HCSS Pediatric Extracorporeal Membrane Oxygenation (ECMO) RN

JOB SUMMARY:Competent Clinician. Possesses knowledge and skill to meet standards for competent professional nursing practice as specified in the Texas Nurse Practice Act. Experienced, knowledgeable, and skilled in specialty area. Competently functions as a member of the interdisciplinary team. Practice is characterized by predominantly interdependent decision-making. Practice is problem focused and patient centered in the manner care is provided. Able to manage unexpected or emergency situations that are commonly seen in assigned specialty population. Serves as a resource for Nurse Clinician I or II. Can manage commonly seen contingency situations that arise on the clinical unit. Provides patient care through nursing practices based upon the American Nurses Association Standards of Professional Practice, and Professional Performance. Values specialty unit, nursing, and institutional strategic initiatives and health system goals.

ESSENTIAL JOB FUNCTIONS
 The ECMO Specialist consults with the ECMO manager and physician when patient condition and/or protocol limits or directives are in question.
 Technical Skills: The ECMO Specialist performs his/her job demonstrating technical ability, understanding of job expectations and compliance with organizational policies and procedures. The ECMO Specialist performs the following job responsibilities:
     - In collaboration with the ECMO physician, evaluates chest x-rays for endotracheal tube placement, cannula position, and status of the lung fields in determining patient status and weaning guidelines; supports and maintains patency of the cannula while patient is undergoing ECMO.
     - Assesses the cardiovascular (hemodynamic) status of the patient through test results (e.g. ABG’s, CBC, etc.) and physical assessment findings.
     -  Performs patient assessment to anticipate and prevent potential problems (e.g., variances in blood pressure, perfusion, and heart rate).
     - Works with bedside nurse to provide care to patient.
     - Monitors the ECMO circuit for air or clots.
     - Infuses blood products, fluids, and/or medications per ECMO protocol.
    - Verifies and implements physician’s orders pertaining to drug dosages and monitors potential drug interactions pertaining to the ECMO patient.
     - Monitors and manages fluids according to ECMO protocol and maintains accurate intake and output records to ensure appropriate fluid levels.
     - Assesses oxygenator function by comparing pre and post oxygenator blood gases
     - Under the direction of a trained ECMO physician ensures lab values are within ordered parameters.
     - Maintains anticoagulation status for the patient based on ordered parameters for aPTT and adjusts Heparin infusion to maintain aPTT within ordered range.
     - Maintains arterial blood gas parameters by adjusting pump flow or oxygenator sweep.
     - Troubleshoots and replaces malfunctioning components of the ECMO circuit.

 Communication & Collaboration: The ECMO Specialist will participate as a member of ECMO Team working with the health care providers in providing quality care for the patient and their family. The ECMO Specialist will demonstrate respect and cooperation in fulfilling the goals and mission of UTMB and the ECMO program.
     -Initiates multidisciplinary collaboration to positively impact the outcomes of care provided.
    - Collaborates with the health care team in the provision of patient care.
    - Recommends modifications in patient management to the ECMO physician based on the relationship between patient diagnosis and ECMO circuit and/or lab parameters.
-      Communicates effectively with the health care team and patients and their families.
     - Initiates steps to support and enhance the patient’s responsibility and self-determination in decision-making concerning health, treatment and well-being.
     - Develops, maintains, and terminates therapeutic relationships with patients and families.
     - Demonstrates good interpersonal communication skills with the health care provider and the patient and their family. All communications, verbal and written, should demonstrate a commitment to customer service and excellence.
 Improvement: The ECMO Specialists will accurately identify and diagnose an issue, identify alternatives, implement a plan, evaluate and communicate results.
 Follows protocol to maintain hematocrit or hemoglobin within the ordered parameter
 Follows protocol to maintain platelet count within the ordered parameter
Marginal or Periodic Functions:
 Adheres to internal controls and reporting structure.
 Performs related duties as required. 

Nursing Process

·         Competently and independently assesses, plans, implements, evaluates, and documents the daily care of assigned patients

·         Competently identifies patient care needs, formulates appropriate nursing diagnoses, develops, and individualizes care plan, and revises plan of care as needed

·         Competently executes physician's orders for all assigned patients. Administers medications and treatments and delivers culturally congruent and specialty appropriate competent nursing care in accordance with UTMB's policies, procedures, and standards in a caring and compassionate manner

·         Competently and independently performs routine and complex technical procedures/skills in assigned specialty area

·         Patient/Family Teaching & Health Promotion

·         Provides uncomplicated and complex patient/family instruction and healthcare teaching based on identified learning needs (patient values, beliefs, barriers, and readiness to learn)

·         Coaches others in strategies for patient/family inclusion and serves as a resource to others for patients/families with complex learning needs

·         Identifies potential impact of family dynamics*

·         Utilizes evidence-based resources to provide patient/family education

·         Utilizes evidence-based teaching strategies such as Teach-Back, AskMe3®, return demonstration, etc.

Care Coordination & Delegation

·         Competently and independently plans, coordinates, and prioritizes patient care activities according to skill level and work complexity

·         Maintains safety and continuity of care using methods such as bedside shift report, hand-off tools/processes, inter-disciplinary care rounds, etc.; Role models and coaches others to utilize these methods

·         Demonstrates flexibility in time management to manage changing patient priorities; coaches and supports others to plan, coordinate and prioritize care

·         Demonstrates competent use of technology in the delivery of patient care and serves as a resource and provides trouble shooting support to others

·         Delegates appropriately; may seek guidance or clarification of non-routinely delegated tasks

Ethics (legal/regulatory), Advocacy & Culturally Congruent Care

·         Identifies ethical situations and initiates appropriate communication/consultation to address

·         Delivers culturally congruent care using available resources to meet the needs of patient/family; recognizes situations in which personal bias may influence

·         Serves as a patient advocate; may seek guidance/assistance in difficult situations

Communication & Collaboration

·         Supports healthy work environment by demonstrating respectful verbal and non-verbal communication with all members of the healthcare team; may seek support with challenging communication issues; addresses behavior that does not support respectful environment

·         Recognizes colleagues when they go above and beyond in demonstrating UTMB’s core values.

·         Plans, coordinates, and prioritizes patient care activities in collaboration/communication with inter-professional team, including consult recommendations

Leadership

·         Recognizes informal and formal unit/hospital leaders and can educate colleagues regarding unit/hospital leadership

·         Recognizes unit, nursing, and institutional strategic initiatives and health system goals

·         Recognizes the importance of financial responsibility to promote fiscal health for the patient, unit, and organization

·         Demonstrates openness to change by actively seeking knowledge and needed information; uses positive communication and role modeling to promote understanding of change to colleagues

·         Functions as a unit leader, providing direction and assistance to team members.

·         Mentors others and promotes professional development of less experienced colleagues

Education, Evidence-Based Practice & Research

·         Actively attends/participates in unit meetings/activities and supports the philosophy and goals of the unit/department and UTMB

·         Mentors others and develops learning opportunities

·         Demonstrates knowledge and utilization of evidence-based resources to guide patient care; coaches colleagues to utilize evidence-based resources

Quality, Resources & Safety

·         Identifies patient safety concerns, and reports appropriately; addresses immediate safety concerns appropriately

·         Coaches others regarding unit quality metrics/outcomes data and improvement activities; actively engages in discussion, activities related to unit goals; Participates in systematic processes to achieve quality outcomes

·         Demonstrates self-care through practices that support personal well-being, personal safety, and injury prevention

·         Serves as a resource to colleagues regarding the Electronic Health Record; identifies opportunities for system improvements and communicates ideas via appropriate channels

General Requirements:

·         Completes required specialty specific Competency Based Orientation (CBO) tools by the initial performance evaluation due date for placement in employee file.

·         Actively participates in the initial and ongoing evaluation of competency using Competency Based Orientation (CBO) tools and e-performance nursing evaluation.

·         Completes the annual self-evaluation on time for competency and performance evaluation.

·         Performs and reports point of care testing (POCT).

·         Prioritizes and organizes work so that required assignments are completed within a specified time frame.

·         Provides and maintains a clean, safe environment and performs and/or assists others to perform proper aseptic technique, isolation procedures and infection control measures.

·         Demonstrates acceptable productivity and practices cost containment for the unit/hospital and the patient.

·         Competently and consistently completes accurate, concise, and legible documentation on all patient, unit, and hospital records (including care delivery and telephone patient related interactions).

·         Competently utilizes electronic forms of communication and documentation.

·         Meets periodic UTMB and unit specific compliance requirements for health screening, training, attendance, safety, and CPR

·         Adheres to internal controls and reporting structure.

·         Performs related duties as required.