Job description
Working as part of the Complex Care Service, the post-holder will provide expert assessment and treatment of patients with complex needs who are at risk from unplanned hospital admission
To support and develop in- reach pathways into care/nursing homes and Croydon University Hospital to facilitate early discharge and prevent long stay admissions
To work in collaboration with the One Croydon Alliance programme office to complete the transformation of adult community services to meet the needs of the adult population in Croydon
To support the use of Telehealth to support discharge and prevent admission for Croydon residents.
Working as a nurse practitioner with a high degree of autonomy, the post-holder will manage undifferentiated and undiagnosed problems using advanced nursing skills by incorporating physical assessment, diagnosis and independent prescribing.
The post-holder will work collaboratively with the matron and medical colleagues to develop frailty pathways within the alliance
To support patients in their homes with complex needs
To support the Matron in actively promoting the use of telehealth and other telehealth solutions across the Alliance to prevent hospital admission
Clinical
To create individualised advanced care plans for complex patients
Assessment and treatment of patients during a crisis,
Identifying complex and specialist need and developing, implementing and evaluating programmes of care.
Facilitating early hospital discharge
Work with a high level of autonomy
Ensure the team delivers clinically effective care and health promotion that is evidence based.
To keep accurate contemporaneous written and / or electronic documentation care plans and reports
Managerial
To influence colleagues to effect changes in service delivery to improve patient care within constraints of job role
Create, maintain and enhance effective working relationships within the nursing team and other care providers across the alliance
To investigate accidents and incidents; identify and implement corrective action plans and monitor completion of action plan. Share learning from incidents, complaints and support safeguarding compliance
Professional development of self and others
Service and practice development
To support any managerial, professional practice and service developments are implemented effectively within the team.
Croydon Health Services NHS Trust provide hospital and community services from a number of community and specialist clinics throughout Croydon.
These include:
- Croydon University Hospital
- Purley Hospital
- The Sickle Cell and Thalassaemia Centre in Thornton Heath
- Community bases at Purley, Sanderstead, New Addington, Broad Green, Woodside
- A minor injuries unit in New Addington
Our Vision:
“Excellent integrated care for you and your family, when and where you need it”
Our 5 key ‘Here for you’ promises to the people of Croydon are:
- You feel cared for by helpful and welcoming staff
- You feel in safe hands with highly professional staff
- You feel confident in your treatment from skilled teams of compassionate clinicians
- You feel we value your time with convenient appointments, minimal waiting and care closer to home
- You feel it’s getting better all the time as we continue to improve our services
MAIN DUTIES AND RESPONSIBILITIES
To participate, promote and support in the use of advanced care planning tools.(e.g. CMC) within CHS Community services
To support links with the Care Home Support Team and other care providers to co-ordinate a single response and to prevent duplication of patient care.
To participate in maintaining an overview of the standards of care being delivered across a defined area, instigating remedial action to improve practice as necessary.
To support the Matron in actively promoting the use of telehealth and other telehealth solutions across the Alliance to prevent hospital admission
Clinical
To work in partnership with members of the One Croydon Programme Office and multiagency colleagues to develop person centred care planning including the use of CMC with a view to creating individualised advanced care plans for complex patients
Assessment and treatment of patients during a crisis, identifying complex and specialist need and developing, implementing and evaluating programmes of care.
Facilitating early hospital discharge for patients back to care homes by providing in-reach into the acute hospital
Work with a high level of autonomy, within agreed guidelines, managing undifferentiated and undiagnosed problems using advanced nursing skills by incorporating physical assessment, diagnosis and prescribing.
Ensure the team delivers clinically effective care and health promotion that is evidence based.
To keep accurate contemporaneous written and / or electronic documentation care plans and reports
Undertake nurse prescribing and to promote safe medicine management within the team.
Managerial
To coordinate and prioritise the management of care for the individuals on the caseload to support the matron to manage sickness, absence, recruitment and retention of staff.
Ensure that off duty rotas and e-rosters are planned appropriately to meet the needs of the service. To support the matron to monitor, appraise and supervise the performance, conduct and practice of the team both directly and indirectly as appropriate;
To influence colleagues to effect changes in service delivery to improve patient care within constraints of job role
Create, maintain and enhance effective working relationships within the nursing team and other care providers across the alliance
To investigate accidents and incidents; identify and implement corrective action plans and monitor completion of action plan. Share learning from incidents, complaints and support safeguarding compliance
To develop and mentor students, colleagues. Facilitate good team working and process through positive leadership.
Balance demands of workload whilst ensuring partnership and collaborative working with several agencies who operate different practice policies
To provide cross-cover if required for rapid response and to deputise in the absence of the Complex care matron
Professional Development
Keep up to date on clinical and professional developments in line with re-validation
Work with the practice educators and Specialist Nurses to provide clinical supervision and to develop training programmes as required.
Work with the Pre-registration Facilitator in planning and providing appropriate learning experiences for students.
Participate in the Trust’s learning sets and clinical supervision systems.
Actively contribute to and participate in research and screening programmes where appropriate.
Utilising research findings and evidence based practice review and analyse a range options to inform clinical decision making.
To participate in changes to service delivery
To utilise knowledge of clinical governance and risk management to provide safe and effective services to patients with Long Term Conditions and End of Life Care.
Service and practice development
To support any managerial, professional practice and service developments are implemented effectively within the team.
To actively participate in directorate clinical governance arrangements contributing to the development of risk assessment action plans.
To participate in the recording of relevant information for monitoring contact activity, evaluating team activities and other data required.
To actively identify areas for service development, interpreting relevant policies, and work in partnership with others to lead and take these forward