Lucile Packard Children's Hospital Stanford Nurse Practitioner/Physician Assistant - MG-Peds-PANS Outpatient (1.0 FTE, Days) in Palo Alto, California

Nursing Advance Practice

Lucile Packard Children's Hospital Stanford is the heart and soul of Stanford Children’s Health. Nationally ranked and internationally recognized, our 311-bed hospital is devoted entirely to pediatrics and obstetrics. Our six centers of excellence provide comprehensive services and deep expertise in key obstetric and pediatric areas: brain & behavior, cancer, heart, pregnancy & newborn, pulmonary and transplant. We also provide an additional, wide range of services for babies, kids and pregnant moms.

Program Information

Lucile Packard Children’s Hospital Stanford was the first public institution to start a PANS service and hosted the first national PANS conference.

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)is a clinical diagnosis given to children who have a dramatic – sometimes overnight – onset of neuropsychiatric symptoms including obsessions/compulsions or food restriction. They are often diagnosed with obsessive-compulsive disorder (OCD) or an eating disorder, but the sudden onset of symptoms separates PANS from these other disorders. In addition, they may have symptoms of depression, irritability, anxiety, and have difficulty with schoolwork. The cause of PANS is unknown in most cases but is thought to be triggered by infections, metabolic disturbances, and other inflammatory reactions.

Like PANS, children withPediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS)have an acute onset – within 2 to 3 days – of neuropsychiatric symptoms, specifically OCD or tics (involuntary, purposeless movements). However, PANDAS patients test positive for a recent streptococcal infection, such as strep throat, peri-anal strep or scarlet fever. Like PANS patients, they also may suffer from uncontrollable emotions, irritability, anxiety and loss of academic ability and handwriting skills.

We know that this condition present a sudden, seemingly inexplicable change in children, and understand that getting accurate diagnosis, proper treatment and family support can make a profound difference for both the child’s health and the entire family’s well-being. Our goal is to provide outstanding care based on groundbreaking research, and to tailor care to your child’s unique combination of symptoms and your family’s personal needs.

Position Summary

The APP is part of a collaborative, multidisciplinary team which is focused on caring for pediatric patients with inflammatory brain disease who meet criteria for the PANS Program (Pediatric Acute-Onset Neuropsychiatric Syndrome). The APP will be participate in multi-disciplinary team meetings to ensure well-coordinated, integrated care. Clinic huddles are held daily. There is opportunity for inclusion in clinic research projects/publications. Other ambulatory functions include chart abstractions, independent and shared visits, triaging outpatient calls from families/providers, appeals/authorizations, and ongoing coordination of care. The APP makes appropriate referrals with collaboration with physician team and interact with other subspecialty services including infectious Disease, ENT, Neurology, Sleep Medicine, Occupational Therapy/Physical Therapy, HEAL.

Team Members: Collaborates with a physician team (Rheumatologist, Immunologist, Psychiatrist, Pediatrician), Nurse Practitioner, Psychologist and Social Worker.

Primary Location: In the outpatient setting, with opportunity to leverage experience on the inpatient side.

Schedule: Full Time, Days, with rotating evening/weekend call once a month.

Essential Functions

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.

Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.

Must perform all duties and responsibilities in accordance with the Service Standards of the Hospital(s).

A. An NP/PA may provide only those medical services which he/she is competent to perform, which are consistent with the NP/PA's education, training and experience, and which are performed in collaboration with a physician.

B. An NP/PA shall consult with a physician regarding any task, procedure or diagnostic problem which the NP/PA determines exceeds his/her level of competence or shall refer such cases to a collaborating physician.

C. Scope of Practice of the NP/PA:

  • Designate ambulatory functions (i.e. chart abstractions, independent and shared visits, number of clinic days, triaging outpatient calls from families/providers, appeals/authorizations, coordination of care)

  • Obtains complete H&P and performs pertinent physical exams with assessment of normal and abnormal findings on new and return patients

  • Administers, orders, furnishes and /or prescribes medications/therapies

  • Requests and evaluates diagnostic studies

  • Orders & collects specimens for routine lab tests, screening & therapeutic procedures

  • Orders PT, OT, radiology, and nursing services.

  • In collaboration with team, initiates arrangements for hospital admissions and discharges.

  • Effectively communicates & interacts with patients, families, staff and members of the community from diverse backgrounds

  • Provides and coordinates patient and family teaching and counseling

  • Makes appropriate referrals and interact with other subspecialty services

  • Recognizes situations which require immediate attention of the physician, and triages accordingly

  • Intervenes in crisis situations in partnership with appropriate members of the care team when necessary to stabilize the patient and family.

  • Facilitates collaboration between providers and coordination of community resources

D. Supervision:

  • Supervision is provided by the supervising/sponsoring physician with clinical privileges at LPCH, or designated attending physicians in the Clinic, Service or Department. Standardized procedures, approved by the supervising physician(s) and the IDPC, are a mandatory mechanism of supervision. Other mechanisms of supervision used may be:

  • Direct on-site, electronic or phone supervision by a supervising physician. A physician cannot supervise more than four (4) NP/PAs at one time.

  • Chart screens on random charts by the supervising physician or designee.

  • Chart audits on random charts as an integral part of selected quality improvement programs.

  • Ongoing Professional Practice Evaluation (OPPE) through tracking of performance indicators.

  • The NP/PA will receive a formal annual performance evaluation by the Lead Advanced Practice Provider (Lead APP), Director of Advanced Practice or supervising manager/director with iNP/PAut from the Lead APP, supervising physician(s) and/or physician delegates, APP peers and the supervising manager/director. Ongoing Professional Practice Evaluation (OPPE) also occurs through tracking of performance indicators.

Minimum Qualifications

Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.


Physician Assistant (PA):

  • Bachelor’s degree or above from an accredited college or university.

  • Graduate of a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant, Inc.

Nurse Practitioner (NP/PA):

  • Master’s or doctoral degree in nursing from an accredited college or university.

  • Graduate of an NP/PA program accredited by the National League of Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE).


A minimum of 1-2 years of advance practice experience in the field of behavioral health treating pediatric patients highly desired.


Physician Assistant (PA):

  • Licensure as a Physician Assistant (PA) in the State of California.

  • Certification as a Physician Assistant (PA) by the National Commission on Certification of Physician Assistants (NCCPA)

  • Certification in Basic Life Support (BLS) from the American Heart Association (AHA)

  • An individual Drug Enforcement Agency (DEA) license issued by the United States DEA for Schedule II-V controlled substances, required only if prescribing controlled substances to outpatients

  • Additional board certification(s) may be required by certain services/departments.

Nurse Practitioner (NP/PA):

  • Licensure as a Registered Nurse (RN) in the State of California

  • Certification as a Nurse Practitioner (NP/PA) in the State of California

  • National Board Certification as a Nurse Practitioner (NP/PA) from an agency accredited by the American Board of Nursing Specialties (ABNS).

Note: New graduate NP/PAs will be allotted six (6) months from their graduation date to obtain national board certification.

  • Certification in Basic Life Support (BLS) from the American Heart Association (AHA).

  • Furnishing license issued by the Board of Registered Nursing (BRN), required only if furnishing medications

  • An individual Drug Enforcement Agency (DEA) license issued by the United States DEA for Schedule II-V controlled substances, required only if prescribing controlled substances to outpatients.

  • Additional board certification(s) may be required by certain specialties/departments.

Licensure/Certification:Additional board certification(s) may be required by certain specialties/departments.

The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job.

Lucile Packard Children’s Hospital Stanford strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, LPCH does not discriminate against any person on the basis of race, color, sex, sexual orientation or identity, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability. Women and men, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply.