Nurse Practitioner - Wound, Ostomy, Continence

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Duke Health Integrated Practice

Duke Health Integrated Practice comprises more than 110 primary and specialty outpatient clinics, extending the reach of the Duke Health mission across the state of North Carolina.

WOCN – Wound, Ostomy, Continence Nurse Practitioner

Position summary

The Oncology WOC Nurse Practitioner provides direct patient care services and performs medical acts as a Nurse Practitioner under the supervision of the supervisory physician to patients 12 years of age requiring management of wound, ostomy, and/or continence issues.

The Nurse Practitioner performs physical exams, collects and documents data, conducts diagnostic and therapeutic procedures, orders and schedules laboratory studies and professional consultations, prescribes appropriate interventions and medications, and provides direct patient care service. Provides leadership in the care of patients with wound, ostomy, and/or continence issues throughout the Cancer Center. This includes utilization of clinical expertise to provide preoperative and postoperative care, counseling, and teaching, educating nurses to ensure knowledge and competency in basic wound, ostomy and continence management; and working collaboratively with colorectal surgeons, urologists, GYN oncologists, radiation oncologists, and other physician specialists in planning and coordinating the care. 

The WOC Nurse Practitioner is an integral part of multiple teams, as a clinician, educator, consultant, leader, and investigator.

Position requirements

Position requires completion of an accredited Nurse Practitioner program, with certification as an Adult, Geriatric, Acute Care or Family Nurse Practitioner (FNP).  Must demonstrate and maintain credentialing and licensing requirements of Duke University Hospital, the North Carolina State Board of Nursing, and The North Carolina Medical Board.

Master's degree in Nursing required. Minimum of 5 years nursing experience highly desired. WOCN experience and certification required. Demonstrated self-direction, leadership, organization skills, and written and verbal communication skills.

Hours

Primary hours will be Monday-Friday, 8am-5pm, and other hours as needed to fulfill the responsibilities of the position. 

Responsible to

The Oncology WOC Nurse Practitioner will report directly to the Team leader and Director. The NP’s clinical practice is supervised by the designated Supervising Physician or under the supervision of all back-up attending physicians listed in the Supervising / Collaborative Practice Agreement.  In addition, s/he will be accountable for clinical outcomes and defined quality indicators as determined by the appropriate inpatient unit / Clinical Service Unit Balanced Score Card and to the standards set forth by the

Process of Evaluation

Evaluation will be ongoing and will encompass the six general areas of competency as defined by The Joint Commission (patient care, medical/clinical knowledge, practice-based learning & improvement, interpersonal & communication skills, professionalism and systems-based practice).  Annual and midyear evaluations using the CAP PPR process will be conducted by the Team Lead in coordination with NP/PA’s primary supervising physician.  Ongoing Review of Care and Quality Improvement meetings with supervising physician will be conducted and documented monthly for the first six months, in accordance with Duke University’s and the designated Board’s standards, then at least once every six months in accordance with the NC Medical Board. 

Specific Job Responsibilities and Standards

Clinical Expert

• Collaborate with physician(s) and healthcare team to assess, diagnose, plan, set priorities and realistic outcomes, and evaluate the effectiveness and cost efficiency of patient care.
• Provide evidence-based clinical care by actively engaging in review of literature
• May order and/or perform the following procedures:
1. Patient history and perform physical exam
2. Laboratory and or diagnostic procedures
3. Application of dressings and bandages.
4. Assess patients for change in status and institute appropriate interventions.

• Communicate verbally and in writing all pertinent patient information to supervising MD, referring MD, nursing staff, home health / hospice agency, and other relevant healthcare providers.
• Document in patients’ medical record all relevant data including but not limited to results of diagnostic tests; laboratory results; patients’ condition and response to therapies/interventions; communications with supervising MD.  

•  Utilize prescriptive privileges for identified patient population and in accordance with DUH and NC Board of Nursing/NC Medical Board regulations.

• Provides specialized nursing treatment, care, stomal siting, and education to patients undergoing urinary or stool diversion in accordance with physician/nursing orders and established policies and procedures.
• Provides specialized nursing treatment, care, and education to patients with draining wounds or requiring continence management or other specialized urologic interventions (such as clean intermittent self-catheterization or continuous bladder irrigation)
• Provides specialized nursing treatment, care, and education to patients with radiation dermatitis
• Serves as a resource to patients and families, providing preoperative counseling and follow-up problem solving after discharge from the hospital.  
• Utilizes comprehensive assessment skills in the evaluation of stoma and wound care products and supplies in an effort to provide quality, cost-effective care.
• Support nursing staff in providing evidence-based clinical care.
• Coordinate clinical practice and/or clinical program services to maximize patient outcomes and to accomplish the strategic objectives of the healthcare team and of the organization.
   
   

Educator:

• Assess educational needs of the Duke nursing staff and healthcare team as it relates to wound, ostomy, and continence care.
• Implement and evaluate appropriate educational programs for nursing staff, MDs, and other healthcare providers as appropriate.
• Role model and precept healthcare learners through contractual agreements.
• Assess educational needs of patients/families and provide culturally-sensitive patient/family interventions as indicated. Use non-technical language when educating patients/families. Document educational interventions in the patient’s medical record. 
  
  Research Utilization and Investigation

• Utilize current research and evidence-based decision-making in all clinical practice.
• Incorporate clinical research findings in the development and implementation of standards of patient care.
• Participate in measuring and documenting outcomes.
• Provide leadership for nursing research.
• Participate in interdisciplinary quality improvement and/or research activities.

 
Consultant

• Serves as a resource and consultant to nursing, members of the healthcare community, and to the larger community in areas of wound, ostomy, and continence management strategies.
• Designs, implements and evaluates programs and projects to facilitate the institutional goals and objectives for wound, ostomy, and continence management.
• Provides leadership in the assessment, development and implementation of policies/procedures, clinical pathways, and standards of care related to wound, ostomy, and continence management.
• Provides leadership in the development of patient education materials that enhance patient care outcomes within clinical specialty.
• Participates in and supports accreditation and regulatory activities of Duke Hospital.
• Serves as an effective change agent, using strategies such as navigating complex systems, promoting effective communications, and representing the broader context of care delivery.

 
Professional Development and Leadership

• Role model professional nursing through conduct, appearance, communication, mutual respect, leadership, ethical decision-making, critical thinking, and problem-solving skills.
• Supports and participates in the strategic plan for the Duke University Health System, Department of Nursing, and Department of Advanced Practice Nursing.
• Communicates effectively to maintain positive working relationships.
• Demonstrates responsibility for professional practice through active participation in professional organizations, and in maintaining both ANP and WOC certification. 
• Enhances the body of knowledge in nursing through exchange of ideas and knowledge using venues such as presentations, publications, posters, and internet.
• Maintains all professional requirements for licensure and certification.
• Participates in Oncology Nursing Leadership activities related to practice, education and research.
   
  

Behavior Standards:

Excellence – We strive to achieve excellence in all that we do.

Standards:

• Acts – and makes decisions – in the best interests of patients and their loved ones, and willingly accepts accountability for outcomes.
• Improves performance that enhances patient care and advances individual, team and organizational goals.
• Effectively uses DUHS resources (time, budget and property) to support optional patient care and operational performance while adhering to organizational policies and procedures.
• Seeks opportunities to improve service provided to patients and their loved ones related to clinical care and support.

Safety – We hold each other accountable to constantly improve a culture that ensures the safety and welfare of all patients, visitors and staff.

Standards:

• Strictly adheres to all established patient, staff and faculty safety procedures.
• Contributes to an environment of safety and security for patients and staff through individual actions.
• Speaks up about all risk of harm; reports patient, staff safety or injury events within twenty-four hours of incident or awareness of incident.
• Actively participates in all mandatory patient and staff safety training.

Integrity – Our decisions, actions, and behaviors are based are based on honesty, trust, fairness, and the highest ethical standards.

Standards:

• Is truthful and honest with patients, their loved ones, and co-workers, and consistently exhibits actions that reflect our values.
• Is accountable for actions and decisions involving patient care or other operational activities, and strives to learn and improve from experience.
• Follows through on commitments made to patients, visitors, co-workers, and others.
• Conducts work positively while doing so in full compliance with all organizational policies, procedures, expectations and patient-centered values.

Diversity – We embrace differences among people.

Standards:

• Applies cultural understandings and sensitivities to enhance patient care, and improves interactions with people of diverse backgrounds.
• Treats all individuals – patients, visitors and co-workers – with courtesy, dignity and respect.
• Contributes to a work environment that is welcoming to all – whether patients, visitors, staff or faculty.
• Demonstrates a sensitivity and awareness of the needs of a diverse workforce and patient population.

Teamwork – We have to depend on each other and work well together with mutual respect to achieve common goals.

Standards:

• Willingly shares expertise and information with others to improve patient care, unit or departmental performance without compromising individual responsibilities.
• Celebrates the accomplishments of others in making a difference in the lives of patients and the success of the organization.
• Takes ownership of decisions made by specific patient care or project teams, and team leaders, and the individual role needed to support them.
• Manages multiple demands while maintaining quality and courtesy; acknowledges and resolves patient or visitor issues.

Physical and mental requirements:

• Able to clearly articulate scope of practice, and practices within those guidelines as a Nurse Practitioner / Physician Assistant

• Able to independently seek out resources and work collaboratively to solve complex problems

• Able to communicate clearly with patients, families, visitors, healthcare team, physicians, administrators, leadership, and others.

• Able to use sensory and cognitive functions to process and prioritize information, perform health assessments, treatment, and follow-up.

• Able to use fine motor skills

• Able to record activities, document assessments & interventions; prepare reports and presentations;
• Able to use computer and learn new software programs
• Able to provide leadership in clinical area of expertise and in meeting organizational goals
• Able to navigate the Hospital and DUHS to provide clinical expertise to specific patient populations

• Able to withstand prolonged standing and walking with the ability to move or lift at least fifty pounds
• Able to remain focused and organized
• Able to work collaboratively with all levels of personnel
   

Working conditions:

The work environment involves risk discomforts that are typical of an acute care setting to include working with patients under isolation and universal precautions. It requires safety precautions, ongoing education and health risk monitoring.  Contact with specimens, chemicals, sharps, radiation, technical equipment and fumes are possible.  Employees are required to wear personal protective attire according to hospital policies and OSHA guidelines.  The work activity and patient acuity levels can create a stressful atmosphere.