- NHS

HIGHLAND

AGENDA FOR CHANGE

NHS JOB EVALUATION SCHEME

JOB DESCRIPTION

  1. JOB IDENTIFICATION

Job Title:Staff Nurse Band 5

Reports to:Emergency Department Manager

Department:Emergency Department (E.D.)

Directorate:Medical

Job Reference:SSMEDDRAIGEGCY06

No of Job Holders:

Last Update:March 2009

  1. JOB PURPOSE
  1. As part of a multidisciplinary team the post holder will have the responsibility for assessment of care needs and the development of programmes of care and / or implementation and evaluation of these programmes ensuring the delivery of high quality care to patients of all age groups presenting with sudden or acute illness and minor major trauma.

2.Play an important role as a team member in the Emergency Departments response to a Major Accident or a Chemical, Radiological or Nuclear contamination incident in NHS Highland, in preparation, receiving and delivering care to multiple casualties.

  1. DIMENSIONS
  1. Provide nursing expertise and management of patients in the Emergency Department, which includes 8 treatment cubicles, 1 specialist Eye / ENT cubicle, dedicated paediatric facilities, Triage Room, 2 Soft Tissue Clinic rooms, dedicated Emergency Nurse Practitioner room, 4 bay Resuscitation Room with x-ray facilities, Clean Procedures room, (CBRN) Chemical, Bacterial, Radiation and Nuclear Decontamination facilities, adjacent Plaster Room, Seminar room with Telemedicine facilities.
  2. Receiving, Assessing, Planning and Implementation of care of Emergency admissions for patients from all specialities e.g medical, surgical, orthopaedic, paediatrics.
  3. Provide facilities and nursing care of emergency admission patients arranged by GP when bed not available on ward.
  4. Patients transferred from Peripheral Hospitals, Primary Care Assessment Centres in NHS Highland, GP surgeries, Prison/Police Custody, NHS 24, all other Outpatient departments.
  5. Emergency Department Consultant led Soft Tissue Clinics
  6. Care of terminally ill patients
  7. Care of bereaved relatives/carers/ friends
  8. Sudden often traumatic death of adults and children
  9. Provide a safe effective service for victims of CBRN decontamination
  10. Infection Control
  11. Awareness of staff rostering and ability to make best use of resources
  12. Awareness of departments supply levels and correct ordering procedures
  13. Supervisory responsibility of junior staff, bank staff, student nurses and approximately 2 E.D. Assistants per shift
  1. ORGANISATIONAL POSITION

DIRECTORATE GENERAL MANAGER

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E. D. MANAGER ---DIRECTORATE NURSE MANAGER

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CHARGE NURSES

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SENIOR STAFF NURSES

(ENP,UCP or RGN/RSCN)

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STAFF NURSE BAND 5(this post)

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EMERGENCY DEPARTMENT ASSISTANTS

  1. ROLE OF DEPARTMENT
  1. The Department provides services for approximately 27500 new attendances per year, for patients of all age groups presenting with sudden / acute illness and patients who have experienced trauma, from minor to major life threatening injuries.
  2. Provides a high quality, safe and supportive environment in order to care for patients, meeting their identified physical and psychological needs.
  3. Main receiving hospital for NHS Highland for multiple numbers of patients in the event of a major incident/accident occurring.
  4. Dedicated facilities for NHS Highland in decontamination of patients contaminated with Chemical, Bacterial, Radiological and Nuclear Waste.
  5. Provides facilities for patient review by senior E.D medical staff in Soft Tissue Clinics
  1. MAIN TASKS, DUTIES AND RESPONSIBILITES
  1. Works as a practitioner within the Statutes and Guidelines as laid down by the Nursing and Midwifery Council.
  2. Is involved with the setting and maintaining of standards of care within the agreed guidelines of NHS Highland policies and procedures and ensures adherence to and delivery of a high quality service.
  3. Is responsible for the assessment of health care needs of patients, involving families / carers, and develops, plans, implements and evaluates programmes of care.
  4. With reference to NHS Highland and NMC guidelines, the post holder is accountable to initiate and maintain patient records e.g Triage / assessment, Nursing Notes, Care Pathways
  5. 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.
  6. Demonstrate skills within scope of Professional Practice with sound clinical knowledge e.g. ECG recording, I.V. drug therapy, basic plaster of paris and splint application, urinary catheterisation, venupuncture, cannulation, wound management and closure including suturing, skin adhesives and steristrips. Able to identify personal limitations and refer to more senior practitioners or medical staff when skills required are beyond scope of practice.
  7. Perform the recognised Manchester Triage model to undertake an autonomous initial assessment of patients health and well being needs, identify care priorities and initiate appropriate treatment or first aid measures, administer analgesia and inform relevant personnel. Monitor waiting room and keep patients updated on waiting times and re-triage if necessary, as per guidelines
  8. Provide nursing expertise and assist medical staff in management of the critically ill or major trauma victims (adults and paediatrics)
  9. Maintain knowledge in Child Protection issues and guidelines.
  10. Undertake appropriate training to administer an identified drug under the guidance of Patient Group Directives.
  11. To be familiar with the departments Major Incident Plan and equipment, taking an active role in preparations and care of multiple casualties received in the event of a major incident or accident occurring.
  12. To be familiar and take active involvement CBRN decontamination procedures and in preparation of the CBRN decontamination suite, to safely accept contaminated patients without risk to staff or other patients.
  13. Has the ability to organise own workload, prioritise and adjust priority in the face of changing demands to ensure all needs are met in the care of E.D patients.
  14. The post holder may regularly undertake the Co-ordinator role to develop own clinical leadership skills, by ensuring good communication between department and wards, facilitate activities to achieve optimum levels of patient care, whilst enabling other team members to focus on their specific objectives.
  15. In absence of reception staff, admit patient on to hospitals PAS system ensuring all information is accurate and updated and discharge patient from PAS system once treatment is completed and patient has left department.
  16. Initiate care and investigations of patients presenting with potential cardiac problems if doctor not immediately available i.e. O2 therapy, cannulation, obtain blood samples, ECG
  17. Participates in Health and Safety policies and procedures e.g. completion of Risk Assessments, Moving and Handling Policies, Control of Substances Hazardous to Health, completion of IR1 forms. Ensures Health and safety of patients, staff and visitors within the department and during transfer to other wards and departments.
  18. Maintains ward supply and pharmacy levels, undertaking correct ordering procedures and ensure economic use of all resources.
  19. Assists in the Discharge and Transfer Planning System to ensure the smooth transition of the patient from hospital to home, community facilities, wards, departments and to other hospitals.
  20. Maintains effective communications with patients / families / carers and other members of the multidisciplinary team to ensure appropriate information is shared and patient needs met.
  21. Supervises junior staff and students providing patient care, acting as a source of advice.
  22. Participates in developing and maintaining a positive learning environment. Undertake teaching of students, nursing colleagues and other members of the multidisciplinary team and participate in orientation and student mentorship programmes, and undertake a Personal Development Plan to facilitate ongoing development.
  23. Creates an environment for evidenced-based nursing and plays an active role in the continuing development of the department, undertaking various aspects of clinical audit as designated by the Charge Nurse, following Clinical Effectiveness guidelines.
  24. Promotes and maintains good working relationships within the Emergency Department and with NHS Highland. Actively participates in relevant meetings pertinent to and promoting the department, emergency nursing and the nursing profession generally.
  25. Works with all team members to ensure a high standard of cleanliness throughout the department promoting good standards of hygiene in conjunction with the Control of Infection Team to ensure infection rates are minimised.
  26. The post holder will be supported and encouraged to develop and undertake link nurse roles as appropriate within a field of their interest e.g. Infection Control, Health promotion, Diabetic, Child Protection, Critical Care areas.
  27. In conjunction with senior staff, actively participates in recruitment of junior staff.
  28. Ensure safe custody of patients valuables, following NHS Highlands policies with accurate and concise documentation
  29. To take charge of a shift on occasions, when required to do so.

7aEQUIPMENT AND MACHINERY

Utilises technical equipment, calibrating when required, checking for faults and ensuring regular maintenance. Is expected to have knowledge of all equipment used in the department and will use equipment once provided with training but may not have daily clinical involvement.

EQUIPMENTUSE

Intravenous PumpsDeliver prescribed drugs / fluids safely

Syringe Drivers}

I.V. lines, venflons, butterfly devices}

Syringes, needles}

Arterial linesInvasive monitoring, essential for

Central Venous Pressure linesacutely ill or trauma patient

Non invasive monitoring equipment for:Measure and observe patients condition

Blood pressure, temperature, pulse,

Oxygen saturations, CO2, telemetry

Blood Gas AnalyserAccurate assessment of arterial blood

Oxygen equipment:

Flowmeters, masks, humidificationDeliver correct prescribed oxygen

Nasal cannulaeconcentrations

Pneupac IPPV ventilatorAid patients respiration / breathing

BPAP machine}

Various suction devicesdrain fluid – upper airway / mouth

Chest DrainsDrain fluid /air from thorax

Nebulisers, Volumatic / spacersDeliver prescribed respiratory therapy

Pulmo-aid

Peak flow meter

Entonox equipment and delivery systemDeliver inhaled analgesia

Resuscitation equipment including:

Defibrillator, Laryngoscope, E.T tubesFor use in resuscitation of acutely ill

Ambu bag, laryngeal masksor trauma patient

Difficult Intubation TrolleySpecialist anaesthetic equipment

Nasogastric tubesDrain gastric contents

Urinary catheters:

Urethral, suprapubicDrain and measure urine

ECG machineRecord heart rhythm

Patient Trauma TrolleySafe transfer and movement of patients

Wheelchairs}

Underarm / elbow crutches}

Monkey poles}

Hoist, Slide sheets, PAT slide}

Stiff cervical collarsHelp protect neck after injury

Head huggers}

Major Incident Equipment including:

Amputation setsAmputation of limbs at incident site

RucksacksResuscitation equipment

Documentation packsEssential documentation for M.I. use

High visibility clothing, helmets etcUse by staff attending incidents

CBRN airtight suitsChemical & Bacterial decontamination

Jupiter respirators}

CBRN inflatable tent, water pump & compressor}

Tyvex radiation protection suitsRadiological/Nuclear decontamination

Geiger counters}

Electric DeSouter sawRemoval of plaster and synthetic casts

Plaster scissors and shearsRemoval of plaster casts

Bair Hugger-patient warming systemAssist in raising patients temperature

Slit lampExamination of eyes

Opthalmascope}

AuroscopeExamination of ears

Doppler machineObserve for arterial pulse

GlucometerMonitor blood glucose

Alcohol breathalyser monitorMonitor blood alcohol levels

Ring cuttersRemoval of rings from injured fingers

Ambulance radio transmitterVerbal contact with ambulances

Chute SystemTransportation of items

Pregnancy testing kits

Digital CameraAfter consent obtained

Taking appropriate clinical photographs

E. D. patient call system

Staff personal safety alarms

Overhead operating lightsUse in technical /delicate procedures

Portable examination lights}

Computers:

PAS system, Intranet,

Toxbase,Information on effects of poisons

Results ReportingObtain patients clinical results

Furniture:

Beds, bedside lockers, chairs

Spenco mattressesUse on beds and trolley

Help prevent pressure sores

Fluid Warming CupboardWarm I.V.fluids for resuscitation

Blood FridgeStore blood for urgent use

Heated Blanket cupboardStore warm bedding

7bSYSTEMS

  1. Maintains patient records in accordance with the NMC guidelines and NHS Highland standards.
  2. When undertaking receptionist duties during Out of Hours, initiate patients records on to E.D. computer system and ensure data is accurate and updated on to hospital Patient Administration System (PAS).
  3. Ensures correct use of computerised systems i.e PAS, Intranet for information and course booking, Results reporting, Toxbase.
  4. Assist senior nurses to maintain ward communication systems
  5. Participates in clinical audit as per guidelines by Clinical Effectiveness

8.ASSIGNMENT AND REVIEW OF WORK

  1. The Nurse in Charge of the shift will assign workload, however the post holder will have the responsibility for assessing, planning and implementing care of patients within professional guidelines.
  2. The Staff Nurse will be responsible to the Charge Nurse for clinical guidance and professional management, work review and formal appraisal of performance.
  3. Works within statutes and guidelines of the NMC, National, Highland and locally agreed policies, protocols and procedures.
  4. The Staff Nurse will delegate work appropriately to Junior staff, Bank staff, Students and Emergency Department Assistants.
  1. DECISIONS AND JUDGEMENTS
  1. Makes autonomous clinical nursing decisions in Triage, assessment, planning and prioritising patient care and delegation of appropriate tasks to team members.
  2. Assesses patients condition, to establish a change consulting and involving other members of the multidisciplinary team as required.
  3. Recognises own limitations in the provision of clinical care and urgency of patient’s needs, referring to other health care professionals accordingly
  4. Supports staff training needs
  5. Frequently assesses patients condition and plans implements and evaluates programmes of care.
  6. Involved in deciding with team members how to spend endowments.
  7. Responds to suggestions from staff and colleagues and assists Department Manager / Charge Nurse to implement changes to improve patient care and staff satisfaction
  1. MOST CHALLENGING / DIFFICULT PARTS OF THE JOB
  1. Working in a diverse area with an unpredictable workload.
  2. Dealing with sudden, often traumatic death in adults, children and babies.
  3. In urgent or emergency situations, being able to deliver quality, spiritually sensitive and culturally appropriate care to patients with communication problems e.g non-English speaking, deaf, have learning difficulties, unidentified unconscious people.
  4. Maintaining up to date clinical skills and knowledge in a wide variety of clinical specialities.
  5. Ability to give direct quality patient care to all patients, prioritising and re-prioritising in the face of changing demands within existing resources
  6. Shift work
  7. Working in a high-risk area for patients attending under the influence of drink and drugs, which are difficult to manage safely and not allowing it to impinge on the safety of other patients in the department.
  8. Dealing with violence and aggression and disruptive / challenging behaviour, both verbal and physical from patients or visitors.
  9. Establish and maintain effective communication with various individuals on complex potentially stressful issues.
  10. Dealing with angry patients / relatives if there are unavoidable delays e.g no admission beds, specialist doctor delayed in theatre,
  11. Continue to work and deliver care after being involved in distressing resuscitation situations.
  1. COMMUNICATIONS AND RELATIONSHIPS
  1. Establishes and maintains professional relationships with nursing colleagues, medical colleagues, healthcare professionals, Out of Hour GP Services, Highland HUB, NHS 24, Scottish Ambulance Service, X-ray, Reception and secretarial staff and voluntary services to provide a planned, co-ordinated and seamless service for patients.
  2. Identifies 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.
  3. Communicates with support departments e.g Estates, Security, I.T., Supplies, Human Resources, Medical Physics, Health and Safety and Pharmacy, Catering, Laundry
  4. Ensures effective communication with all team members, which proves challenging due to various shift patterns across the 24 hour period.
  5. Participates in regular meetings with colleagues for the purpose of developing emergency nursing services, discussing and problem solving challenges in clinical care and team development.
  1. PHYSICAL, MENTAL, EMOTIONAL & ENVIRONMENTAL DEMANDS OF JOB

Physical

  1. Frequent moving and handling of patients - in bed / trolley, on to and off trolleys, from bed/trolley to chair, assistance with walking, transfer from ambulance trolley, undertake co-ordinated log rolls for patients with potential spinal injuries, assist injured/ill patients out of private transport.
  2. After health clearance undertake training in preparation in Chemical and bacterial decontamination procedures wearing airtight suits and respirators.
  3. Hand washing / cleansing between each patient
  4. Washing and cleaning patients.
  5. Frequent wearing of disposable gloves.
  6. Frequent need to walk, stand and bend during shift to provide patient care
  7. Frequent transfer of patients and belongings to and from other wards and departments.
  8. Frequently assessing the risk of violent / aggressive / challenging behaviour of patients and visitors and deal with it appropriately.
  9. Fine motor skills and dexterity to 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.
  10. Frequent checking of equipment attached to patients e.g. IV fluids, IV pumps, catheters, Cardiac monitors.
  11. Removing full out door clothing from unconscious / incontinent / uncooperative patients

Mental / Emotional

  1. Concentration, decision-making and organisational skills to cope with competing demands e.g. dynamic changes in patient condition, personnel issues with staff, sudden staff sickness, arrival of multiple trauma patient(s) or several patients arriving together requiring assessment and attention.
  2. Frequently recognising patients’ urgent health care needs and making appropriate instant decisions to provide appropriate clinical management, often without being in full receipt of patients’ full medical history.
  3. Dealing with emotional effects of caring for patients and their families who may be distresses anxious or worried.
  4. Dealing with emotional effects on patients, family and oneself when breaking bad news.
  5. Giving police statements / attending court over incidents.
  6. Possibility of attending Child Protection Case Conferences.
  7. Concentration required checking documentation / patient notes and calculating drug dosages whilst subject to frequent interruptions from patients, relatives and team members.
  8. Particular challenges communicating with a large number of staff who work shifts to provide a 24 hour service, ensuring information is disseminated accurately to all staff and that they have the equitable opportunity to give feedback on, raise and discuss issues.

Environmental