Transplant Nephrology Physician Assistant

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Indicate key areas of responsibility, major job duties, special projects and key objectives for this position. These items should be evaluated throughout the year and included in the written annual evaluation.

The APP works collaboratively with transplant nephrologists, transplant surgeons, transplant coordinators, pharmacists, nursing staff, and other advanced practice professionals to develop and implement comprehensive care plans for patients undergoing evaluation for kidney transplant and for post-transplant recipients. The APP plays a key role in coordinating care across the transplant continuum, addressing the medical, psychological, and social needs of patients and their families in the outpatient setting.

Strong interpersonal, organizational, and communication skills are essential, as the role requires frequent patient education, coordination with multidisciplinary teams, and communication with referring providers. The APP is expected to maintain up-to-date knowledge of transplant nephrology through ongoing review of current literature and a commitment to continued professional development. The mission, vision, and core values of Brigham and Women's Hospital (BWH) are integral to all aspects of practice. The transplant APP serves as a collaborative partner within the BWH Nephrology Division and the broader community of BWH advanced practice professionals.

As a member of the BWH Nephrology Division, the NP/PA will be responsible for the following duties:

Clinical Care

• Provide outpatient clinical care during 2 scheduled clinic sessions per week in the kidney transplant clinics.
• Conduct comprehensive evaluations of patients with CKD and ESRD referred for kidney transplant evaluation, including medical history review, physical examination, diagnostic data interpretation, and patient counseling.
• Manage longitudinal outpatient follow-up of kidney transplant recipients greater than three months post-transplant, including routine visits and problem-focused assessments.
• Collaborate with transplant nephrology attendings in the development and implementation of individualized care plans.

Transplant-Specific Management

• Monitor allograft function, laboratory values, and clinical trends in post-transplant patients.
• Assist in the management and adjustment of immunosuppressive medications according to established protocols and under physician supervision.
• Identify, evaluate, and help manage transplant-related complications, including infection, rejection, hypertension, metabolic abnormalities, and medication toxicities.

Care Coordination

• Coordinate care with transplant surgeons, transplant coordinators, pharmacists, nursing staff, infusion services, and other subspecialists.
• Arrange and facilitate infusion center treatments for kidney transplant recipients when clinically indicated.
• Ensure timely follow-up of test results, referrals, and treatment plans.

Patient Communication and Education

• Regularly review and respond to patient messages and clinical inquiries via the electronic medical record (In Basket).
• Provide education to transplant candidates and recipients regarding immunosuppressive adherence, infection prevention, vaccination guidelines, and long-term post-transplant care.

Documentation and Quality

• Maintain accurate, timely, and comprehensive documentation in the electronic medical record.
• Participate in multidisciplinary transplant meetings, clinical conferences, and quality improvement initiatives.
• Assist with the development, implementation, and adherence to transplant clinic workflows and protocols.

Professional Practice

• Collaborate with other advanced practice providers within the Nephrology Division and across BWH.
• Maintain required licensure, certification, and continuing education.
• Demonstrate ongoing engagement with current transplant nephrology literature and best practices.

Supervisory/Managerial Responsibilities (Y/N): N

Includes Budgetary Responsibilities (Y/N): N

SKILLS/COMPETENCIES REQUIRED: Must be realistic, objective, measurable and related to principal duties described above.

• Staff adheres to all C.A.R.E. Standards

Medical Knowledge
Medical knowledge includes an understanding of pathophysiology, patient presentation, differential diagnosis, patient management, surgical principles, health promotion and disease prevention. The APP must demonstrate core knowledge about established and evolving biomedical and clinical sciences and the application of this knowledge to patient care in their area of practice. In addition, the APP is expected to demonstrate an investigatory and analytic thinking approach to clinical situations.

The APP is expected to demonstrate:

• Clinical Knowledge
• Understands causes, risk factors, and disease processes related to CKD, ESRD, and kidney transplantation
  Recognizes common transplant-related complications (rejection, infection, graft dysfunction, medication toxicity)
  Understands principles of immunosuppression, including indications and monitoring
• Clinical Assessment
• Identifies signs and symptoms relevant to pre- and post-kidney transplant patients
  Performs focused and comprehensive histories and physical exams
  Differentiates normal vs abnormal findings in transplant patients
• Diagnostic Skills
• Orders appropriate laboratory and diagnostic studies for transplant patients
  Interprets labs, imaging, and other diagnostic data accurately
  Uses diagnostic information to formulate a differential diagnosis
• Clinical Management
• Participates in management of common post-transplant medical conditions (HTN, DM, electrolyte disorders, anemia, infection)
  Assists with immunosuppression adjustments per protocol and attending guidance
  Identifies patients requiring urgent evaluation, admission, or specialty referral
• Preventive Care
• Applies transplant-specific preventive care practices (vaccinations, cancer screening, infection prevention)
  Screens for complications in asymptomatic transplant patients when indicated
• Care Coordination
• Coordinates care with transplant nephrologists, surgeons, pharmacists, and coordinators
  Arranges referrals, infusion services, and follow-up testing as needed
• Documentation & Systems
• Uses EMR efficiently for order entry, medication reconciliation, and result review
  Provides timely, accurate, and complete clinical documentation
  Demonstrates basic knowledge of outpatient transplant billing and coding
• Professional Practice
• Communicates clearly with patients, families, and multidisciplinary team members
  Demonstrates organization and time-management skills
  Engages in ongoing learning and professional development

Physical and mental abilities required

• Must be energetic, quality driven and have proven ability to be a productive member of a cohesive team of peers, dedicated to providing optimum patient care.
• Must exercise the highest degree of professional judgment under the direct supervision and guidance of a licensed physician.
• Must maintain a professional attitude towards patients and exercise such mature independent originality in solving problems not covered by existing guidelines, within legal limits, to meet the needs of the patients.
• Must maintain a professional attitude towards patients at all times and an excellent and collegial working relationship with other personnel involved in patient care.
• Must demonstrate understanding of procedures, policies and documentation required to ensure compliance with hospital standards of care.

EDUCATION: Specify minimum education and clearly indicate if preferred or required.

Education requirements for this position (Y/N): Y

For PA's

• Must have successfully completed a Graduate Level, accredited Physician Assistant Program approved by AMA Board of Approval and Certification of PA programs.
• Must have 4 years of college level education and baccalaureate degree or equivalent. (BS/MS joint programs are also acceptable; BS with PA certificates are acceptable for graduates before 1995).
• Board Certification by the National Commission on Certification of PA/NPs is required.

For APRN's

• Completion of a master's or post master's degree in acute care, adult or family NP program accredited by the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC)
• Current certification by the American Nurses Credentialing Center or an equivalent body.
• Current active licensure to practice in the expanded role in the state of Massachusetts.

LICENSES, CERTIFICATIONS, and/or REGISTRATIONS (if applicable): Specify minimum credentials and clearly indicate if preferred or required.

License, Certification or Registration is required by law or regulation. (Y/N): Y

Other certifications or registrations are required by the hospital. (Y/N): Y

• NCCPA/NP certified
• License as a Physician Assistant in Massachusetts
• Maintain current DEA and Massachusetts Controlled Substance Licenses
• Complete 100 hours of CME according to national and state regulations during each 2 year period of employment.
• NP must have current Massachusetts Registered Nurse Licensure/ Advanced Practice
• NP Certification in Basic Life Support for Healthcare Providers required
• NP must maintain updated continuing education requirement for certification and licensure
• Maintain current ACLS certification
• Complete BWFH Professionalism Program within 3 months of date of hire.
• Complete BWFH Procedural Sedation Training, if determined necessary.

EXPERIENCE: Specify minimum creditable years of experience and clearly indicate if preferred or required

Experience requirements for this position (Y/N):

• One year of relevant experience as a APP in this specialty, would be ideal but is not necessary.
• Other previous hands-on patient care experience may be considered at the discretion of the Medical Directors.

WORKING CONDITIONS: Describe thepace of work and environment in which it is performed.

The APP position on the team can be quite challenging, requiring both teamwork and individual initiative. A high level of patient care is required while working quickly and often multi-tasking. The APP schedule may require long workdays while maintaining a goal of 40 hours/week on average.

Physical Requirements

• Standing Frequently (34-66%)
• Walking Frequently (34-66%)
• Sitting Occasionally (3-33%)
• Lifting Frequently (34-66%) 35lbs+ (w/assisted device)
• Carrying Frequently (34-66%) 20lbs - 35lbs
• Pushing Occasionally (3-33%)
• Pulling Occasionally (3-33%)
• Climbing Rarely (Less than 2%)
• Balancing Frequently (34-66%)
• Stooping Occasionally (3-33%)
• Kneeling Occasionally (3-33%)
• Crouching Occasionally (3-33%)
• Crawling Rarely (Less than 2%)
• Reaching Frequently (34-66%)
• Gross Manipulation (Handling) Frequently (34-66%)
• Fine Manipulation (Fingering) Frequently (34-66%)
• Feeling Constantly (67-100%)
• Foot Use Rarely (Less than 2%)
• Vision - Far Constantly (67-100%)
• Vision - Near Constantly (67-100%)
• Talking Constantly (67-100%)
• Hearing Constantly (67-100%)