AGENDA FOR CHANGENHS JOB EVALUATION SCHEME

JOB DESCRIPTION TEMPLATERevised February 2010

1. JOB IDENTIFICATION Job Title: Community Staff Nurse/Clinic Nurse

Reports to: Team Manager

Department, Ward or Section: District Nursing Service West Team (Inverness and Beauly)

Operational Unit/Corporate Department: Inner Moray Firth Operational Unit, South & Mid

Job Code: SMOUNESSCOMMNURS03

No of Job Holders: 35

Date: January 2017

2. JOB PURPOSE

To contribute to the delivery of care to the total corporate and locality caseloads ensuring the delivery of high standards of care to patients and their families in accordance to identified care plans.

3. DIMENSIONS

Based in the RNI and working within the District Nurse team to meet the community nursing care needs of the local populations, there will be a focus on the delivery of care in a clinic setting for this post.

The District Nursing service is provided 7 days per week from 8.30am to 6pm in close collaboration with General Practices, Community and Acute Hospitals, Social work services and voluntary agencies.

4. ORGANISATIONAL POSITION

5. ROLE OF DEPARTMENT OR SECTION

The District Nursing service provides care to patients in their own homes and in the clinic setting who are predominately older people with multiple pathology and complex health and social care needs leading to chronic ill health, disability and dependence on carers, families, statutory and voluntary services to remain in the community. The aim of the service is to manage health care in the community to promote independence, prevent admission to hospital or facilitate hospital discharge. The service is provided in conjunction with local hospitals, Raigmore District General, Primary Health Care Team and Social Work Community Care Team and Home Care service. Patients access the level of care required on a needs-led basis.

AssistantGeneral Manager

Team Manager

Deputy Team Managers

Health Care Assistant

Community Staff Nurse

6. MAIN TASKS, DUTIES AND RESPONSIBILITIES

Operational definition of nursing“The purpose of nursing and midwifery is to support each person to obtain, regain or maintain their optimum state of health and independence within the scope of any physical, psychological or social limitation, and to influence policies which affect health. This includes the use of nursing and midwifery knowledge and skills to empower individuals and communities, by providing or enabling access to appropriate care and support aimed at achieving the best attainable quality of life or a peaceful death”. (Highland Primary Care NHS Trust 2002).

Professional nursing is practised within the concept of health and is grounded upon the World Health Organisation’s definition of health which is: “a state of complete, physical, psychological and social well-being and not simply the absence of disease or infirmity” (WHO 1978).

1. Assist the Team Manager/Deputy or Senior Staff Nurse in corporate caseload management (organising workload on geographical basis and nurse attachment to GP practices taking account of individual’s workloads, skills requirements of patients, skills and learning needs of staff and frequency of liaison with GP re. individual patients).

2. Assess the health and social care needs of patients and their carers analysing and synthesising complex physiological measurements, emotional and psychosocial state and environmental settings identifying deviations from normal. Make nursing diagnoses, plan, implement and evaluate nursing interventions to meet needs agreed with patients and carers, with referral to other services as required and reporting patient progress to caseload manager.

3. Assist patients, relatives and other formal and informal carers towards self-care and rehabilitation through the provision of therapeutic, compensatory, educative, facilitative, rehabilitative, advocacy and supportive clinical patient care.

4. Demonstrate clinical nursing skills and teach and assess students/observers during community placements if required e.g. Student nurses, Return to Practice Nurses, Medical students and Medical Registrar (nursing student placements are continuous).

5. Actively participate in implementation of clinical guidelines, best practice statement and relevant audits of clinical practice to promote evidence based care and the attainment of healthcare governance requirements.

6. Identify own education, training and support needs via the PDP and Review process and access clinical supervision and, or action learning. Inform Team Leader of interim skills and knowledge needs.

7. Practice within team administrative systems, national NHS, NHS Highland and NMC guidance.

8. Work collaboratively with the Team, Deputy Team Manager and Senior Staff Nurse in the day to day operational management of the service including implementation of NHS Highland policies and practices e.g., health and safety, infection control, PIN Guidelines and standing financial instructions.

9. Contribute to regular caseload profiling and community health needs assessment through the collation of activity data, for the purpose of influencing health improvement priorities.

Dimensions (Clinical)

Patients in the palliative stages of disease management or terminal phase of life requiring control of symptoms (e.g. pain, nausea / vomiting, pressure area care, continence management),

assessment of need / and referral for other services (eg. Marie Curie nursing), provision of nursing equipment (e.g. profiling bed, pressure relieving equipment), psychological and emotional support to patient and family, health advice and education and follow-up bereavement support to relatives.

Teaching self-care procedures to enable patients and relatives to manage health needs (eg. administration of medications, use of nebulisers, oxygen therapy, PEG feeding).

Wound management - wound assessment, prescription and application of dressings and associated health education, self-care and nutritional advice.

Administration of prescribed medications, e.g. injections, enemata etc.

Continence promotion – assessment of incontinence, promotion of continence and supply of continence products.

Chronic disease management (e.g. Coronary heart disease and Diabetes), screening and monitoring re secondary prevention with the primary health care team.

Long term management, rehabilitation and support of patients with chronic degenerative conditions and disability that result in associated health problems, compromised mobility and restricted ability to self care e.g.- pressure area management and skin care, - continence management including catheter care, - provision of nursing equipment,- on-going monitoring and assessment of health and care needs to remain safely at home with

referral for services i.e. home care, community alarm, meals at home, day care / respite services, mobility aids and adaptations;

- health education and advice i.e. diet, exercise, self care, medication concordance, pain control, etc.

- assisting patients/carers adapt to limitations imposed by health related problems including emotional and psychological aspects of chronic ill health and dependency and anticipatory guidance,

- prevention of complications of chronic ill health through early recognition of signs and symptoms disease and health status monitoring – i.e. chronic disease management screening, blood pressure recording, urinalysis, haematological assessment etc.

Clinical procedures relevant to working within the Investigation and Treatment Clinic inc. Venepuncture, ECGs, Picc line care and IV antibiotic therapy. This clinic will receive patient referrals directly from Raigmore Hospital and will act as an interface between the acute and primary care services within the Inner Moray Firth Unit.

Training will be arranged as appropriate.

7. EQUIPMENT AND MACHINERY USED

1. General office equipment including computers – E-mail, NHS Highland Intranet and Internet, basic word processing.

2. Assess patient’s needs for:

minor aids and adaptations; profiling beds; electric air pressure relieving and overlay mattresses and cushions and supply appropriate

product as per Equipment Loan Store operational policy. 3. Provide mobile hoists4. Basic car maintenance5. Technical clinical equipment including calibrating where required, checking for faults and ensuring regular maintenance as follows:

Equipment UseSyringe drivers Subcutaneous drug administrationEar syringes Removal of debris in earsSuction machines Removal of excess oral and airway secretionsBlood glucose monitors Diabetic blood sugar control Ultra sound “Doppler” Assessment of arterial blood supply in lower legHypodermic syringes and needles Drug administration by injectionDrug specific specialist needles and syringes Drug administrationVenepuncture needles and blood collection tubes Collection of blood samplesECG monitor Take readings for medical staffPercutaneous endospic gastrostomy (PEG) feeding pump

Direct feeding into the stomach via fistula

Sharps containers Disposal of needles, syringes and drug vialsAnaphylaxis emergency equipment – face mask and adrenaline for injection

Resuscitation

Urinary catheters – urethral and suprapubic and associated drainage equipment

Managing urinary incontinence

Sphygmomanometers Blood pressure recordingOxygen Cylinders and concentrators To administer oxygen to patients in their homeNebulisers Administration of medication via nebuliserSuture/staple removal equipment To remove sutures, staples and clips and for

suturing minor woundsPressure relieving equipment – mattresses and cushions

To prevent pressure Ulcers in patients.

Apnoea monitors Alarms when patient has not breathed within a set time. Used in patient with sleep apnoea

Thermometers Temperature recording.

8. SYSTEMS

1. Maintain patient records in accordance with NMC guidelines and NHS Highland standards.

2. Complete and submit to Team Manager or deputy, end of month mileage returns & time sheets.

3. Complete Administrative Data System returns re patient visits, monthly.

4. Assist the Team Manager to monitor and revise caseload management.

9. ASSIGNMENT AND REVIEW OF WORK

1. Clinical workload is generated and prioritised via the nursing process (assessment, planning, implementation and evaluation).

2. Professional development is reviewed via PDP process.

3. Accountable for own actions without direct supervision and care provided by unqualified staff.

10. DECISIONS AND JUDGEMENTS

1. Make autonomous clinical decisions using comprehensive knowledge, skills and experience of the clinical service and setting taking account of the guidance of the professional body (Nursing and Midwifery Council) and the employers’ policies and procedures informing Team Manager / Deputy/Senior Staff Nurse of patient progress.

2. Make autonomous workload management decisions prioritising patient care and sharing of workload with colleagues and delegation to nursing students and unqualified team members.

3. Recognise own limitations in the provision of clinical care and urgency of patient needs referring to other health care professionals accordingly.

11. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB

1. Involvement in change, service and practice

2. Negotiating packages of care with other disciplines / agencies who work within different cultures, different response times and budgetary constraints.

3. Coping with potential and actual complex and or conflicting perspectives of choice of care options between staff, patients, carers and other disciplines or agencies using negotiation and counselling skills to achieve compromise and defuse possible volatile situations to achieve the best outcome for the patient.

4. Stressful mental and physical demands of lone working in non NHS settings, for example patients homes, where unpredictable behaviours, often associated with substance abuse are encountered and un-hygienic environments or the presence of animals present increase personal risk and challenges to the provision of professional standards of care.

