Detailed job description and main responsibilities

Management

• Responsible for a caseload of patients, using recognised criteria and guidelines.
• Responsible for direct referrals to other disciplines as appropriate.
• Co-ordinate and facilitate the care of patients, preventing fragmentation duplication and delays in care.
• To anticipate present and future care needs of patients and develop plans to meet these needs, with particular focus on avoiding unnecessary hospital admissions.
• To adhere to all Trust policies procedures and standards of practice.
• To maintain NMC registration as required and work within NMC guidelines, appertaining to current nursing practice e.g. code of professional conduct, standards for administration of medicines, scope of professional practice and guidelines for records and record keeping.
• To attend and participate in clinical supervision.
• To manage changing clinical situations e.g. prioritising unscheduled call at short notice, or at a sudden exacerbation of the patient’s condition.
• To assist in the development and quality improvement tools to review professional practice and identify improvements.
• To work with the Respiratory team to refer appropriately to Pulmonary Rehabilitation Service.
• To assist the Band 7 in managing a central database of patients with Home Oxygen in the Bexley Borough.
• To ensure efficient and effective use of resources within own practice.
• To participate in the Personal Development Review (PDR) process to identify training needs.
• To maintain NMC registration.

Leadership

• To act as an advocate for raising the profile of people who suffer from respiratory disease to a wider audience e.g. the public and other health and social care professionals across organisational and professional boundaries.
• To support the vision of clinical case management for patients with COPD, working collaboratively with all professionals, relatives and carers to ensure an understanding of patient’s physical, social and environmental factors.
• Identify gaps within the service influencing and developing new ways of working.
• To act as a mentor to other staff where appropriate, providing education, training and support to colleagues and peers.
• To embrace and implement change to facilitate high quality health outcomes.
• To provide advice on respiratory conditions and assist Band 7 to improve and develop services across organisational and professional boundaries.

Clinical

• To use clinical practice skills and knowledge, using nationally recognised assessment tools. Undertaking an in depth assessment, to identify patient medial, social, psychological and spiritual needs.
• To negotiate and develop a personal care plan with the patient, health care professional, carers and their relatives.
• To diagnose and instigate therapeutic treatments based on best available evidence to manage and improve health outcomes.
• To use knowledge and skills to order diagnostics, e.g. blood tests and X rays and prescribe within the nursing and/or the extended/supplementary formulary, and provide advice to patients and their carers on medicines management.
• To work in partnership with GPs, nurse practitioners and hospital consultants to determine a diagnosis when required and formulate a plan of care and follow-up.
• To support GPs, community and primary care nurses in the case finding and management of patients, ensuring that Trust protocols and pathways are followed.
• To work with the Trust’s lead GP and others to support practise in setting up and maintaining respiratory registers, stratifying patient by risk and developing specialist respiratory clinics.
• To be a resource to community and primary care nurses and acute sector staff in assisting with transfer of care of patients with additional respiratory needs.
• To be able to use specialist equipment relevant to the area of work (e.g. spirometry. Pulse oximeter, or Capillary Blood Gas machine) and provide education and training to other practitioners in these areas.

Education

• To raise the profile and understanding of COPD within Primary and community care.
• To assist in planning educational programmes for patients with respiratory disease and design information such as information leaflets and questionnaires.

Research and Audit

• To keep up to date, implement and monitor current research based practice.
• To provide leadership in any audit or quality assurance projects.
• Promote current research and evidenced based care within the team and locality.

Communication

• To use advanced skills to communicate effectively with patients and carers to include sensitive and complex information in a language they understand.
• To utilise communication skills to prepare patients and their families for changes in conditions and support choices about end of life care and related issues e.g. living wills and discussing care options.
• To be able to keep accurate contemporaneous documentation and care plans and provide written reports as required.
• To maintain contact with the patient if they are admitted to hospital and give the unit treating the patient the information they need to ensure integrated and consistent care.
• To use communication skills to foster multi-disciplinary team working.

Health and Safety

• To develop a working environment and culture that promotes health safety and security.
• To be conversant with and adhere to trust policies, procedures and guidelines.
• To ensure the correct use of equipment and supplies and report and deficiencies.
• To have responsibility for the health, safety and welfare of self and any colleagues and to comply with health and safety regulations at all times.
• To minimise the risk of cross infection and be conversant with the trust’s infections control policy.
• To be competent in assessing and implementing risk assessments with regard to the health and safety of both patients, staff and carers.
• To ensure mandatory training is kept up to date in line with trust policies.