Date : May 2015 Job Title : Clinical Nurse Specialist ICU Outreach Department : Intensive Care / High Dependency Unit : Location : North Shore and Waitakere Hospital Reporting To : Charge Nurse Manager ICU/HDU Operations Manager (ICU/HDU) for performance objectives. Direct Reports : Nil Functional Relationships with : Internal Operations Manager ICU/HDU. Charge Nurse Manager ICU/HDU Head of Division for Nursing Consumers & their families Clinical Director Nursing staff supporting the unit functioning e.g. Clinical Charge Nurses, Clinical Nurse Educators, RN colleagues, Clinical Coaches Director of Nursing & Midwifery Medical teams Allied Health team Support Services: pharmacy, nutrition, laboratory, clinical engineering, facilities External Colleagues in other DHB s Committees/Groups Unit Meetings M & M Meetings ICU/HDU Our DHB Purpose, Values and Standards At the heart of Waitemata DHB is our promise of better care for everyone. This promise statement is the articulation of our three-fold purpose to: 1. promote wellness, 2. prevent, cure and ameliorate ill health and 3. relieve the suffering of those entrusted to our care. At the heart of our values is the need for all of us to reflect on the intrinsic dignity of every single person that enters our care. It is a privilege to be able to care for patients, whānau and our Approved by the Director of Nursing & Midwifery May 2015 Page 1
community, a privilege that is sometimes overlooked in our day to day work. Our standards and behaviours serve as a reminder to us all about how we are with our patients and with each other. Purpose of the role Co-ordination and further development of the Critical Care Outreach Service ensuring delivery is efficient, effective and of a high standard. Developing and creating Critical Care Outreach Team (CCOT) initiatives that support patient safety and develop competence and capability of WDHB nurses including Critical Care Outreach Registered Nurses. Advanced practice nursing role that provides specialist advice on management approaches to care delivery for the critically ill presenting with complex needs. Teaches / coaches to support care delivery and supports best practice initiatives. Approved by the Director of Nursing & Midwifery May 2015 Page 2
Professional Development of specialty practice Professional Leadership and Expertise Clinical Nurse Specialist KEY ACCOUNTABILITIES Domain One Professional responsibility Includes accountabilities for professional, legal, ethical and culturally safe practice. This includes being able to demonstrate advanced critical thinking, judgement and accountability for own actions and decisions Practice nursing in a manner that respects the boundaries of a professional relationship Provide an environment of trust and respect Work to understand the patient/family/ whanau s interpretation of the illness to consider the options and goals Acts appropriately to protect self and others when faced with unexpected client responses, confrontation, personal threat and other crisis situations Is courteous, diplomatic and positive in working relationships especially in stressful situations Appropriately challenge health care practice which could compromise client safety, privacy or dignity Ensure that action is taken where problems and safety issues are identified Following & complying with H&S policies & processes & applying them to their own work activities Identifying, reporting & self-managing hazards where appropriate Early and accurate reporting of incidents at work Ensures the professional and political integrity of WDHB by carrying out all functions in compliance of the Treaty of Waitangi and by demonstrating a serious commitment to keeping the treaty alive. Shows sensitivity to cultural complexity in the workforce and patient population Company health and safety policies are read and understood and relevant procedures applied to their own work activities Workplace hazards are identified and reported, including self-management of hazards where appropriate Can identify health and safety representative for area Provide thoughtful, constructive evaluation in peer review Consistently exhibits fair, dependable and ethical conduct; ensuring others reflect on the WDHB core values Preceptor and support new staff to ensure they become an effective team members Is self-directed and shows initiative in care delivery and teamwork Involves an advocate when the client requests support or has limited abilities in decision making Is a role model by continuing to work on personal and professional development Utilizes critical thinking and managerial skills, mentoring and offering educational guidance To work progressively and constructively towards clinical levelling and to take on adjunctive responsibilities. Develop and role model the ethos of team work and collegial support Respond to patient/client inquiries with complete, accurate and timely information, addressing concerns / complaints raised by the Critical Care Outreach service Approved by the Director of Nursing & Midwifery May 2015 Page 3
Education and clinical teaching Clinical Care/Care Coordination Domain Two Clinical Nurse Specialist Management of nursing care at advanced practice level Includes accountability related to patient/client assessment and management of advanced nursing care that is supported by evidence Demonstrate skill in clinical health assessment in the clinical setting. Identifying changes in patient/client condition Take appropriate actions and acts to prevent deterioration Effectively identify changing needs and refer appropriately Demonstrate technical competence in undertaking relevant treatments and practices Assess patients with multiple problems to provide immediate care and assess when other team members need to be called / referred to Co-ordinate and prioritise the care for a number of patients, utilizing the Critical Care Outreach Team resource effectively and appropriately Care is adapted to respond to multiple priorities utilizing resources effectively with innovation Help the patient/client understand the treatment and care plan Assist patient/family/whanau to participate in care as desired Assist patient/family/whanau cope with the implications of the situation and adapt the care plan accordingly Integrate knowledge of bio-science and patho-physiology when evaluating patient response to intervention/therapy Use, develop and introduce informal and formal methods of teaching appropriate to the individual or group