NP/PA- Pre Liver Transplant

  • Mass General Brigham
  • MGH Main Campus 55 Fruit Street Boston 02114
  • Apr 28, 2023
Full time Nurse Practitioner (NP)

Job Description

 

Under the supervision and direction of the Division Chief and Senior Administrative Director, with additional collaboration and oversight from the Medical and Clinical Directors, and the Transplant Nurse Director, and in accordance with the rules and regulations of Massachusetts governing Nurse Practitioner (NP) or Physician Assistant (PA) practice, the Liver Transplant NP or PA - referred to collectively hereafter as Advanced Practice Practitioner (APP) - will be responsible for the intake and ongoing care of all patients referred to the liver transplant program. Under the direction of a hepatologist, the APP will be primarily responsible for the care of these patients from the time of referral until the time of liver transplant. The scope of the position includes: patient care, education (patient, MGH nursing staff, and community practitioners), quality assurance, administrative activities, and coordination of all pre-transplant care. There also may be with the opportunity to participate in research endeavors as time allows.

 
 
 

An APP is a registered healthcare professional with certification to provide clinical care in an expanded role to individuals, families and/or groups in a variety of care settings.  In collaboration with physicians, she/he is responsible for diagnosis, prescribing treatment, and providing follow-up care for patients during all phases of wellness and illness.  She/he initiates referrals for implementing the patient's total care plan involving other health disciplines within and outside the hospital.  The role of the APP has an emphasis on patient and family teaching and education. 

 
           
 
 
Clinical Practice
 
  • Has a sound knowledge of medical and scientific principles and appropriately applies those principles to practice.
  • Provides independent primary care practice.  She/he performs physical examinations, orders appropriate diagnostic testing, determines a care plan including prescribing medications, and follows patients appropriately utilizing society clinical guidelines as a basis for actions. The APP may assist physicians with procedures as necessary.
  • Performs medication management and reconciliation.
  • Functions in direct collaboration with the hepatologists and surgeons assigned to the Transplant Center.  Initiates, facilitates and develops interdisciplinary collaboration. Participates in all aspects of the pre-liver transplant patient’s care. The APP may also on occasion be involved with the management of post-transplant and general liver disease patients.

  • In collaboration with patients and families, she/he designs a plan of care based on an assessment of physical, emotional and social needs.

  • Identifies current trends in health care and their implication for clinical practice.

  • Responds to changes in clinical practice by planning, designing, implementing and evaluating institutional guidelines, protocols and standards in collaboration with other professional staff.

  • Completes clinic notes on patients in a timely fashion.

  • Follows up on all lab and radiology results on all assigned patients.

  • Participates in multi-disciplinary rounds and division-wide conferences as well as other key transplant patient management meetings.

  • Provides patient and family education throughout all parts of the patient’s care

  • Provides support and clinical management advice to local practitioners on all pre-liver transplant patients.

  • Applies innovative approaches to solving complex clinical problems.

  • For emergent issues and when physicians are unavailable, evaluate and manage patients and consult physicians as appropriate.

  • Facilitates patient transfers from outside hospitals and coordinates with appropriate parties to ensure a smooth transition of care.

  • Maintains patient's right to privacy; assuring patient dignity in the provision of care.

 
 
 
 
 
Pre-Transplant Responsibilities:
 
  • Facilitate the initial contact between all referring MDs and the MGH Liver Transplant Program. This will include direct outreach to community medical practices.

  • Identifies appropriate transplant evaluation candidates upon referral and interacts with appropriate staff as needed to make that determination.

  • Works with other team members to determine appropriate evaluation testing and to determine if any additional information from the referring physician(s) is required.

  • Perform a comprehensive review of the medical record.

  • The APPs will see all new transplant evaluation patients in the Pre-Transplant Multidisciplinary Clinics on Monday and Wednesday afternoons and will present these patients at Transplant Committee Meeting.

  • Sees new patients with cirrhosis not yet ready for a transplant evaluation in the MGH Liver Center under the direction of a hepatologist and provides follow-up care for these patients.

  • Reviews tests performed as part of the liver transplant evaluation and during all subsequent care up until the time of their liver transplant. 

  • Provides seamless care from the inpatient to the outpatient setting to for all pre-liver transplant patients admitted to the hospital through close communication with the Liver Consult Service. 

  • Obtains a translator if needed

  • Acts as a resource and provides support to the Transplant RN Coordinators and Administrative Assistants during the coordination of the care of all pre-liver transplant patients during all phases of their care: transplant evaluation, outpatient follow-up, and during any hospitalizations. 

  • Plays an active role in the evaluation of any patient referred for a liver transplant evaluation in the outpatient setting.  The evaluation should include, but is not limited to:

    • Medical/surgical evaluation
    • Educational assessment
    • Laboratory evaluation
    • Radiological evaluation
    • Nutritional evaluation
    • Psychosocial evaluation
 
  • Interprets serological and other test results of all the transplant candidates

  • Identifies all clinically important medical/surgical co-morbidities in the transplant candidates and evaluates as indicated.

  • Ensures that patient is assessed for presence of malignancy prior to listing

  • Identifies and assesses absolute and relative contraindications to transplantation

  • Ensures patient understands the risks and benefits of immunizations required prior to transplantation.

  • Functions as the candidate advocate by applying knowledge of growth, development, educational, and cultural background during candidate/family/legal guardian interactions.

  • Provides education to candidate/family/legal guardian about:

    • Evaluation process
    • OPTN regulations
    • Organ allocation
    • Waiting phase
    • Transplant process
  • Considers and reviews with candidates the risks/benefits of expanded criteria organs including HCV+ grafts and DCD organs.

  • Provides education to patients on the average transplant wait times for liver transplant based on underlying diagnosis and correlation with natural MELD exception MELD scores.  

  • Discusses with patients the availability of Transplant Center research protocols.

  • Identifies and responds to the psychosocial and economic needs of the transplant candidate/family/legal guardian during evaluation through close communication with Transplant Social Work, Transplant Psychiatry, and Financial Services.

  • Oversees the periodic, formal transplant reevaluations of patients on the waiting list.

  • Orders all preoperative procedures required (e.g. cardiac catheterization, biopsy) that will be booked by the Administrative Assistants.

  • Maintains timely communication with referring physicians, health care providers and payors

  • As circumstances require, the following are tasks that may be requested of the APP:

 
 
 
 
 
Relationship Management:
 
 
 
 
 
 
Other Duties:
 
  • Develops systems to ensure follow-up with patients, referring physicians and internal transplant team members.

  • Receives routine clinical questions or updates from patients, whether by phone or email.
  • Reviews patient questions with physician, when appropriate, and responds.
  • Documents all patient conversations or emails in the electronic medical record systems.
  • Monitors and responds, when indicated, to emails and phone calls that come into the Epic inbox and telephone line.
  • Participates as requested in practice, divisional, MGH and Partners quality initiatives. 
  • Participates in various hospital and system committees as assigned.
  • Maintains tracking system to determine program effectiveness.
  • Documents and reports all referring physician questions, concerns, complaints, and resolutions.
  • Meets routinely with transplant physicians and leadership to report on activities, referral patterns, customer satisfaction, problems, and recommendations.
  • Meets routinely with supervisors to review statistics, progress and overall performance of the program

 

Educational:
  • Develops and implements patient instructions for routine testing and procedures.

  • Acts as a resource to other care providers with questions about abdominal transplantation and its care management.

     
 
Professional Development
  • Maintains and updates knowledge and skills based on current education/nursing and health care practices.  Is encouraged to advance his/her medical and technical skills as appropriate to deliver optimum patient care.
  • Identifies own learning needs and goals, and designs a plan to meet them.
  • Participates in professional staff and student teaching both formal and informal.
  • Fulfills professional role through involvement in professional organization activities, presentations, publications and research.  Attends internal and external education meetings and reads appropriate professional journals to maintain and enhance skills and clinical competence.
  • Completes the 100 hours of continuing medical education necessary during each 2-year period of employment. 

 

Job Requirements

QUALIFICATIONS & SKILLS REQUIRED: 
  • Current Nurse Practitioner licensure in Massachusetts.
  • Current certification as a nurse practitioner and authorization to practice as a nurse practitioner in Massachusetts.
  • Master's degree required in nursing.
  • Minimum of 2 years relevant nursing experience.
  • Demonstrates maturity and self-confidence
  • Professional knowledge: Clinical, healthcare management knowledge to enable effective interactions and communications with clinicians, healthcare administrators, and other professionals.
  • Time Management: Exceptional organizational skills and ability to prioritize effectively and complete tasks; Flexibility to handle multiple tasks and deadline pressures. 
  • Leadership: Highly motivated, independent and capable of performing in a complex environment; Strong sense of initiative and work ethic to carry out tasks to completion; Demonstrates forthrightness and integrity.  Ability to identify issues/projects and initiate plans to address asking for direction when appropriate; Ability to communicate effectively, sell ideas, and take ownership and responsibility for activities. 
  • Interpersonal/communication:  Excellent interpersonal, written and oral communication; Good command of English language, including medical and scientific terminology.
  • Information Systems/Technology Skills:  Exceptional computer skills (including operating systems, word processing, database, electronic mail, Internet, spreadsheets, and other office management systems); Ability to maintain database and run associated analysis and reporting as needed to track growth of referrals.  
  • Quality Assurance: Skills to work efficiently and effectively and strive to do so in all aspects of position; Effective project management skills and attention to detail.
  • Critical Thinking/Decision Making:  Ability to appropriately evaluate all aspects of a situation and to independently make appropriate and timely decisions. 
  • Discretion and Confidentiality:  Ability to handle sensitive and confidential matters discreetly. 
  • Safety/Compliance:  Knowledge in aspects of safety applicable to position; Knowledge of and compliance with institutional, JCAHO, HIPAA, ACGME and other regulatory bodies’ standards.

 

 
ORGANIZATIONAL RELATIONSHIPS:
 
  • Works closely with abdominal transplant patients and their families.
  • Works as a member of the MGH Division of Transplant Surgery, which includes attending surgeons, attending medical physicians, staff, fellows, and ancillary personnel.
 
WORKING CONDITIONS:

Work will be performed in an inpatient and outpatient clinic setting, working primarily in the outpatient setting.  The work may require the lifting of heavy objects and patients, as well as exposure to potentially infective material.  Work requires contact with needles and other sharp instruments, monitoring devices, and other state-of-the-art equipment.  Prolonged standing can be expected.  Walking to and from the patient care units can be expected.  Hazards present from exposure to combustible anesthetic or disinfecting agents are minimized when safety precautions are strictly adhered.

 
 
SUPERVISORY RESPONSIBILITY:  

No direct supervisory responsibilities; however, is responsible for coordinating, organizing, and working with groups of individuals at all levels of the organization in arranging for patient access, in conducting day-to-day responsibilities and in managing various projects.  Will be required to carry a pager during business hours.

FISCAL RESPONSIBILITY:

No direct fiscal responsibilities; however, is responsible for prudent fiscal management of program resources (e.g. employee overtime, supplies, etc.).

 

Specialty

Transplant Nursing