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The Inpatient Advanced Practice Provider (APP) for the Department of Pulmonary and Critical Care Medicine provides comprehensive clinical services to hospitalized adult and geriatric patients with pulmonary and related cardiopulmonary conditions on the medical and surgical floors at Mary Washington Hospital and Stafford Hospital. The APP functions as an integral member of the inpatient pulmonary care team and practices in collaboration with the attending Pulmonologist under a formal practice agreement, in accordance with Commonwealth of Virginia regulations governing Nurse Practitioners and Physician Assistants. Daily co-rounding, joint patient staffing, and physician-led patient evaluation are core elements of the care model. Clinical decisions are reached collaboratively, with shared responsibility for the inpatient pulmonary plan of care between the APP and the collaborating physician. The APP also works closely with hospitalists, intensivists, nursing, respiratory therapy, and other allied health professionals.
Two (2) APP positions share continuous inpatient pulmonary coverage in an alternating 1-week-on / 1-week-off model. The standard on-week consists of seven (7) consecutive days of clinical coverage with daily shift duration of approximately 10 to 12 hours. APPs may rotate between Mary Washington Hospital and Stafford Hospital based on operational and patient care needs of the service line. Schedule, shift length, days of coverage, site assignment, and clinical assignments are subject to modification at the discretion of the Medical Director of Pulmonology to meet patient care needs and the operational requirements of the service line.
The APP is responsible for the assessment, diagnosis, and management of acute and chronic pulmonary conditions, participation in daily rounds, coordination of care, facilitation of discharges, and provision of patient and family education. The role includes ordering and interpreting diagnostic studies, prescribing pharmacologic and non-pharmacologic therapies, and performing approved pulmonary procedures, including chest tube management, intrapleural fibrinolytic administration, indwelling pleural catheter management, and ultrasound-guided thoracentesis.
The APP practices clinically under a formal practice agreement with the collaborating Pulmonologist(s) and operationally under the Vice President of Nursing Services or designee, in accordance with Commonwealth of Virginia regulations.
Essential Functions & Responsibilities
Clinical Care
Perform comprehensive inpatient evaluations, including history and physical examinations, for patients admitted with pulmonary diagnoses such as COPD, asthma exacerbations, pneumonia, pulmonary embolism, interstitial lung disease, respiratory failure, pleural disease (parapneumonic effusion, empyema, malignant effusion, hemothorax), bronchiectasis, hemoptysis, and tracheostomy-dependent patients on the floor.
Staff all inpatient pulmonary consult and follow-up patients daily with the collaborating Pulmonologist, including face-to-face rounding, case discussion, and joint development of the daily clinical plan.
Manage an expected daily inpatient consult and rounding census of approximately 10 to 20 patients, with workload distribution adjusted based on acuity, site coverage, and service line demand.
Participate in daily interdisciplinary rounds and manage ongoing inpatient pulmonary care jointly with the collaborating pulmonologist of the week.
Develop and implement evidence-based diagnostic and treatment plans, including ventilatory support recommendations, oxygen therapy, NIV (CPAP/BiPAP) and high-flow nasal cannula titration, and pulmonary hygiene strategies.
Order, review, and interpret diagnostic studies including laboratory tests, arterial blood gases, pulmonary imaging (CXR, CT chest, CT-PA), pleural fluid analysis, and non-invasive cardiopulmonary studies.
Prescribe pharmacologic and non-pharmacologic therapies within scope of practice and according to departmental and institutional guidelines.
Respond to acute changes in patient condition and serve as a clinical responder for floor pulmonary patients during Rapid Response and Code Blue activations, initiating emergency or life-sustaining interventions per BLS / ACLS protocols and coordinating timely ICU upgrade when indicated.
Facilitate timely discharge planning, including patient education, medication reconciliation, home oxygen qualification, DME coordination, and coordination with case management and post-acute care services.
Document all patient encounters clearly and accurately in the electronic medical record (Epic).
Support a physician-billed care model in which the collaborating Pulmonologist personally performs and documents the history and physical examination and the medical decision-making for each encounter and serves as the billing provider. APP notes are structured to support physician evaluation and management documentation, with the collaborating physician personally appending an attestation confirming participation in the history and physical examination and performance of the medical decision-making for each encounter billed under the physician's NPI.
Patient & Family Education
Educate patients and families regarding pulmonary diagnoses, treatment plans, procedures, medications, oxygen therapy, inhaler technique, action plans, and post-discharge expectations.
Provide counseling related to disease management, smoking cessation, and respiratory therapies (CPAP/BiPAP adherence, airway clearance regimens).
Ensure patient understanding and adherence to care plans, including teach-back verification at discharge.
Collaboration & Communication
Serve as a liaison between physicians, nursing staff, respiratory therapy, consulting services, and ancillary departments.
Request and coordinate specialty consultations as appropriate, including Interventional Pulmonology, Thoracic Surgery, Interventional Radiology, Oncology, Palliative Care, and Pulmonary Rehabilitation.
Coordinate scheduling for inpatient bronchoscopy, EBUS-TBNA, navigational bronchoscopy, thoracentesis, and chest tube placement.
Refer eligible patients to the weekly Thoracic Oncology / Lung Cancer Conference (Thursdays) and ensure required imaging and pathology are uploaded prior to discussion.
Communicate effectively with physicians, nurses, and other healthcare providers regarding patient status and plan of care.
Participate in quality improvement initiatives, policy development, and practice guideline review specific to inpatient pulmonary care.
Qualifications
Education
MSN (Nurse Practitioner) or MPAS (Physician Assistant) or equivalent required.
Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) track strongly preferred for the inpatient scope; FNP considered with relevant inpatient experience.
Licensure & Certification
Active, unrestricted Commonwealth of Virginia Nurse Practitioner or Physician Assistant license required.
National board certification (AACN, ANCC, or NCCPA) required.
Active DEA registration required.
AHA BLS Provider CPR required.
AHA Advanced Cardiovascular Life Support (ACLS) required.
MWHC will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status (EOE). We are also committed to equitable and transparent compensation practices and comply with all applicable pay transparency and pay equity laws.
Compensation Pay Range:
$58.61 - $73.26