AGENDA FOR CHANGE

NHS JOB EVALUATION SCHEME

JOB DESCRIPTION TEMPLATE

1.  JOB IDENTIFICATION

Job Title: MIDWIFE – INTEGRATED HOSPITAL & COMMUNITY
Reports to: - MIDWIFERY TEAM LEADER
Department, Ward or Section: - MIDWIFERY UNIT, BELFORD, HOSPITAL, FORT WILLIAM
CHP, Directorate or Corporate Department: - NORTH & WEST OPERATIONAL UNIT
Job Reference:
No of Job Holders: 10
Last Update: September 2012

2. JOB PURPOSE

Carry continuing professional responsibility as an Autonomous Practitioner for a midwifery caseload, to provide midwifery managed care ensuring appropriate delegation of work according to the skills of the team, providing supervision, support and advice to team members.
To contribute to the overall strategy of Midwifery care within NHS Highland working collaboratively with obstetric, midwifery and professions allied to care in this field.
3. DIMENSIONS
·  To provide midwife managed care for low risk women, plan care throughout the pregnancy episode in a remote and rural location
·  Continue you to work with colleagues to improve and develop services for low risk women.
·  A Team of 7.39 WTE Midwives will provide the above covering Fort William and surrounding areas, client list around 250 per annum with support from 1.8 WTE Midwifery Assistants
·  Delivery of care will take place within Midwifery Led Unit and client’s home. Intra partum care will take place both within the unit and clients home.
·  To work collaboratively with obstetric colleagues in Raigmore and other team members in a designated location to provide safe, effective and evidence based care for medium and high risk women.
·  Regardless of classification of care (low, medium or high) liaison with other agencies will be regarded as an essential component of the care package.
·  There will be an Out of Hours (OOH’s) (1 in 2/3 per week) commitment providing cover for the Fort William and surrounding areas.

4. ORGANISATIONAL POSITION

Management Structure
Professional Accountability to Head of Midwifery

5. ROLE OF DEPARTMENT

·  Provision of Midwifery Care to all women in Fort William and surrounding area. Care involves ante natal, intra partum and post natal to women in all categories of care (low, medium or high risk).
·  Provision of an environment for care on an outpatient basis both for clinical and non-clinical reasons i.e. midwifery and consultant clinics, preparation for parenthood classes.
·  Aqua natal classes will be provided by Midwifery Unit staff out with the department in a local facility.
·  Provide an environment for learning for student midwives, nursing students and medical students as per requirement of course syllabus from a given educational institute.
·  Care provided will be up to date based on evidence from local and national sources, Best Practice statements etc.
·  The post holder will play a vital role in all of the above activity.

6. MAIN TASKS, DUTIES AND RESPONSIBILITIES

CLINICAL

·  Holistically assess the needs of women preconceptually, during a maternity episode and into parenthood. To plan, provide and evaluate care in accordance with NMC requirements, specifically Midwives Rules and Code of Practice and in partnership with family group.

·  Carry continuing responsibility as an Autonomous Practitioner across a defined geographical area, to provide midwife managed care in collaboration with midwifery & obstetric colleagues
·  Continually maintain and develop professional and clinical knowledge (in collaboration with the Team Leader and Supervisor of Midwives) to provide evidence-based practice with proven clinical effectiveness.
·  Contribute to research and audit, setting and maintaining standards and quality of midwifery care in accordance with National, local and Clinical Governance frameworks.
·  Assess, initiate and implement care as a member of the Midwifery Team, enabling the service to provide a wide range of midwifery skills, including perineal suturing, venepuncture, cannulation and CTG monitoring.
·  Initiate management of emergencies such as resuscitation, haemorrhage, shoulder dystocia, fetal malpresentation.
·  Identify the care and support needs of the client group, offering counselling advice and decide on further referral as required i.e. Ante natal screening, prophylactic admin of Anti D, Newborn screening
·  Establish and maintain professional communications with colleagues in the Midwifery Integrated Care Team, Medical/Obstetric Services and Allied Healthcare. Professions throughout NHS Highland to achieve appropriate input to client care.
·  Post holder will provide a safe environment to facilitate normal, including water birth both within the Midwifery Unit & home environment
·  Responsible for accurate and efficient documentation regarding all clients care and ensuring statistical records are maintained and submitted to appropriate departments in accordance with NHS Highland and NMC.
·  Comply with NMC Rules and Code of Professional Conduct.
·  To be aware of and comply with the requirements of current Health and Safety Legislation, it’s subordinate Regulations and Approved Codes of Practice to ensure compliance and safe working practice.
·  Contribute to the design and implementation of Maternity Services Policies, Procedures and Guidelines in NHS Highland.
·  Post holder will have a commitment & responsibility for OOH’s which exceeds contracted hours.
MANAGERIAL
·  The post holder will manage own caseload
·  The post holder will assist in the selection and supervision of Midwifery Assistants.
·  Post holder will take the lead in various aspects of managing the team i.e. staff rotas, holiday allowances, adherence to PIN guidelines, SVQ support, ordering
·  The post holder will act in line with NHS Highland Child Protection Policy Guidelines in cases of suspected or actual child abuse or neglect, working collaboratively with other agencies to plan, implement and evaluate programmes of care.
·  Post holder will have responsibility as the nominated ‘Fire Officer’ for Belford Hospital & be instrumental in local Major Incident Plan.
EDUCATION
·  The post holder will educate various groups by leading, organising and facilitating training and education activities as required.
·  Teach and supervise Midwifery Students, Student Nurses and Support Staff as required.
·  Plan and participate in health promotion, preparation for parenthood programmes and give client information to enable to make informed choices on health and care options.
·  The post holder will facilitate clinical supervision and may function as an Supervisor of Midwives
·  The post holder will contribute to a range of Public Health Initiatives including provision of education/training of various groups by leading, organising and facilitating training and education activities

7a. EQUIPMENT AND MACHINERY

The post holder will have knowledge of use of the following equipment within the Midwifery Unit & Community:
·  IT Systems essential to assist communication – essential to communication within and out with NHS
·  Cardiotocograph (CTG) – assessing fetal heart patterns
·  Hand held doptone – auscultating fetal heart
·  Mobile phone – communication
·  Fax machine – communicating in formation
·  Jaundice meter – measuring levels of neonatal jaundice
·  Sphygmomanometer – measuring blood pressure
·  Infant resuscitaire containing all necessary equipment for the resuscitation & stabilisation of the neonate – resuscitation of neo nate if necessary
·  Transport incubator – safe transportation of neo nate for on going care
·  Entonox & oxygen cylinders – entonox for pain relief, oxygen for emergency use for mothers and babies
·  Electronic baby weighing scales – weighing babe
·  Electronic thermometer – taking temperatures
·  Venepuncture needles, syringes & blood collection tubes – taking blood and transporting to lab
·  Cannulae – administration of IV blood
·  Urinary catheters – emptying bladder
·  Sharps/placenta disposal containers – safe disposal of sharps
·  Suction machine & catheters – suctioning if necessary
·  Obstetric mannequins dolls – maintenance of essential skills
·  Disposable delivery & suturing instruments – delivering babes and suturing perineiums
·  Perinneal suturing simulator – maintaining suturing skills
·  Speculae – vaginal examination
·  Neonatal oral suction catheters – suctioning if necessary
·  Breast pump – emptying breasts to assist breast feeding
·  Ordinary & delivery mechanical beds with attachments (lithotomy poles) – delivering and suturing
·  Extractor fan – cooling
·  TV & video – parent ed
·  Birthing ball- birth aid
·  Portable birthing pool & necessary equipment (pump & tubing) – water birth and labour
The post holder must be familiar with the use of all of the above. In house training will be provided for all types of equipment.
7b. SYSTEMS
·  Maintain client records in accordance with NMC guidelines & NHS Highland Standards
·  Complete Administration Data System Information i.e. Maternity Dashboard
·  Efficient use of resources & stock control, ordering stores & supplies with authorisation from Midwifery Manager
·  Record annual leave, mileage forms & monthly time sheets & forward to Midwifery manager for authorisation
·  Entry of data into Scottish Birth Record (National Web based data base)
·  Recording of OOH/midwifery activity to be forwarded to Midwifery Manager for annual Midwifery Service statistics & audit information
·  Use computer system to effectively communicate with colleagues and multi disciplinary team and NHS Highland intranet

