Assistants in Nursing working in the acute care environment. Health Service Implementation Package

Transcription

1 Assistats i Nursig workig i the acute care eviromet Health Service Implemetatio Package

2 NSW DEPARTMENT OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) Fax. (02) TTY. (02) Produced by: Workforce Developmet & Iovatio Brach Health System Support Divisio NSW Departmet of Health Tel. (02) Fax. (02) This work is copyright. It may be reproduced i whole or i part for study traiig purposes subject to the iclusio of a ackowledgemet of the source. It may ot be reproduced for commercial usage or sale. Reproductio for purposes other tha those idicated above requires writte permissio from the NSW Departmet of Health. NSW Departmet of Health 2009 SHPN (WDL) ISBN For further copies of this documet please cotact: Better Health Cetre Publicatios Warehouse PO Box 672 North Ryde BC, NSW 2113 Tel. (02) Fax. (02) Further copies of this documet ca be dowloaded from the NSW Health website August 2010

3 Cotets Sectio 1 Itroductio... 4 Sectio 2 Icorporatig Assistats i Nursig ito the acute care cliical skill mix Stage 1: Idetifyig opportuities for AIN positios i acute care cliical areas Stage 2: Skill mix review ad maagemet process for icorporatig AINs Stage 3: Key questios to evaluate the Stage 2 skill mix review process Sectio 3 Educatio ad Developmet Geeral iformatio o the HLT32507 Certificate III i Health Services Assistace Recommeded competecy uits for the skill set Assistig i Nursig Work i Acute Care Assessmets icluded i HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) Up skillig existig workers to the HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) Cliical placemet guidelies for cliical areas Career pathways i ursig Sectio 4 Scope of practice of acute care Assistats i Nursig Positio Descriptio Assistat i Nursig Acute Care Acute Care Assistat i Nursig Care Activities List Sectio 5 Delegatio ad supervisio...30 Sectio 6 Defiitios...32 Sectio 7 Refereces...37 Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 1

4 List of Tables ad Figures List of Tables Table 1: Key questios to evaluate the Stage 2 skill mix review process Table 2: NSW Health Preferred Core Uits ad Electives for HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) Table 3: Summary of cotet covered i the required electives for HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) Table 4: Acute Care AIN Care Activities List List of Figures Figure 1: Steps to idetify opportuities for utilisig Assistats i Nursig... 7 Figure 2: The skill mix review ad maagemet process for icorporatig AINs... 9 Figure 3: Commo uits of competecy across the HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) ad ursig qualificatios PAGE 2 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

5 Abbreviatios ADL AHS AIN ANMC CIAP CS&HISC CVAD DMF Activities of Daily Livig Area Health Service Assistat i Nursig Australia Nursig ad Midwifery Coucil Cliical Iformatio Access Program Commuity Services ad Health Idustry Skills Coucil Cetral Veous Access Device Natioal Framework for Decisio Makig by Nurses ad Midwives (ANMC, 2007) IIMS N/A NUM O2 OHS&R PEG PICC RN NSW Health Icidet Iformatio Maagemet System Not applicable Nursig Uit Maager Oxyge Occupatioal Health ad Safety ad Rehabilitatio Percutaeous edoscopic gastrostomy Peripherally Iserted Cetral Catheter Registered Nurse VAD Vascular Access Device RPL Recogitio of Prior Learig EEN Edorsed Erolled Nurse RTO Registered Traiig Orgaisatio EEO Equal Employmet Opportuity TPR Temperature, pulse, respiratios EN Erolled Nurse Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 3

6 SECTION 1 Itroductio The availability ad skill of huma resources i health is the foudatio of a sustaiable publicly fuded health system. Australia Health Miisters have udertake iitiatives aimed at adoptig a strategic approach to workforce plaig i the health sector. Demographic ad epidemiological factors cotiue to shape the chagig cotext for the health workforce, demadig more co-ordiated ad itegrated services. This has maifested i redesigig patiet care processes aroud patiet eeds rather tha havig services plaed aroud the health care professioal based o historical practice arragemets. This eviromet has provided the stimulus for the Healthcare Assistat Iitiative, a project implemeted by NSW Health. As a part of this Iitiative a process of cosultatio has occurred to establish a cosistet approach to the educatio, role ad employmet of assistats withi ursig services i the NSW public health system. This resource documet has bee iformed by that cosultatio ad developed to assist with establishig cosistet practices at the Health Service level. It is evisaged that practices of employmet ad cliical allocatio of Assistats i Nursig as well as promotio of the role as a valuable team member withi acute care ursig services will be supported by the use of this resource. The title Assistat i Nursig (AIN) is used throughout this documet to describe a health care provider who assists health care professioals i the provisio of ursig care to patiets i acute care settigs. This resource documet supports the Healthcare Assistat Iitiative, the aims of which iclude: improve utilisatio of AINs i ursig teams i a ward or uit settig to support models of care ad better itegrate assistats i ursig ito team work practices; further develop assistat roles i supportig health professioals, ad better utilise skills withi the professioal workforce; facilitate appropriate traiig programs for ursig assistat roles, i cosultatio with health professioals; ad stadardise titles ad positio descriptios for AINs across the NSW public health system. The documet is comprised of four sectios coverig; 1. Processes to assess ad evaluate the icorporatio of AINs ito cliical eviromets, 2. A overview of the educatio ad developmet of AINs, 3. The compoets establishig the scope of practice of a AIN; ad 4. Delegatio ad supervisio guidelies. The guidelies withi this documet will be supported by further iformatio ad resources to idetify specific practices with regard to the employmet of all AINs i NSW Health. Further developmet ad sharig of tools or guidelies to assist i supportig the itegratio ad effectiveess of AINs as team members is ecouraged withi ad across Health Services. PAGE 4 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

7 SECTION 2 Icorporatig Assistats i Nursig ito the acute care cliical skill mix This sectio icludes a umber of tools to assist maagers to make decisios about how to icorporate AINs whe reviewig the skill mix i their cliical areas. Determiig the most appropriate skill mix is a complex process. These tools are therefore provided as a guide to assist urse maagers avigate through the steps ad take ito accout a rage of cosideratios. The followig three stages are recommeded to idetify suitable areas for AINs ad each stage is explored i more detail i this Sectio: Stage 1 Idetify appropriate opportuities for AINs i acute care cliical areas Stage 2 Review the ursig skill mix ad maage the process for icorporatig AINs Stage 3 Ask key questios to evaluate the Stage 2 review process Implemetatio recommedatios: Review all resource documets ad modify to local requiremets Review ad modify AHS/facility orgaisatioal structure to icorporate AINs Develop the required policies, protocols ad guidelies relevat to icorporatig AINs ito cliical eviromets Establish the cliical areas that are appropriate for AIN positios Establish target positios for AINs Develop a chage maagemet pla Develop a AIN employmet pla Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 5

8 2.1 Stage 1: Idetifyig opportuities for AIN positios i acute care cliical areas Stage 1 idetifies broad steps to assess the cliical eviromet ad develop support for specific cliical area reviews with a view to icorporatig AINs i the cliical skill mix 1. Figure 1 represets a process to idetify these opportuities. It is importat for urse maagers to use a process to clearly distiguish betwee each of the steps i the flowchart, which iclude: The skill mix capacity for supervisio of AINs i a cliical area. This step helps to idetify the level of decisio makig, supervisio ad support registered urses ca afford whe cosiderig skill mix ad the above patiet depedecy characteristics. Durig each of the steps, evidece is reviewed to idetify or create opportuities to itroduce AINs i appropriate cliical areas. I some cases, the evidece may ot support the use of AINs i the skill mix of particular cliical areas ad it is importat to idetify these situatios. Legislative or regulatory requiremets that could prohibit the allocatio of a AIN i ay particular cliical area, for example, do the Poisos ad Therapeutic Goods Act 1966, the Poisos ad Therapeutic Goods Regulatio 2008, or the Nurses ad Midwives Act 1991 prohibit the allocatio of AINs i ay cliical areas? Practice stadards or evidece that idicates a specific urse skill mix i a cliical area. The patiet case mix depedecy levels of a cliical area ad how this aligs with the care activities ad scope of practice of the AIN. This Implemetatio Package cotais a agreed scope of practice ad AIN patiet care activities to assist with this step. This step ivolves askig questios such as: - What are the predomiat patiet care activities withi the cliical eviromet? - Which of those patiet care activities alig with the scope of practice of a AIN? - What is the ratio/average umber of patiets who have predictable outcomes to patiet care activities withi the scope of practice of a AIN? - What is the ratio/average umber of ustable patiets that require costat applicatio of techical skills beyod the scope of practice of a AIN? 1 Skill mix refers to all staff that deliver ursig care PAGE 6 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

9 Figure 1: Steps to idetify opportuities for utilisig Assistats i Nursig Review backgroud ad scope of practise documets Are there ay legislative or regulatory requiremets for a RN &/or E/EN oly skill mix? Idetify ad review requiremets NO YES Ed review process Are there predictable patiet outcomes regardig ADLs & routie moitorig? Alig AIN positio descriptio ad Scope of Practice documets with ward/uit patiet cliical mix/depedecy YES NO Ed review process Is there capacity for supervisio of AINs? Review skill mix: No. of Nurses i Trasitio No. of RNs No. of ENs Use of casuals YES NO Ed review process Is the model of ursig care appropriate? Review model of care. Implemet appropriate model of care to accommodate all members. YES Go to STAGE 2 Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 7

10 2.2 Stage 2: Skill mix review ad maagemet process for icorporatig AINs Stage 2 provides specific elemets to be cosidered whe udertakig a process of skill mix review ad maagemet to icorporate AINs. The steps i Stage 2 reflect a review ad maagemet process that starts at the coclusio of Stage 1. Stage 2 cosists of the followig four steps: Step A: Assessmet, recommeds the aalysis ad aligmet of patiet eeds, staff umbers, staff characteristics ad the cliical eviromet usig established ad locally developed tools. Step B: Pla, recommeds strategies to prepare the eviromet to support the itroductio of AINs, icludig idetificatio of role chages ad staff developmet eeds. Step C: Implemet, recommeds strategies to move forward with skill mix chages. Step D: Evaluate, idetifies patiet, urse ad evirometal outcomes that could be reviewed to determie the effectiveess of the skill mix chages, usig established ad locally developed tools. Please refer to Figure 2 which presets a flow chart represetig the above four steps i the skill mix review ad maagemet process for icorporatig AINS. PAGE 8 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

11 Figure 2: The skill mix review ad maagemet process for icorporatig AINs A. ASSESS D. EVALUATE Patiet outcomes cliical idicators chages i urse sesitive patiet outcome - (IIMS data) - aecdotal evidece Nurse outcomes chages i roster flexibility perceived workload perceived resposibility sick leave commuicatio role focus/utilisatio Eviromet outcomes staff attritio rates budgetary role overlap collaborative culture policy/protocol adherece Patiet eeds umber cliical mix complexity depedecy Staff umbers availability scope of practice experiece support Eviromet physical support services culture Model of Care NUMs spa of cotrol - cliical leadership - policy ifluece C. IMPLEMENT Provide orgaisatioal support Promulgate relevat policies ad protocols Maitai appropriate staffig cosistecy Deliver educatio ad traiig Establish tools/resources/ documets Commece moitorig ad feedback mechaisms MATCH B. PLAN Rosterig idetify appropriate AIN umbers ad shifts Staff developmet/educatio Develop moitorig ad feedback mechaisms Model of Care chages Supervisio guidelies Role redesig Review local work flow practices Local protocol/policy developmet Pre implemetatio data collectio Review employmet processes Support etwork Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 9

12 2.3 Stage 3: Key questios to evaluate the Stage 2 skill mix review process Stage 3 is comprised of a umber of key questios to ask whe evaluatig the Stage 2 skill mix review ad maagemet process for icorporatig AINs i cliical areas. A list of possible questios that could be asked is represeted i Table 1. The questios are desiged to help review ad evaluate cosideratios observed durig the four steps i Stage 2. The Yes, Not Applicable (N/A) ad To be addressed colums i Table 1 ca be used to idetify assessmets, relevat strategies, outcomes, elemets for further actio ad ew strategy developmets over time, as the process is followed. Questios ca be modified, added ad/or removed accordig to the requiremets of the Health Service, facility, or ward/uit where the skill mix review process is uderway. PAGE 10 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

13 Table 1: Key questios to evaluate the Stage 2 skill mix review process A. Assessmet Yes N/A 1 Are the patiet eeds cetral to all skill mix decisios? To be addressed 2 Are there mechaisms i place for matchig the skill mix with patiet eeds/ depedecy? 3 Are patiet umbers (cesus) maitaied cosistetly? 4 Are there protocols for maagig times whe cliical areas are over patiet cesus? 5 Is the patiet cliical mix cosistet? 6 Are there low to o levels of outlier fluctuatios? 7 Is there little or o chage i patiet complexity patters across the uit/ward? 8 Are there protocols for skill mix/umber resposes to chages i patiet care demads? 9 Are there protocols for redeploymet of staff i respose to staff deficits e.g. uplaed leave? 10 Are ursig skill mix decisios cosistet with regulatory/madated/ recommeded requiremets? 11 Are ursig staff decisios made by a urse leader? 12 Are there policies/guidelies for ogoig evaluatio of ursig staff skill mix decisios? 13 Are the roles ad resposibilities of ursig care providers articulated i policies ad positio descriptios? 14 Are there sufficiet resources to support the implemetatio of the idetified skill mix? 15 Is staff safety cosidered i skill mix? 16 Is the physical eviromet cosidered i skill mix decisios? 17 Do skill mix decisios support the best use of all ursig resources? 18 Do skill mix decisios cosider patiet outcomes relative to the model of ursig care delivery? 19 Are skill mix decisios made ad evaluatios coducted i cosultatio with other members of the ursig team? 20 Does the process to make skill mix decisios measure patiet acuity, complexity, variability ad umber? 21 Do skill mix decisios allow flexibility i respose to chages i patiet acuity, complexity, variability ad umber? 22 Does evidece support skill mix decisios regardig workload, productivity, availability, umber ad employmet status (i.e. full time, part time, casual, agecy)? 23 Do skill mix decisios recogise the competecies ad experiece of the staff providig ursig care? 24 Do staff have opportuity for iput ito skill mix decisios? e.g 3 25 Are the results from moitorig ad evaluatio used to improve skill mix decisios? Elemets to be addressed Number Issue Actio e.g.20 No curret mechaism for measurig. Day to day decisios based o the professioal judgemet approach, ad loger term decisios utilise Geeral Workload Calculatio Tool. Support the developmet of processes that are also sesitive to patiet depedecy chages ad safe care stadards. Allocate specific resposibility to a Nurse Maager. Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 11

14 B. Pla Yes N/A To be addressed 1 Have idetified elemets of assessmet requirig actio bee addressed? 2 Is the roster reflective of appropriate capacity for supervisio requiremets? 3 Have staff atteded educatio ad traiig regardig positio roles, resposibilities, accoutabilities ad support mechaisms? 4 Have moitorig ad feedback mechaisms bee developed? 5 Has the model of care bee evaluated ad appropriate chages made? 6 Are staff resources ad guidelies available? 7 Have staff participated i processes to reflect o ad idetify productive ad progressive work practices? 8 Has a formal ad documeted process bee developed to esure AIN activities are appropriate ad moitored? Elemets to be addressed Number Issue Actio C. Implemet Yes evidece To be addressed 1 Has there bee a orietatio/resource book/package developed for AINs? 2 Are there established mechaisms to support staff ad AIN team buildig/ developmet? 3 Are staff aware of mechaisms to maage skill mix cocers/disputes? 4 Have health care colleagues received commuicatio regardig ursig team chages ad AIN role? 5 Have ursig support staff received commuicatio regardig ursig team chages ad AIN role? 6 Are there strategies to support cosistet messages regardig ursig team roles to patiets / cosumers / sigificat others? 7 Are tools/resources/documets readily available to all staff? 8 Have moitorig ad feedback mechaisms bee commuicated to staff ad put i place? 9 Are all ursig staff aware of processes to review AIN activities? 10 Are all ursig staff aware of the process to moitor ad maitai appropriate AIN activities? Elemets to be addressed Number Issue Actio PAGE 12 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

15 D. Evaluatio/Outcome Yes evidece To be addressed 1 Have there bee positive, egative or o chages idetified ad reported i cliical idicators related to skill mix decisios? 2 Is there other evidece of appropriate skill mix decisios? 3 Has there bee stability or improvemet to roster flexibility? 4 Are staff expectatios of team member roles reasoable? 5 Are staff expectatios of team member resposibilities reasoable? 6 Have there bee ay treds idetified i sick leave related to skill mix decisios? 7 Do staff express satisfactio with their commuicatio? 8 Do staff recogise role boudaries ad miimise practice overlaps? 9 Do Registered Nurses report cofidece i their supervisory capabilities? 10 Have there bee ay treds reported i attritio rates attributed to skill mix decisios? 11 Is the cost of skill mix decisios sustaiable? 12 Are there overt ad covert sigs idicatig positive progress towards collaborative practice withi the allocated skill mix? 13 Are there positive sigs/reports idicatig adherece to policy ad guidelie? 14 Do skill mix decisios make the best use of resources? 15 Are there cost savigs related to turover, reduced abseteeism, ad reduced overtime/agecy staff that ca be liked to skill mix decisios? 16 Are there cost savigs related to improved urse sesitive patiet outcomes that ca be liked to skill mix decisios? e.g 3 Elemets to be addressed Number Issue Actio e.g 1 Icrease i medicatio errors i two areas that have experieced recet skill mix chages. Aecdotal evidece suggests perceived ambiguity i roles ad resposibilities withi team. Review icidet ivestigatios Review ad esure educatio ad traiig has bee provided ad atteded Review commuicatio ad feedback mechaisms ad cosult staff Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 13

16 SECTION 3 Educatio ad Developmet The qualificatio, HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care), is the atioally recogised qualificatio to trai as a Assistat i Nursig i the acute care eviromet. This sectio provides iformatio o the qualificatio as well as other iformatio related to the educatio ad developmet of AINs, icludig: The uits of competecy NSW Health have recommeded studets complete to obtai the qualificatio ad support their employmet as acute care AINs i the NSW public health system. A umber of uits ivolve a cliical placemet compoet i the acute care eviromet. The cotet elemets, essetial skills ad assessmets of the six recommeded electives icluded i the qualificatio. Iformatio about up skillig existig workers to the HLT32507 Certificate III i Health Services Assistace qualificatio with the skill set, Assistig i Nursig Work i Acute Care. The iformatio ca be used to idetify ad support existig workers to covert or upgrade their curret qualificatios through a Recogitio of Prior Learig (RPL) process. Supervisio guidelies for staff to assist ad support studets o their cliical placemet ad to ecourage developmet of positive relatioships based o a uderstadig of the resposibilities of all ivolved. The uits of competecy that are commo across the HLT32507 Certificate III Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) ad higher level qualificatios, which shows how the Certificate III qualificatio cotributes to the pathway ito careers i ursig. Implemetatio recommedatios: Develop relatioships with traiig providers (Registered Traiig Orgaisatios) to maitai programme to practice relevace by moitorig ad feedback mechaisms Dissemiate iformatio across ursig services Review cliical placemet processes for AIN studets ad maximise positive studet ad cliical placemet area experiece Idetify ad support existig workers i ursig care or health care roles who would beefit from covertig their qualificatios or gaiig a qualificatio Develop or icorporate AINs i established metorig systems to progress their career i ursig where desired PAGE 14 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

17 3.1 Geeral iformatio o the HLT32507 Certificate III i Health Services Assistace HLT32507 Certificate III i Health Services Assistace qualificatio icludes the optio of a umber of skill sets ad covers workers i a rage of work roles. Health Services Assistace ivolves the worker i direct cliet cotact uder supervisio. This qualificatio has bee structured to provide either: a geeric qualificatio that covers a rage of work fuctios, or a skill set which is targeted to specific work roles, oe of which is the Assistig i Nursig Work i Acute Care which traslates to the role of AIN i the acute care settig. Outlied i Table 2 below is the recommeded skill pathway proposed by NSW Health for the elective skill set i Assistig i Nursig Work i Acute Care. It cosists of six compulsory core uits ad a further ie electives, six of which are required by the Health Traiig Package to obtai the targeted Assistig i Nursig Work i Acute Care qualificatio. The qualificatio is delivered over 360 omial hours, with the miimum recommeded hours for theory beig 310 hours ad a additioal miimum 50 hours of cliical placemet. NSW Health has requested that preferred traiig providers esure at least 50 of the cliical placemet hours are coducted i a acute care settig. Table 2: NSW Health Preferred Core Uits ad Electives for HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) CORE UNITS 6 Uits Competecy Code Competecy Title BSBFLM303B C Cotribute to Effective Workplace Relatioships BSBMED201A C Use Basic Medical Termiology HLTAP301A C Recogise Healthy Body Systems i a Health Care Cotext HLTHIR301A C Commuicate ad Work Effectively i Health HLTIN301A C Comply With Ifectio Cotrol Policies ad Procedures i Health Work HLTOHS200A C Participate i OHS Processes ELECTIVES 9 Uits Competecy Code Competecy Title HLTFA301B E Apply First Aid. HLTCSD305B RE Assist with cliet movemet. HLTCSD208B RE Trasport cliets. HLTCSD306B RE Respod effectively to difficult or challegig behaviour. HLTCSD201B RE Maitai high stadard of cliet service. HLTAIN301A RE Assist Nursig Team i a acute care eviromet. HLTAIN302A RE Provide support i a acute care eviromet HLTHIR403B E Work effectively with culturally diverse cliets ad co-workers. HLTHIR404B E Work Effectively with Aborigial ad Torres Strait Isladers. Or Leged C RE E Compulsory for issue of this qualificatio Required Elective for Assistig i ursig work i acute care as listed i the Traiig Package rules Preferred elective proposed by NSW Health. While there are a rage of electives to select from to allow for flexibility related to specific workplace eeds, NSW Health has specifically requested preferred traiig providers to iclude these electives i the qualificatio. Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 15

18 3.2 Recommeded competecy uits for the skill set Assistig i Nursig Work i Acute Care This sectio provides a overview of the cotet covered withi each of the six required electives, which must be studied to be awarded the qualificatio, HLT32507 Certificate III i Health Services Assistace with the skill set, Assistig i Nursig Work i Acute Care. A overview of the essetial skills resultig from the study of each uit of competecy is also icluded as well as iformatio o how the studet is assessed. Further iformatio o assessmet is provided i Sectio 3.3. The iformatio i Table 3 has bee summarised from the Health Traiig Package (HLT07) Versio 1 For more detailed iformatio please go to ad look uder traiig packages health. Table 3: Summary of cotet covered i the required electives for HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) Competecy Title Cotet Elemet Essetial skills Assessmet HLTCSD305B Assist with cliet movemet Prepare to assist with cliet movemet Assist with cliet movemet Operate liftig ad trasferrig equipmet Assist a professioal with cliet movemet Observatio of performace i a actual or simulated workplace settig. Complete assistace with cliet movemet Deal with coflict Assist cliets with meals HLTCSD208B Trasport cliets Prepare cliet for trasport Trasport cliet Apply safe workig practices, icludig maual hadlig Iterpret ad follow the istructios ad guidace of health professioals Solve problems icludig the ability to use available resources ad prioritise workload The studet must provide evidece of specified essetial kowledge ad skills. Assessmet occurs i the workplace or i simulated workplace coditios. Work with others ad display empathy with cliets ad relatives Deliver cliet Use readig ad writig skills Use oral commuicatio skills Use umeracy skills Essetial skills that are commo across competecy uits are ot repeated i list PAGE 16 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

19 Competecy Title Cotet Elemet Essetial skills Assessmet HLTCSD306B Respod effectively to difficult ad challegig behaviour Pla respose Apply respose Idetify whe assistace is required Maitai persoal safety ad the safety of others Foresee ad respod quickly ad effectively to cotigecies Most appropriately assessed i the workplace (simulatig difficult or challegig behaviour) or i a simulated workplace ad uder the ormal rage of work coditios. Maitai duty of care Report ad review icidets Effectively use techiques for moitorig ow service area icludig cliet satisfactio Speak i a firm, diplomatic ad culturally appropriate maer Remai calm ad positive i adversity Thik ad respod quickly ad strategically Remai alert to potetial icidets of difficult or challegig behaviour Moitor ad/or maitai security equipmet HLTCSD201B Maitai a high stadard of cliet service Commuicate appropriately with cliets Establish ad maitai a appropriate relatioship with cliets Work withi role ad resposibility Comply with relevat policies, protocols, guidelies ad procedures Most appropriately assessed i the workplace or i a simulated workplace ad uder the ormal rage of work coditios. Act i a respectful maer at all times Establish ad maitai relatioships Iterpret ad follow istructios Evaluate ow work ad maitai a high stadard of cliet service Hadle complaits ad coflict or refer as appropriate Work effectively as part of the team Use literacy skills i readig, writig ad oral commuicatio Use problem solvig skills to: Effectively utilise available resources Prioritise workload Demostrate respect for cliets Commuicate i a odiscrimiatory, supportive ad iclusive maer Liste ad respod to commuicatio iitiatives of cliets Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 17

20 Competecy Title Cotet Elemet Essetial skills Assessmet HLTAIN301A Assist ursig team i acute care eviromet Assist with the delivery of ursig care to cliets i a acute care eviromet Commuicate effectively with cliets whe collectig iformatio ad data ad assistig with persoal care eeds Observatio of workplace performace is essetial for assessmet of this uit. Support the cliet to meet persoal care eeds i a acute care eviromet Use equipmet ad follow procedures for collectig cliet cliical data Work i a team eviromet Operate equipmet ad aids utilised i the delivery of persoal care Work effectively uder supervisio Work uder directio ad supervisio Work effectively with cliets, colleagues ad supervisors Deal with coflict Work i a maer that respects the digity of cliets Display empathy to cliets ad relatives HLTAIN302A Provide support i a acute care eviromet Maitai accurate records Comply with admiistratio protocols of a acute care eviromet Maitai cliet health records i a secure ad cofidetial maer Complete forms ad documets i a clear, cocise ad factual maer Observatio of workplace performace is essetial for assessmet of this uit. Collect ad process workplace iformatio Collate ad dispatch iformatio accordig to specific timeframes ad orgaisatioal requiremets Orgaise ad supply equipmet required i a acute care eviromet PAGE 18 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

