Nurse Case Manager (Regional Pacific) Pacific Health Development

Transcription

1 POSITION DESCRIPTION Nurse Case Manager (Regional Pacific) Pacific Health Development Position Holder's Name:... Position Holder's Signature:... Manager/Supervisor's Name:... Manager/Supervisor's Signature:...

2 PURPOSE OF THE POSITION Counties Manukau Health through its Pacific Health Development team has a contract to deliver Medical Treat Scheme to six Pacific countries as well as working with New Zealand s realm countries of Niue, Tokelau and the Cook Islands. The Nurse Case Manager (Regional Pacific) Pacific Health Development will be responsible for providing clinical lead for the management of Pasifika patients who meet the Overseas Referral Criteria of our partner Pacific Countries who are referred to Pacific Health Development for assessment and treatment in New Zealand funded through the MTS contract. Through the established process they will provide the appropriate linkage to the specialist and the hospital or private facility as appropriate. They will work actively in partnership with the medical and nursing staff across the care continuum to ensure safe, patient and fanau/whanaau centred care in line with the vision and values of Counties Manukau Health. The aim is to ensure Pasifika patients who come to New Zealand for treatment receive the agreed care, and are managed back to the care of the referring doctors of their home country. The Nurse Case Manager (Regional Pacific) will be responsible to support individual patient pathways across the health interface, establishing effective working relationships with members of the multi disciplinary team, patients, their families and/or care givers as required for each referral from the Pacific Island partners. Vision & Values Our Organisational Strategic Goal We care about achieving health equity for our community. Together, the Counties Manukau health system will work with others to achieve equity in key health indicators for Maaori, Pacific and communities with health disparities by We will measure the impact we have on healthy life years every year. This is our commitment to act and be deliberate in our choices and priorities. This means that people will live longer healthier lives in the community. Our Organisational Values We aspire to live and breathe our values every day as the foundation of our strategic actions:

3 Position in the Organisation PACIFIC HEALTH DEVELOPMENT STRUCTURE Comment [EP(1]: Eleanor can you update the structure please EA to GM and Regional Pacific GM Pacific Health Development Regional Pacific Health Gain Fanau Ola Community & Workforce Pacific Health Development Leaders Senior Programme Manager - NZMAT Public Health Advisor Manager Fanau Ola Community & Workforce Manager Regional Pacific Programme Manager 1 Analyst Nurse Lead Social Work Lead Programme Manager Tertiary Associate Programme Manager Community Regional Pacific Programme Manager TBC Regional Pacific Coordinator Fanau Ola Nurses Case Managers x 5 Social Workers x 2 Cancer & Fanau Ola Nurse Community & Workforce Coordinator Associate Programme Manager Workforce Administrator - Fanau Ola and Community and Workforce Pacific Health Development 2016 NATURE AND SCOPE OF RESPONSIBILITIES: Key Accountability To support the management of Pasifika Patients who are referred from partner Pacific Islands to New Zealand for treatment under the Medical Treatment Scheme (Overseas Referral Scheme) or through CMH normal referral process for New Zealand citizens Standards / Achievements The Nurse Case Manager works to triage referrals of patients from partner Pacific countries referred under the Overseas Referral Scheme to proactively assess, support and manage the pathway to receiving care or other necessary services as part of a planned intervention Responds to the ORS Coordinator / referring clinician of the Pacific Countries with an letter of acceptance / declined within 24 hours of receipt of the referral Referrals from the countries of Niue, Cook Islands and Tokelau who are New Zealand citizens, will be referred directly into the referral centre at Manukau Super Clinic or directed to the emergency department as required Will liaise with the specialist and service manager or private health facility to obtain an estimate of cost for treatment and hospitalisation for ORS referrals Works collaboratively with the service booker/scheduler to ensure the referred Pasifika patients are coordinated to see specialists or attend treatment where required. Demonstrates a high level of care management, acting autonomously in a variety of contexts. Provide and maintains documentation including individual patient records, referrals and requests for advice and provides discharge information back to patient referrer and others involved in Patient Care.

4 To evaluate and monitor standards of clinical practice and access risk To contribute to the management of Pacific Health Development Maintains own professional development Collect, collate and organise data on the referred patients and provides reports as required. Case manages Pasifika patients with the Fanau Ola team social workers and other agencies as appropriate or required Utilises expertise in assessment, clinical and case management of Pasifika Patients referred into PHD Manages good open communication with the patient, fanau and referring country around all aspects of the referral pathway into care Reviews patients processes to ensure Pasifika patients receive care and other interventions as required and in a timely way Maintains open lines of communication with clinicians and other agencies around any issues that may arise related to their Pasifika patients Attends and actively participates in the meetings that relate to patient care services Identifies unsafe practice and responds appropriately to ensure safe outcomes Ensures the rights of patients, staff and families are upheld Maintains continuous development and accuracy of Nurse Case Manager Regional Pacific desk file. Provide strong clinical leadership skills with in the multi-disciplinary team Utilises critical thinking and decision making skills where appropriate Provides monthly reports directly related to Overseas Referrals Advocates on behalf of patient and Fanau as appropriate and in a culturally appropriate manner Promotes innovative and creative clinical nursing practice and ensure it is validated with best practice and research activities Promotes a patient and Fanau focussed approach Monitors and reviews Pacific information relating to patients and other referral pathways and outcomes of Pasifika Fanau Ola intervention through the ORS from each Pacific country Develops innovative intervention and support within the Regional Pacific response to further enhance the services to deliver best practice Recognises barriers to engagement and compliance and develops an ability to work collaboratively with others to develop an appropriate solution Works with the Regional Pacific Programme Managers to provide accurate timely reports of achievement against outcomes. Maintains own clinical competence and complies with the requirements of the Health Practitioners Competency Assurance Act. Maintains a current Professional Development and Recognition Programme (PDRP) portfolio Participates in annual performance review process to identify ongoing professional development requirements. Monitors national and international trends in the area of practice Maintains and update own knowledge base related to clinical

5 Health and Safety Recognises individual responsibility for workplace Health & Safety under the Health Safety Act 1992 Resource Management Provide leadership in care delivery speciality Attends educational opportunities and conferences relevant to the role and scope of practice and uses this knowledge to improve practice. Actively participates in relevant professional organisations. Networks with other clinical nurse coordinators both regionally and nationally for sharing of knowledge and processes, looking to continuously improve the quality of care to patients. Provide strong clinical leadership skills within the multidisciplinary team. Recognised barriers to engagement and compliance and develops an ability to work with others to develop an appropriate solution. Work practices ensure safety for self and others Advice or assistance is sought before commencing an unfamiliar work practice Hazards are identified, control plans documented, and hazards eliminated, minimised or isolated Complies with CMDHB incident reporting policy Emergency management procedures and compulsory / compliance education and training completed. Ensures a safe working environment and safe working practices. Ensures that all accidents/incidents in the workplace are investigated, and that hazards are recognised and adequate controls are put in place. Effectively uses trouble shooting and problem solving processes as issues arise. Ensures effective time management skills and priorities workload appropriately Provides an interface between all stakeholders and acts as a key liaison person between members of the team Actively contributes to the formation and review of divisional documents, guidelines, policies and procedures affecting service delivery. Ensures documentation is accurate and maintains confidentiality of information within a legal/ethical framework Recognises and values the roles and skills of all members of the health care team and their delivery of care. Maintains a high level customer service focus with patients, families and multidisciplinary team members in accordance with CMDHB Vision and Values. Actively seeks resolution with regards to patient complaints in a customer focussed and effective manner to a timely and appropriate resolution Actively role models behaviour expected of a Nurse to protect self, and others when faced with unexpected patient responses, confrontation, personal threat or crisis situation Communicates effectively with patients and their families, staff, groups and communities Structures, systems and processes are aligned to enable, support and reinforce effective business performance in line with the Pasifika Health Plan, Ministry of Health and Service targets.

6 Cultural Competency Individual responsibilities, actions and contributions enhance Pasifika cultural competency within practice Utilisation of information technology Advocates for patients and their families to ensure they understand the plan of care and treatment options Complies with organisational clinical policies and guidelines. Leads or contributes to, the development or review of clinical policies and guidelines related to the care and coordination of patients requiring elective surgery Maintains a current knowledge of relevant issues, trends and practices Behaviour demonstrates cultural appropriateness and sensitivity Builds and maintains productive working relationships Demonstrates an understanding in health of barriers and disparities that affect Pasifika patients and their families Is aware of and supports Tikanga Best Practice Is proficient in capturing patient information Demonstrates ability to access and use available clinical information systems. Is conversant with applications required for specific discipline/role. For example, i.pm, Concerto, Outlook, E-Shared Care etc. Maintains own professional development by attending relevant IT educational programmes Demonstrates ability to use incident reporting system and manage incidents systematically. PROBLEM COMPLEXITY The Nurse Case Manager (Regional Pacific) PHD will regularly be challenged by a wide range of problems from all areas, levels and disciplines throughout the DHB, Primary Health and the community. Therefore there will be a requirement to be able to prioritise issues while still providing high quality customer service. The range of problems will be diverse and require solutions customised to meet the circumstances of the Pasifika patient. Therefore opportunities will arise to provide innovative options to the client, based on proven outcomes. There will be demands to meet deadlines, maintain accuracy and quality of information. Failure to do so could impact on the organisation in terms of patient risk. The Fanau Ola Nurse Case Manager (Regional Pacific) will be expected to identify multidisciplinary strengths and weaknesses and implement change to reflect best practices whilst influencing Pasifika patient and Fanau outcomes within contractual and budgetary constraints. Problems will vary from advising on or resolving complex issues of patient care on a daily basis. Problem solving, observation, reporting and negotiation skills are frequently used to ensure the implementation of an effective Regional Pacific coordination system.

7 Key relationships: Internal: Diverse range of Nursing and Medical staff Pharmacists Clinical Records Information Services Interpreters Emergency Care RP Programme Managers Service/General Managers External: Private health providers Primary Health care Providers CMO/Directors/Clinicians from Pacific Island Health Services St John Ambulance Services SCOPE FOR ACTION The Regional Pacific Nurse Case Manager will be accountable for the effective co-ordination and management of Pasifika patient care that has been referred to PHD from our Pacific Island partner countries under the Overseas Referral Scheme of that country and will need to develop individual solutions for each referral as required. The Nurse Case Manager (Regional Pacific) while working within the Regional Pacific team will be aligned with the management of the Fanau Ola Nurse Case Managers under the Nurse Lead and may from time to time be directed to other duties should the need arise. They will at all times, act in compliance with policy, professional jurisdiction and statutory requirements. PERSON SPECIFICATIONS Qualification Experience / Skills Minimum Registered Comprehensive Nurse Current NZ Practicing Certificate Post graduate diploma with a strong commitment to ongoing education Speaks a Pasifika language Clean drivers licence Functioning as a Proficient or Expert Registered Nurse in the PDRP 5 years clinical practice Excellent written and verbal communication skills Relevant clinical experience and expertise Preferred Completed PGDip Speaks a Pasifika language Worked in variety of health services 5 years clinical practice relevant clinical experience and expertise in primary and secondary health care Significant networks with DHBs, Health providers Problem solving/planning

8 Personal Qualities Advanced patient assessment skills Knowledge of legal and ethical responsibilities Collaboration and consultation skills. Competent level of computer literacy Knowledge of legal and ethical responsibilities Patient and fanau / family care focussed approach to care planning Ability to work independently or as a member of a team. Strong ability to problem solve The capacity to demonstrate strong clinical leadership. Ability to understand differing and competing clinical perspectives Sound analytical skills Commitment to ongoing professional development. Self-reflective and critical Passion for Pasifika Health Enthusiasm Experience Excellent written and verbal communication skills Understanding of legal and ethical responsibilities Research skills Teaching experience Report writing skills Clinical leadership skills Collaboration and consultation skills Conflict management skills Excellent report writing