8. ASSIGNMENT AND REVIEW OF WORK

Working as an Autonomous Practitioner with the workload being generated via GP practices clients, other healthcare professionals & partner agencies. Caseload allocation is determined by geographical location and general workload of the midwifery team. Workload is planned utilising resources within agreed parameters ensuring individual patterns of client care.
Reports to Midwifery Manager, work on a daily basis is unsupervised.
Participate in reporting mechanisms to inform Midwifery Team Leader of issues or concerns.
Participate in Midwifery Team meetings, multidisciplinary meetings to ensure effective communication, discuss caseloads, practice issues & service provision as appropriate
The post holder will be guided by local Protocols & Guidelines supported by the Supervisor of Midwives (as per statute), peers, obstetric colleagues & Midwifery Team Leader on an on-going basis. Feedback is regularly provided to the post holder from fellow professionals within the Team, women themselves & obstetric colleagues.
Personal & Professional Development needs will be regularly discussed & agreed with the post holder and Midwifery Manager as part of the eKSF &PDP process
The post holder will be proficient in anticipation of problems both of a clinical or non clinical nature taking steps to resolve without being requested to do so.
9. DECISIONS AND JUDGEMENTS
·  Decision making often in isolation i.e. arrangement for safe transfer of client to appropriate environment for on going care
·  Judgement based on a high level of clinical skill & experience
·  Confidence to challenge decisions made by other professionals essential
·  Autonomous working on a daily basis
·  Responsible for the day to day running of the department on a regular basis with decisions being made for activity of team members
·  Makes decisions about care based on the best available evidence with women, their partners and
families
·  Makes decisions re the reporting of child protection issues as per Child Protection Guidelines

10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB

·  Out of Hours (OOH’s) demands – there is a need to continue to educate women, prioritise and develop confidence in decision making.
·  There is a need to demonstrate flexibility allowing for changing circumstances.
·  Working in isolation – there is a need for regular peer review, case conferencing and clinical supervision.
·  Working with the demands of vulnerable families
·  Dealing with obstetric emergencies/ complications, having the competence & confidence in a stand alone situation
·  Commitment to homebirth as per women’s of place of delivery
·  Personal safety issues & implementation of Lone Working Policy
11. COMMUNICATIONS & RELATIONSHIPS
PEOPLE/
ORGANISATIONS / PURPOSE / NATURE / FREQUENCY
Midwifery colleagues
Medical colleagues
Allied Healthcare Professions
Other disciplines / Sharing complex
Clinical and
Management
Information, de-
briefing & liaising / Face-to-face,
Telephone, written & electronic
communications / As required
Statutory & Voluntary Agencies / Advocacy, information seeking & liaising / Face-to-face, telephone, written
& electronic
communications / As required
Client & Families / Provision of care,
sharing information, health promotion / Face-to-face,
telephone, written
& electronic
communications / As required
NHS Highland / Information sharing on local
Trust issues pertaining to staff
& service management / Informal & formal meetings, verbal,
Written & electronic
communications / As required
Midwives, Students & other
Disciplines / Teaching / Formal & informal
settings / As required
12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
PHYSICAL SKILLS: Regular requirement to carry out following tasks:
Venepuncture, Intra muscular injection, cannulation, suturing, vaginal examination, normal delivery of babies, perform effectively in maternal or neonatal emergency, driving manual handling and keyboard
PHYSICAL EFFORT:
Occasional moving & carrying of equipment on daily shifts to & from base to location. Occasional awkward positioning for delivery of babes and breast feeding mums. Physical skills to support women to labour and birth normally.
MENTAL DEMANDS: Concentration needed for all aspects of clinical care, documentation, liaison, meetings & decision making. Interruptions experienced frequently i.e. telephone, one to one liaisons. Daily concentration required for high level of decision making required as an autonomous practitioner & organisational skills to cope with competing demands, client’s needs & unpredictability of Midwifery Practice. Communication difficulties with non English speaking clients.
EMOTIONAL EFFORT: Distressing circumstances experienced whilst dealing with adverse events poor outcomes, domestic violence, child protection, complaints, challenging clients, families, colleagues & complex cases. Lone working in the community requires skill to continually assess risk to self, team & clients. Working in a remote & rural location also requires skill to continually assess & manage client care. Demand of job does, at times, impact on personal circumstances particularly in the context of OOH’s work.