POSITION DESCRIPTION Position title: Patient at Risk Team Date Produced/Reviewed: June 2009 Position Holder's Name: Position Holder's Signature :... Line Managers Name : Line Managers Signature :... Date :... Service: Acute Care Page 1 of 13
PURPOSE OF THE POSITION The, Patient at Risk (PAR) team - provides a 24/7 service across the organisation on the Middlemore site is responsible for the clinical and professional leadership support while acting as an organisational resource to enhance clinical support for patients with, or potential for, physiological instability. requires expert clinical nursing skill and knowledge. PROFESSIONAL RELATIONSHIPS Nurse Manager Critical Care Complex CND Acute Care Associate Charge Nurse Manager PAR Nurse Practitioner ICU/HDU CCC Clinical Resource Nurse Key: Line Management relationship Clinical and Professional relationship Service: Acute Care Page 2 of 13
Vision & Values Organisational Shared Vision Our DHB shared Vision is to work in partnership with our communities to improve the health status of all, with particular emphasis on Maori and Pacific peoples and other communities with health disparities. We will do this by leading the development of an improved system of healthcare that is more accessible and better integrated. We will dedicate ourselves to serving our patients and communities by ensuring the delivery of both quality focussed and cost effective healthcare, at the right place, right time and right setting. Organisational Values Partnership Care and Respect Professionalism Teamwork Innovation Responsibility Working alongside and encouraging others in health and related sectors to ensure a common focus on, and strategies for achieving health gain and independence for our population Treating people with respect and dignity, valuing individual and cultural differences and diversity We will act with integrity and embrace the highest ethical standards Achieving success by working together and valuing each other s skills and contributions Constantly seeking and striving for new ideas and solutions Using and developing our capabilities to achieve outstanding results and taking accountability for our individual and collective actions Service: Acute Care Page 3 of 13
NATURE AND SCOPE OF RESPONSIBILITIES Key Accountability Clinical Practice Expectations Demonstrates effective co-ordination and support of the physiologically unstable ward patient and patient at risk Demonstrates excellent clinical skills in the identification, assessment, care and support of the Patient at risk/physiologically Unstable Patient (PUP) Provides timely response to PUP calls and clinical concerns of staff. Ensures the provision of collaborative and timely support, education and intervention relating to the Patient at Risk/Physiologically Unstable Patient Provides follow-up reviews to patients discharging from ICU/HDU and patients being transferred from EC identified as having high risk scores Liaises with ICU, HDU, Theatre Recovery and Emergency department in assessing PAR patients, coordinating ongoing care and ensuring patients appropriate placement for the provision of that care. Demonstrates excellent clinical assessment skills and displays the ability to utilise knowledge of the relevant pathophysiology to interpret diagnostic/ laboratory tests in identifying the Patient at Risk. Utilises these skills to plan and implement ongoing collaborative patient care. Documentation in clinical notes reflects appropriate clinical decision making and collaboration. Practices as a member of the multi/interdisciplinary team to improve outcomes for patients with physiological or potential for physiological instability. Demonstrates the ability to work within an interdisciplinary team in a Clinical Leadership role ensuring the provision of timely, appropriate care and management of the Patient at Risk. Liaises collaboratively with the ICU/HDU team to ensure physiologically unstable ward patients receive timely review and appropriate management. Service: Acute Care Page 4 of 13
Clinical and Professional Leadership Promotes Counties Manukau District Health Board (CMDHB) as a centre of excellence for Nursing and Midwifery practice. Promotes the provision of person-centred care to achieve positive patient-care outcomes. Promotes the provision of children/ whanau centred care to achieve positive family outcomes Initiates and promotes effective teamwork and collaborative relationships within the inter/multi-disciplinary team and across the health services. Facilitates the implementation of both organisational and nursing visions, values and goals. Seeks and identifies situations of clinical risk and takes appropriate actions to ensure a safe environment and positive healthcare outcomes for patients/clients, families/whanau and staff. Acts as a role model demonstrating culturally and clinically safe nursing and midwifery practice at all times. Applies critical reasoning and professional judgement to nursing practice issues/decisions. Contributes to the development of integrated service delivery. Actively enhances CMDHB s nursing and midwifery practice and performance by participating in appropriate local regional, national and international forums. Participates in CMDHB Credentialing process by providing assessments, education and ongoing support and supervision Works with ICU/HDU ACNM s, ICU registrars and ICU/HDU Works with ICU/HDU ACNM s, ICU registrars and ICU/HDU Nurse Practitioner (NP) and service based inter/multidisciplinary teams to identify and appropriately manage patients who are physiologically unstable using the PUP scoring system. Using advanced clinical skills in addition to the PUP scoring system, identifies patients at risk and works closely with the Primary teams to monitor and implement interventions to prevent deterioration. Promotes and Audits the PUP scoring system to improve identification and management of Physiologically Unstable patients. Collaborates with nursing teams to ensure clinical leadership, nursing care delivery and implementation of CMDHB policies and practices. Discusses and works with Charge Nurse Managers, Shift Coordinators and ward staff to identify physiologically unstable patient needs and develop a plan of action to meet the 24/7 needs of these patients. Uses organisational systems and processes to communicate and feedback on clinical risk and critical incidents to appropriate senior nurses and/or medical staff Service: Acute Care Page 5 of 13
Liaises with Duty Mangers to work towards a healthy workplace through Safe Staffing initiatives and the use of Escalation plan when required. Provides clinical support for after hours specialist interventional procedures Identifies and communicates clinical competency issues to the appropriate Clinical Manager and /or Nurse Educator. Provides first response to all emergency calls Education and Clinical Teaching Evidence Based Practice Utilises best practice principles of teaching to maximise the effectiveness of applied learning in clinical practice within the guidelines of CMDHB Policies and Procedures. Supports the development of nursing staff in all areas of nursing assessment, clinical examination and planning, implementing and evaluating care. Identifies and communicates clinical competency issues to the appropriate Clinical Manager. Fosters inquiry, critical thinking and research skill acquisition among the nursing workforce to advance nursing practice and patient/client care Works to ensure the recommended research based best practice guidelines/policies are implemented across CMDHB. Actively participates in the development and review of guidelines, policies and procedures for CMDHB Service: Acute Care Page 6 of 13
Quality and Risk and Continuous Quality Improvement Professional Development and Clinical Competency (Self) Evaluates the effectiveness, efficiency and safety of clinical nursing practice throughout CMDHB. Assists in the implementation of nursing and midwifery practice, promoting and assisting with the PDRP utilising strategies to support continuous quality improvement, maximising nursing and midwifery staff involvement in this improvement. Acts to identify and minimise clinical risk and enhance patient/consumer satisfaction. Identifies the need for and contributes to projects that enhance the clinical implementation of nursing practice utilising evidence based practice within the CMDHB framework. Provides quality and risk management by early identification of potential hazards, analysis and evaluation of infection control and the intervention, management and monitoring of Blood and Body Fluid accidents Assists in the implementation and management of initiatives to address differential access to healthcare services in CMDHB s culturally diverse community. Participates in audit and review of quality monitoring systems and processes such as utilisation of the PUP tool Explores the ethical dimensions of nursing and midwifery practice and seeks positive outcomes in the management of ethical dilemmas. Undertakes future quality initiatives as required Liaise closely with Security and Daily Operations Unit in the provision of a Safe Staffing Healthy Workplace environment at CMDHB Facilitates and/or participates in debriefing of clinical incidents. Support staff by initiating debriefing as required. Promote CMDHB Zero Tolerance to Violence Work with staff to identify high risk clients to ensure the establishment of an appropriate management plan Practices professionally in accordance with legal, ethical and culturally safe standards as per CMDBH policies, procedure and guidelines within Nursing Council guidelines. Demonstrates professionalism within individual practice. Maintains and develops own clinical expertise and knowledge in specialty nursing practice. Participates in professional supervision as required. Pro-actively participates in own performance development and review. Attends educational opportunities/conferences relevant to CRN PAR role and scope of the role. Service: Acute Care Page 7 of 13
Information and systems technology. Health & Safety To recognise individual responsibility for workplace Health & Safety under the Health and Safety Act 1992 Constantly seeks innovation when develops improved and effective systems Demonstrates use of the phone and paging systems Demonstrates access and use of the available clinical information systems. Demonstrates competency with Windows 2000 or similar. Is conversant with applications required for specific discipline or role. For example PIMS, Concerto, Outlook, Onestaff, Microsoft Access and RiskPro. Continue to lead and support appropriate systems and information technology initiatives. Actively seeks out innovative solutions through improved IT systems. Supports and champions Workforce Analysis technology. At all times ensures a safe working environment and safe working practices Plan, lead, organise and control Health & Safety activities directed at preventing harm in the workplace, in consultation with employees and Health & Safety representatives for area Ensure that all accidents/incidents in the workplace are investigated, and that hazards are recognised and adequate controls put in place. Provides quality and risk management by early identification, minimisation, and notification of potential hazards. PROBLEM COMPLEXITY The Patient at Risk Team will be required to manage complex problems of a wide and varied nature across the organisation on a daily basis. The PAR Team will be regularly challenged by the requirement to continually re-prioritise their workload to ensure that all patients receive appropriate nursing and multidisciplinary assessment and intervention twenty four hours seven days per week. There will be demands to respond with in a time appropriate manner, maintain accuracy and quality of information. Failure to do so would impact on the organisation in terms of patient safety / wellbeing and organisational effectiveness. The CRN will escalate decision making in times of clinical patient need and ensure safe and optimal staffing for patients at risk. Service: Acute Care Page 8 of 13
SCOPE FOR ACTION The as part of the Patient at Risk Team will be empowered to make independent recommendations and nursing responses related to physiologically unstable patient needs and will be expected to use problem-solving skills to develop innovative approaches to clinical issues on a daily basis. The will liaise and collaborate with the Critical Care Complex Associate Charge Nurse Managers, ICU Registrars, ICU/HDU Nurse Practitioner, Ward Charge Nurses Midwives and the multidisciplinary team to ensure that all patients receive interventions and care appropriate to the level of instability. DIMENSION OF THE ROLE The CRN PAR through formal referrals and professional networks identifies physiologically unstable ward adult patients and has a child focused perspective to all paediatric patients in Middlemore Hospital. The focus is on providing early patient assessment and timely intervention and support to the acutely unwell or deteriorating patient through role modelling expert clinical skills, promoting best practice, facilitating multidisciplinary collaboration, and providing education. Due to knowledge and skill required within both Paediatric and Obstetrics specialties, the CRN PAR Team will provide clinical and professional resource. The CRN PAR will also provide organisational staff support and supervision as required dependant on the presence or absence of CNM / CMMs, Nurse Educators, CND or other senior nursing staff. The CRN PAR will be responsible to the ACNM and Nurse Manager Critical Care Complex for achievement of agreed objectives and operates within the confines of Counties Manukau District Health Board. Professional Direction and Clinical support will be sought from the Nurse Practitioner ICU and the Clinical Nurse Director. COMMUNICATION The Patient at Risk Team will encounter problems related to a wide variety of clinical issues across the organisation, which will require communication, negotiation and collaboration with a range of health professionals and management staff. Situations may often call for tact, diplomacy and will require information to be handled in a discreet and sensitive manner. In conflict situations will be required to exercise sound judgement, negotiation and persuasiveness skills, toward facilitating a workable outcome. The CRN role requires advanced communication and negotiation skills so that they can ensure appropriate and timely clinical care can be provided in a cohesive manner from a range of services across continuum of care. Service: Acute Care Page 9 of 13
RELATIONSHIPS External Internal Committees/Groups (Team Responsibility to attend) Families/whanau caregivers/consumers. Healthcare providers outside CMDHB. Police / Security personnel. Other DHBs CYFS Social workers Correction services General Practice teams All nursing, midwives and clinical staff. Associate Charge Nurse Managers ICU/HDU Critical Care Complex medical staff ICU/HDU Nurse Practitioner Duty Managers. Security, Orderly Service. Telephone Exchange, Director of Midwifery, CND s, Charge Nurses, Clinical Nurse Educators, Nurse Specialists. New Graduate coordinators. Allied Health Staff: Dieticians, Physiotherapists, Laboratory Staff, Radiographers, Pharmacists / On-call Pharmacist. Ambulance and transit staff. Resuscitation Coordinator. Bereavement Care. Occupational Health, Social Workers. Cultural Support Team Service Managers. Psychiatric/Crisis Team. Multi-disciplinary teams. Allied Health, Healthcare Assistants. Other personnel across CMDHB. Senior Nurse Group. Patient Safety Committee. Mortality and Morbidity Meeting. Medicine Advisory Committee NZNO./ PACT PDRP progression New Graduate Programme Service: Acute Care Page 10 of 13
PERSON SPECIFICATION ESSENTIAL EDUCATION EXPERIENCE/ KNOWLEDGE SPECIFIC SKILLS PERSONAL and PROFESSIONAL QUALITIES Registered Nurse with current NZ practicing certificate. Postgraduate certificate/diploma in acute, emergency or critical care specialty nursing practice. Advanced practice in acute setting. Minimum 5 years post registration. Minimum proficient competence on PDRP in acute, emergency or critical care practice Knowledge and understanding of the Treaty of Waitangi and implications in nursing practice. Knowledge of current nursing professional development issues. Ability to access and utilise available clinical information systems. Experience in multi-disciplinary clinical teamwork Experience in problem solving, priority setting, and implementing plans/goals. Advanced assessment skills Experience in negotiation and conflict management Basic knowledge and understanding of Medico-Legal and Ethical responsibilities Ability to work autonomously while still being a member of a team Patient / Healthcare consumer focus. Works within defined scope of practice of a Senior Nurse and has clear understanding of direction and delegation as per NZ Nursing Council guidelines. A genuine interest and commitment to quality and service. The capacity to demonstrate strong clinical leadership. A commitment to the development of the nursing profession within Counties Manukau District Health Board. A professional development plan. Ability to promote effective teamwork and collaborative relationships within the multidisciplinary team and across health services. A commitment to cultural awareness and its application to nursing practice. HIGHLY DESIRABLE Clinical Master s degree. Qualified Critical Care Nurse Maintained Expert level of clinical competence on PDRP in acute, emergency or critical care practice Extensive advanced practice across specialties. Extensive nursing management of physiologically unstable patients (Cardiac and Haemodynamic)..Experience in interdisciplinary team work Advanced interpretation of laboratory, cardiac, and chest radiology. Audit / Research skills Demonstrated ability in the development and management of staff. Service: Acute Care Page 11 of 13
A commitment to improving nursing practice and standards of care. ORGANISATIONAL COMPETENCIES Description Leadership Ability to develop and communicate the vision for the future, inspiring a belief in and commitment to the goals of the organisation / team. Ability to articulate the CMDHB vision and values and help facilitate change. Is able to draw together a range of perspectives within the CMDHB multidisciplinary team. People Management Leads, communicates expectations and agreed goals, providing ongoing feedback and objectively evaluates nursing performance. Able to recognise and acknowledge achievements of others. Ability to inspire collaborative efforts among the interdisciplinary team. Teamwork Works collaboratively with other CMDHB team members to achieve organisational objectives. Seeks out opportunities to support others in achieving their goals. Recognises and respects individual differences. Cultural Approach Understands the significance of the Treaty of Waitangi. Displays cultural/spiritual sensitivity and a willingness to work positively with organisational strategies to improve healthcare opportunities for the culturally diverse CMDHB community. Self Management Sets high personal standards/goals and maximises opportunities to achieve these. Displays drive and energy and persists in overcoming obstacles. Is proactive and displays initiative. Adapts to growth and facilitates change. Understands personal limitations. Can work to deadlines to achieve outcomes. Patient/Client/ Takes action to fully comprehend the needs of patient/client Population Focused populations and actively promotes such needs and priorities. Utilises a multidisciplinary approach to meet patient needs. Communication / Interpersonal Skills Expresses information effectively, both verbally and in writing. Adjusts language and style to the recipients and considers their frame of reference. Ability to utilise information technology within CMDHB. Creates opportunities to network throughout CMDHB and with other Healthcare providers. Communicates with empathy, integrity, consideration and respect. Innovation Actively reflects on practice, utilising critical thinking to explore new opportunities/models of care and develop creative and effective solutions to improve outcomes. Applies skilled analysis and sound reasoning in problem solving / decision making. Flexibility / Adaptability Ability to communicate, adapt, negotiate effectively and creatively, within a hugely varied scope of practice while meeting the needs of a diverse client base, as a member of a multi-disciplinary team. Planning and Able to establish timeframes, identify possible barriers to these, Service: Acute Care Page 12 of 13
Monitoring realistically allocate resources and accomplish goals. Able to self-evaluate/critique, monitor progress and address problems to achieve outcomes Service: Acute Care Page 13 of 13