abilities Identify patient s readiness to learn and implements teaching appropriately Domain Three Interpersonal relationships and enhancing the patient experience Includes accountability for interpersonal and therapeutic communication with clients/patients and members of the health care team. Act as referral point for Critical Care Outreach Registered Nurses for clinical advice and senior opinion Participate in the multi-disciplinary meetings / clinical rounds Seek guidance from other specialist nurses / medical colleagues when a new situation arises Care is managed to adapt to input from the multidisciplinary team Supports other Critical Care Outreach staff to deliver care appropriately; acting as both role model and supervisor. Client progress is reviewed and appropriate referral or adjustment of the care plan made in consultation with the client and health care team Seek feedback from colleagues about the consistency and standards of own practice Participate and lead the multidisciplinary clinical decision making process Provide feedback in a constructive, assertive manner, completing and supporting the appraisal process. Approved by the Director of Nursing & Midwifery May 2015 Page 4
Workplace Health & Safety Research & Audit; Evidence based practice Service Development Quality Improvement: Guideline and policy development Supports Professional Activity Clinical Nurse Specialist Domain Four Interprofessional healthcare and quality improvement to deliver organisational objectives Includes accountability for evaluating the effectiveness of care and promotion of nursing perspective within the health care team Contribute and deliver team building activities Co-ordinate and lead the education programme addressing care of the acutely unwell adult outside the critical care unit Make suggestions and take action to improve the quality and reduce the cost of services Contribute and lead in service planning and quality improvement Co-ordinate and ensure appropriate staff are available to the Critical Care Outreach Team to deliver appropriate patient care and support the WDHB quality agenda Develop and review agreed KPI s Deliver and develop education to improve student learning and orientation of new team members Participate in peer review and case review to ensure that the client receives the best care possible Maintain and review ongoing clinical audit processes, ensuring useful and accurate data is made available to the wider WDHB team. Is involved in quality improvement activities/auditing including applying the Health & Safety policies to own work activities, identifying hazards and reporting self management of hazards VERIFICATION: Employee: Manager: Date: Note: This job description forms part of an individual s contract of employment and must be attached to that contract. Approved by the Director of Nursing & Midwifery May 2015 Page 5
PERSON SPECIFICATION POSITION TITLE: Critical Care Outreach - Clinical Nurse Specialist - ICU/HDU Minimum Preferred Qualification RCpN, RGON, BA Nursing Continued development through post-registration education and learning opportunities Registered Nurse with 5 years experience with Experience demonstrated appropriate clinical experience at this level. Critical care experience is essential in order to provide expert physical assessment and give advice on the correct course of action. Post graduate tertiary education in HDU/ICU is highly desirable. Advanced resuscitation training. Ability to interpret results (blood results, ECG s etc). Competence in management of patient s requiring both invasive and non invasive respiratory support, so as to provide advice and support (IPPV, CPAP, non-invasive ventilation, care of tracheostomy). Knowledge of nutritional needs of critically ill patients and those recovering from critical illness. Excellent communication skills to facilitate liaison between CCOT, service personnel, wards and other specialists. Understanding of physical, cognitive and psychological problems following critical illness. Accountability, legal and ethical awareness. Strong audit skills to ensure evaluation, development and reporting for the Critical Care Outreach service. Strong communication skills to effectively share clinical knowledge with others, teaching and guiding staff effectively Use of information and computer support systems Strong team work reputation Personal attributes Contemporary view of nursing practice as evidenced by an innovative and dynamic approach to patient care in the acute care setting. Excellent communication and interpersonal skills Understanding of and commitment to the principles of Approved by the Director of Nursing & Midwifery May 2015 Page 6
Skills/Knowledge/Behaviour the Treaty of Waitangi. Ability to work with minimal direction, knowing when to seek medical advice A positive nursing identity and ability to act as role model for other nursing staff Able to lead and manage change Able to handle stress effectively in self and others Positive manner, able to influence without conflict, good facilitator, provides clear direction Upholds confidentiality with reputation for high integrity and discretion Sensitive and constructive in responding to the needs of individuals and groups, recognising cultural difference. An active listener, has a way of valuing everyone s opinions Reputation for excellent nursing practice and ability to coach and guide staff to meet patient needs. A credible role model Demonstrated expertise in guiding care planning for complex patients and working with families Detailed knowledge and understanding of the legislation surrounding privacy and informed consent Excellent communicator, highly articulate and excellent listening skills Self-directed/use of initiative, confident skill in negotiation and consultation Manages personal stress effectively Upholds confidentiality with a reputation for integrity and discretion Ability to work well in a team, enhancing the capability and contribution of the team Ability to effectively share clinical knowledge with others and help transform practice Conflict resolution ability, articulate and skilled at resolving interdepartmental issues Assertive, able to address areas of concern and personnel issues effectively Works effectively using a sense of humour Seeks guidance and supervision Has experience in maintaining good relationships to ensure continuity of care and integration, hospital and community care Approved by the Director of Nursing & Midwifery May 2015 Page 7