 years of Advanced Practice Registered Nurse experience.
• At least 1 year of inpatient hospital medicine experience.

Physical Requirements: Heavy lifting, 45 pounds and over, Moderate carrying, 15-44 pounds, Pushing 1 hour, Reaching above shoulder, use of fingers, both hands required, walking 8 hours, standing 4-6 hours, Ability for rabid mental and muscular coordination simultaneously, near vision correctable at 13" to 16" to Jaeger 1-4, Far vision correctable in one eye to 20/20 and to 20/40 in other, Depth perception, ability to distinguish basic colors, ability to distinguish shades of colors, hearing (aid may be permitted), mental and emotional stability. Working closely with others, working alone, protracted or irregular hours of work.