Detailed job description and main responsibilities

Main Duties and Responsibilities

Assist in the delivery of an advanced specialist nursing service for people with a diagnosis of heart failure with preserved ejection fraction.

Provide specialist nursing advice and support to patients, their families and other healthcare professionals following diagnosis and through treatment.

 Ensure continuity of a high standard of evidence based nursing care, assessing health, health related and nursing needs of patients, their families and other carers by identifying and initiating appropriate steps for effective care.

 Responsibility for own network caseload, ensuring all patients have an accurate plan of care, which reflects the assessment undertaken and incorporates the issues and recommendations made ensuring clear documentation in the patient’s records and handheld records.

 Where possible and necessary, support frail patients through home visits.

 Actively liaising with the hospital at home team to prevent acute hospital admissions by admitting suitable patients into virtual wards with Telemonitoring facilities as per H@H protocols.

 Actively liaising with St Christopher’s Palliative Care team to manage patients with advanced heart failure symptoms or signs and to support their psychological and social needs where possible.

 Actively liaising with ward staff when patients are admitted with acute decompensation to facilitate high quality clinical outcomes and effective discharge planning.

 Triage referrals from other healthcare providers with the assistance of the cardiology heart failure consultants and the Integrated Heart Failure MDT coordinator.

 Follow up patients as appropriate and ensure all relevant information is available to enable patients to make an informed choice about their treatment.

 Coordinate and attend weekly MDT meetings ensuring all active caseload patients are presented.

 Deliver a seamless service through the development of enhanced Multidisciplinary team (MDT) processes and communication.

 Participate in the identification and development of clinical protocols and strategies to enhance both the continuity and standard of specialist care in line with NICE and the ESC guidelines.

 Participate in the process of operational policies review annually in accordance with national standards.

 Ensure all care is given in accordance with agreed protocols.

 Work closely with key staff members to maintain nurse led patient assessment and outpatient follow up services

 Regularly review those clinical notes of patients requiring imminent admission or clinic attendance, ensuring all assessments, diagnostic investigation and test results are up-to-date and in place.

Liaise with local community, social services, paramedics and voluntary organisations to develop existing services for clients, careers and health professionals.

 Actively involve service users in providing feedback of their experiences of the current service and suggestions for improvements.

 Participate in the development of appropriate patient group directives to facilitate/enhance the discharge process.

 To participate in relevant for  at Care Group, Trust or PCG/PCT Level to represent the service perspective.

Education and Research 

Ensure all patients are fully informed of the risks and benefits of proposed procedures / treatments, contributing to the process of securing informed consent.

Produce and provide all patients with relevant and accessible written information regarding their treatment in accordance with Trust standards.

 Supervise and participate in the delivery of programmes of education and training according to the identified needs of clients, carers and other involved in their care.

 Work with other clinical staff to identify knowledge gaps in relation to specialist patients and ensure staff are appropriately educated.

 Contribute to the development of nursing practice within the team.

 Where appropriate, to act as a practice supervisor to Trust and honorary contract employees.

 Actively participate in educational events provided by the Trust and primary care sector.

 Attend meetings and conferences as appropriate ensuring that you are fully conversant with current issues both within the Trust and within the specialist services locally and nationally.

 Promote and facilitate evidence-based practice and clinical audit within the Trust, raising the profile and enhancing the contribution of nursing   to   patient   care   and   informing   business   and   service development plans.

 Participate in and assist with any appropriate/relevant Trust approved research projects conducted within the service.

 Promote nursing research and evidenced based practice relevant to the speciality.

 Publish   and   present   relevant   clinical   practice   and   service developments.

Management

Liaise effectively with all other disciplines within the Trust and at local level.

 Participate in the management of change to improve standards and communication links from Primary Care through to Acute Trusts.

 Assist in developing policies and protocols to improve patient care.

 Actively contribute to any relevant initiatives within the care group and provide support to colleagues and Heads of Nursing.

 Contribute positively to the leadership of nursing within the care group acting as an effective role model.

 Comply with measures to actively manage and reduce risk to patients, ensuring the formal reporting and recording of adverse incidents in line with Trust policy.

 Network with the team of clinical nurse specialists within the Trust to evaluate, develop and promote the specialist-nursing role.

 Utilise and maintain information systems to aid audit and to provide regular activity analysis reports.

 Maintain contemporaneous and accurate treatment records, submitting relevant statistics, reports and activity data as requested. To participate in the evaluation of the service in terms of clinical effectiveness, clinical excellence and value for money.

 Ensure the best use of available resources is used within agreed budget to provide a cost effective service.

 Support effective links within primary, secondary and tertiary care to ensure effective communication.

 Ensure compliance with the Trust's Equality and Diversity Policy, supporting the delivery of the Trusts Race Equality Scheme and the Trust's duty to positively promote race equality and equality of opportunity for disabled people ensuring services are responsive to the needs of equality groups.

Personal Professional Development 

Achieve a range of clinical competencies as required to fulfil the role.

Keep up to date with current literature and research in the speciality.

Maintain your own personal and professional development in accordance with PREP requirements, attending mandatory study sessions as required.

 Undergo and actively participate in own performance appraisals.

 Keep up to date with NMC, relevant specialist Faculty & Trust guidelines and protocols.

 Adhere to the NMC Code of Professional conduct working within and accepting responsibility for maintaining agreed levels of competence.

 Working towards higher degree or equivalent.