Family Nurse Practitioner/ Physician Assistant

Summary
The population in primary care family practice includes newborns, infants, children, adolescents, adults, pregnant and postpartum women, and older adults. The focus of care is the family unit, as well as the individuals belonging to the family, however the family chooses to define itself. The family nurse practitioner or physician assistant is a in the context of community, with broad knowledge and experience with people of all ages. Engages in a patient-centered approach to providing care for patients and their families. FNP/PAs demonstrate a commitment to family-centered care. FNP/PAs practice primarily in ambulatory care settings.

Essential Functions
Must be able to perform the essential functions of the job.

I. HEALTH PROMOTION, HEALTH PROTECTION, DISEASE PREVENTION, AND TREATMENT
The FNP/PA is a provider of direct health care services. Within this role, the FNP/PA synthesizes theoretical, scientific, and contemporary clinical knowledge for the assessment and management of both health and illness states. These competencies incorporate the health promotion, health protection, disease prevention, and treatment focus of a family practice.

A. Assessment of Health Status
These competencies describe the role of the FNP/PA in assessing all aspects of the patient’s health status, including for purposes of health promotion, health protection, and disease prevention. The FNP/PA employs evidence-based clinical practice guidelines to guide screening activities, identifies health promotion needs, and provides anticipatory guidance and counseling addressing environmental, lifestyle, and developmental issues.

1. Obtains and accurately documents a relevant health history for patients of all ages and in all phases of the individual and family life cycle.

2. Assesses (a) the influence of the family or psychosocial factors on patient illness, (b) conditions related to developmental delays and learning disabilities in all ages, (c) women’s and men’s reproductive health, including, but not limited to, sexual health, pregnancy, and postpartum care, and
(d) problems of substance abuse and violence.

3. Performs and accurately documents appropriate comprehensive or symptom-focused physical examinations on patients of all ages (including developmental and behavioral screening and physical system evaluations).

4. Performs screening evaluations for mental status and mental health.

5. Identifies health and psychosocial risk factors of patients of all ages and families in all stages of the family life cycle.

6. Demonstrates proficiency in family assessment.

7. Demonstrates proficiency in functional assessment of family members (e.g, elderly, disabled).

8. Assesses specific family health needs within the context of community assessment.

9. Identifies and plans interventions to promote health with families at risk.

10. Assesses the impact of an acute and/or chronic illness or common injuries on the family as a whole.
11. Distinguishes between normal and abnormal change with aging.

B. Diagnosis of Health Status
The FNP/PA is engaged in the diagnosis of health status. This diagnostic process includes critical thinking, differential diagnosis, and the integration and interpretation of various forms of data. These competencies describe this role of the FNP/PA.

1. Identifies signs and symptoms of acute physical and mental illnesses across the life span.

2. Identifies signs and symptoms of chronic physical and mental illness across the life span.

3. Orders, performs, and interprets age-, gender-, and condition-specific diagnostic tests and screening procedures.

4. Analyzes and synthesizes collected data for patients of all ages.

5. Formulates comprehensive differential diagnoses, considering epidemiology, environmental and community characteristics, and life stage development, including the presentation seen with increasing age, family, and behavioral risk factors.

C. Plan of Care and Implementation of Treatment
The objectives of planning and implementing therapeutic interventions are to return the patient to a stable state and to optimize the patient’s health. These competencies describe the physician assistant’s role in stabilizing the patient, minimizing physical and psychological complications, and maximizing the patient’s health potential.

1. Provides health protection, health promotion, and disease prevention interventions/treatment strategies to improve or maintain optimum health for all family members.

2. Treats common acute and chronic physical and mental illnesses and common injuries in people of all ages to minimize the development of complications, and promote function and quality of living.

3. Prescribes medications with knowledge of altered pharmacodynamics and pharmacokinetics with special populations such as infants and children, pregnant and lactating women, and older adults.

4. Adapts care to meet the complex needs of older adults arising from age changes and multiple system disease.

5. Identifies acute exacerbations of chronic illness and intervenes appropriately.

6. Evaluates the effectiveness of the plan of care for the family, as well as the individual, and implements changes.

7. Evaluates patient’s and/or other caregiver’s support systems and resources and collaborates with and supports the patient and caregivers.

8. Assists families and individuals in the development of coping systems and lifestyle adaptations.

9. Makes appropriate referrals to other health care professionals and community resources for individuals and families.

10. Provides care related to women’s reproductive health, including sexual health, prenatal, and postpartum care.

11. Assesses and promotes self-care in patients with disabilities.

12. Performs primary care procedures, including, but not limited to, suturing, minor lesion removal, splinting, microscopy, and pap tests.

13. Recognizes the impact of individual and family life transitions, such as parenthood and retirement, on the health of family members.

14. Uses knowledge of family theories and development to individualize care provided to individuals and families.

15. Facilitates transitions between health care settings to provide continuity of care for individuals and family members.

16. Intervenes with multigenerational families who have members with differing health concerns.

17. Assists patient and family members to cope with end of life issues.

18. Applies research that is family-centered and contributes to positive change in the health of and health care delivery to families.

19. Accurately and thoroughly completes patient records in a timely manner.

II. PROVIDER-PATIENT RELATIONSHIP
Competencies in this area demonstrate the personal, collegial, and collaborative approach which enhances the FNP/PA’s effectiveness of patient care. The competencies speak to the critical importance of interpersonal transactions as they relate to therapeutic patient outcomes.

1. Maintains a sustaining partnership with individuals and families.

2. Assists individuals and families with ethical issues in balancing differing needs, age-related transitions, illness, or health among family members.

3. Facilitates family decision-making about health.

III. TEACHING-COACHINGFUNCTION
These competencies describe the FNP/PA’s ability to impart knowledge and associated psycho-motor skills to patients. The coaching function involves the skills of interpreting and individualizing therapies through the activities of advocacy, modeling, and tutoring.

1. Demonstrates knowledge and skill in addressing sensitive topics with family members such as sexuality, finances, mental health, terminal illness, and substance abuse.

2. Elicits information about the family’s and patient’s goals, perceptions, and resources when considering health care choices.

3. Assesses educational needs and teaches individuals and families accordingly.

4. Provides anticipatory guidance, teaching, counseling, and education for self-care for the identified patient and family.

IV. PROFESSIONAL ROLE
These competencies describe the varied role of the FNP/PA, specifically related to advancing the profession and enhancing direct care and management. The FNP/PA demonstrates a commitment to the implementation, preservation, and evolution of the FNP/PA role. As well, the FNP/PA implements critical thinking and builds collaborative, interdisciplinary relationships to provide optimal care to the patient.

1. Demonstrates in practice a commitment to care of the whole family.

2. Recognizes the importance of participating in community and professional organizations that influence the health of families and supports the role of the FNP/PA.

3. Interprets the FNP/PA role in primary and specialty health care to other health care providers and the public.

4. Serves as a resource in the design and development of family community-based health services.

V. MANAGING AND NEGOTIATING HEALTH CARE DELIVERY SYSTEMS
These competencies describe the FNP/PA’s role in handling situations successfully to achieve improved health outcomes for patient, communities, and systems through overseeing and directing the delivery of clinical services within an integrated system of health care.

1. Maintains current knowledge regarding state and federal regulations and programs for family health care.

VI. MONITORING AND ENSURING THE QUALITY OF HEALTH CARE PRACTICE
These competencies describe the FNP/PA’s role in ensuring quality of care through
consultation, collaboration, continuing education, certification, and evaluation. The monitoring function of the role is also addressed relative to monitoring one’s own practice as well as engaging in interdisciplinary peer and systems review.

VII. CULTURAL COMPETENCE
These competencies describe the FNP/PA’s role in providing culturally competent
care, delivering patient care with respect to cultural and spiritual beliefs, and making health care resources available to patients from diverse cultures.

Non-Essential Job Functions
• Attend and participates in staff meetings and in-services as assigned.
• Adhere to and support UHC’s policies, practices and procedures.
• Accept assigned duties in a cooperative manner and perform all other related duties as assigned by Supervisor.
• Work scheduled shifts.

Knowledge, Skills and Abilities
• Must be able to demonstrate a working knowledge of computers, fax, phone and other office machines.
• Must have excellent communication skills, be able to cope with mental and emotional stress related to the position, function independently, and have flexibility and personal integrity.
• Must demonstrate on an ongoing basis the ability to develop and maintain good working relationships with co- workers.

Working Conditions/Physical Demands
Requires frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling. Ability to communicate verbally, and in writing with an excellent comprehension of the English language. Work is generally performed in an indoor, well-lighted, well-ventilated, heated and air-conditioned environment.

Education/Certification/Licensure
1. Must hold an active North Carolina NP/PA license
2. Must hold active certificate issued by the North Carolina State Board of Nursing and/or Medicine to practice in NC.
3. Must have completed an accredited, Board-approved master’s or post-master’s nurse practitioner/physician assistance program or other Board-approved program that awarded an advanced degree or course of study considered by the Board to be equivalent to that required for certification in NC at the time the course was completed.
4. Must have a valid and unrestricted DEA certificate.
5. Experience in family practice preferred.
6. Excellent interpersonal skills required.
7. Must be computer literate.