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NHS GRAMPIAN
JOB DESCRIPTION
POST REF NO: LF6495
CLOSING DATE: 16 OCTOBER 2013
1. JOB IDENTIFICATION
Job Title:
Senior Staff Nurse / Band 6
Department(s):
Ophthalmology/ Ward 30 and Eye Outpatients Department
(Team Leader/Pre-Assessment Nurse), Aberdeen Royal
Infirmary, Foresterhill, Aberdeen
Hours:
37.5 hours per week
Band/Salary:
Band 6 - £25,783 - £34,530 per annum
2.
JOB PURPOSE
THE POST HOLDER WILL:
Actively participate in the delivery of evidence/research based patient care as a qualified nurse in the
multi disciplinary team within the department.
Act as an effective role model. Demonstrating leadership skills and guidance.
Proactively support an environment which delivers patient centred care.
Deliver specialist ophthalmic care as an autonomous practitioner.
Consistently develop their own clinical experience and be responsible for the teaching, supervision and
assessment of qualified and unqualified staff. Providing management intervention where required.
Take charge of the service in the absence of the Senior Charge Nurse, managing in a manner which
reflects their knowledge of NMC / Trust and National guidelines and policies.
Ensure risk management is appropriately measured and escalated.
3. ORGANISATIONAL POSITION
Clinical Nurse Manager
Senior Charge Nurse
Senior Staff Nurse Band 6
Band 5 Staff nurses
Band 3 Auxiliaries
4. SCOPE AND RANGE
Ward 30 is an 8-bedded ward, separated into three distinct areas. Ocular assessment area,
day case area and in patient area. The in patient area provides care for both surgical and
medical ophthalmic patients, both elective and non-elective, both in patient and day case.
The ward closes every Friday evening, with an ophthalmic nurse on duty over the weekend,
any patients still requiring in patient status are housed in ward 40. The trained nurse on duty
and nursing auxiliary attend to any casualties requiring to be seen over the weekend with the
on call medical team.
Ocular assessment clinics are run from the ward and take place 4 times per week. An out of
hour’s casualty service is also provided. Approximately 600 patients will pass through the ward
on a monthly basis of which less then 50% are inpatients. This includes ward attenders for
medical treatments and surgical examinations.
Staffing Numbers: Members of nursing staff of various grades equating to 16.17 wte
2 members of staff at A&C level
Student nurses on a continual basis.
Services provided in the ward include:In patient care
Pre assessment
Day surgery
Medical interventions / assessment of ocular conditions
Clerking of in-patients surgery
Out of hour’s casualty service
The post holder will be proficient in all areas of the aforementioned areas following support
and certification locally.
5. MAIN DUTIES/RESPONSIBILITIES
Clinical:
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Leads and directs the assessment, planning, implementation and evaluation of patient care
through effective communication and documentation according to professional policies and
procedures.
Communicates effectively with patients and carers both in the pre assessment phase and
in day case and in patient areas.
Demonstrates a high standard of nursing evidence based research practice
Ensures patients are involved in decision-making regarding their care.
Demonstrates the ability to perform specific clinical skills required within ophthalmology
 Performs all key tasks related to ocular assessment of patients, which includes –
- Slit lamp examination
This involves seating the patient at a piece of equipment not unlike a camera place on a
table, which is moveable. This camera has high magnification lenses and when the patient
is positioned appropriately the operator looks through the lenses enabling her to examine
the eye in detail. The operator adjusts light, focus and angles of light to ensure a thorough
examination is carried out.
- Applanation tonometry
This is an examination done at the slit lamp by one of the attachments known as a
Goldmanns Applanation tonometer. A prism made of plastic attached to a pressure arm
flattens the cornea of the eye. The prism is brought into contact with the cornea, the nurse
having first explained the procedure to the patient and prepared the eye by instilling local
anaesthetic eye drops used according to protocol, and flourescein drops. The patient must
keep the eye very still. The operator turns the measuring drum, which regulates the force
applied to the pressure arm. The tension is increased on the eye until a surface of known
and constant size is reached. With the use of blue filter light and the flourescein drops the
operator can see a distinct yellow green ring when the flattened area is constant. The
intraocular pressure in mmHg is found by multiplying the drum reading by ten.
- Biometry
This is an examination done on the IOL Master, which measures the axial length of the
eye. The patient is seated at this sophisticated piece of equipment and the head is
positioned accordingly. The patient is asked to look at the red fixation light. In the case of
poor visual acuity the patient should wear glasses. On the screen display a crosshair with
a circle in the middle appears. The operator must fine align the instrument so that the
reflection of the alignment light appears within the circle With the use of a computer
screen, a 'joy stick' and good hand eye co ordination the operator is able to start the
measurements. It is essential
that the operator know the ocular history of the patient as previous surgeries can alter the
measurement significantly. Two measurements of the axial length are taken. The
measurements appear on the screen on a graph (a video image overlaid with a graph
similar to those known from ultrasonic measuring instrument.
- Keratometry (1)
Also done on the IOLmaster but done to measure the curvature of the cornea. Patient
remains in the previous position and is asked to fixate on the yellow light this time. The
operator must align the instrument so that 6 peripheral measuring points are symmetrical
with the circular crosshair and appear optimally focussed. The patient is often advised to
blink before the measurements are taken to produce an adequate tear film. This improves
the reflectivity of
the cornea. If the patient has dry eyes, the administration of a tear replacement solution
may
assist in obtaining a correct measurement. It is important that the operator has ascertained
this prior to examination.
Keratometry (2)
A hand held keratometer can also be used. This is held by the operator who needs to
position the patient safely in a seat and holding the keratometer securely hold it as close to
the patients eye as possible and take readings accordingly. This requires good hand eye
co ordination.
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A Scan (1)
This measures the depth of the anterior chamber and is also done on the IOL Master. The
patient is asked to fixate on the yellow light, which appears very bright this time as the
system automatically turns on lateral slit illumination. The operator must fine align the
instrument so that the image point appears to be optimally sharp within the square on the
display, the image of the cornea is not disturbed by reflections and the anterior crystalline
lens is optimally visible. The machine then takes measurements at appropriate time
intervals. It is important that the operator has an understanding of the measurements and
their value as incongruity can cause the wrong strength of lens to be inserted by the
surgeon and give a poor visual result.
A Scan (2).
A hand held probe is placed on the cornea of the patient by the operator whilst the
patient is seated at a slit lamp for examination. The machine, to which the probe is
attached takes measurements of the depth of the anterior chamber (five in total) which
the operator must assess for accuracy(this is a skill gained through experience and is
essential in order to assess accurately the exact strength of lens required to be inserted
into the eye.) Further measurements may need to be taken in order to gain accuracy.
- Focimetry
A focimeter is used to verify the strength of spectacles and can be used to check the
spherical lens power, the cylindrical lens power, the axis of astigmatism, the reading
addition and the prismatic correction. The calculations are based on a straightforward
mathematical formula, which again must be accurate in all areas.
All these procedures are complex and require extensive training in both theory and
practice.
- Epilation
Removal of offending or ingrown eyelashes which can cause corneal damage and
excessive tearing. Done via slit lamp utilising fine forceps
- Sac Washout
This is a procedure done to ascertain the patency of the lacrimal apparatus, which forms
the tear drainage system within the eye. The procedure is done by dilating the punctum
(tear duct) on the lower inner eyelid. A fine bore cannula, attached to a 2ml syringe filled
with normal saline is then inserted and guided towards the naso lacrimal duct (towards
the nose from the eye lid) Normal saline is then injected and patient instructed to swallow
if felt at the back of the throat (this means the duct is patent) If the duct is blocked the fluid
will back track and leak from the punctum on the upper lid. Nurse will then document this
appropriately for the surgeon to take action.
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Ensure all investigations in relation to the general pre admission assessment are carried
out e.g. Venepuncture for blood film, recording of ECGs, ascertaining ability of patient to
lie flat for a prolonged period of time, ensuring medication will not interfere with procedure
e.g. warfarin therapy, insulin therapy. Taking an accurate history of pervious and existing
medical conditions if any and any previous surgical ,diagnostic or medical interventions
Record and report on any related social issues, which may prevent the patient being
admitted, and attempt to resolve them within parameters of ability.
Ensure the assessment, planning and implementation of nursing and associated care of
pre admission patients is carried out.
Provide health promotion and education of patients and carers as well as staff.
Demonstrates up to date knowledge of medical and surgical conditions and treatments
within ophthalmology.
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Provides one to one care for ophthalmic patients receiving monoclonal antibody drug
therapy which requires access to resuscitation equipment and facilities due to the nature of
the drug.
Carry out postoperative eye examinations and first day checks on ophthalmic patients
ensuring there are no complications or potentially sight threatening problems within the
eye.
Work alongside the nurse specialist in the provision of a pre and postoperative nurse led
clinic in Shetland, and provide a pre admission assessment service to the same utilising all
the procedures as mentioned previously
Actively participates in the care and maintenance of ward stock and equipment in relation
to ocular assessment
Management/Organisational:
 Actively participates as an effective team leader and member of the multi disciplinary team
for ophthalmology
 Practices and promotes confidentiality at all times.
 Demonstrates the ability to delegate staff effectively.
 Deputies for SCN in their absence/attend meetings, carries area bleep for ophthalmology.
 Proactively leads a team and communicates with all colleagues in a professional manner.
 Management and running of specialist ocular clinics for pre admission assessment.
 Effectively organises own workload by organising and arranging the clinics in order to
maintain maximum efficiency.
 Provides support to others within the team.
 Participates in the orientation of new staff
 Demonstrates ability to address issues arising in a professional and discreet manner whilst
knowing own limitations.
 Assist/manage the ward area as and when required.
 Maintain associated records, ensuring accuracy and adhering to NMC/NHS Grampian local
policies at all times
 Demonstrates an understanding of and adherence to local and National Health and Safety
policies and procedures.
 Communicates effectively with patients, carers and members of the multi disciplinary team
 Demonstrates an awareness of effective utilisation of available resources to ensure
economy and practicality
 Demonstrates established leadership skills by managing the workload of the service area
staff, ensuring efficient and effective time and resource management.
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Professional Development:
Actively participates in the appraisal of staff/knowledge of eksf.
Actively participates in teaching programmes/orientation of new staff.
Acts as a positive role model for all disciplines of staff.
Demonstrates willingness to develop managerial skills.
Educate new nursing staff to ensure proficiency within the day case unit.
Accountable for own professional actions, not directly supervised
Demonstrates a commitment to developing clinical skills and expertise
Shows an awareness of research and audit and actively participates in the latter
Maintains responsibility for own professional development
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Service Delivery
Assists senior nurse in contributing toward future development of the service/redesign
Shows positive attitude in suggested changes in practice and participates in those
changes
Actively contributes to the provision of continuity of care for all patients in the service.
6. SYSTEMS AND EQUIPMENT
Administrative systems:
Review and locating of patients notes.
The post holder is required to report any incidents through the datix system.
To develop competence in computer skills required fro the area
e.g.: SSTS,eksf,Microsoft office/intra/internet skills
Clinical:
Slit lamp for examination of anterior segment of the eye and the measurement of intra ocular
pressure.
IOL Master
The IOL Master is used for Biometry (measurement of the axial length of the eye) Keratometry
(measurement of the corneal curvature) A Scan (measurement of the depth of the anterior
chamber) and white to white determinations of the human eye (measurement of the actual
width of the iris to ensure accurate lens measurement). It calculates the strength of intraocular
lens required.
A sophisticated piece of equipment, it requires skill and extensive training to use.
Keratometer (manual, handheld) essential for biometry measures the curvature of the
cornea. Tonopen Hand held instrument for the measurement of intra ocular pressure.
Focimeter- measures the power of the lens in spectacles
Snellen Chart- for measuring and recording visual acuity
ECG machine – recording of cardiac rhythm.
Venepuncture and cannulation- extraction of blood samples and insertion IV cannula for
venous access.
7. DECISIONS AND JUDGEMENT:
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The post holder must always work within the NMC Code of Professional Conduct.
To plan, organise and allocate staff according to the work load in ward and daycase area.
Delegation of duties/responsibilities to junior staff.
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Responsible for ensuring all measurements taken on the IOLMaster are accurate and
advising as required. Inaccurate measurements can cause poor visual result as the
surgeon relies on these to assess the type of intraoccular lens to be inserted.
 Responsible for assessing patient suitability for day case/ in patient procedures by
reviewing notes patient examination (ocular and general physical) and assessing
social circumstances.
 Consult with medical staff re patient health status and social circumstances.
 Consult with ophthalmologists regarding measurements of the eye if they seem unusual
or incongruous.
 Arrange for further medical investigations e.g. blood tests, urinalysis, x-ray etc by liasing
with general practitioner and or practice/district nurse.
 Plan and evaluate patient suitability following investigations and liaise with medical staff
and anaesthetic staff if in doubt.
 Along with nurse specialist responsible for pre and postoperative examination and
treatment
of patients in Shetland Islands.
 Largely
working
unsupervised
therefore
accountable
for
own
clinical
judgement/professional actions.
8. PHYSICAL DEMANDS OF THE JOB
Post holder may have to adapt their shift pattern to cover daycase and ward area.
Post holder may have to work alone.
Use of equipment requires a high degree of concentration, as accuracy is vital to achieve
optimal optical results. Most of the work involves sitting at a slit lamp using a binocular
magnifier in darkened surroundings
Moving and handling of patients into small spaces for examination at a slit lamp.
9. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
The post holder will communicate effectively and professionally at all times.
Utilise effective leadership skills in order to manage workload and develop a clinical
environment
which is positive and effective for both staff and patients.
Assist in the co-ordination of the availability of beds in ward 40 for weekend ward closure.
Ensuring that knowledge is sufficient to ascertain inaccuracies in measurements and
take appropriate action
Time management – due to waiting times/lists targets it is essential as many patients are seen
and treated as quickly as is feasible and safe.
Maintaining skills on new equipment and teaching them to others. Coping with elderly, infirm
patients and ensuring accuracy in measurements and all other aspects of pre admission
assessments.
Not directly supervised.
10. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB
Knowledge: Knowledge of ophthalmology and policies and procedures in relation to
Ocular assessment.
Knowledge of equipment used in ocular assessment for explanation to
patients and management of said equipment.
Knowledge of NMC/NHS Grampian policies
Experience: Experience of ophthalmology
Pre admission assessment of patients for cataract, glaucoma and ocular
Motility.
Running nurse led clinics.
Training:
First level registration RN or equivalent.
In house and external training in use of high tech, complex pieces of
Equipment.
Recognised ophthalmic qualification
In theory and practice of speciality.
JOB TITLE
:
Senior Staff Nurse (Band 6)
LOCATION
: Ward 30, Aberdeen Royal Infirmary
Criteria
Essential
Desirabl
e
Qualifications and Training
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NMC Registration
Evidence of commitment to own professional development
Evidence of post registration study
Slitlamp examination skills
Ophthalmic skills certification
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Experience
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Extensive post registration experience
Broad ophthalmic experience
Mentorship experience
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Knowledge, Skills and Attribute
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Sound relevant knowledge
Excellent patient care standards
Excellent organizational skills
Excellent communication and interpersonal skills
Evidence of leadership skills
Commitment to staff development
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Personal Qualities
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Hard working, team worker / leader
Reliable
Self motivated and motivational
Committed to continuing personal professional development
Pleasant, positive disposition
Particular Requirements
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This post requires a PVG Check
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