5. Covering a large remote and rural geographical area. The roads are mainly single track/unclassified with passing places that are winding, have steep gradients and blind summits.

6. Lone working when dealing with complex, sensitive and contentious situations.

7. Developing and learning new skills

12. COMMUNICATIONS AND RELATIONSHIPS

1. Establish and maintain professional relationships with nursing colleagues, members of the Primary and Acute Health Care Team and wider health / social care / voluntary service networks to provide a planned co-ordinated, seamless service for patients/clients.

2. Ensure the role and function of the service is known to all patients through verbal communication and the provision of service information leaflets providing the opportunity to discuss care needs / care provision and obtain feedback.

3. Maintaining effective communication and professional relationships with patients and their families, especially within a small community setting.

4. Developing good observational skills and the ability to recognise verbal and non-verbal cues.

5. Early identification of potential and actual complex and or conflicting perspectives of choice of care options between staff, patients, carers and other disciplines or agencies using negotiation and counselling skills to achieve compromise and defuse possible volatile situations to achieve the best outcome for the patient.

6. Observe confidentiality in accordance with NMC and NHS Highland polices.

13. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB

Physical Skills Fine motor skills and dexterity to take blood, administer injections, calibrate equipment – daily.

Physical Effort Regular effort to assist bed-bound patients to move position. Bend and kneel to work with patients in cramped and restrictive environments, e.g. dress leg

wounds – daily Driving long distances to visit patients particularly out with normal working hours and on single

track / unclassified roads.

Mental Effort Concentration, decision making and organisational skills to cope with competing demands,

(dynamic changes in patients conditions, personnel issues with staff, sudden staff absences, unpredictable nature of referrals, contacts from within and out with the organisation – managers,

other departments, other agencies) daily. Recognising patients’ urgent health care needs and making rapid decisions to provide

appropriate clinical management - daily. Ability to calculate drug dosages, daily. Negotiation skills to co-ordinate complex packages of care with a wide range of people and

agencies as required. Daily and continuous concentration to assess and provide patient care and assist in the

management of the corporate caseload with frequent interruptions either in person or by telephone.

Concentration to drive in a busy urban environment during tourist season visiting patients homes to deliver care – daily.

Emotional Effort Emotional demand in relation to family and human dynamics, coping with team members,

patients or carers in distress or crises such as dying and death, particularly following a long period of care (weeks – months).

Emotional demands related to change - organisational, policy and practice - ongoing. Risk-assess patient’s homes and be inventive to create a safe working environment whilst being

sensitive to patients environment and property - daily.

Environmental (Working Conditions)

Coping with unpleasant materials and smells – bodily fluids, excreta, infected wounds – daily. Exposure to aggressive, verbal and physical behaviour where there is little or no support. Driving in extreme weather conditions in remote and untreated single track roads with additional

hazards of sheep, deer and other domestic animals. Exposure to aggressive domestic/farm animals e.g. dogs - creating a safe entrance to the

patients home whilst keeping up relationships with patients and assessing risk. Exposure to passive smoking. Daily lone working in the community requiring self-reliance to continually assess risk to self, team

and patients.

14. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB

1. RGN. Registered with the NMC.2. Knowledge of, and ability to, apply all relevant NHS Highland and professional policies, procedures

and guidelines.3. Knowledge of processes involved in health and social policy development and of current policies and

their impact on district nursing services4. Knowledge of the physical, social, emotional, psychological, mental, cultural effects of ageing,

disability, and chronic ill health, and, ability to assess an individual’s needs and behaviours and in collaboration with a senior member of the team plan care within this broad context.

5. An understanding of clinical skills relevant to district nursing or working toward:- Holistic assessment of patients and carers needs.- Chronic disease management at tertiary preventive and terminal stages specifically related to

diabetes, circulatory disease, major neurological conditions.- Wound and skin care management and prevention of pressure ulcers.- Management of elimination e.g., promotion of continence and management and symptom control

of incontinence – catheterisation: male, female and supra pubic, bowel care.

- Palliative/Terminal care including operation of syringe driver.- Ultra sound “Doppler” assessment of arterial blood supply to lower limbs.- Venepuncture.- Ear syringing.- Bladder scanner.- ECGs.- Teaching patients and carers to self care and provide anticipatory guidance re disease

progression, symptom management and consequences for lifestyle and quality of life.- Teaching and assessing junior staff and students.- Communication skills e.g. liaison, negotiation, and counselling skills.- Health Promotion and Health Education.

6. A willingness to be involved in teaching, supervising, monitoring and supporting others in the achievement of the above skills.

7. IT skills – e-mail, basic word processing, ability to search inter and intranet.8. Good level of physical health and stamina, large and fine motor fitness and dexterity.9. Car driver.

15. JOB DESCRIPTION AGREEMENT

I agree that the above Job Description is an accurate reflection of my duties and responsibilities at the date of signing.

Job Holder’s Signature:

Manager’s Signature:

Date:

Date: