POSITION DESCRIPTION Dementia Clinical Nurse Specialist CMDHB Dementia Care Service Date Produced October 2012 Reviewed: Position Holder's Name : Position Holder's Signature :... Manager / Supervisor's Name : Manager / Supervisor's Signature:... Date :... Approval Date: 26/10/12 Review Date:: 26/10/14 Approval Clinical Nurse Directors Mental Health Services and Community Geriatrics Final Approval Director Of Nursing Position Title: Dementia Care Service Clinical Nurse Specialist
PURPOSE OF THE POSITION This position is responsible for the provision of clinical expertise and leadership in CMDHB Dementia Care Pathway in order to ensure the development and ongoing Dementia specific specialist service. The CMDHB Dementia Care Service will provide assessment, care planning and treatment that is comprehensive and informed by specialist knowledge, throughout the journey of dementia. This will be provided within the scope of the CMDHB Dementia Care Pathway Model of Care in a manner that best meets the dementia client/families needs and expectations and is congruent with the vision and values of Counties Manukau District Health Board. Specifically this role will include: Working with the Clinical Heads, Mental Health Services for Older People (MHSOP) and Health of Older People (HOP), Managers and Professional Leaders to develop, implement and monitor the strategic and operational directions for an integrated multidisciplinary community based Dementia Care Service to ensure and maintain a high quality of services provided to people with dementia and their families throughout their journeys Facilitate the development of nursing practice within the service. Vision & Values Organisational Shared Vision CMDHB s Shared Vision is to work in partnership with our communities to improve the health status of all, with particular emphasis on Maaori and Pacific peoples and other communities with health disparities. We will do this by leading the development of an improved system of healthcare that is more accessible and better integrated. We will dedicate ourselves to serving our clients, families/whaanau and carers and communities by ensuring the delivery of both quality focussed and cost effective healthcare, at the right place, right time and right setting. Organisational Values Partnership Care & Respect Professionalism Teamwork Innovation Responsibility Working alongside and encouraging others in health and related sectors to ensure a common focus on, and strategies for achieving health gain and independence for our population Treating people with respect and dignity, valuing individual and cultural differences and diversity Acting with integrity and embracing the highest ethical standards Achieving success by working together and valuing each other s skills and contributions Constantly seeking and striving for new ideas and solutions Using and developing our capabilities to achieve outstanding results and taking accountability for our individual and collective actions 1
PLACE IN THE ORGANISATION This posion descrip on is set out incorporang the compet ency framework for registered nurses in New Zealand and clearly describes the addional responsibilies and exper se required of a clinical nurse specialist. NATURE AND SCOPE OF RESPONSIBILITIES Key Accountabilities Professional Responsibility Demonstrates knowledge, judgement and accountability in relation to professional, legal and ethical responsibilities and cultural safety. Demonstrates promotion of an environment that maximises client s safety, independence and quality of life and health. Demonstrates accountability for directing, monitoring and evaluating nursing care that is provided by other health professionals. Standards / Achievements As a registered nurse Meets the requirements of the registered nurse competencies for Domain One. Maintains currency of own credentialing process, is compliant with the Professional Development Recognition Programme (PDRP) and participates in annual performance review. Maintains regular interactions with other senior nurses within the health of older people and mental health services. As a clinical nurse specialist Takes accountability for keeping knowledge up to date in geriatric and mental health for older people nursing with a particular focus on dementia care. Identifies own learning needs and negotiates appropriate resources to meet these. 2
Engages in life long learning to assure evidence based practice. Provides nursing leadership through the promotion of an environment of self accountability and responsibility for clinical decision making. Management of nursing care and service delivery With a focus on care delivery demonstrates the ability to provide advanced specialist nursing care and expertise both in direct care and in supporting other staff in the management of a defined patient group/area of speciality practice by; Providing planned nursing care to achieve identified outcomes Undertakes comprehensive and accurate nursing assessment of patients Ensures documentation is accurate and maintains confidentiality Undertakes CMDHB Tikanga Best Practice, Pacific Cultural and cultural diversity training and implements it into service provision. Works closely with the Maaori and Pacific Health stakeholder groups and other cultural specific providers across the sector, where appropriate. Understands the possible adverse outcomes of dementia and nursing care. Actively promotes an environment that supports client safety, independence, wellbeing, recovery where possible and a dignified end of life. Provides leadership for preceptoring of nurses during orientation, nursing students and new graduate nurses, providing a positive experience in our service for this group. Provides leadership to ensure that there is clear understanding of the roles of delegation and direction in nursing. Participates in clinical supervision and peer review with other members of the MDT. Maintains positive professional networks for professional development, staying abreast of evidence based practice approaches. Actively participates in locally based meetings focused on nursing, aged care/dementia. Contributes to research, policy development, and publications related to clinical practice. Integrates health promotion and education in practice and the practice of other nurses. As registered nurse The clinical nurse specialist will meet the requirements of the registered nurse Domain Two nurses involved in clinical practice As Clinical Nurse Specialist Provides an environment that supports clients to set and achieve their goals. Provides an environment that supports client centred care and services. Uses specialist (Gerontology and Mental Health of Older People) nursing knowledge, judgement, advanced health assessment and diagnostic reasoning skills to provide client centred-case consultations, identifying client goals and making recommendations on how the client s can be managed to achieve their goals through health promotion, maintenance and restoration of health, function and wellbeing, recovery/ 3
Ensure the patient has adequate explanation of the effects, consequences and alternatives of proposed treatment options Acts appropriately to protect oneself and others when faced with unexpected patient responses, confrontation, person al threat or other crisis situations Evaluated patient progress toward expected outcomes in partnership with patients Interpersonal Relationships for Management Demonstrates effective interpersonal relationships with others, including effective interviewing and counselling skills and establishing rapport and trust Demonstrates that he/she communicates effectively with members of the health care team, including using a variety of effective communication techniques, employing appropriate language to context and providing adequate time for discussion rehabilitation and end of life care. Evaluates the effectiveness of nursing care and recommendations made in relation to client management and the expected outcomes in partnership with the clients/ families/ whaanau. Role models and supports evidence based practice in dementia care across the key clinical teams DCS, ARHOP, MHSOP, acute services, Primary Health Care, and Age Related Residential Care (ARRC) Provides a point of reference for clients, team members, managers and other health care professionals in matters relating to working with people with dementia. Promotes innovative and specialist evidence based clinical expertise in dementia care Provides client/ family education / explanations about treatment options at a level expected of an advanced practice nurse Advocate on behalf of clients/ families/ whaanau /colleagues as appropriate in a culturally safe manner. Interpersonal Relationships for Management Demonstrates effective interpersonal relationships with others, including effective interviewing and counselling skills and establishing rapport and trust. Demonstrates that he/she communicates effectively with members of the health care team, including using a variety of effective communication techniques, employing appropriate language to context and providing adequate time for discussion. As Clinical Nurse Specialist Recognises and values the roles and skills of all members of the health care team and their delivery of care. Develops and environment of trust among the team members promoting and fostering a supportive and cohesive environment enabling effective practice Demonstrates effective communication, conflict resolution and negotiation skills. Uses a coaching and mentoring model to assist, other nurses and members of the team to improve their skills/knowledge. Participates in business, nursing and education planning processes at strategic and service levels. Actively coordinates the team to ensure that there is support for caseload management and coordination. Leads the development of client/clinical pathways, guidelines, policies and procedures in the CMDHB DCS. 4
Inter-professional health care and quality improvement Demonstrates a collaborative and participative approach with colleagues and members of the health care team when facilitating and coordinating care Demonstrates recognition and valuing of the roles and skills of all members of the multidisciplinary team. Demonstrates participation in quality improvement activities to monitor and improve standards of care provided prevention Quality and Risk Demonstrates involvement in quality improvement projects which will include specifically the development of the Dementia Care Pathway service. Demonstrates participation in quality improvement activities to monitor and improve standards of care provided Demonstrates a collaborative and participative approach with colleagues and members of the health care team when facilitating the development of the Dementia Care Pathway Service HEALTH & SAFETY Organisational Recognises individual responsibility for workplace Health & Safety under the Health and Safety Act 1992 Uses review process and liaises with other health professionals to ensure that clinical care provided is appropriate, cost effective and efficient. Participates in, and when necessary leads meetings within the service. As a Registered nurse The clinical nurse specialist will meet the requirements of the registered nurse competencies for Domain Four As Clinical Nurse Specialist Actively seeks innovation and best practice initiatives to improve care deliver and client outcomes for the DCS. Meets accepted contemporary practice standards as measured via agreed key performance indicators, incidents, complaints and quality audits. Collects information on service provision to evaluate service effectiveness. Evaluates the effectiveness of the pathways, guidelines, policies and procedures so they continued to be evidence based and reflect contemporary practice. Identifies and undertakes audit activities and monitors nurse sensitive quality indicators. Demonstrates an understanding of and an ability to assess and respond to risk issues. Leads, coordinates and reviews effectiveness of quality improvement activities such as the establishment of: o Facilities, infrastructure and related equipment o Staffing, job descriptions and recruitment (in particular Navigator role) o Workforce development processes o Establishment of best practice guidelines (inclusive of cognitive tools, (Person Centred Care Planning) PCCP, Legislative requirements, Advanced Care Plans (ACP), and information sharing) Ensures Key Performance Indicators of the service are reached. As a CMDHB employee Counties Manukau DHB Health and Safety policies are read and understood and relevant procedures applied to own work activities. Workplace hazards are identified and reported including selfmanagement of hazards where appropriate. 5
CULTURAL SAFETY Organisational Commitment to the principles of Treaty of Waitangi Honouring Cultural Diversity Can identify health and Safety representative for area. As Clinical Nurse Specialist Assists in review of policies, procedures and education where there may be an impact on the health and safety of health care team. Assists in the review of incidents related to the Dementia Care Service and identifies any trends that may indicate a need to develop corrective action plans, undertake a review of policies, procedures and education for de-escalation and management of aggressive patients/families/visitors. In conjunction with the nurse educator utilises the CMDHB education framework to support the development of corrective action plans to address clinical issues identified that may impact on staff health and safety. Uses accepted mentoring and/or reflective practice framework when debriefing staff involved in difficult and stressful situations As a registered nurse Refer to Domain One for registered nurses As CMDHB employee Respect, sensitivity, cultural awareness is evident in interpersonal relationships. Cultural differences are acknowledged by respecting spiritual beliefs, cultural practices and lifestyle choices of women and their families/whaanau. Utilise Information Technology Demonstrates the ability to access and use available clinical information systems. Is conversant with applications required for specific discipline/role (for example, HCC, ipms including Contacts and Diaries, Concerto, Outlook, Risk Pro, etc). With the MDT, negotiates the most appropriate platform for communication and record keeping for the DCS. Maintains own professional development by attending relevant IT educational programmes. Demonstrates literacy and computer skills necessary to record, enter, store, retrieve and organise essential client records. PROBLEM COMPLEXITY 6
The Dementia Care Clinical Nurse Specialist is expected to manage a variety of complex and unpredictable problems and issues related to a wide range of clinical activities both across the specialist service and within the organisation. The range of problems will be diverse and often highly complex, and require innovative non-routine solutions customised to meet the circumstances of the client and their carers/families/whaanau. There will be a requirement to prioritise issues and negotiate time frames, while still providing a quality customer service. Failure to do so would impact on the organisation in terms of risk management. SCOPE FOR ACTION The Clinical Nurse Specialist will be required to develop innovative approaches to problem-solving and utilise the skills of other team members to co-ordinate and resolve problems. They will need to negotiate with and co-ordinate a variety of staff at all levels across the organisation and will frequently need to develop individual solutions for each issue and problem. Solutions will be evidenced based. Specifically in this role the Clinical Nurse Specialist is responsible for the implementation of a jointly agreed work programme that will be reviewed monthly to meet service needs. The Clinical Nurse Specialist will actively develop relationships with internal and external agencies to reduce duplication of services and deliver seamless transition of care. The Clinical Nurse Specialist is involved in the development and implementation of policy, procedures and guidelines. They bring new initiatives and ideas to improve organisational efficiency and improve client outcomes. The Clinical Nurse Specialist has an understanding of budgetary requirements, contracts with external services and resources available to the service. There will be a commitment to the vision and values of