Clinical Nurse Specialist (Diabetes-Integrated Care)

HSE Job Specification, Terms and Conditions

Job Title, Grade, Grade Code / Clinical Nurse Specialist (Diabetes – Integrated Care)
(Grade Code: 2632)
Campaign Reference / NRS0925
Closing Date / 12 noon, Friday 20thSeptember 2013
Proposed Interview date(s) / Week commencing 4th November 2013
Taking up Appointment / To be indicated at job offer stage.
Organisational Area / All Health Service Executive (HSE) Areas – DML, DNE, West and South
Location of Post / Please note that the panel being created from this recruitment campaign will be used to fill vacancies at all HSE sites as appropriate. Further vacancies may become available nationally and applicants are encouraged to apply should they be interested in working in any area.
There are immediate vacancies for Clinical Nurse Specialist (Diabetes – Integrated Care) in:
  • LetterkennyGeneralHospital
  • CavanGeneralHospital.

Details of Service / The development of the National Diabetes Programmemodel of integrated diabetes care will enhance effective clinical care of patients and the optimal use of resources. The aim of the model is to facilitate the structured/managed care of patients with uncomplicated Type 2 Diabetes in the primary care setting only; while patients with complicated Type 2 Diabetes will be managed by primary and secondary care services. To this end, the diabetes service and multidisciplinary team will include a Clinical Nurse Specialist (CNS) in Diabetes -Integrated Care.
The appointment of a CNS in Diabetes - Integrated Care, is an essential element in the provision of a collaborative link to achieve integration between primary care and secondary care providers. The role is also an essential resource in empowering patients to achieve optimum diabetes control.
The CNS (Diabetes – Integrated Care)will work as part of a multidisciplinary team, delivering diabetes care to all patients with Type 2 Diabetes in General Practice, as part of, and working to the National Diabetes ProgrammeIntegrated Care Programme. The post holder will operate within the agreed model of integrated diabetes care and have agreed referral protocols and care pathways for providing care to patients with complicated Type 2 Diabetes referred to him/her and will provide support to healthcare professionals involved in the provision of integrated diabetes care (complicated and uncomplicated) in primary care.
The CNS (Diabetes - Integrated Care) will work 80% of his/her time in general practice/primary care. She/He will provide a link for referral to the diabetes services in the acute hospital/secondary care setting and will spend 20% (1 day per week) of his/her time in the diabetes services in the secondary care diabetes centre. There will be agreed referral protocols for patients who need referral to Secondary Care Diabetes Services.
Prescriptive authority for medicinal products will be an advantage to the implementation of the Integrated Care Programmes, thus successful candidates will be requested to undertake the requirements to become a Registered Nurse Prescriber (RNP) in Ireland.
Reporting Arrangements / The post holder:
  • Is professionally accountable to the Director of Nursing in the acute hospital/secondary care setting
  • Will have line management reporting arrangements to the Asst Director of Nursing responsible for the Diabetes Nursing Services.

Key Working Relationships / The post holder will:
  • Have a clinical working relationship with the relevant Consultant Endocrinologist in secondary care, the Primary Care Clinical Lead responsible for the service and the GP responsible for the patient.
  • Provide support to healthcare professionals involved in the provision of integrated diabetes care in primary care such as General Practitioners and Practice Nurses and other primary care nurses partaking in the Integrated Care Programme.
  • Provide support to healthcare professionals involved in the provision of integrated diabetes care in secondary care services.
  • Provide support to an integrated care programme management/governance committee/group/structure developed to ensure the Integrated Care Programme and the CNS role is embedded in the primary care and secondary care settings across organisations.

Purpose of the Post / The purpose of this post is to support the implementation of the National Diabetes Programme model of integrated care/structured diabetes care in primary care in order to enhance the process of care for patients between primary and secondary care. This post will also involve the core elements of the CNS post to include clinical audit and research.
Principal Duties and Responsibilities / Clinical Focus– direct and indirect clinical care
The CNS (Diabetes – Integrated Care) will:
  • Practice in accordance to relevant legislation, the scope of Nursing & Midwifery Practice Framework (ABA 2000) and Code of Professional Conduct (ABA 2000).
  • Assess, using agreed nursing assessments, develop individualised care plans, initiate and evaluate care and treatment modalities within agreed interdisciplinary protocols to achieve agreed patient/client centred clinical and nursing outcomes.
  • Identify health promotion priorities in the area of specialist practice
  • Use a case management approach to patient with complex needs, to include prescribing of appropriate medications once a Registered Nurse Prescriber (RNP).
  • Implement health promotion strategies for patient/client groups in accordance with the public health agenda.
  • Support Practice Nurses and General Practitioners involved in the diabetes integrated, structured care programme.
  • Develop and evaluate, in consultation with stakeholders, integrated care pathways for patients with Type 2 Diabetes.
  • Liaise with hospital staff in order to facilitate the integration of care between primary and secondary organisations.
  • Attend identified general practices/primary care centres to support the GP and Practice Nurse in the provision of structured integrated diabetes care for patients.
  • Use standardised equipment to monitor and treat diabetes within the community, which is in line with best practice.
  • Agree and establish clear referral pathways to enhance communication and co-operation with medical staff, GPs, Practice Nurses and Public Health Nurses and members of the primary care and secondary care teams.
  • Support the initiation and continuing care of patients with Type 2 Diabetes who have been commenced on insulin/injectable therapy.
  • Facilitate liaison with secondary care services as per agreed protocol and as necessary for individual patients/clients by spending one day per week in the secondary care diabetes service where duties will include:
  • Preparation of inpatients for discharge as per integrated care programme, who fall into the remit of the CNS to include new & review patients
  • Case management liaison with Consultant Endocrinologist/ Hospital based diabetes nurse team for patients who fall beyond the remit of the CNS as agreed by the integrated care programme.
Patient Advocate
The CNS (Diabetes – Integrated Care) will:
  • Enable patients/clients families and communities to participate in decisions about their health needs
  • Articulate and represent patient/client interests in collaboration with the multidisciplinary team
  • Implement changes in healthcare services in response to patient/client need and service demand
  • Provide an efficient, effective and high quality service, respecting the needs of each patient
  • Actively promote positive approaches enabling patients and families to participate in the management of their diabetes.
  • Participate in team discussions regarding treatment for diabetic patients
  • Have knowledge of existing resources/services, which help patients and their families/significant others, e.g. social services, support groups, entitlements.
  • Establish maintain and improve procedures for collaboration and co-operation between acute services, community services and voluntary organisations.
Education and Training: - Patient, Self and others
The CNS (Diabetes – Integrated Care) will:
  • Assist with the establishment, delivery and evaluation of structured patient education programmes
  • Provide group or individual education sessions for the commencement of injectable therapies/insulin therapy where appropriate, for patients with Type 2 Diabetes.
  • Provide mentorship, perceptorship, teaching, facilitation and professional supervisory skills for nurses and midwives and other healthcare workers.
  • Educate patient/clients, families and communities in relation to their healthcare needs in the specialist area of practice.
  • Facilitate structured and impromptu educational opportunities to facilitate staff development and patient education.
  • Identify own continuing professional development needs and engage accordingly
  • Provide advice and support to practice staff involved in the diabetes structured care in Primary Care
  • Be responsible for his/her continuing education through formal and informal educational opportunities, thus ensuring continued credibility amongst nursing, medical and paramedical colleagues.
  • Liaise with academic centres including graduate and post graduate education departments in advisory or teaching capacity
  • Participate as an active member on practice and community conferences relating to provision of diabetes care
  • Promote an awareness of diabetes through health promotion literature and make health promotion and education literature available to practices.
  • Undertake the nurse prescribing of medicinal products certificate and achieve other requirements to become a registered nurse prescriber within an agreed timeframe i.e. within 2 years of taking up the post.
Audit and Research
The CNS (Diabetes – Integrated Care) will:
  • Utilise local IT systems to maintain current patient data
  • Identify, critically analyse, disseminate and integrate nursing/midwifery and other evidence into the specialist area of practice.
  • Initiate and participate in evaluations and audits
  • Use outcomes of audit to improve service provision
  • Participate in the audit system, which will measure effectiveness of care
  • Contribute to the delivery and implementation of guidelines and standards in Diabetes Care across the care settings.
  • Participate in quality improvements initiatives
  • Participate and initiate research projects which have the potential to add to the body of nursing knowledge
  • Contribute to service planning and budgetary processes through use of audit data and specialist knowledge
Consultant
The CNS (Diabetes – Integrated Care) will:
  • Provide professional leadership in clinical practice and act as a resource and role model for specialist practice.
  • Generate and contribute to the development of clinical standards of practice and guidelines
  • Use specialist knowledge to support and enhance general/midwifery practice
  • Maintain a network of contacts and communication links with other professionals and organisations in the area of specialist practice including nursing and multidisciplinary team members within the service and Public Health Nurses, General Practitioners and all other health professionals in the community and voluntary groups as appropriate.
  • Foster relationships with allied health professionals/agencies which enhance multidisciplinary team working and ensuring role clarity.
Health & Safety
The CNS (Diabetes – Integrated Care) will:
  • Contribute to the development of policies, procedures guidelines and safe professional practice and adhere to relevant legalisation, regulations and standards.
  • Have a working knowledge of HIQA Standards as they apply to the role, for example, Standards for Healthcare, National Standards for the Prevention and Control of Healthcare Associated Infections, Hygiene Standards etc. and comply with associated HSE protocols for implementing and maintaining these standards.
Management / Administration:
The CNS (Diabetes – Integrated Care) will:
  • Provide an efficient, effective and high quality service, respecting the needs of each patient/client
  • Effectively manage time and caseload in order to meet the changing and developing service
  • Continually monitor the service to ensure it reflects current needs
  • Implement and manage identified changes
  • Ensure confidentiality in relation to patient/client records is maintained
  • Maintain accurate and up to date statistics of the service provided, including audit of patient/client contacts
  • Represent the specialist service at local, national and international meetings as required.
  • Maintain accurate and contemporaneous records/data on all matters pertaining to the planning, management, delivery and evaluation of this service in line with HSE requirements.

Compile and maintain resource files of services available to persons with diabetes, respond to queries from hospitals, GPs and Practice Nurse regarding diabetes services.

  • Facilitate the holding and maintenance of a diabetes register in each practice in the Integrated Care Programme.
  • Ensure that practices have a call/recall system appropriate to the provision of this service.
  • Develop, in conjunction with the participating practices, an up to date documentation system for use by all personnel involved with the project.
  • Collect statistical information and data to help develop and improve the service
  • Produce regular reports on progress in service development
  • Contribute to service planning process
The above Job Specification is not intended to be a comprehensive list of all duties involved and consequently, the post holder may be required to perform other duties as appropriate to the post which may be assigned to him/her from time to time and to contribute to the development of the post while in office.
Eligibility Criteria
Qualifications and/ or experience / Candidates must, at the latest date for receipt of completed applications for the post:
Be registered in the General Division of the Register of Nurses kept Bord Altranais agus Cnáimhseachais na hÉireann (Nursing Midwifery Board Ireland) or be entitled to be so registered
and
Have at least 5 years post registration experience in the generaldivision of the register of which the applicant is currently practicing
and
Have a minimum of 2 years experience in the specialist area of diabetes nursing care*
and
Have the ability to practice safely and effectively fulfilling his/her professional responsibility within his/her scope of practice
and
Demonstrate evidence of continuing professional development
and
Must hold a Level 8 post registration National Qualifications Authority of Ireland (NQAI) major academic award relevant to the specialist area of Diabetes prior to application.
*Examples of experience would include working in General Medical Nursing where patient with diabetes arecared for, Emergency Departments, Endocrinology ward/departments
Health
A candidate for and any person holding the office must be fully competent and capable of undertaking the duties attached to the office and be in a state of health such as would indicate a reasonable prospect of ability to render regular and efficient service.
Character
Each candidate for and any person holding the office must be of good character
Age
Age restrictions shall only apply to a candidate where he/she is not classified as a new entrant (within the meaning of the Public Service Superannuation Act, 2004). A candidate who is not classified as a new entrant must be under 65 years of age.
Post Specific Requirements /
  • Demonstrate depth and breadth of experience in providing nursing care relevant to the area of diabetes to include experience of working autonomously in an outpatient setting and experience of constructing diabetic care packages/treatment programmes for diabetic clients.
  • Once appointed as the CNS the appointee must agree to undertake the Nurse Prescribing of Medicinal Products Certificate, and achieve the requirements to become a Registered Nurse Prescriber (RNP) in Ireland within an agreed timeframe (i.e. 2 years of taking up the post).