21 3.3 Assessmets icluded i HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) Assessmets udertake as part of the qualificatio must meet the criteria set out for Registered Traiig Orgaisatios (RTOs) by the Commuity Services ad Health Idustry Skills Coucil (CS&HISC). Give the rage of ways i which people ca be employed as Assistats i Nursig, NSW Health is developig resources such as a Policy Directive to clarify the acute care AIN role. Providig additioal iformatio through resources such as these will facilitate Health Services to employ uiform practices i developig the role of all AINs. The followig provides iformatio o the process for upskillig existig workers for work i acute care ad recogisig the skills ad experiece of existig staff who may ot hold the acute care qualificatio. Each of the competecy uits are assessed i formal classroom settigs, workplace settigs ad/or by simulated laboratory/cliical assessmets. The miimum specific cliical skills assessmets that a studet must successfully complete to be awarded the HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) are: TPR measuremet Blood pressure measuremet Blood glucose/sugar level measuremet Simple woud cleasig ad dressig Collectig ad testig urie specime (Urialysis) Had washig Cardiopulmoary resuscitatio Maual hadlig Patiet physical movemet 3.4 Up skillig existig workers to the HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) Curretly there are AINs with oe or more of a variety of qualificatios/experiece levels workig i the NSW public health system who have ot attaied the HLT32507 Certificate III i Health Services Assistace qualificatio with the skill set Assistig i Nursig Work i Acute Care. These iclude: Udergraduate studets of ursig studies; Those who hold the Certificate III i Aged Care; Those who hold the Certificate III i Health Services Assistace (Geeric Qualificatio); ad Those who have o-the-job experiece with o qualificatio. Attaimet of the uits of competecy i the HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) qualificatio ca occur i a umber of ways icludig through: Formal or iformal educatio ad traiig Experieces i the workplace Geeral life experieces, ad/or Ay combiatio of the above I awardig the qualificatio the primary cosideratio is whether the cadidate is competet, ot how the competecy is acquired. Skills Recogitio (icludig Recogitio of Prior Learig RPL) is the process through which a perso s skills, kowledge ad experiece are assessed by a qualified ad experieced traier/assessor i order to ascertai the perso s level of competecy agaist a rage of vocatioal skills. Recogitio processes ca oly be delivered by appropriately qualified ad experieced traiers/assessors o behalf of a registered traiig orgaisatio (RTO). Recogitio processes are geerally provided as part of the erolmet cost of a course. However, if full recogitio services are requested before erolmet, a RTO may charge a commercial fee for this service. Typically, a perso s previous work experiece ad curret qualificatios are assessed ad compared with the uits of competecy cotaied i the qualificatio i which they hope to erol. Depedig o the outcome, some uits of competecy i the target qualificatio may be grated via recogitio (also kow as Advaced Stadig). Up to a etire qualificatio may be grated via recogitio. The perso seekig recogitio is required to provide evidece of their skills kowledge ad experiece. The Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 19

22 types of evidece required will vary from assessor to assessor ad RTO to RTO. Evidece may rage from a iterview, paper-based qualificatios or refereces, ad examples of work. RTOs may also use other meas, e.g. challege tests (quizzes or practical activities aimed at gaugig competecies) to assess competecy. Where a perso is deemed by the qualified assessor to be almost competet agaist uits i a qualificatio, a gap traiig program is desiged to trai i oly those skills which are curretly lackig. As a result of recogitio processes, a perso may be able to complete a qualificatio more quickly ad cheaply tha would be the case if the etire qualificatio had to be completed. This also works for the employer who is fudig traiig as it meas that staff will gai qualificatios over a shorter timeframe, potetially at a lower cost ad with less time away from duties. 3.5 Cliical placemet guidelies for cliical areas This sectio provides iformatio o supervisig AIN studets who are udertakig the HLT32507 Certificate III i Health Services Assistace qualificatio with the skill set, Assistig i Nursig Work i Acute Care, whilst they are o their cliical placemet with the Health Service. The iformatio is provided to assist staff to support the studets ad ecourage developmet of positive relatioships based o a uderstadig of the resposibilities of all ivolved. Objectives: Patiet safety Studet orietatio Studet learig Facilitatio model: Registered Traiig Orgaisatios will provide studet facilitators while studets are o cliical placemet. Supervisio: Frot lie ursig uit maagers (NUMs) are resposible for esurig that there is a appropriate level of supervisio for studets i the cliical area or otherwise seekig alterative arragemets. The supervisio of a studet by a registered or erolled urse may be direct or idirect accordig to the patiet care ad studet competecy cotext. All supervisig urses are resposible for commuicatig ay cocers with studet performace to the frot lie maager (NUM). Direct supervisio ca be: Cotiuous required whe the studet is ew to the area of practice ad is operatig at a ovice level. Frequet required whe the studet is judged by the supervisig registered urses to be ot yet proficiet or is experiecig a crisis of cofidece. Occasioal required whe the studet has bee judged by supervisig registered urses to be safe ad proficiet yet eeds to build up cofidece i the provisio of care (Departmet of Nursig ad Midwifery, Sterlig Uiversity, UK) 2. Accoutabilities: A registered urse is accoutable for the allocatio of patiet care activities to studets, esurig the studet ca safely ad competetly perform the allocated activities. A registered urse at the poit of care is required to decide, accordig to the specific practice settig, the idividual studet s curret competecies ad the patiet eeds ad status as to the care activities allocated. A registered urse or erolled urse supervisig a studet is required to have the level of competece to be able to guide ad assist the studet i achievig the cliical placemet learig objectives. Assessmet: Assessors of studet competecies are provided by the Registered Traiig Orgaisatio. The assessmets will occur durig cliical placemet ad laboratory simulatio. 2 Departmet of Nursig ad Midwifery, Uiversity of Sterlig. Iformatio for metors. accessed from http//: o PAGE 20 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

23 Performace Maagemet: The Registered Traiig Orgaisatio is resposible to address ad maage performace issues the studet may have durig cliical placemet. Studets must have the appropriate theory ad/or simulated practice from the educatio programme prior to performig direct patiet care activities. 3.6 Career pathways i ursig The HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) qualificatio will support studets to work as a assistat i ursig i acute care eviromets. Completig this qualificatio ad goig o to work as a AIN i acute care provides the perso with the opportuity to gai valuable cliical experiece ad also helps to fiacially support further studies i ursig at either the Certificate IV or Diploma levels i erolled ursig or a bachelor of ursig level. This qualificatio also supports the developmet of studet cofidece by providig a etry level towards a ursig career pathway that is flexible ad less arduous, helpig to meet varied lifestyle resposibilities. Commo competecy uits are foud across the Certificate III, Certificate IV ad Diploma programmes, providig a pathway from HLT32507 Certificate III i Health Services Assistace to becomig a erolled/divisio 2 urse, by completig HLT43407 Certificate IV i Nursig, HLT51607 Diploma of Nursig or HLT61107 Advaced Diploma of Nursig. O successful completio of a qualificatio, a studet is able to apply for recogitio ad credit trasfer if applicable to other qualificatios. Figure 3 shows the competecy uits of traiig icludig those that are commo across the HLT32507 Certificate III Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) ad higher level qualificatios. Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 21

24 Figure 3: Commo uits of competecy across the HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) ad higher ursig qualificatios AIN EN EN EN RN Certificate III Certificate IV Diploma Advaced Bachelor of Nursig i Nursig of Nursig Diploma HLT32507 HLT43407 HLT51607 HLT61107 (Assistig i ursig work i Acute Care) 15 Compulsory (9 Electives) (Erolled/ Divisio 2 Nursig) 18 Compulsory (4 Electives) (Erolled/ Divisio 2Nursig) 21 Compulsory (5 Electives) (Erolled/ Divisio 2 Nursig) 7 Compulsory (5 Electives) BSBFLM303B BSBMED201A HLTAP301A HLTHIR301A HLTOHS200A HLTCSD305B HLTCSD208B HLTCSD306B HLTIN301A HLTCSD201B HLTFA301B HLTAIN301A HLTHIR403B HLTAIN302A HLTHIR404B HLTIN301A HLTIN301A HLTOHS300A HLTFA301B HLTFA301B HLTAP401A HLTHIR403B No formal liks to Tertiary Qualificatios Idividual istitutios may decide to offer limited credit poits towards a Bachelor Degree HLTHIR403B HLTEN401A HLTHIR404B HLTHIR404B HLTAP501A HLTOHS300A HLTEN507A HLTEN401A HLTAP501A HLTEN507A Key represet competecy uits that make up the madatory umber idicate recommeded elective competecy uits for a AIN qualificatio idetify commo competecy uits betwee idetified Certificate III, Certificate IV ad Diploma qualificatios idetify commo competecy uits betwee Certificate IV ad Diploma qualificatios NSW Health recommeded Electives i Certificate III PAGE 22 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

25 SECTION 4 Scope of practice of acute care AINs This sectio provides the two primary documets outliig the roles, resposibilities ad scope of practice of the AIN workig i acute care i NSW Health. The documets aim to develop workplace uderstadig ad cofidece i the scope of practice of the AIN workig i acute care. The documets iclude: Acute Care AIN positio descriptio Acute Care AIN care activities list Both the Acute Care AIN positio descriptio ad the Acute Care AIN care activities list have bee developed through wide cosultatio with key stakeholders icludig Health Service ursig ad workforce staff, Departmet of Health staff ad the NSW Nurses Associatio. 4.1 Positio Descriptio Assistat i Nursig Acute Care The positio descriptio describes the acute care AIN positio details, qualificatios, key fuctios, scope of practice ad resposibilities. The stadard statemets of employee obligatios are icluded as a miimum for idividual Health Services to expad o accordig to their established formats. A AIN will be allocated ursig activities that are withi the parameters documeted i the NSW Health positio descriptio. Ay additioal cotext specific ursig activities allocated must follow a formally documeted process that reflects the ANMC Decisio Makig Framework ad health services guidelies Implemetatio recommedatios: Utilise the AIN positio descriptio to iform staff of the roles ad resposibilities of the AIN acute care positio ad its cotributio to the AIN scope of practice Formulate local protocol ad guidelies to support practices appropriate to AIN scope of practice Develop or utilise curret processes that formally moitor ad authorise appropriate AIN care activities Maitai stadardised AIN roles ad resposibilities withi Health Services Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 23

26 Positio Descriptio Assistat i Nursig Acute Care, May 2010 Positio Descriptio Positio Details Positio No: Positio Title: Resposible to: Reports to: Divisio: Award: Locatio: Hours of Work: Performace Maagemet: Assistat i Nursig (AIN) Acute Care Director of Nursig Services Nursig Uit Maager Nursig Public Health System Nurses ad Midwives (State) Award NSW Health Health Services Seve day shift worker Appraisal after iitial 3 moths the aually Positio Requiremets 1. Qualificatios HLT32507 Certificate III i Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) or equivalet 2. Key fuctios Provisio of support to the ursig team i the delivery of ursig care i a acute care eviromet as directed by the Registered Nurse Provide direct care activities to patiets i accordace with the ursig care pla ad uder the supervisio of a Registered Nurse 3. Scope of Practice Assistats i ursig work withi a pla of care uder the supervisio ad directio of the Registered Nurse ad withi the limits of the Assistat i Nursig positio descriptio Assistats i Nursig retai resposibility for their ow actios ad remai accoutable to the Registered Nurse for all allocated fuctios Assistats i Nursig practice i accordace with NSW Health guidelies, the positio descriptio ad local policy ad protocol Assist Registered ad Erolled Nurses with patiet care itervetios as directed Cotribute to collectig accurate health care iformatio ad maitaiig accurate health care documetatio as required Commuicate effectively with patiets ad other health care team members i accordace with appropriate protocol PAGE 24 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

27 4. Resposibilities Assist i the delivery of the followig direct care activities as allocated by a Registered Nurse; Maitai the appearace ad fuctio of equipmet such as liftig ad mobilisig aids, pressure reducig mattresses ad other cliical devices used i ursig itervetios showerig, bathig, spogig repositioig, pressure area ad ski care hair washig, shavig mouth ad deture care eye ad ear care assistace with toiletig provisio, removal ad cleaig of bedpas ad urials geeral ward ambulatio ad support mobilisatio as per pla of care reiforce istructios o use of aids for mobility or care as detailed i pla of care, where appropriate assist with positioig, posture maiteace ad comfort observe ad report patiet completio of ad performace of tasks i lie with care pla set up ad assistace with patiet meals ad fluids for assessed low risk patiets applicatio of ati thromboemboletic stockigs simple woud dressigs last offices/care of the deceased Chage ad make up occupied ad uoccupied beds Promote ad maitai a clea, comfortable ad safe eviromet for patiets, staff ad visitors 5. Stadard Statemet of Obligatios (To be completed by Health Service/ursig uit) 5.1 Professioal practice 5.2 Educatio ad professioal developmet 5.3 Ifectio cotrol 5.4 Code of Coduct 5.5 OHS ad R 5.6 EEO Assist i the collectio of cliical data as allocated by a Registered Nurse; patiet weighig ad specific measuremets specific patiet observatios ursig admissio (ot ursig history or assessmet) Observe patiets physical ad psychological status ad resposes durig the course of iteractios withi scope of kowledge, ad report chages to the Registered Nurse Report all patiet observatios to the appropriate Registered Nurse Documet all patiet resposes to direct care/assistace give, iclude i progress otes ad cliical records i accordace with the pla of care ad orgaisatioal protocols Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 25

28 4.2 Acute Care Assistat i Nursig Care Activities List The Acute Care AIN Care Activities List provides boudaries o the rage of activities that a ewly qualified AIN ca be reasoably expected to udertake. Notes o Table: 1. A defiig factor of appropriate allocatio to the activities idetified below is the cotext i which the decisio is beig made please refer to the Australia Nursig ad Midwifery Coucil Decisio Makig Framework 3 for practice guidelies. As idividual AINs gai experiece ad cofidece i their role, ursig colleagues cofidece i them will also grow. To avoid uderutilisatio or iappropriate extesio of AIN activities durig itroductory periods ad while cofidece icreases, Health Services will be required to develop, if ot already available, a process for moitorig the practice of a AIN as they develop skills ad kowledge withi the described scope of practice. Where AINS are employed as part of the ursig team, resposibilities for patiet care, supervisio ad practice should be viewed as follows: 2. Activities refers to those activities that are withi the scope of practice of a AIN who has completed the qualificatio HLT32507 Certificate III Health Services Assistace (Descriptor: Assistig i Nursig Work i Acute Care) i.e. expected etry level skills. 3. Explaatory commets are made where applicable ad iclude examples of what could be expected to be reported to registered urses. The provisio of safe patiet care is a shared resposibility of all those ivolved i the delivery of ursig care. AINs are to work at all times uder the supervisio of a registered urse. Registered urses allocate patiet care activities with predictable patiet outcomes to AINs. AINs retai resposibility for their ow practice, reportig patiet care outcomes to registered urses ad workig withi their scope of practice ad level of experiece. AINs are resposible for usig their iitiative relative to their scope of practice ad role as a supportive team member. The Acute Care AIN Care Activities List is preseted i Table 4. 3 Australia Nursig ad Midwifery Coucil. (2007) PAGE 26 NSW Health Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package

29 Table 4: Acute Care AIN Care Activities List Activities Direct Patiet Care Activities of Daily Livig Showerig Spogig Washes Face ad hads Perieal toilets Post op Tepid Groomig Shave Hygiee Presetatio Simple eye care Oral hygiee Dietary assistace Set up meals Oral itake Mobilisatio Assist ambulatio Posture maiteace ad comfort Reiforce istructios o use of aids Ski care Pressure relieve/pressure Area Care Moisturise Maitaiig a dry eviromet Patiet Commuicatio Cosult patiet regardig activities of daily livig (ADLs) Reflect commitmet to patiet rights ad resposibilities Reiforce patiet orietatio to ward eviromet Commets ad geeral examples of what to observe ad report Mobility, ski itegrity Ski itegrity, comfort, metal orietatio Ski itegrity, comfort, metal orietatio Ski itegrity, comfort, metal orietatio Discharge, comfort, iflammatio of broke mucus membrae Low risk feedig as per risk assessmet Itake capacity/appetite Ability to maage diet Ability to maitai posture Comfort Ability to maage aids Respiratory rate o exertio Coditio of ski Idetificatio of presece of dressigs Patiet cocers/issues Patiet cocers/issues Patiet disorietatio Cliical data collectio Temperature Pulse Respiratios Blood pressure (maual ad electroic) Weight Girth/thigh measuremets Fluid Balace Chart (basic) Food chart Stool/emesis chart Urialysis Blood Glucose levels Neurological observatio Woud care Simple dressig Idividual chages Idividual chages Idividual chages Idividual chages Idividual chages Patiet cocers/issues Idividual chages Patiet cocers/issues Idividual chages Idividual chages Patiet cocers/issues Idividual chages Basic cosciousess Idividual chages Descriptio of woud Patiet experiece Assistats i Nursig Workig i the Acute Care Eviromet Health Service Implemetatio Package NSW Health PAGE 27