Advanced Nurse Practitioner - Surgical Care

This position is located at the Clement J. Zablocki VA Medical Center, Milwaukee Wisconsin, in the Surgical Care Division. The Advanced Practice Nurse (APN) II Certified Nurse Practitioner (NP) practices in the Pre-Operative / Pre-Procedure Clinic to provide a full range of services emphasizing quality, timeliness, and the advancement of the Veterans Affairs (VA) mission. The NP provides advanced clinical practice, consultation, and management.

Major duties and responsibilities of the position:

• Assess the Veterans, their planned operative procedure, co-morbidities, and help risk stratify the patient so that pre-operative evaluation can occur by the most appropriate clinic.
• Perform the pre-operative history & physical exam following the templated note in the electronic health record (EHR) to ensure all Veteran risk factors are captured for the most accurate risk assessment.
• Review all pertinent EHR notes, lab tests, X-Ray exams, cardiac tests, pulmonary function tests, and other pertinent information for the patient in developing the assessment of the Veteran undergoing a surgical procedure.
• Communicate with referring sections and/or surgeons performing the surgical procedure with any patient concerns or recommendations.
• Based on Veteran history & physical, review of EHR notes and results of tests and planned procedure(s), make recommendations to proceed with planned operation or to order additional testing prior to surgery; communicate recommendations to the referring team.
• Collaborate with COTC RN staff, anesthesia provider(s), Primary Care provider, consult teams (Cardiology, Pulmonology, etc.), and referring providers as needed to develop a pre-operative assessment of the patient.
• Facilitate, coordinate, and monitor the patient's progress through the pre-operative clinic, including recommended additional testing to ensure timely preparation for the surgical procedure.
• Initiate referrals and consults to specialty services.
• Assist in the development of clinical protocols, policies, procedures and plans of care reflecting specific needs of the pre-operative patient.
• Utilize evidence-based practice in the pre-operative clinic.
• Provide education to the patient and family on the pre-operative process, patient morbidities, patient lifestyle concerns, etc., as needed.
• Assesse and adjust the plan of care as needed to achieve optimal patient outcomes.
• Identify deviations from established protocols, care standards, and clinical pathways; investigate and actively intervene to correct variances as appropriate.
• Support the interdisciplinary team caring for the patients by updating knowledge and skills through literature reviews, discussions and presentations.
• Function as a role model for the nursing staff and actively participates in the care of the pre-operative Veteran.
• Assist in the orientation of new staff to the pre-operative clinic.
• Maintain competence through attendance at job-related educational opportunities.
• Demonstrate leadership and works collaboratively with the interdisciplinary team.
• Prescribe pharmacologic and non-pharmacologic interventions, as appropriate.

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: Monday to Friday from 8:00 am to 4:30 pm
Telework: Not Available
Virtual: This is not a virtual position.
Relocation/Recruitment Incentives: Not Authorized
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 Knowledge and Experience:

• Experience with evaluating veterans who will be undergoing a surgical procedure.
• Experience with assessing co-morbidities and risks related to the surgical procedure.
• Experience with the performance of History & Physical exams in an efficient and timely manner.
• Experience working collaboratively and communicating with surgeons, anesthesiologists, RNs, other physician extenders, trainees, and staff from multiple services.
• Experience or exposure to EKG readings.
  

Physical Requirements: This position includes a level of physicality normally associated with duties performed by nurses such as direct patient care, and potentially long periods of walking, standing, sitting, moderate lifting, repeated bending, or kneeling.

Examples may include but are not limited to:

• Significant amounts of time standing assisting assigned patients
• Utilization of safe patient handling and mobility protocols