Skills, competencies and/or knowledge / Professional Knowledge
Demonstrate:
  • an in-depth knowledge of the role of the Clinical Nurse Specialist and clinical nurse specialist practice
  • a vision for diabetes integrated care provision crossing primary and secondary boundaries
  • clinical knowledge of all aspects of diabetes care provision
  • an understanding of the principles of clinical governance and risk management
  • ability and evidence of teaching in the clinical area
  • a working knowledge of audit and research processes
  • evidence of computer skills including use of Microsoft Word, Excel, E-mail and Online Search facilities.
Communication & Interpersonal Skills
Demonstrate:
  • effective communication skills
  • ability to build and maintain relationships particularly in the context of multidisciplinary working
  • ability to present information in a clear and concise manner
  • ability to manage groups through the learningprocess
  • ability to provide constructive feedback to encourage future learning
  • effective presentation skills
Planning and Organisational skills
Demonstrate:
  • evidence of effective planning and organisational skills including awareness of appropriate resource management.
  • ability to attain designated targets, manage deadlines and multiple tasks
  • ability to be self directed, work on own initiative
  • a willingness to work flexibly in response to changing local/organisational requirements
Leadership and Team Management skills
Demonstrate:
  • leadership and team management skills including the ability to work with multidisciplinary team members.
Customer/Client Focus:
Demonstrate:
  • awareness and active appreciation of the service user
  • commitment to providing a quality service
  • evidence of motivation by ongoing professional development.
Analysing & Decision Making
Demonstrate:
  • effective analytical, problem solving and decision making skills

Other requirements specific to the post / Access to transport as the post will involve frequent travel
Campaign Specific Selection Process
Shortlisting / Interview / Short listing may be carried out on the basis of information supplied in your application form. The criteria for short listing are based on the requirements of the post as outlined in the eligibility criteria and skills, competencies and/or knowledge section of this job specification. Therefore it is very important that you think about your experience in light of those requirements.
Failure to include information regarding these requirements may result in you not being called forward to the next stage of the selection process.
Those successful at the shortlisting stage of this process (where applied) will be called forward to interview.
Code of Practice / The Health Service Executive will run this campaign in compliance with the Code of Practice prepared by the Commission for Public Service Appointments (CPSA). The Code of Practice sets out how the core principles of probity, merit, equity and fairness might be applied on a principle basis. The Codes also specifies the responsibilities placed on candidates, feedback facilities for candidates on matters relating to their application, when requested, and outlines procedures in relation to requests for a review of the recruitment and selection process, and review in relation to allegations of a breach of the Code of Practice. Additional information on the HSE’s review process is available in the document posted with each vacancy entitled “Code Of Practice, Information For Candidates”.
Codes of Practice are published by the CPSA and are available on in the document posted with each vacancy entitled “Code of Practice, Information For Candidates” or on
The reform programme outlined for the Health Services may impact on this role and as structures change the job description may be reviewed.
This job description is a guide to the general range of duties assigned to the post holder. It is intended to be neither definitive nor restrictive and is subject to periodic review with the employee concerned.