CMDHB and to client-focused service. This is a unique and autonomous role which provides leadership to a multi disciplinary team, frequently working in a low socio-economic area of cultural diversity. COMMUNICATION The Clinical Nurse Specialist will communicate with a variety of internal staff as well as varied agencies and organisations external to CMDHB. They will need excellent communication and negotiation skills so that they can ensure appropriate and timely clinical care can be provided in a cohesive manner from a range of services across tertiary, secondary and primary health settings. Interpersonal skills Situations may often call for tact, diplomacy and will require information to be handled in a discreet and sensitive manner. In conflict situations, they will be needed to exercise sound judgement, negotiation and persuasiveness skills, facilitating a workable outcome. DIMENSION OF THE POSITION The Clinical Nurse Specialist is professionally responsible to the Clinical Nurse Director, (ARHOP and MHSOP), and responsible to the Service Manager ARHOP and the Clinical Heads for achievement of objectives and goals in the work plan. 7
The Clinical Nurse Specialist will provide expert contributions at an organisational level, and will make recommendations for improvement in clinical nursing practice within the DCS related to quality, resource and performance issues. This includes effective liaison with staff and appropriate external parties and groups, co-ordination of available resources, optimisation of staff skills and effective training and development. POSITIONS REPORTING Directly Nil Indirectly Support Staff, Medical Teams and Members of the MDT PERSON SPECIFICATIONS EDUCATION EXPERIENCE/ KNOWLEDGE ESSENTIAL Registered Nurse. Has achieved Post Graduate qualification or equivalent in relevant clinical area. Has a professional development plan and /or career plan. A minimum of five years clinical experience in Assessment and Rehabilitation or Mental Health services for older people Demonstrated ability in advance health assessment and diagnostic reasoning nursing practice. Functioning at RN Expert level or senior nurse level on the PDRP. Knowledge of current socio-political issues within nursing and in their specialty area. Knowledge and understanding of medico/legal and ethical responsibilities. In-depth knowledge of dementia and its impact on personhood. Knowledge of Older People health issues including falls and continence. The ability to work independently and lead a team. HIGHLY DESIRABLE Clinical Masters Degree Demonstrated ability in the development and management of staff. 8
SPECIFIC SKILLS PERSONAL and PROFESSIONAL QUALITIES Clinical expertise which includes sound clinical judgement and decision making. Critical thinking and analytical skills. Demonstrated ability in problem solving, priority setting, and planning. Ability to critique research and use it as the basis of practice. Excellent communication at all levels of the organisation and ability to establish effective networks. Demonstrated ability to self evaluate and reflect on practice. Demonstrated ability in expert practice working collaboratively across settings and within interdisciplinary environment. Demonstrated ability in developing and influencing health/socio economic policies and nursing practice at local, regional and national levels. Demonstrated ability in negotiation/conflict and management skills. A passion for improving Dementia Care nursing practice and standards of care. A strong recovery and resilience focus. A strong commitment and genuine interest in quality and service. The capacity to demonstrate strong clinical leadership. A commitment to the development of the nursing profession within CMDHB. A commitment to cultural safety and its application to nursing practice. Active involvement in relevant, professional/other organisations. Demonstrated ability in scholarly research inquiry into nursing practice. Demonstrated ability in programme and service development. Articulates scope of nursing practice and its advancement. Active involvement in relevant, professional/other organisations. Knowledge of the MOH contracts. 9
Clinical Nurse Specialist Dementia Pathway Services This is an Addendum to the Clinical Nurse Specialist Position Description it is expected that the key focus will be set up and organisation of the service Introduction To achieve the successful set up and organisation of the service the CNS will have a lead role. Objective To provide expertise in dementia care To support the development and implementation of dementia care service Activities Leads the development of dementia pathway into practice including relevant care pathways, guidelines, policies and procedures Leads standards of practice, protocols and policies for the service. Acts as an effective role model in the creation and establishment of the Navigator role within the CMDHB Dementia Care Service (DCS). Collaborates with managers and clinical leaders to lead and manage development and change processes. Liaises with Primary Health Care teams and other health professionals to identify and prioritise client/community needs in alignment with the Primary Healthcare Strategy. Applies expert knowledge of issues related to driving, decisional capacity, guardianship and powers of attorney and advanced care planning (ACP). This job description should be regarded as flexible and may be changed according to the requirements of the service following consultation. 10