Download agenda for change - NHS Scotland Recruitment

AGENDA FOR CHANGE
NHS JOB EVALUATION SCHEME
JOB DESCRIPTION TEMPLATE
Revised February 2010
1. JOB IDENTIFICATION
Job Title: Cardiac Rehabilitation Nurse Specialist/co-ordinator
Reports to (insert job title): Lead Nurse Raigmore
Department, Ward or Section: Cardiac Rehabilitation Service
CHP, Directorate or Corporate Department: Medical and Diagnostics Division, Raigmore
Job Code:SSMEDDRAIGMI54
No of Job Holders: One
Effective date of this job description:
2. JOB PURPOSE
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The overall aim is to support and empower cardiac patients and families with
cardiovascular disease to gain the best physical, mental and social health in order
that they preserve or resume optimal functioning in their community and through
improved health behaviour, slow or reverse progression of disease.
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To lead the ongoing development and maintenance of the Cardiac Rehabilitation
service in the Highlands, taking a leading nursing role in the promotion of best
practice in Cardiac rehabilitation in conjunction with colleagues across operational
units practicing at Advance Practice level (as defined within Careers Framework)
supporting colleagues in Primary care and Secondary Care, through the provision
of training, advice and support to enhance their knowledge and skills promoting
self-care management and the prevention of hospital re-admission.
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To provide individualised care planning and co-ordination of services at all stages
of their rehabilitation, so reducing morbidity and premature mortality.
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To lead and co-ordinate the Cardiac Rehabilitation service for Highland patients
pre and post Cardiac Surgery.
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To identify potential improvements to the current service within Raigmore and NHS
Highland and In consultation with Line Management, Cardiac Consultants and HQA
advice,
implement
these
improvements;
taking
into
consideration
recommendations from national standards and guidelines including those from the
Heart Disease improvement plan, NICE, SIGN and BACPR.
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Undertake research and lead clinical audits in own specialist area.
3. DIMENSIONS
Cardiac Rehabilitation is the process by which patients with cardiac disease, in partnership
with the multi-disciplinary team, are supported to achieve and maintain optimal physical and
psychosocial health.
This post is responsible for implementing and co-ordinating the service within Raigmore
hospital and NHS Highland; ensuring patients are supported throughout the whole Cardiac
rehabilitation pathway.
2
5
Conduct final CR
assessment
Assess patient
Patient
presentation
0
Identify and refer
patient
1
Manage referral
and recruit patient
Patient discharged
4
Deliver
comprehensive
*CR programme
3
Develop patient
care plan
6
Discharge and
transition to long
term management
Sharing cardiac rehabilitation information (education) and long-term management strategy with the patient
*CR = cardiac rehabilitation
Patient eligibility for cardiac rehabilitation.
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Acute coronary syndrome
Stable angina
Angioplasty (PCI/PPCI)
Stable Heart Failure
Cardiac valve surgery
Coronary Artery Bypass surgery
Implantation of a cardiac defibrillator or cardiac resynchronisation device
Heart transplantation
Grown up congenital heart disease
2015 Statistics indicate 750 patient referrals
4. ORGANISATIONAL POSITION
CCU, AMAU,
6C, Cath Lab,
ICD / Heart
Failure Teams
Community
Heart Manual
Facilitators
0.2 WTE Cardiac
Rehab Nurse
Senior Charge Nurse
CCU
Cardiac
Rehabilitation
Nurse/Coordinator
THIS POST
0.52 WTE
Healthcare Assistant
0.4 WTE Admin
assistant
Consultant
Cardiologists
Community
Rehabilitation
physiotherapists
Cardiac Rehab
Management
5. ROLE OF DEPARTMENT OR SECTION
To provide
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The overall aim is to support patients and families through all stages of the cardiac
rehabilitation pathway, to empower and support people to self manage their
condition through risk factor prevention so reducing hospital re-admission,
morbidity and premature mortality.
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To co-ordinate services at all stages of their rehabilitation.
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To act as an educational resource, ensuring key workers practice within the agreed
clinical pathways promoting self-management and best practice.
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To develop and implement service improvement strategies.
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To contribute to the implementation of national recommendations and standards.
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To contribute and participate in local and national research projects and
strategies.
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To formally audit and evaluate the cardiac rehabilitation service at local and
national levels.
6. MAIN TASKS, DUTIES AND RESPONSIBILITIES
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Act as a role model, practicing person centred, and evidence based care as described
within BACPR and NICE guidelines and the local MCN for cardiology. Providing
individualised care and support for patients who require management of Coronary Heart
Disease and other patients meeting the criteria for cardiac rehabilitation.
Practice at and advanced level and be a specialist in the management of acute and post
acute cardiac conditions, analysing complex information to plan, implement and evaluate
cardiac rehabilitation and risk reduction management.
Utilise critical thinking and analytical skills, incorporating critical reflection, drawing on a
diverse range of associated knowledge disciplines, higher level clinical judgement and
problem solving in decision making to determine person centred therapeutic
interventions.
Receive and act upon referrals directly from health care professional, assess, prioritise,
plan, implement and evaluate care, making referrals to other team members and
specialist departments as necessary to ensure optimal quality of care.
To manage own caseload of patient, developing effective relationships with patients
families and carers taking into consideration the complexity of managing chronic illness
with their daily living.
Be able to work autonomously managing a case load of patients in the acute setting,
clinics and during telephone consultation.
Provide telephone consultation/consultations post-discharge from hospital.
Work as a member of the MDT to provide seamless and effective care for patients
between hospital and the community advising on changes in clinical care as appropriate.
Be able to recognise clinically sensitive/emotionally charged situations and communicate
sensitive condition related information to patients and their families/carers with empathy
and reassurance.
Empower people with cardiac conditions to make informed decisions about their health
using interpersonal and communication skills, where there may be significant barriers to
acceptance in order that they are able to confidently self manage their condition.
Work effectively with interpreters where there is a language barrier: with other health care
professionals or carers where there is a learning, physical or mental health barrier to
understanding or self-care
Monitor and assess effectiveness of treatment of cardiac related medications. Advice
patients on alternating diet and lifestyle to reduce known risk factors liaising with medical
staff and other nurse specialists as required.
Empathically inform patients and their families about the short and long term.
complications associated with cardiac conditions and support them when intervention and
treatment is necessary.
Provide effective communication with patients and their families/carers to impart
information which may be seen to be of a highly emotive and stressful nature
Act as the patients advocate through effective support and information enabling the
patient to make choices and decisions concerning their treatment
Be able to communicate life-changing events to patients, their families/carers e.g.
disease process, diet, weight reduction, exercise and activity advice.
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Act as a specialist resource to other professionals in primary and secondary care
ensuring optimum liaison and co-ordination of care.
Ensure patient records are completed accurately and managed appropriately and
confidentially within the data protection act and NMC guidelines.
Provide telephone advice and support to patients and multi-disciplinary colleagues in the
wider area.
To provide a drop in nurse led clinic prior to cardiac rehabilitation exercise classes at
Raigmore. Supporting patients and advising on medication management and risk factor
reduction.
Facilitate and participate in a joint nurse/ long term conditions psychologist clinic for
patients suffering from psychological and emotional distress.
Lease with the Heart Failure nurse specialist, ICD nurse specialist and medical team to
ensure a clear cardiac rehabilitation pathway for their patient group.
Manage the day to day running of the Highland Heartbeat Centre including quarterly and
annual health and safety inspections and risk assessment as per NHS Highland policy.
Clinical/Professional leadership
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To work in accordance with NHS Highland Trust objectives to adhere to Trust policies
and procedures.
Maintain effective working relationships with the wider cardiology team, enabling joint
working initiatives between secondary and primary care.
Be a specialist in Cardiology Nursing providing advice within the hospital and as
necessary to other organisations.
To act as a professional leader and role model in all aspects of work and at all times.
To expand scope of clinical practice to enhance the effectiveness of the department
and organisation.
To represent NHS Highland as a member of the Cardiac Rehabilitation Interest Group
(CRIGs) committee.
Represent NHS Highland at BACPR national conference.
To represent cardiac rehabilitation on the Cardiac MCN.
To line manage a Health Care assistant for the Cardiac Rehabilitation Service.
To line manage an administrative assistant for the Cardiac Rehabilitation Service.
To line manage the angioplasty nurse specialist.
To provide educational support and advice to the Cardiac Rehabilitation.
Physiotherapist at the Highland Heartbeat Centre Raigmore hospital.
Ensure that the Cardiac Rehabilitation Service in Raigmore is managed within budget.
Undertake research and help facilitate researchers from the wider cardiology field to
improve and inform practice.
Lead clinical audits for cardiac rehabilitation
Organise the educational components of the Raigmore exercise classes.
Liaise with public health, local initiative leads and the voluntary sector to promote selfmanagement within cardiac rehabilitation.
Ensure collection of data for national audit of cardiac rehabilitation.
Develop Cardiac Rehabilitation pathways in NHS Highland.
Organise annual training for physiotherapist involved in the delivery of cardiac
rehabilitation in the Highlands.
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Advice team leads about professional standards of practice within Cardiac
Rehabilitation.
Maintain professional links with other members of the MDT supporting cardiac
rehabilitation within the Highlands, including pharmacy, dietetics, occupational
therapy, physiotherapy and psychology.
Develop, organise and deliver training to members of CCU, 6c and the cardiac
Interventional Suit.
Facilitate Interventional Suite Audit Training days.
Link with Pharmaceutical organisations to deliver training to cardiology team.
Source and order educational information to provide menu driven information to
patients and families.
Participate in wider government initiatives such as the Living it Up project to promote
self-management.
Promote government training initiatives such as the HeartE project to facilitate
learning.
Take responsibility for own professional, clinical and managerial development by
participating in regular education and training by attending appropriate courses,
national and international conferences.
Participate in regular personal development reviews.
Practice in clinical supervision and seek networking opportunities to further own
professional knowledge and development.
7. EQUIPMENT AND MACHINERY USED
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Utilise technical equipment
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Defibrillator – to respond during a cardiac arrest situation in the Highland Heartbeat
Centre- in conjunction with ILS course.
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Heart Monitors- to monitor heart rate during the exercise classes.
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Blood pressure monitoring, before, during and after classes.
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Gym equipment – to assist with classes.
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Communication and IT systems e.g. computers/lap tops, maintenance of patient records.
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Telephone and teleconferencing facilities to enable communication links with patients
and the wider MDT.
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Fax machine to enable referral to and from other Cardiac Rehabilitation Centres
8. SYSTEMS
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Maintaining patient treatment records and statistics related to audit.
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Maintain own Personal Development plan and portfolio of PDP.
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Utilise computer systems including PMS, SCI stores, email, clinical pathway resources.
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Monitoring budget for Cardiac Rehabilitation Department.
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Work as a practitioner within the guidelines and standards of the NMC and NHS
Highland.
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Provides service activity reports to line manager and head of service.
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Acts upon relevant statistics obtained through audit in order to enhance delivery and
quality of patient care.
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Teleconferencing facilities
9. ASSIGNMENT AND REVIEW OF WORK
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Works autonomously managing referrals from all practitioners within primary, secondary
and tertiary care.
Manages self-referrals.
Education, learning and development needs are identified via e-KSF and PDP&R
process.
Works within the statutes and guidelines of the NMC, National, Highland and locally
agreed policies, protocols and procedures.
Anticipate and develop strategies to resolve service challenges and needs involving
patients, colleagues, peers, lead nurses, consultants and managers.
Attends and participates in speciality meetings, staff meetings, and nurse development
meetings.
10. DECISIONS AND JUDGEMENTS
 Responsible for developing/updating protocols for the cardiac rehabilitation service.
 Responsible for the implementation of standards and national guidelines.
 Recognises own limitation in the provision of clinical care and refer to other healthCare professionals accordingly.
 Accountable for own professional actions demonstrating resilience, determination
and leadership in context that may be unfamiliar, complex and unpredictable.
 Responsible for providing and coordination cardiac rehabilitation service for patients in
the highlands.
 Responsible for providing support to staff within Raigmore hospital and Highlands
 Responsible for managing the Cardiac Rehabilitation Budget.
 Ensuring appropriate use of Highland Heartbeat Endowment Fund.
 Ensure appropriate use of Highland Cardiac Physio Equipment fund.
 Undertaking all aspects of clinical duties as an autonomous practitioner
including professional and legal accountability and clinical risk management for all aspects
of own work.
11. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
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Working as an autonomous practitioner.
Organising back fill for own job and for the Cardiac rehabilitation Physiotherapist and
assistant physiotherapist.
Coping with the backlog following annual leave and training days.
Engaging with community team leads to promote cardiac rehabilitation in their area.
Managing cardiac rehabilitation with limited resources Highland wide.
Developing and sustaining the service whilst meeting the needs of patients, families and
carers.
Coping with patients/carers/relatives fears and anxieties following a life threatening event
or life-influencing diagnosis.
Ensuring equity of care in all areas.
12. COMMUNICATIONS AND RELATIONSHIPS
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Communicate very sensitive, complex condition related information to patients/families
and carers overcoming barriers to communication.
Identify potential and existing challenges in care options for patients, carers and staff,
using negotiating and counselling skills; including motivational interview techniques to
achieve reconciliation and best outcomes for patients.
Communicate with patients and carers face to face/telephone/email
Participate in MDT meetings.
Lead and participate in regular meetings with consultants, nurses, AHPs, administration
staff and patient representatives for the purpose of planning, managing, evaluating and
developing the cardiac rehabilitation service.
Communicate with tertiary centres to plan Cardiac rehabilitation and follow-up
consultations following cardiac surgery.
Facilitating and organising of rehabilitation, treatment and support between primary and
secondary care.
Understanding service demands in primary and secondary care and communicating
effectively between both to ensure best outcome of care for the patient.
Maintaining effective and supportive communication with
o British Heart Foundation
o Resuscitation Training Staff
o Heart Support Groups
o Chest Heart and Stroke Scotland
o Cardiac Rehab teams in Scotland
o Heart Manual facilitators in community and Raigmore
o Cardiac Physiotherapists in Highlands
o Social work professionals
o Voluntary sector
Face to face, email, telephone, letter, and teleconferencing.
13. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
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Physical
Computer skills-manual dexterity
Use of Defibrillator and emergency equipment
Fitness to participate in exercise class
Ability to drive
Mental
o Clinical reasoning skills
o Time management and organisational skills
o Concentration during clinical assessment and ward rounds
o Balancing clinical with non-clinical work-load
o Managing challenging behaviour
o motivational interview techniques
o Teaching and clinically supervising patients, staff and carers on a daily basis,
managing interruption during consultations in order to maintain concentration.
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Emotional
o Supporting and advising patients and relatives during a time of emotional stress
o Supporting and advising patients who are experiencing anxiety and fear following
diagnosis.
o Constant provision of reassurance to patients and families experiencing difficulty
coping with diagnosis.
o Engaging with the family to resolve social issues which prevent risk factor
reduction and self-management in CHD patients.
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Environmental
o Working in different environments within Raigmore hospital and the wider NHS
which are often noisy, with constant interruption, alarms, buzzers, ward rounds,
patients called away for investigations during consultation, visiting times etc.
o Non-clinical demands are high at times with up to 50% of the working day spent at
the computer.
o Changing environments and cultures within wards, day case unit, exercise classes
and primary care, adapting to different settings to create and environment
appropriate to delivering patient care and service improvement initiatives.
14. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB
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First level registered nurse
Degree level education
Significant post registration experience including experience in cardiac rehabilitation or
cardiology
Team leader/line manager/service development skills
PDP&R evidence of ongoing professional development.
First level line management and budgetary skills.
Specific training and skills
 Immediate Life Support Certificate or willingness to complete
 Heart manual facilitator or willingness to complete
 Health promotion skills
 Motivational interviewing skills
 Brief intervention training, alcohol and smoking cessation
 Extensive knowledge of national cardiology guidelines and standards
 ECG interpretation skills
 Teaching and presentation skills
 Counselling skills
 British association of cardiovascular disease prevention and rehabilitation trained or
willingness to train.
 IT skills, including email, systems management (PMS), results reporting, database input,
patient notes, access to IDLs,
 History taking skills
 Time management skills
 Ability to recognise adverse signs and symptoms relating to specific cardiac conditions.
15. JOB DESCRIPTION AGREEMENT
I agree that the above Job Description is an accurate reflection of my
duties and responsibilities at the date of signing.
Job Holder’s Signature:
Date:
Manager’s Signature:
Date: