Pediatric Cardiac Stepdown Advanced Practice Provider (APP)
Work Arrangement:
Requisition Number: 271974
Regular or Temporary: Regular
Location:
Durham, NC, US, 27710
Personnel Area: DUKE HOSPITAL
Date: Sep 3, 2026
At Duke Health, we're driven by a commitment to compassionate care that
changes the lives of patients, their loved ones, and the greater community. No
matter where your talents lie, join us and discover how we can advance health
together.
About Duke University Hospital
Pursue your passion for caring with Duke University Hospital in Durham, North
Carolina, which is consistently ranked among the best in the United States.
The largest of the four Duke Healthhospitals with 1062 patient beds, it
features comprehensive diagnostic and therapeutic facilities, including a
regional emergency/trauma center, an endo-surgery center, and more.
Duke University Hospital
Center for Advanced Practice
Pediatric Cardiac Stepdown Advanced Practice Provider (APP)
Nurse Practitioner or Physician Assistant
Job Location
Duke University Hospital
Job Summary
The Duke Hospital Pediatric Cardiac Stepdown Advanced Practice Provider
(APP), including both Nurse Practitioner (NP) and/or Physician Assistant
(PA), provides direct patient care services for critically ill pediatric
patients aged 0-21 with acute, complex, and chronic illness across a variety
of care settings. It is appropriate for the NP to provide care for an aging
pediatric patient beyond the age of 21 with a pediatric condition for a
limited period of time.
Utilizing acquired knowledge of physiology, pathophysiology and pharmacology,
the Pediatric Cardiac Stepdown APP exercises independent decision making in
the assessment, diagnosis and development of the plan of care for patients on
the Pediatric Cardiac stepdown service. In collaboration and consultation with
the supervising physician, the APP contributes to excellence in patient care.
As an advanced practice provider, the APP is additionally involved in
education, consultation, research and leadership throughout the Duke Health
System, organization and profession.
Job Duties and Responsibilities
Clinical Expert
In collaboration with the attending of service and/or residents, round
daily on patients to assess, diagnose, plan treatment, set priorities and
realistic outcomes, and evaluate the effectiveness and cost efficiency of
patient care.
Provide and coordinate clinical care for service specific patients through
established protocols and under the hospitalist supervising physician or
back up physician who is either on site or available by pager.
Collaborate with the chief resident, residents, fellows, attending other
APP colleagues, nurses, and patient resource managers to formulate
treatment plans and monitor patient progress.
Perform procedures specific to the work environment after demonstrated
competency and within the guidelines of scope of practice and
credentialing protocols.
Assess patients for change in status and institute appropriate
interventions. Initiate emergency interventions in an effort to stabilize
the patient until physician support arrives.
Postoperative stabilization and management.
Develop patient care pathways, protocols and guidelines for the management
of specific problems in conjunction with physicians and other members of
the health care team.
Analyze clinical practice patterns so as to provide the best medical care
and to increase effectiveness and efficiency.
Communicate verbally and in writing all pertinent patient information to
supervising MD, nursing staff, patient resource manager, home health
agency, and other relevant healthcare providers.
Document in the 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 only for identified patient population.
Prescriptive authority for prescribing, ordering, and or administering
drugs; including (but not limited to) schedule II, III, IV, and V drugs
and necessary medical devices.
Role model competence in all nurse practitioner / physician assistant
advanced skills.
Give daily handoff to appropriate attending, APP, resident and/or intern
at the end of the shift.
Educator:
Assess educational needs of the patient-care staff and provide one-on-one
as well as formal education as needed.
Assess educational needs of the patients / families and provide
culturally-sensitive patient/family education interventions as indicated.
Use non-technical language when educating patients and families. Document
all education in patients' medical record.
Implement and evaluate appropriate educational programs for DUHS patient
care staff and other healthcare providers as appropriate.
Role model and precept healthcare learners through contractual agreements.
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 care.
Support IRB approved clinical research/trials though a variety of
activities including but not limited to: obtaining consent; ordering
diagnostic tests; recording laboratory & diagnostic results; administering
therapeutic interventions; and reporting patient outcomes including
toxicities or adverse events.
Participate in interdisciplinary quality improvement and/or research
activities.
Participate in measuring and documenting outcomes.
Consultant:
Provide expertise and resource information to other healthcare providers,
patients and families, and the community at large related to pediatric
diseases, procedures, interventions, and conditions.
Implement and evaluate appropriate educational programs for referring MDs
Develop, implement and evaluate standards of care/practice
guidelines/policies and procedures/care maps/protocols within area of
specialization.
Develop programs and projects in areas of expertise to facilitate the
attainment of the goals and objectives of the Duke University Hospital and
Duke University Health System.
Professional Leadership and Development:
Role model advanced practice professionalism through conduct,
communication, dress, leadership, ethical decision-making, critical
thinking and problem solving skills.
Participate in at least one professional organization.
Demonstrate responsibility for professional practice through active
participation in the CAP, and professional organizations. Meet Continuing
Education requirements as designated by the NC Medical Board and/or NC
Nursing Board. Maintain professional certification.
Enhance the body of knowledge in area of specialization through written
publications, oral presentations, posters, continuing education, etc.
Maintain all professional requirements for licensure and certification
Job Eligibility Requirements
Education
NP: Graduate of an accredited MSN or DNP Acute Care Pediatric Nurse
Practitioner program.
PA: Graduate of an ARC accredited Physician Assistant program.
Licensure
NP: Current unrestricted RN licensure issued by or recognized by the NCBON
with authorization to practice as an NP
PA: Current unrestricted medical license issued by the NCMB with authorization
to practice as a PA
Certification
NP: National certification as an NP (PNP-AC is the only certification
accepted)
PA: PA-C
Experience
Prior experience as a Nurse Practitioner/Physician Assistant in a pediatric
acute care clinical setting strongly preferred with preference for a cardiac-
specific background. Registered Nurses with at least 2 years of pediatric
cardiac nursing experience preferred.
Physical and mental requirements
Able to clearly articulate scope of practice, and practices within those
guidelines as a Nurse Practitioner / Physician Assistant in the state of
North Carolina and within the Duke University Health System.
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
Job Hours
12-hour shifts to provide day and night coverage 7 days a week including
holidays. Rotating schedule, nocturnist (nights-only) schedule, and weekend-
only schedule options available.
Duke is an Equal Opportunity Employer committed to providing employment
opportunity without regard to an individual's age, color, disability, gender,
gender expression, gender identity, genetic information, national origin,
race, religion, sex (including pregnancy and pregnancy related conditions),
sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation,
creativity, and belonging. Our collective success depends on the robust
exchange of ideas—an exchange that is best when the rich diversity of our
perspectives, backgrounds, and experiences flourishes. To achieve this
exchange, it is essential that all members of the community feel secure and
welcome, that the contributions of all individuals are respected, and that all
voices are heard. All members of our community have a responsibility to uphold
these values.
Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include
essential job functions that require specific physical and/or mental
abilities. Additional information and provision for requests for reasonable
accommodation will be provided by each hiring department.
Nearest Major Market: Durham
Nearest Secondary Market: Raleigh
