A Brief Overview

The Nurse Practitioner (NP) functions under this Nurse Practitioner Job Description
approved by the Interdisciplinary Practice Committee (IDPC). The NP provides routine
are and management of the patient with acute and chronic complaints, in collaboration
with the supervising physician, and through implementation of standardized procedures.
Specific functions pertaining to the Service, Clinic or Department are established by the
NP and his/her supervising physician(s), and approved by the appropriate medical and
nursing administrators, the IDPC, the Credentials & Privileges Committee, the Stanford
Hospital and Clinics (SHC) Medical Executive Committee and the SHC Board
Credentials, Policies and Procedures Committee.

This job description covers all classifications for NPs within the organization. All NPs
must meet all elements of the Essential Functions, Qualifications, and Supervision.
There is a voluntary Career Ladder for NPs who are interested in promotions for clinical
expertise and contributions to the institution as well as the profession. Promotion is
determined based on the Center for Advanced Practice Career Ladder Handbook. Here
is a description of the various levels:

Job Attributes: LEVEL I LEVEL II LEVEL III

FLSA Status: Exempt Exempt Exempt
Job Code: 400077 400169 400170

Requirement:

LEVEL I: Entry level

LEVEL II: Meets Career Ladder criteria for NP II
LEVEL III: Meets Career Ladder criteria for NP III

Locations
Stanford Health Care

What you will do

 A. An NP may provide only those medical services which he/she is competent to

perform, which are consistent with the NP’s education, training and experience, and
which are performed under the supervision of a physician who is responsible for the
patients cared for by that NP.
 B. An NP shall consult with a physician regarding any task, procedure or diagnostic
problem which the NP determines exceeds his/her level of competence or shall refer
such cases to a collaborating physician.
 C. Scope of Practice of the NP:
 Evaluates and treats patients with acute, chronic complaints and health maintenance
concerns related to specialty, according to written standardized procedures. [see
Appendix A: Assessment & Management of Patients]
 Obtains complete histories and performs pertinent physical exams with assessment of
normal and abnormal findings on new and return patients, according to written
standardized procedures. [see Appendix A Assessment & Management of Patients]
 Performs or requests and evaluates diagnostic studies as indicated upon evaluation of
the patient, according to written standardized procedures. [see Appendix A:
Assessment & Management of Patients]
 Administers, orders, furnishes and prescribes medications, according to written
standardized procedures. [see Appendix B : Administering, Ordering, Furnishing or
Prescribing of Drugs; Formulary Protocol]
 Orders and collects specimens for routine laboratory tests, screening procedures and
therapeutic procedures, including blood and blood products.
 Orders physical therapy, occupational therapy, respiratory therapy, radiology
examinations and nursing services.
 Performs designated procedures after demonstrated competency, according to written
standardized procedures where applicable.
 Obtains informed consent, as indicated.
 Initiates arrangements for hospital admissions and discharges and completes
appropriate paperwork.
 As directed by the supervising physician, enrolls patients in investigational studies
approved by the Investigational Review Board (IRB), and orders the necessary tests
and medications. [see Appendix B: Administering, Ordering, Furnishing or Prescribing of
Drugs; Formulary Protocol] Medications that are not FDA-approved or are used for a
non-FDA-approved indication (off-label use) require a patient-specific order in advance
from the supervising physician.
 After appropriate training, assists the supervising physician in the operating room. The
RN First Assistant directly assists the surgeon and practices under the supervision of
the surgeon during the intraoperative phase. The RN First Assistant must adhere to
standardized procedures and not concurrently function as a scrub nurse.
 Recognizes and considers age-specific needs of patients.
 Effectively communicates and interacts with patients, families, staff and members of the
community from diverse backgrounds.
 Recognizes situations which require the immediate attention of a physician, and initiates
life-saving procedures when necessary.
 Facilitates the coordination of inpatient and outpatient care and services as needed.
 Facilitates collaboration between providers and coordination of community resources.
 Ensures compliance with legal, regulatory and clinical policies and procedures.
 Participates in quality improvement initiatives.
 Provides and coordinates patient teaching and counseling.
 Other duties as assigned.

Education Qualifications

 Master’s or Doctoral degree in nursing from an accredited college or university.

 Note: NPs hired prior to March 1, 2012 are not subject to this educational requirement.
 Graduate of an NP program accredited by the National League of Nursing Accrediting
Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE).

Licenses and Certifications

 RN - Registered Nurse - State Licensure And/Or Compact State Licensure and

 NP - Nurse Practitioner and
 NPF - NP Furnishing Number and
 BLS - Basic Life Support and
 DEA - Drug Enforcement Administration

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional
experience for our patients and families. Candidates for employment and existing
employees must adopt and execute C-I-CARE standards for all of patients, families and
towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and
represents a framework for patient-centered interactions. Simply put, we do what it
takes to enable and empower patients and families to focus on health, healing and
recovery.

You will do this by executing against our three experience pillars, from the patient and
family’s perspective:

 Know Me: Anticipate my needs and status to deliver effective care

 Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better
health
 Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity
and is committed to equal opportunity and non-discrimination in all of its policies
and practices, including the area of employment. Accordingly, SHC does not
discriminate against any person on the basis of race, color, sex, sexual
orientation or gender identity and/or expression, religion, age, national or ethnic
origin, political beliefs, marital status, medical condition, genetic information,
veteran status, or disability, or the perception of any of the above. People of all
genders, members of all racial and ethnic groups, people with disabilities, and
veterans are encouraged to apply. Qualified applicants with criminal convictions
will be considered after an individualized assessment of the conviction and the
job requirements.

The surgical PA practicing in Trauma Surgery exercises flexibility and adaptability to manage a
broad range of medical and surgical conditions under the supervision of licensed Trauma
Surgeon.
Because the spectrum of trauma surgery encompasses many organ systems, the trauma surgery
PA must be knowledgeable about a wide range of pathophysiology as well as how the injuries
sustained should be prioritized. Trauma remains the leading cause of death in the first four
decades of life and is surpassed only by cancer and atherosclerosis as the major cause of death in
all age groups.
Approximately 60 million injuries occur annually in the United States. Roughly one-half, or 30
million of these injuries require medical care, and 3.6 million require hospitalization. Nearly nine
million of these injuries are disabling - 300,000 permanent disabilities and 8,700,000 temporary
disabilities. For this reason, it is necessary that Trauma PAs have compassion for individuals
involved in a trauma and are able to deal with the social issues that subsequently arise.

Job Qualifications
 PA master degree
 Post-graduate surgical residency in General Surgery or Emergency Medicine, or have at
least two years of experience in either General Surgery or Emergency Medicine

General Duties & Responsibilities

 Evaluates the trauma victim and institutes immediate therapy
 Performs first assistant duties in the operating room
 Assists with post-operative management and follows the patient through the critical care
portion of their recovery
 Attends to the patient closely on the hospital surgical ward
 Enables continuity of care by following up in the Trauma surgery clinic
 Makes rounds with the attending surgeon and fills her/him in on pertinent issues
involving patient care
 Fields patient calls after hospital discharge or general follow-up questions
 Triages patients to the ER or trauma clinic
 Manages patients undergoing a broad range of procedures, including Orthopaedic, ENT,
OMFS, Urology and Vascular
 Determines when appropriate consultation is needed and speaks with that service
Surgical Ward Duties & Responsibilities
 Orders and interprets appropriate laboratory and diagnostic studies and collates data
 Requests and follows up on recommendations of consultants (usually after discussion
with the surgeon)
 Assesses fluid and electrolyte balance
 Manages and removes tubes and drains
 Formulates a differential diagnosis and confirms or refutes the options according to the
physical exam and data obtained
 Identifies and prioritizes surgical, medical and psychosocial problems
 Orders and renews appropriate medications

TRAUMA PA

Job Summary:

Provide surgical, medical and critical care services and contribute to the design and delivery of high
quality, cost effective, values- based patient care for our patients and patient care under the supervision
of physicians

Essential Duties:

Record medical histories, perform physical examinations, review diagnostic imaging and labs and
formulate accurate diagnoses under physician’s supervision.

Orders appropriate laboratory and diagnostic procedures.

Effectively develop and implement patient care treatment plans in consultation with supervising
physicians.

Consult with physician(s) when appropriate to assess patient condition and treatment.

Assist in the Operating Room as required.

Become credentialed and perform advanced bedside surgical procedures.

Ensure that medical charts, patient billing and related administrative duties are completed in a timely
manner.

Maintain current knowledge of medical practices and treatment, including participating in professional
development activities and maintaining licensure.
Attends required meetings and participates in committees as assigned.

Provides patient education. Instructs patient and family regarding medications and treatment Uses
Universal Precautions including personal protective equipment for anticipated contact with blood or
other potentially infectious materials.

Maintains HIPPA compliance and protects sensitive data at all times.

Adheres to organizational and department specific safety standards and guidelines.

Education:

Physician Assistant

Bachelor’s or Master’s degree preferred.

Completion of an accredited two- (2) year Physician Assistant program required.

Certification by the National Commission on Certification of Physician Assistants.

Advanced Registered Nurse Practitioner

Masters as Advanced Registered Nurse Practitioner

Board certification as either

Acute Care Nurse Practitioner

Adult-Geriatric Acute Care Nurse Practitioner

Experience:

At least 1 year of Physician Assistant or Advanced Registered Nurse Practitioner experience in

Emergency Medicine, Hospitalist, General Surgery or Trauma/Critical Care

and/or

Post graduate residency as a Surgical Physician Assistant or Advanced Registered Nurse Practitioner
preferred.

License/Certification:

CPR certification.

Physician Assistant

Possession of or eligibility for a HAWAII License as a Physician Assistant

Advanced Registered Nurse Practitioner

Possession of or eligibility for a Washington License as an Advanced Registered Nurse Practitioner

Possession of or eligibility for a Drug Enforcement Agency License for Schedule II Controlled Substances

Current Advanced Cardiac Life Support within the first year of hire

Advanced Trauma Life Support within the first year of hire

Fundamentals of Critical Care Support within the first year of hire

Additional Responsibilities:

Adhere to and exhibit our core values:

Integrity: Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness.

Compassion: Feeling with others, being one with others in their sorrows and joys, rooted in the sense of
solidarity as members of the human community.

Excellence: Outstanding achievement, merit, virtue; continually surpassing standards to

achieve/maintain quality.

Teamwork: Collaborate and be kind to internal and external teammates.

Stewardship: Treat organization resources as precious and work according to LEAN principles.

Professionalism: Act at all times with character, the skill, good judgment, and polite behavior that
reflects well on the organization.

Clinical Environment

Trauma nurse practitioners typically work in hospitals. Some trauma NPs may take some shifts working
in emergency departments, sharing duties with other emergency or acute care nurse practitioners.
However, hospitals also have a need for trauma expertise in intensive care units, burn units, and
outpatient trauma facilities. One of the most important things to note about working in trauma is that
no matter which part of the hospital a nurse practitioner works in, he or she is going to feel the time
pressure of treating trauma victims. In fact, open-heart surgery pioneer Dr. R. Adams Cowley first coined
the term “golden hour” for dealing with trauma patients. At the University of Maryland Medical Center,
the R. Adams Cowley Shock Trauma Center is one of the most advanced trauma centers in the world.
The staff is trained with the credo that “trauma is a time-related disease.” Regardless the working
environment, trauma nurse practitioners must be prepared to work efficiently and flexibly, with little
room for error.

They’re educated to work independently managing trauma patients or in conjunction with other
healthcare professionals. The Society of Trauma Nurses adds that these NPs can work under three
models: population-based, service-based, or physician-based. In population-based care, NPs follow
patients throughout the continuum of care, inpatient and outpatient. In service-based practice, NPs
follow inpatient trauma victims, while in physician-based models, NPs offer healthcare services for a
specific doctor’s patients regardless of their position in the continuum of care.

Typical Daily Procedures

Trauma nurse practitioners may fill various roles within healthcare on a regular basis, all revolving
around trauma patients. In many trauma settings, the NP provides the continuity of care. This means
that the same trauma nurse practitioner will assist with an initial assessment, carrying a patient through
surgery in collaboration with physicians and others, and eventually on to recovery. All this generally
happens in conjunction with providing education and support to the patient and his or her family.

In addition, daily tasks for trauma nurse practitioners may include:

Ordering medical tests and initiating emergency care

Planning, implementing, and evaluating treatments

Caring for wounds

Monitoring trauma patient progress

Serving as liaisons between various healthcare workers

Collaborating with teams of doctors, surgeons, case managers, nurses, social workers, and other
personnel

Performing daily trauma rounds

Completing discharge evaluations

Following up with patients

Communicating with consultants and families

Unlike trauma nurses, trauma NPs typically have more comprehensive prescriptive privileges (depending
on their state of practice authority), and may complete minor procedures such as catheter and chest
tube insertions or removals; taking out foreign objects; draining wounds; managing ventilators;
addressing complex injuries; and other first assisting responsibilities.
Traumatology, Surgical Critical Care
and Emergency Surgery
Trauma/Emergency Surgery Core
Competencies
Patient Care

 Fellows will gather essential and accurate information about their patients
 Fellows will make informed decisions about diagnostic and therapeutic interventions based
on patient information, scientific evidence, and clinical judgment
 Fellows will develop and carry out patient management plans in the Emergency
Department, Trauma Bay, Operating Room, ICU, and general care units
 Fellows will communicate effectively with consultants and other health care providers,
leading to patient focused care
 Fellows will communicate effectively and demonstrate caring and respectful behavior when
interacting with patients and families.

Medical Knowledge

 Fellows will demonstrate an investigatory and analytic thinking approach to patient care.
 Fellows will know and apply to their patients basic and clinically supportive science in
relation to blunt injury, penetrating injury, and emergency surgical pathology
 Fellows will develop a working knowledge of the aspects of managing the trauma team
and related personnel, while using triage concepts to stratify care to multiply injured, and
multiple patients.
 Fellows will develop a working knowledge of the administrative and management aspects
of running a Trauma Service.

Practice-Based Learning and Improvement

 Fellows will locate, appraise, and assimilate evidence from scientific studies related to
trauma and emergency surgery.
 Fellows will use critical appraisal of the literature in journal club and their own readings to
evaluate clinical studies as they relate to injured and critically ill surgical patients.
 Fellows will use information technology to manage patient information and support their
own education.

Interpersonal and Communication Skills

 Fellows will create and sustain a therapeutic and ethically sound relationship with patients.
 Fellows will work effectively with others as leaders of the Trauma team.

Professionalism

 Fellows will demonstrate a commitment to carrying out professional responsibilities and

adherence to ethical principles
 Fellows will demonstrate sensitivity and responsiveness to patients' culture, age, gender,
and disabilities.

Systems-Based Practice

 Fellows will understand how Trauma care and practices affect other health care
professionals, the care organization, and the larger society.
 Fellows will practice cost-effective health care and research allocation that does not
compromise quality of care.