AGENDA FOR CHANGE
NHS JOB EVALUATION SCHEME
JOB DESCRIPTION
1. JOB IDENTIFICATION
Job Title: Advanced Paediatric Nurse PractitionerReports to: Senior Nurse Paediatrics – Paediatric Unit
Department, Ward or Section: Paediatric Assessment Unit, Highland Children’s Unit
Operational Unit/Corporate Department: Inner Moray Firth Operational Unit, Raigmore
Job Reference: SSWCHDRAIGCHLD18
No of Job Holders: TBC
Dated: June 2016 (Effective June 2015)
2. JOB PURPOSE
The postholder is expected to provide high quality holistic patient care within the Paediatric Assessment Unit (PAU) of the Children’s ward, using advanced levels of decision making and clinical judgement.The postholder will have similar responsibilities to that of middle grade medical staff within PAU, utilising advanced clinical skills and expertise, making autonomous decisions regarding immediate clinical care, advice and management from admission to discharge/transfer; aiding patient flow within PAU.
The postholder will ensure that children and young people’s health needs are assessed; treatment and management implemented and evaluated in partnership with patients and families, providing specialist advice to healthcare professionals, other agencies, carers, clients and relatives.
The postholder will be fundamental in developing strategies to improve practice; this will include undertaking research and audit, development of evidence based guidelines and protocols, developing and delivering education strategies for staff within the unit.
3. DIMENSIONS
The purpose of PAU is to assess, stabilise and treat paediatric emergency admissions; followed by planning and delivering expert paediatric care as required.
The postholder will be responsible for the delivery of advanced paediatric nursing within PAU, working collaboratively with both medical and nursing teams; holding similar responsibility to that of middle grade medical staff within PAU.
The postholder will actively undertake clinical supervision of ward nursing staff and junior doctors to facilitate the development of clinical skills and practice to a high standard.
The postholder will be expected to attend all paediatric crash calls within the children’s ward; and other departments as required.
4. ORGANISATIONAL POSITION
5. ROLE OF DEPARTMENT
Raigmore Hospital is the only hospital within NHS highland that supports paediatric patients. It provides inpatient, day case and outpatient provision for acute and chronic patients for all specialities.The Paediatric department provides care for all specialities across NHS Highland and supports a 30 bed inpatient ward; including 4 High Dependency beds, a 6 bed day care unit, outpatient facilities for acute and chronic care and a paediatric assessment unit (PAU).
PAU provides acute and emergency assessment and treatment of sick children. Following initial management and treatment, plans will be made within this area to discharge, admit or transfer.
PAU provides immediate care for all specialities supporting Children age 0 -16 years. The unit can take referrals from A & E, General Practices, or direct from the patient home (on open access policies), triaging all paediatric emergency admissions from 8am-10pm seven days a week.
6. MAIN TASKS, DUTIES AND RESPONSIBILITIES
Clinical
1. Works as an APNP within the statutes and guidelines governed by the Nursing and Midwifery Council.2. Uses expert knowledge to assess the clinical condition of the patient and initiate care accordingly.
3. Demonstrate knowledge of the pathophysiology of acute and chronic diseases or conditions commonly seen in practice. Differentiating between normal, variations of normal and abnormal findings.
4. The postholder is responsible for analysis and interpretation of history, presenting symptoms, physical findings and diagnostic information to develop appropriate differential diagnosis.
5. Initiate and interpret laboratory and radiological investigations appropriate to the clinical situation and needs of the patient; acting accordingly.
6. Assess, diagnose and manage sick children, demonstrating critical thinking and diagnostic reasoning skills, working in partnership with senior medical staff.
7. Makes clinical decisions at an advanced level, initiating treatment using protocols and guidelines as required; and admit, discharge or transfer patient where appropriate.
8. Assist and/or leads medical and nursing staff in clinical emergencies.
9. Demonstrate and maintain advanced paediatric resuscitation skills; acting as a member of the paediatric resuscitation team, taking the lead role as required.
10. Demonstrate the ability to perform a variety of advanced clinical skills and procedures required within the specialty.
11. Demonstrate a sound working knowledge and adherence to NHS Highland policies and procedures at all times.
12. Provide support, guidance and advice on clinical issues to ward and medical staff, ensuring that evidence based practice is promoted.
13. Communicate to an optimum level with patients, carers and the multidisciplinary team.
14. Ensure patients and carers are involved in decision-making regarding their care.
15. Ensure the delivery of a high standard of evidence based clinical practice.
16. Maintain up to date knowledge of relevant conditions and procedures.
17. Undertake independent non-medical prescribing in line with NHS Highland policies and procedures.
18. Initiate drug therapy/medication in accordance with legislation, supply and prescribing of medications.
19. Facilitate APNP led clinics providing expert knowledge and clinical decision making to ensure appropriate management and follow-up as required.
20. Participate and collaborate with other disciplines in relation to child protection issues as required.
Leadership and Management
1. Motivate staff to provide high standards of care by acting as a role model.
2. Lead the development of new clinical protocols, guidelines and evidence based changes in practice within the PAU setting to develop and improve outcomes for sick children and their families.
3. Initiates and develops specific guidelines relevant to the APNP service to ensure advanced levels of care are maintained monitored and reviewed in adherence with local and NMC guidelines.
4. Identify areas of service development and improvement in relation to PAU care.
5. Initiate and undertake research and audit projects which may improve clinical outcome. Interpret, disseminate and act on findings to improve service.
6. Supports and assist nursing staff with co-ordination of PAU, delegating tasks and duties as required.
7. Support and maintain good working relations with all wards and departments and actively promote the paediatric Team.
8. Represent the paediatric team at relevant meetings, disseminating information with other members of the team.
9. Implement and evaluate improvements to clinical practice in conjunction with other members of the Paediatric Department.
10. Ensure the Paediatric team are aware of responsibility to implement and adhere to local risk management / health and safety strategy.
11. Coordinate referrals to other services as required; i.e. Physiotherapists, dieticians etc.
12. Carry out other duties as required by the service that are consistent with the responsibility of the grade.
Educational and Professional Development
1. Utilise informal and formal opportunities for teaching and education with ward nursing and medical staff, ensuring that education delivery is thoroughly researched and complies with local and national best practice.
2. Undertake clinical skills supervision of nursing and medical staff to ensure high standards of practice in all clinical areas within remit.
3. Liaise with Children’s Ward HDU Clinical Educator when developing educational programmes to share best practice and ensure consistency of approach.
4. Maintain own clinical skills to a high standard to ensure safe delivery of care.
5. Attend mandatory training as per NHS Highland.
6. Maintain responsibility for own professional development.
7. Identify areas for personal development through the PDP & eKSF process.
8. Demonstrate a willingness to undertake further education and study.
9. Supervise and assess the clinical skills of nurses and medical staff within PAU, offering support and supervision where required.
7a. EQUIPMENT AND MACHINERY
Utilise technical clinical equipment, calibrating when required, checking for faults and ensuring regular maintenance; and ensure appropriate reporting where necessary. The postholder is expected to have a wide comprehensive knowledge of equipment used within acute setting.
Equipment / Use
Airway adjuncts – LMA, guedel airway, naso-pharyngeal airway, bag valve mask, ET tubes
Oro-pharyngeal and tracheal suction equipment
Tracheostomy tubes and associated equipment
Oxygen equipment – Flow meters, masks, cannulae, nebulisers, humidification circuits, NIV, CPAP
Monitoring equipment; cardiac, blood pressure, temperature, oxygen saturation monitors – all types used in the hospital
Medisense monitor
Resuscitation equipment including automated defibrillator.
Invasive monitoring and venous access devices; central lines,Hickman lines, implanted vascular access devices, PICC lines
Various infusion devices; infusion pumps,
blood warmers, PCA pumps, epidural infusion pumps, syringe drivers
Intravenous lines, venflons, butterfly devices, syringes, needles.
Arterial blood gas needle and syringe
Arterial blood gas analyser
Ophthalmoscope
Nasogastric tubes.
PEG Feeding
(Percutaneous Endoscopic Gastronomy).
Urinary Catheters – suprapubic, urethral.
Various hoists, slings and patient movement equipment.
Electric beds and various pressure relieving mattresses.
Computers and software; word, excel, power point, results reporting system, internet, intranet including e-mail, SSTS, printers
Chute System / )
) To maintain patent airway in emergency situations
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To give correct prescribed oxygen concentration.
To give respiratory therapy.
To measure and observe patients condition and act appropriately on changes in condition.
To monitor patients blood sugar and act appropriately on any changes in condition.
To resuscitate
To measure and observe patients condition and act appropriately on changes in condition.
To access for blood sampling or the administration of medication
To administer prescribed fluids and/or drugs safely
To administer prescribed fluids and/or drugs safely
To administer prescribed fluids and/or drugs safely
To monitor changes in patients condition and act appropriately
Examination of eyes.
To drain gastric contents.
To deliver prescribed nutritional feed direct to stomach.
To drain urine.
To move patients safely.
Safe movement and comfort of patients.
To access results of clinical investigations
Administration
Transportation of items.
7b. SYSTEMS
1. Maintain patient records in accordance with NMC Guidelines and NHS Highland standards.2. Develop and maintain database / records of audits of unit.
3. Maintain own training records and attendance at study days / courses.
4. Access internet and intranet for protocols, guidelines, educational resource purposes.
5. Computer use for communication, reviewing laboratory results and x-rays via PACS and accessing DATIX system.
6. Input and access written and computerised patient documentation i.e. IDL systems.
8. ASSIGNMENT AND REVIEW OF WORK
1. Works within statutes and guidelines of the Nursing & Midwifery Council at all times.2. Follows NHS Highland and locally agreed policies, protocols and procedures.
3. The postholder has the ability to work autonomously within this area assessing and identifying clinical priorities.
4. Self directs and manages own workload on a daily basis.
5. Identifies areas for service development in conjunction with Senior Charge Nurse/Ward Manager.
6. Accesses support from SCN/Ward Manager pertaining to nursing and managerial issues.
7. Work load assignment, clinical supervision and practice reviewed by senior medical staff.
8. Undertakes own professional development review with Line Manager via eKSF process.
9. DECISIONS AND JUDGEMENTS
1. As an autonomous practitioner prioritises own workload, anticipates problems or needs and responds to challenges as they arise.
2. Makes complex autonomous clinical decisions including analysis, diagnosis and clinical management, based on an in-depth broad expert knowledge and interpretation of clinical and other findings such as laboratory investigations and x-rays (with support of consultant paediatrician as required).
3. Decisions include use of advanced skills at resuscitation, admission and discharge from PAU and children’s ward, demonstrating an awareness of options and implications when initiating treatment.
4. Utilise own professional judgement to decide when patients require senior medical intervention or referral to another speciality, taking responsibility and accountability for clinical decisions.
5. Recognises own limitations and is aware of procedure to contact Senior Medical staff when required.
6. The postholder is able to order investigations, and implement treatment following analysis of results.
7. Exercises the ability to challenge any interaction which fails to deliver a quality seamless service.
10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
1. Unpredictability of the workload and the dynamic change from routine to emergency with no prior notice.2. Making independent clinical decisions based on own clinical assessment and interpretation of other findings such as laboratory results.
3. Working with and communicating effectively with a large body of staff and clinicians.
4. Complex nature and emotional demands within the speciality; for example critically ill or terminally ill children.
5. Supervising/mentoring inexperienced staff while they gain competencies to become safe practitioners within the ambulatory setting.
6. Supporting parents, children and other staff when children are diagnosed with abnormalities, or dealing with bereavement.
11. COMMUNICATIONS AND RELATIONSHIP
1. Acts as a patient /staff advocate through the application of ethical, legal and professional knowledge and skills.
2. Communicates effectively, highly sensitive, complex condition related information to families.
3. Uses a high level of interpersonal, professional and communication skills in hostile antagonistic or highly emotive situations such as dealing with clients with severely challenging behaviour.
4. Demonstrates effective verbal and written communication with all members of the multidisciplinary team within own department and relevant departments.
5. Liaises with social work and community services on highly sensitive information e.g., child protection, ability of parental care, situations of abuse within the family unit etc.
6. Offers a strong level of support, teaching and education to staff within the children’s ward and PAU and other relevant departments.
7. Make justifiable referrals to a wide range of other healthcare professionals and specialities which may include the admission or discharge of patients from hospital.
8. Participate in National specialist groups, which facilitate net-working and sharing best practice providing professional specialist advice.
9. Act as an exemplary professional role model to the multi disciplinary team, patients and families.
12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
Physical
1. The postholder must also be able to quickly get to clinical emergencies and provide care / resuscitation as required.
2. Ability to perform complex medical procedures over beds, incubators and cots.
3. The postholder must be able to tolerate unpredictable workload patterns and irregular break times.
4. Due to the nature of the post and workload, the postholder is at risk of exposure to needle stick injuries and bodily waste e.g. sputum, urine, faeces, vomitus, blood and exudates and must be able to deal with such situations as per NHS Highland guidelines.