JOB PURPOSE

The Advanced Nurse Practitioner is an experienced practitioner working autonomously and in conjunction with other health care professionals to assess, diagnose, treat and discharge unscheduled patients with undifferentiated problems and long term conditions. The post holder with demonstrate safe clinical decision-making and expert care for patients. They will work collaboratively within the practice team to meet the needs of patients, support the delivery of policy and procedures and provide nurse leadership, as required. They will take a role in clinical audit and practice developments.

The post-holder will be a key member of the Aird Medical Practice multidisciplinary team.

  1. To undertake advanced level assessment in order to address undifferentiated illness, ailments and injury by using expert knowledge and clinical judgement to diagnose, initiating interventions and negotiate discharge, to refer or follow up arrangements.
  2. To provide health promoting, person centred, evidence based clinically effective nursing care.
  3. To continually improve patient care pathways, in conjunction with other statutory and voluntary services, for patients, and their carers.
  4. Will be working as part of the wider practice team but will work autonomously and independently without direct supervision. Responsible for the diagnosis, assessment, planning, delivery and evaluation of high quality health care.
  5. Using a proactive approach to promoting health and wellbeing, detection and prevention of vulnerability, preventing illness, reacting and responding to existing or potential ill health issues and contributing to reduction in unplanned hospital admissions.

MAIN TASKS, DUTIES AND RESPONSIBILITIES

CLINICAL PRACTICE (80%)

Main Duties

  1. Works autonomously as an Advanced Nurse, adhering to defined guidelines, assessment and history taking, using advance clinical examination. Provide treatment, request and interpret tests, complete full comprehensive documentation, prescribe medication within the scope of a non-medical prescriber. Works as an autonomous practitioner within the Statutes and Guidelines as laid down by the Nursing and Midwifery Council and the NMC code of Practice
  1. Provide a first point of contact within the practice for patients presenting with acute unscheduled undifferentiated, undiagnosed problems. Provide telephone triage and consultations as required. Perform home visits where appropriate.
  1. Perform appropriate triage model to undertake an autonomous initial clinical assessment of patient’s health and well-being needs, identify care priorities and initiate appropriate treatment or first aid measures, administer analgesia and inform relevant personnel. Arrange follow up appointments with him/herself or other health professionals as required.
  1. In accordance with the practice timetable make him/herself available to undertake a variety of duties including surgery consultations (on the day and pre-bookable), telephone consultations, unscheduled care responsibilities, home visits, visits to Care Homes, checking and signing prescriptions, dealing with queries and paperwork (including the management of patients results and letters) and other correspondence in an efficient and timely manner.
  1. Refer patients to other members of the multidisciplinary team and/or other medical specialties for assessment/ treatment where appropriate. Delegate/ allocate duties arising from consultations to the Practice Nurses and Health Care support worker e.g. dressings, venepuncture, chronic disease management etc
  1. Organise own workload and adjust priority of changing demands to ensure all needs are met in the care of the Practice patients and other practices as required.
  1. Prescribe safe, effective, cost-effective and appropriate medication in accordance with national and practice protocols and formularies. Review patient medication for therapeutic effectiveness appropriate to patient needs and in accordance with national and practice protocols. Provide information and advice on prescribed and over the counter medication.
  1. Identify, diagnose and manage treatment plans for patient at risk of developing long-term conditions in accordance with national and NHS Highland guidelines, referring to practice team and other nurse specialists as appropriate for ongoing management and advice.
  1. Provision of immediate care of patients presenting with potential cardiac problems i.e. O2 therapy, cannulate, obtain blood samples and ECG.
  1. Ensure the smooth transition of patients from home to hospital/ hospital to home/ community facilities, wards, departments or other hospitals and onward referral to scheduled services
  1. Maintain effective communications with patients/ families/ carers and other members of the multidisciplinary team to ensure appropriate information is shared and patient needs met.
  1. With reference to NHS Highland and the NMC Code of Conduct, the post holder is accountable to initiate and maintain patient records e.g. Triage / assessment, Nursing Notes, Care Pathways, clinical notes (Vision, Docman), ECS and Anticipatory Care Plans.
  1. Perform some nursing interventions as required including INR testing and dosing, phlebotomy, wound management, insertion and removal of sutures etc. These will vary depending on the availability of the Practice Nurse and Health care assistant.
  1. Provide sexual and reproductive health advice and management and refer as appropriate to Highland Sexual Health services.
  1. Support and manage women presenting for cervical cytology consultations, and undertake cervical screening as required, depending on the availability of practice nursing.
  1. Implement and participate in vaccination and immunisation programmes for adults and children.
  1. Provide travel advice and vaccinations.
  1. Provide health promotion advice including smoking cessation, weight reduction and alcohol brief intervention if appropriate.
  1. Provide support and advice to patients and their families or carers, giving the knowledge required to help them understand and cope with their condition, offering psychological, physical and spiritual support, including health support and accident prevention.
  1. Maintain knowledge in Child Protection issues and guidelines.
  1. Promote the health and safety of patients, staff and visitors.
  1. Seek medical decision making support as required.
  1. Adhere to NHS National, NHS Highland and NMC policies and codes of practice including record keeping/ care planning, health and codes of practice including record keeping/ care planning, health and safety, infection control, PIN guidelines and standing financial instructions.
  1. Work with adult and children services integrated teams, liaising with Social Work and District Nursing Services and other professionals as required.
  1. Work with all team members to ensure a high standard of cleanliness in conjunction with the Control of Infection Team to ensure infection rates are minimised.
  1. Ensure appropriate stock and equipment is available within clinical/ practice environment.

LEADERSHIP AND MANAGEMENT (10%)

  1. Sets high standards of professional practice and clinical leadership.
  1. Involved with the setting and maintaining of standards of care within the agreed guidelines of Practice and NHS Highland policies and procedures and ensures adherence to and delivery of a high-quality service, whilst developing clinical leadership.
  1. Consultation with the multi-disciplinary team to develop and support initiatives in order to deliver enhanced levels of care and patient experience.
  1. Supports the practice multi-disciplinary team in managing and driving change and developmentthrough planning, communication and action within the multidisciplinary team to ensure objectives are met.
  1. Consultation with regards to development and implementation of new local guidelines.
  1. Facilitates the work of members of the practice team through knowledge, support and advice, ensuring standards of care are met, monitored and maintained.
  1. Assist the multi-disciplinary team in maintaining effective communication systems in the practice ensuring staff access relevant documented minutes and information and are involved and informed of all agreed decisions.
  1. Assists in Health and Safety policies and procedures being maintained and accurate and up to date records are kept e.g. Completion of Risk assessments, Moving and Handling, Control of Substances Hazardous to Health, Mandatory training needs.
  1. Maintain training records.

FACILITATION OF LEARNING (10%)

  1. Participating in and encouraging others to undertake audit activities.
  1. Providing mentorship and coaching to multi-disciplinary colleagues, promoting evidence-informed practice and a learning environment.
  1. Participates in developing and maintaining a positive learning environment. Undertake teaching of students, nursing colleagues, GP registrars and other members of the multidisciplinary team. Participate in orientation and student mentorship programmes, encourage staff with Personal Development Plans to facilitate ongoing development.
  1. Participate in the implementation and audit of standards of clinical care and positively influence proposed changes to practices to ensure a high standard of patient care, promote evidence based practice and the attainment of healthcare governance requirements.
  1. Provide professional and clinical supervision / ensure team members have access to effective professional and clinical supervision.
  1. Continuously assess and update own professional education needs utilising the education framework within the Advanced Practice Toolkit, maintaining a current PDP, ePortfolio and NMC revalidation.

EQUIPMENT AND MACHINERY

Utilise technical clinical equipment, calibrating where required, checking for faults and ensuring regular maintenance as follows.

General Equipment

  • Use of office equipment including computers, lap top computer, scanners, printers, shredders etc and communication aids such as telephone and video-conferencing
  • The post-holder must be computer-literate and have a working knowledge of standard office software (Microsoft Word, Excel, Powerpoint, Outlook)
  • Use of practice computer system (Vision, Docman)
  • Patient assessment and monitoring equipment
  • Tympanic thermometers,
  • Pulse oximeters.
  • Spirometers
  • 24 hour BP and ECG monitoring equipment
  • Sphygmomanometers manual/digital
  • Blood glucose monitors
  • Hypodermic syringes and needles
  • Venepuncture needles and blood collection tubes
  • Sharps containers
  • Anaphylaxis emergency equipment – face mask, defib machines and adrenaline for injection.
  • Urinary catheters – urethral and supra pubic and associated drainage equipment
  • Oxygen cylinder
  • Centrifuge

SYSTEMS

A good knowledge and ability to use computer software systems is required. This includes:

  • GP Practice Administration System (Vision) and relevant Clinical Decision Support Systems (daily) – Used for examining, searching and recording clinical details of individual patients. Knowledge of and ability to search these systems required. The post holder must be able to update relevant patient data on such systems.
  • SCI store (daily) – Used for results reporting for accessing patient results e.g. haematology, biochemistry and immediate discharge letters (IDLs).
  • Docman (daily) – document management system for results and letters.
  • Electronic Highland Joint Formulary (daily) – The post holder must have a good working knowledge of this software package which is loaded onto GP practice systems to enable quick and appropriate selection of drugs at the point of prescribing.
  • Standard Operating Procedures and other practice procedures (daily).Microsoft Word (daily) - Writing reports, protocols, guidelines, educational materials, maintaining work log, patient medication charts, general communication e.g. letters.
  • Microsoft Excel (weekly) - Generating spreadsheets for recording project data, analysing prescribing data, recording prescribing budget data, producing graphs as part of audits and reviews carried out in the practice.
  • E-mail (daily) - Extensively used as means of communication.
  • Internet and NHS Highland Intranet (daily). Searching for and accessing data and information etc. on medicines, treatment guidelines, best-practice ethical and legal practice. Used to acquire information, which is then summarised and disseminated to other professionals.
  • Maintain confidential patient records (paper and electronic).
  • Maintain and update personal systems for managing, organising and securely storing data, information and documents.
  • Work within the requirements of relevant legislation e.g. the Misuse of Drugs Act, the Medicines Act, the Data Protection Act.
  • Assists in maintenance of accurate staff records relating to PIN guidelines e.g. leave through annual leave, sick leave, family friendly policies, training, PDPs.

ASSIGNMENT AND REVIEW OF WORK

The post holder is expected to work autonomously, organising and prioritising their own workload in relation to meeting the needs of the service. The remit also includes responsibility for decision making regarding the assessment, subsequent diagnosis and management plan of patients presenting during practice opening times

The post holder will:

  • Working during practice opening hours, undertake assessment, diagnosis, treatment and discharge of unscheduled and scheduled patients.
  • Is expected to anticipate problems / needs and take steps to resolve them, e.g. arrange direct admission to hospital, arrange home visit by District Nurses etc
  • Be able to analyse complex information on which, judgements and consequently sound decisions and diagnosis will be based.
  • Be accountable for professional conduct in accordance with NMC standards.
  • Be responsible for exercising professional judgement in relation to the clinical element of their role.
  • Make clinical decisions in partnership with patients and their families, other clinicians and members of the MDT.
  • The workload is determined by the needs of the service and the post holder will delegate / allocate work appropriately to the Practice nursing team and others.
  • When undertaking Advanced Nurse (Primary Care) duties the post holder will seek clinical guidance from senior medical staff as appropriate.

DECISIONS AND JUDGEMENTS

  1. The ability to quickly assess and respond to patients needs in emergency situations.
  2. Post holder will be responsible for ensuring that clinical practice meets the standard of care set by the NMC and NHSH, and that non-compliance with these standards is managed in accordance with the appropriate policies and procedures.
  3. Provision of professional advice to staff and students and an ability to recognise own limitations and the requirement for appropriate referral.
  4. Judgments involving highly complex facts or situations, which require the analysis, interpretation and comparison of a range of options.
  5. Assessment of patients’ complex needs (physical, psychological, social and spiritual) to establish a change in condition, inform clinical decision making and plan care.

COMMUNICATIONS AND RELATIONSHIPS

The post-holder will be expected to communicate effectively with patients in order to assess, diagnose, treat and discharge patient. This will require both verbal and listening skills.

The post holder will need to establish and maintain regular communication with:

  • GPs, nurses and other clinical staff at the practice.
  • Practice manager and other practice staff.
  • Patients.
  • Local health and social care staff; including care home staff, care at home staff, nursing teams, hospital teams, integrated teams and specialist services.
  • External bodies, e.g. professional and regulatory bodies.

The post-holder will be expected to:

  1. Identify potential and existing challenges in care options for patients, carers and staff, using negotiation and counselling skills to achieve reconciliation and the best outcomes for the patients.
  2. Communicate effectively verbally, in writing or electronically and non-verbally.
  3. Ensure effective communication with all team members.
  4. Liaise with external agencies e.g. Police, SAS, Social Work.
  5. Participate in regular meetings with colleagues for the purpose of planning, managing and developingservices, improving patient care, discussing policy issues, amending, updating, implementing and evaluating them, discussing and problem solving challenges in clinical care and team development.
  6. Facilitate effective dissemination of information to all relevant staff.
  7. Demonstrate empathy, sensitivity and support when communicating with patients, relatives and staff, especially in relation to breaking bad news and dealing with emotionally challenging situations.
  8. Regularly demonstrates the ability to handle highly sensitive information in a manner not liable to offend or antagonise.
  9. Deal with situations when patients do not easily understand their care packages, due to culture, language or learning difficulties.
  10. Maintain confidentiality in accordance with NMC and NHS Highland policies, including promoting compliance and adherence to the requirements of the Data Protection Act and the Caldicott Guidelines.

PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB

Physical Skills

  1. Highly developed physical skills where a degree of precision or speed and high levels of hand, eye and sensory co-ordination are essential, e.g. take blood samples, administer injections, suture insertion and removal, insertion of venflon devices to set up IV access, calibrate equipment, use computer keyboard.

Physical Effort

  1. Remove full outdoor clothing from unconscious / incontinent / uncooperative patients.
  1. Daily efforts to assist patients to move/walk/transfer

Risk assess to create a safe working environment whist being sensitive to patient’s environment and property.

Mental Effort

  1. Concentration, decision-making and organisational skills to cope with competing demands
  2. Recognising patients’ urgent health care needs and making appropriate decisions to provide appropriate clinical management, sometimes without being in full receipt of patients’ full medical history e.g. temporary patients
  3. Concentration required checking documentation / patient notes/ prescriptions/ results and calculating drug dosages
  4. Autonomous lone working recognising patient’s urgent health care needs and making rapid decisions to provide appropriate clinical management – daily

Emotional

  1. Dealing with emotional effects on patients, family and oneself when breaking bad news
  2. Emotional demand in relation to family and human dynamics, dealing with people in high distress or crises such as dying and death.
  3. Dealing with emotional effects of caring for patients and their families who may be distresses anxious or worried.
  4. Emotional demands of coping with colleagues diverse personalities.
  5. Emotional demands of working unsupervised in patients’ homes.
  6. Emotional demands of patients and relatives spiritual needs.

Environmental

  1. Coping with unpleasant materials and smells – bodily fluids, excreta, infected wounds – daily.
  2. Assessing the risk of violent / aggressive / challenging behaviour of patients and visitors and dealing with it appropriately.
  3. Exposure to hazardous substances.
  4. Exposure to violence and aggression.
  5. Working in a patient’s home, where there may be reduced lighting and confined space

KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB