Advanced Nurse Practitioner Band 7
JOB SUMMARY / PURPOSE:
The post holder is expected to work as a highly skilled senior practitioner with expert knowledge, delivering evidence based practice to a designated population within Powys.
As an autonomous practitioner the post holder will act within their professional boundaries, providing care for the presenting patient from initial history taking, clinical assessment, diagnosis, treatment and evaluation of care. They will demonstrate safe, clinical decision-making and expert care, using assessment and diagnostic skills, for patients within the general practice. The post holder will demonstrate critical thinking in the clinical decision-making process. They will work collaboratively with the general practice team and wider MDT to meet the needs of patients providing nurse leadership as required.
The post holder will exercise a high degree of personal professional autonomy and make critical judgments to satisfy the expectations and demands of the role. The post holder will be guided by local and national policies, and identify ways to interpret and advise relevant stakeholders accordingly.
The post holder will be expected to act as a practice leader, managing their own workload and work across professional, organisational, agency and system boundaries to improve services and develop practice to the designated population.
DUTIES & RESPONSBILITIES
Management and Leadership
1. Demonstrate the ability to lead and promote Nurse specialist knowledge and skills within the primary care multi-disciplinary team using evidence based practice in all patient interventions.
2. Practice within the NMC Code at all times, acting as a change agent and role model to promote peoples’ equality, diversity and rights.
3. In collaboration with the practice recognise situations where scope of practice needs to be expanded to improve the service and identify subsequent educational needs.
4. Organise own workload and adjust priority of changing demands to ensure all patients’ and service needs are met.
5. Develop and maintain partnership working with other practitioners/ disciplines involved in the patient pathway.
6. Actively participate in practice team meetings, developing plans and strategies to drive the service forward based on clinical need and local and national directives.
7. Act as an advocate for the patient at all times, ensuring a person-centred approach and that their individual needs are central to practice, policies, procedures and guidelines.
8. Actively seek and engage in clinical supervision and mentorship to facilitate personal and professional development of self and others. Lead on development of policy and protocols to support nursing practice within primary care.
9. Carries out PADRs for Practice Nurses and Health Care Support Workers.
10. Understand own role and scope and identify how this may develop over time.
1. To act as an autonomous practitioner working independently and in conjunction with other health care professionals to assess, diagnose and treat the conditions of patients within primary care, initiating referrals as appropriate.
2. Triage patients via telephone as and when required providing appointments to appropriate discipline maximising Nurse practitioner skills and contribution to primary care according to assessed need.
3. Provide a range of work procedures and practices which require advanced theoretical knowledge and practical experience: Conducting advanced physical assessments, examinations and investigations to identify complex and unstable health needs, to aid diagnoses and develop a comprehensive and appropriate treatment plan.
4. Oversee the patient’s treatment and investigation pathway, ensuring it is seamless and well communicated to all parties. Ensure that issues of concern are escalated appropriately.
5. Use advanced clinical assessment skills to autonomously manage patients presenting to the service, to ensure that optimal physical and psychological care needs are met.
6. Use of advanced clinical skills and autonomous judgement to prescribe drug treatments for patients following interpretation of clinical findings, requesting bloods and other investigations where appropriate.
7. Monitor and review the effectiveness of interventions with the patient and colleagues to meet changing and complex needs and established goals of care.
8. Proactively identify, diagnose and manage treatment plans for patients at risk of developing a long-term condition. Provide support and management throughout the long term disease trajectory including engagement in end of life pathway.
9. Diagnose and manage both acute and chronic conditions, integrating both drug and non-drug based treatment methods into a management plan.
10. Prescribe and review medication for therapeutic effectiveness, appropriate to patient needs and in accordance with evidence-based practice and national and practice protocols, and within scope of practice.
11. Work with patients in order to support compliance with and adherence to prescribed treatments. Provide information and advice on prescribed or over-the-counter medication on medication regimens, side-effects and interactions.
12. Prioritise health problems and intervene appropriately to assist the patient in complex, urgent or emergency situations, including initiation of effective emergency care.
13. Support patients to adopt health promotion strategies that promote healthy lifestyles, and apply principles of self-care.
14. Implement and participate in vaccination and immunisation programmes for both adults and children including overseas travel.
15. Assess, identify and refer patients presenting with mental health needs in accordance with Mental Health pathways.
16. Promote and deliver evidence-based care for patients presenting with aural conditions.
17. Undertake minor surgery as appropriate to competence.
18. Support and manage health needs of women presenting for family planning, cervical cytology or sexual health consultation.
19. Be proactive in developing new ways of working. Nurse led initiatives to increase quality of life for patient; improve their knowledge to promote self-management of symptoms through anticipatory care approach to avoid and reduce unplanned episodes of admission to hospital.
20. Work within scope of practice as an Independent Nurse Prescriber in line with the All Wales Formulary, British National Formulary and NICE guidance. Adhere to NMC Code and local medicines management policies and guidance. Ensure prudent use of health care resources, with clinically and cost effective prescribing decisions.
21. Undertake clinical Nursing practice at an advanced level using expert knowledge and clinical skills to deliver holistic care to people accessing primary care services.
22. Develops and manages highly specialised programmes of care providing highly specialised advice concerning care beyond the scope of normal nursing practice eg establishes differential diagnoses, management/ Treatment plan and referral on as appropriate.
23. Undertakes frailty reviews of patients, including medication reviews.
1. Produce accurate, contemporaneous and complete records of patient consultation, consistent with legislation, policies and procedures.
2. Assess effectiveness of care delivery through self and peer review, benchmarking and formal evaluation.
3. Initiate and participate in the maintenance of quality governance systems and processes across the organisation and its activities.
4. Utilise the audit cycle as a means of evaluating the quality of the work of self and the team, implementing improvements where required.
5. In partnership with other clinical teams, collaborate on improving the quality of health care responding to local and national policies and initiatives as appropriate.
6. Evaluate patients’ response to health care provision and the effectiveness of care.
7. Use a structured framework (eg root-cause analysis) to manage, review and identify learning from patient complaints, clinical incidents and near-miss events. Support and participate in shared learning across the practice and wider organisation.
8. Understand and apply Safeguarding issues that support the identification of vulnerable and abused children and adults, and be aware of statutory child/vulnerable patients health procedures and local guidance.
9. Ensure the whole team have skills and knowledge regarding domestic violence, vulnerable adults, substance abuse and addictive behaviour. Provide guidance and support to ensure appropriate referral if required.
10. Actively contributes to practice/ service /team audit / research activity as required. Instigates audit activity and identifies, applies and disseminates research findings related to clinical practice.
11. Assist in the development of practice protocols and clinical protocols for the team.
1. Ensure continual professional development to maintain expert knowledge and skills through accredited courses, attendance at relevant training, forums, courses and conferences.
2. Identify educational objectives for own professional development which reflect local and national service needs.
3. Complete mandatory training matrix, to comply with organisational training requirements and clinical governance.
4. Support and deliver education programmes to meet the learning needs of service users and the wider MDT.
5. Facilitate undergraduate learning for nursing and medical student through placement in the primary care setting. Provide mentorship as required to MDT colleagues promoting evidence based practice.
6. To participate in Patient Education Programmes that most appropriately meet the needs of the individuals. Signpost to specialist programmes relating to self-awareness and management of a chronic condition. Engage with self-management programmes providing expert input as required.
7. Integrates theory into practice and establishes links with educational institutions.
8. To actively participate in the research and development agenda, focusing on improvements to service delivery.
1. Provide and receive complex, sensitive or contentious information and where there are significant barriers to communication, address using advanced interpersonal and communication skills.
2. Utilise communication skills to establish and maintain therapeutic and professional relationships to meet the needs of patients, GP practice, peers and other professions / agencies.
3. Demonstrate skills in conflict resolution and competent negotiation skills to motivate, emphasise, counsel and reassure, when dealing with difficult and challenging situations.
4. Be responsible for recording, processing and storing information generated, ensuring any transfer of information follows Clinical Governance guidelines, using IT systems appropriate for workplace.
5. Use tact and diplomacy while communicating and influencing and at all times treat people with dignity and respect. Communicate unpleasant or bad news sensitively and provide counselling and reassurance as required.
6. Collaborate with multi-disciplinary teams across primary and secondary care, promoting integrated pathways of care.
7. Utilise and demonstrate sensitive communication styles, to ensure patients are fully informed and consent to treatment.
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