NURSE PRACTITIONER

DEFINITION OF CLASS:

This is specialized professional community health nursing work providing direct primary care, comprehensive nursing, therapeutic and preventive health care services in an expanded nurse role as a nurse practitioner to individuals, families and groups in clinics, health centers, schools, offices and other community locations. Clients served are of all ages from diverse cultural backgrounds. Contacts are with clients, their families, physicians, Health Department and County Government staff, school personnel, public and private health-related and social service agencies to exchange work information, consult, teach, collaborate, resolve problems and coordinate care. Public Service/Assistance is provided through the lengthy and detailed questioning of clients to determine the nature of service and assistance required, and through the provision of specialized direct care.

A Nurse Practitioner is responsible for providing care to clients by assessing clients' health status, conducting physical examinations, providing treatment and prescribing medications, recommending follow-up care, and making referrals to appropriate health professionals. In addition, an employee in this class provides health teaching, counseling and guidance to clients and their families. Work is performed under the direction of a higher level nurse who provides administrative and professional nursing supervision, and under the technical direction of a physician with whom a joint formal written contract has been signed. This agreement serves as the basis for the performance of nurse practitioner functions. It allows the nurse to provide direct medical care services ordinarily performed by a physician, e.g., conducting physical examinations, ordering laboratory tests, interpreting test results and conducting treadmill stress tests. Performance of this work affects the physical well-being of patients. An employee in this class performs work in accordance with guidelines including but not limited to the Maryland Nurse Practice Act, Code of Maryland Regulations concerning Practice of the Nurse Practitioner, and established Health Department policies, procedures and practices. The employee uses these guidelines to determine which client conditions can be treated directly and which ones warrant referral to a physician, emergency room, or other health professional. Employees in this class have diagnostic and prescriptive authority, and most cases are handled independently, with a Physician spot-checking medical records. Nurse Practitioners normally refer to a Physician only those cases involving complications with which they have only limited knowledge. Work requires making a variety of decisions concerning interpretation of considerable information and data drawn from physical examination results and laboratory reports. Work is performed in a variety of clinical settings and involves considerable standing and bending in the assessment and treatment of clients and some lifting, carrying or moving of objects weighing up to fifty pounds or using equivalent forces. While conducting physical examinations, employees in this class are regularly exposed to body fluids and human waste. Such exposure requires the wearing of protective gloves and the following of special procedures for contact with such communicable diseases as hepatitis, tuberculosis, HIV/AIDS, syphilis, and herpes.

EXAMPLES OF DUTIES: (Illustrative Only)
Obtains a comprehensive health history from client or family, performs a detailed physical examination and health assessment, makes a critical evaluation of client health status, discriminates between normal and abnormal findings, and enters information into medical record.
Conducts maternity, family planning and other clinics depending on specialty of Nurse Practitioner.
Formulates and implements plan of care which may involve various forms of treatment and prescribed medications; recommends follow-up care and makes referrals as needed.
Identifies and manages acute and chronic illness in accordance with established protocols of care.
Performs and/or requests special individual and community screening and laboratory tests, interprets the results and takes appropriate action.
Maintains current clinical and nursing records.
Provides emergency services or crisis intervention in the absence of the physician, including life-saving emergency procedures.
Co-manages the health supervision of clients within specific County Government programs, evaluating and managing health problems with Physician, and deciding which clients need additional care either within or outside the scope of department's services.
Provides follow-up care to clients who have been diagnosed, treated, and referred by a Physician.
Provides health screening activities for community groups.
Serves as a consultant to other health care providers.
Teaches clients and family members ways to maintain or improve health status.
Performs related duties as required.

MINIMUM QUALIFICATIONS:
Experience: Three (3) years of full-time equivalent post-licensure experience as a nurse, two (2) years of which must have been in the appropriate specialty area, one (l) year of which must have been in community health nursing.
Education: Graduation from a National League for Nursing accredited college or university or an equivalent program as determined by the Maryland State Board of Nursing Examiners, with a Bachelor's Degree in nursing and a Master's Degree in public health, community health nursing or other appropriate nursing specialty; and successful completion of a Nurse Practitioner Program.
Equivalency: An equivalent combination of education and experience may be substituted for the Master's Degree or for the required experience, but not for the successful completion of a Nurse Practitioner Program.
Knowledge, Skills and Abilities:
Considerable knowledge of nursing, medical and public health theories and practices required to provide specialized technical and direct care to individuals, families and the community.
Considerable knowledge of nurse practitioner principles and medical fact in health promotion and maintenance, disease prevention, physical and psycho-social assessment, and management of health and illness in the provision of primary care.
Considerable knowledge of selected pharmaceuticals, their desired effects, side effects and complications which may arise from their use.
Considerable knowledge of available community resources for referral.
Considerable knowledge of applicable Federal, State and County laws and regulations.
Considerable knowledge of and the ability to screen and diagnose chronic health problems; e.g., hypertension, diabetes.
Skill in applying technical nursing and medical procedures.
Skill in operating medical and nursing equipment.
Ability to take medical histories, conduct physical examinations using palpation, percussion, observation and auscultation skills, to interpret physical examination and selected laboratory test results, and identify deviations from the normal.
Ability to establish and maintain a cooperative relationship with clients and client groups in order to provide instruction, counseling, education and health guidance.
Ability to provide emergency treatment for life-threatening conditions, e.g., cardiac arrest, shock, hemorrhage.
Ability to maintain complete records of client services.
Ability to analyze and interpret data and write comprehensive reports.
Ability to communicate clearly and effectively, both orally and in writing.
Ability to attend meetings or perform other assignments at locations outside the office.

LICENSE:
Possession of a current license to practice as a Registered Nurse and certification as a Nurse Practitioner in the State of Maryland issued by the Maryland State Board of Nurse Examiners. (A written agreement with a precepting Physician, approved by the Maryland State Board of Nursing, will be required to perform as a Nurse Practitioner.)

PROBATIONARY PERIOD:
The probationary period must be 12 months for a full-time or part time employee appointed to a merit system position, and 6 months for a promoted employee, during which time performance will be carefully evaluated. Continuation in this class will be contingent upon successful completion of the probationary period.

MEDICAL PROTOCOL: Limited Core Exam

Class Established: May 1985
Revised: May 1993 (M)
April, 2002(M)