Clinical Nurse Specialist (Stroke Care)
Clinical Nurse Specialist (Stroke Care)
Job Specification, Terms & Conditions
Job Title and Grade / Clinical Nurse Specialist (Stroke Care) (Grade Code 2632)Campaign Reference / NRS0590
Closing Date / 9th March 2012 at 12 noon
Proposed Interview Date(s) / Week commencing 2nd April 2012
Taking up
Appointment / To be indicated at job offer stage
Organisational Area / All Health Service Executive (HSE) Areas – DML, DNE, West and South
Location of Post / To be advised at ‘Expression of Interest’ stage
Please note a recruitment panel will be created to fill posts in all HSE areas as they arise
Details of Service / In recent years new techniques and strategies for improving the care of people with stroke have emerged. For example, the benefits of organised clinical services for stroke care have been clearly established. Hospital-based Stroke Units for acute and initial rehabilitation of patients with stroke and TIA are associated with a reduction in death and institutional care of around 20%, with one additional patient returned to community living for every 20 patients treated.
Following emergency admission to hospital with stroke, administration of ‘clot-busting’ thrombolysis therapy can reverse or substantially reduce disability in one-third of patients treated within 90 minutes of stroke onset. However, strict administration guidelines mean that only 8-15% of confirmed ischaemic stroke patients are eligible for such treatment. Because of the potential for catastrophic brain haemorrhage associated with thrombolysis given inappropriately and the brief time-window for treatment, substantial organisation is needed to select appropriate patients on arrival in emergency departments and to safely deliver treatment to those most likely to benefit.
At the end of peoples’ hospital stay there is substantial evidence that Early Supported Discharge programmes for selected stroke patients are associated with reduced hospital costs, fewer bed-days used, and greater patient satisfaction.
Recent data suggests that organised rapid-access diagnostic services for ambulatory patients with TIAs (‘warning’ strokes) result in 80% reduction of disabling strokes within one week, and substantial savings in cost and hospital bed utilisation. Available evidence suggests that these services may be delivered in various settings (same-day TIA clinics, day hospital/medical assessment units, stroke units), provided rapid access is available to specialist assessment, diagnostic investigations, and appropriate treatment.
In Ireland and internationally, patients with stroke and TIA have traditionally been admitted to general medical wards and have had acute medical care provided by hospital physicians with general but not further specialist training in stroke medicine. Similarly, healthcare governance structures and systems of care have usually been generic in nature, with little development of specific governance structures, services, and cross-specialty systems tailored to the needs of patients with stroke and TIA.
The Stroke Programme is one of the Clinical Strategy & Programmes Directorate clinical care programmes aiming to improve access, quality and cost-effectiveness of services. Access to acute stroke treatment will be improved through the development of thrombolysis, rehabilitation and TIA services. Quality objectives will be achieved through the development of a governance structure and the implementation of a stroke register to monitor the process and outcome of care for the patient. Cost objectives will be achieved through more targeted use of resources and decreased length of stay.
The mission of the National Stroke Programme is to deliver better care through better use of resources. The vision is to design standardised models for the delivery of integrated clinical care and toembed the sustained clinical operational management of the integrated pathway
The overall aim of the National Stroke Programme is to ensure
•National rapid access to best-quality stroke services
•Prevent 1 stroke every day.
•Avoid death or dependence in 1 patient every day.
The areas covered by the programme are
1.Governance
2.Prevention - Atrial Fibrillation
3.Prevention - TIA/Carotid
4.Emergency Stroke Care
5.Acute Stroke Unit Care
6.Stroke Care in the Community
8.Stroke Register
Please note the panel created from this recruitment campaign will be used to supplement the existing national panel for Clinical Nurse Specialist (Stroke Care) and will be used to fill vacancies at all HSE sites as appropriate.
There are immediate vacancies for Clinical Nurse Specialist (Stroke Care) in the following sites:
- RoscommonCountyHospital
The Galway/Roscommon Group is part of a network of hospitals in the HSE West area providing a range of clinical services for patients. In July 2011 the Emergency Department in RCH was changed to an Urgent Care Centre. These changes were made to ensure patient care; patient safety and patient outcomes are optimised. RCH continues to provide acute hospital care for the population of Roscommon and wider area. It will do this as part of a wider network of acute hospitals across western area and will be supported by others hospitals in the region.
It is envisaged that RCH will be a centre of excellence for diagnostics for the West. Already new services have commenced in RCH. In September 2011 a new Plastic Surgery service commenced in RCH under the leadership of Dr. Deirdre Jones, Consultant in Plastic and Reconstructive Surgery A new development is RCH is the introduction of Rheumatology Telemedicine on October 2011. This new service has been warmly welcomed by all and especially by the patients who have availed of it to date.
A Medical Asessment Unit is in operation 5 days per week. Rapid Access Clinic service is also in place. Endoscopy Suite is being developed at RoscommonCountyHospital in line with Health Service Executive proposals which will meet all JAG, Hygiene Regulations, Decontamination and Infection Control requirements, and Acute Medicine Programme. The function of the Endoscopy Unit will be to facilitate all scope procedures at RoscommonCountyHospital in a dedicated unit and ensuring that it meets best practice and all relevant standards. The Department will provide a service for day attendees and will consist of a two roomed Endoscopy Suite and appropriate level of reception, preparation and recovery areas in line with national guidelines.
It is expected that RoscommonCountyHospital will become a recognised centre for the National Cancer Screening Programme and also be able to facilitate patients from other hospitals in order to reduce waiting times for diagnostic and surveillance scopes/procedures. With the provision of thisdevelopment on site it is also hoped that we will also be able to widen the service to offer Bronchoscopy, Cystoscopy and a range of other such like scope services which will be facilitated by our own Consultants and visiting Consultants from GUH and other hospitals in the network.
Informal Enquiries for this post:
Maura Daly Loftus, Assistant Director of Nursing
Contact Details: Tel: (090) 66 26200.
- MidlandRegionalHospital, Mullingar
- CavanGeneralHospital
- WexfordGeneralHospital
- KerryGeneralHospital
- Our Lady’s Hospital, Navan, Co Meath
There may be vacancies in the following Hospitals
- St Columcille’s Hospital, Loughlinstown
Acute hospital services in the hospital’s catchment area are currently been reconfigured. As part of this reconfiguration process a 10 bed stroke rehabilitation unit will be established at St. Columcilles. The successful candidate for the position of Clinical Nurse Specialist /Stroke Care will play a lead role in the development and operation of the service.
St. Columcille’s Hospital is a small (106 bed) AcuteGeneralHospital providing speciality impatient and outpatient services in Cardiology, Endocrinology/Diabetes, Elderly Medicine and Acute General Internal Medicine.
Informal Enquiries for this post:
Ms. Barbara Mennis, Director of Nursing
Contact Details: Tel: 01 2115221
Dr. Rachael Doyle, Consultant Geriatrician
Contact Details: Tel: 01 2115030
- Our Lady of Lourdes Hospital, Drogheda, Co. Louth
Informal Enquiries for this post:
Ms Edel Kirwan, CNM3
Contact Details: Tel: 087 9308285
- BantryGeneralHospital
Please note some of these vacancies may be filled by the existing panel.
Reporting Relationship / The post holder:
- Is professionally accountable to the Director of Nursing (DON) or designated officer as required and works in partnership with the multi disciplinary team.
- Will report to the Asst. DON or designated officer as required on operational matters.
Purpose of the Post / The role of the Clinical Nurse Specialist in Stroke Care is to provide for the care and on-going management of patients with stroke. The post holder will be required to work as a key member of the multi-disciplinary team in the hospital providing physical, psychological and emotional support to stroke patients and their families throughout their stroke disease trajectory. She / he may act as a liaison between Stroke Services, Primary Care Teams, Community Care Teams and other agencies. The post holder will work as part of the multi disciplinary team to achieve the strategic objectives of the Stroke Service.
Principal Duties and Responsibilities / Professional Responsibilities
The Clinical Nurse Specialist (Stroke Care) will:
- Practice nursing according to the Code of Professional Conduct and the Scope of Practice Framework as laid down by the Irish Nursing Board (An Bórd Altranais) and the National Clinical Guidelines for Stroke
- Adhere to national, regional and local Health Service Executive (HSE) guidelines, policies, protocols and legislation
- Work within their scope of practice and take measures to develop and maintain the competence necessary for professional practice
- Maintain a high standard of professional behaviour and be accountable for their practice
- Be aware of ethical policies and procedures which pertain to their area of practice
- Respect and maintain the privacy, dignity and confidentiality of the patient
- Follow appropriate lines of authority within the Nurse Management structure.
The Clinical Nurse Specialist (Stroke Care) will:
- Work in collaboration with other members of the multidisciplinary team in assessing, planning, implementing and evaluating an individualised plan of care for patients with stroke and stroke related illnesses which meets each patient's needs. This will encompass:
neurological status-NIHSS / GCS, Pre-morbid status-mRS, etc.
-Planning patient care - the Clinical Nurse Specialist (Stroke Care) will work closely alongside the multidisciplinary team (MDT) and within agreed protocol driven guidelines to develop individualised a plan of care
-Delivery of patient care through patient/family education, nurse led-secondary
prevention clinics
-Evaluation of patient care -through audit and research to evaluate quality of patient
care. Outcomes of audit / research should also contribute to the service plan of care
to the stroke patients / clients and families in the hospital community and outpatient
settings.
- Provide an efficient, effective, and high quality service, respecting the needs of each patient e.g. sameday assessment of stroke patients including rapid tPA assessment and rapid access TIA referrals, establishing a history from the family and patient, management of acute complications and providing information and education to both patient, staff and family
- Effectively manage time and caseload e.g. same day referral assessment and education of stroke patient, weekly inpatient education, TIA assessment and education, OPD stroke secondary prevention and MDT meetings and staff / other education.
- Accept appropriate referrals from members of the multidisciplinary team and other allied health professionals
- In collaboration with Consultant staff, with other members of the multidisciplinary team refer strokepatients for diagnostic tests and investigations which have been agreed within set protocols e.g. U/S Carotids, CT Brain, Holter, Echo, Fasting bloods for risk factors, BP Monitor, Smoking Cessation and referral to other members of the MDT as agreed
- Make variations in prescribed clinical options, within agreed protocols
- Provide nurse led secondary prevention clinics in conjunction with the Consultant thus helping to formulate future care and treatment plans
- Monitor and ensure maintenance of adequate and effective discharge planning for patients returning to their own homes or residential care
- Arrange referrals to other appropriate specialist services in consultation with the consultant
- Provide psychological support for patients and their families
- Communicate with patients, families and friends, assess needs and provide relevant support, information, education, advice and counselling when and where necessary
- Develop close working links with other stroke services and actively participate in stroke networks
- Actively promote the liaison and co-ordination of care for patients between stroke services, the hospital and the community
- Contribute to the development and implementation of information sharing protocols, audit systems, referral pathways, individual care plans and shared care arrangements through regular meetings and liaison with stroke nurse specialists nationally alongside IHF and the HSE
- Identify and utilise professional and voluntary resources and facilities at local and national level by direct or indirect referral
- Participate in the Departmental Clinical Governance processes, working in partnership with the Head of Department, Assistant Director of Nursing/CNM3, Clinical Governance lead and local stroke governance group
- Ensure that effective clinical governance procedures are maintained and evolve according to defined needs and demands in stroke service.
Patient Advocate
The Clinical Nurse Specialist (Stroke Care) will:- Act as patient advocate, involving communication, negotiation and representation of stroke patients values and decisions in collaboration with other members of the MDT
- Liaise with other health service providers in the development and ongoing delivery of this service by co-ordinating weekly MDT meetings
- Develop and support the concept of advocacy particularly in relation to patients' participation in decision making thereby enabling informed choice of treatment options through education and information
- Provide and advocate for appropriate assessments, supports and strategies for patients with disease related changes and difficulties
- Establish, maintain and improve procedures for collaboration and co-operation between acute hospital services, community services, primary care and voluntary organisations
- Take appropriate action on any matter identified as being detrimental to staff and/or service user care or well being which may be inhibiting the efficient provision of care
The Clinical Nurse Specialist (Stroke Care) will:
- Maintain clinical, nursing and managerial competence, in current developments, in the field of stroke care to include keeping up to date with relevant research to ensure evidence-based practice and research utilisation
- Keep abreast of current trends in nursing through reading, attending seminars and having thorough knowledge of nursing policy and standards
- Identify the educational needs of patients, their carers, other professionals and students and participate in training programmes as required
- Work with and supervise the care given by student nurses and provide for their personal and professional development
- Co-operate with colleagues in providing learning opportunities for all staff and students
- Assist in the educational programme of all staff who may care for patients affected by stroke, including student nurses
- Use every opportunity for discussion, demonstrations and teaching for both patients and staff
- Liaise and foster good communications with the Nurse Education Centre
- Participate in the orientation programmes of all new staff within the department and
- Educate and provide supportive care to the patient and their family through all stages of stroke disease trajectory.
The Clinical Nurse Specialist (Stroke Care) will:
- Manage the Stroke Register, keeping an up-to date monthly account of stroke service statistics that will include data on referrals, total number of stroke patients, tPA figures, age LOS, discharge destinations, mortality and OPD numbers to audit and plan services
- Promote individual best practice interventions in accordance with the identified needs of patients
- Undertake and lead in clinical and organisational audit to continually evaluate the effectiveness of the service provided against established research/evidence
- Participate and promote nursing research and associated research in this specialist area, identifying nursing topics and issues, involving the MDT through presentations
- Ensure the views of all consumers are effectively sought, channelled and acted upon
- Implement and manage changes identified by audit and research and required within stroke services
- Contribute to the development of key performance indicators and monitoring of same within stroke services
Consultant
The Clinical Nurse Specialist (Stroke Care) will:- Act as resource in providing specialist knowledge, expertise and care in liaison with the multidisciplinary team
- Promote the role of the Stroke Care Nursing Services among health care staff
- Work with, support, advise and help build up the knowledge and expertise of the other healthcare professionals involved in providing care for stroke patients, through regular formal and informal education.