Detailed job description and main responsibilities

Assesses, diagnoses, and implement treatment plans using advanced clinical skills and knowledge, working collaboratively with patients in treatment decisions such as planned advance directives near end of life care

Analyses and interprets highly complex information gained during clinical assessments to make a differential diagnosis of an individual’s problem or illness and decide on an appropriate course of action or treatment

Instigates therapeutic treatment/interventions consistent with the best available evidence; transferring and applying knowledge and skills in order to improve health outcomes

Recognises and manages early symptoms of disease exacerbation and acute illness based on an understanding of disease process and current evidence on practice standards

Advocates for the patient and confers as appropriate, working with GPs and/or hospital consultants to ensure robust communication around clinical care as indicated

Designs and monitors care plans for patients being cared for by the integrated community teams, general medicine and other specialist teams as appropriate

Empowers carers and family members, recognising and utilising the skills and expertise of carers as equal partners in care

Makes patient referrals to other specialist where indicated

Independently prescribes in accordance with the Department of Health, Professional and Trust guidelines

Embraces and uses technology such as telehealth and telecare as appropriate to enhance patient outcomes

Delivering High Quality Care and Measuring Impact

Leads on the implementation of the Chief Nursing Officer Strategy ensuring that our nurses are aligned with the national direction for improvement.  By aligning the fundamental approach led by the Chief officer of using the 10 key commitments to design care and continuing to use the 6C’s as a basis for ‘good’ nursing care.

Be the Patient Safety Champions, identifying and managing adult safeguarding incidents in collaboration with Social Care

Conducts regular nursing care audits including reviewing care on joint visits with team members and/or multi-professional team members

Role models and embeds the Trust core values and behaviours within members of the community nursing team

Facilitates clinical multi-disciplinary supervision groups encouraging reflection in and on nursing practice for continuous improvement

Evaluates the need for practice improvement to promote safe, effective and reliable care that as a positive impact on patients

Evaluates and critiques current practice against best available evidence/benchmarks

Takes responsibility for producing the data for the Dashboard or balanced score care every month

Records keeping

Maintains accurate and contemporaneous patient records immediately after nursing interventions in line with the Trust and NMC standards for record keeping

Contemporaneously records all communications relating to patients with other professionals 

Develops outcome focused care plans with clear timeframes and review dates

Reviews and audits patient records within the team to ensure compliance with the Trust and NMC records keeping standards

Records all meetings and communications regarding staff management and performance with support from the Human Resources Advisor

Applicants should have a broad understanding of application of research to practice, and current professional issues. You will be expected to have sound clinical skills, demonstrate a flexible approach and commitment to providing a high level of care to clients in the community and be an excellent change agent.

A full UK driving licence and daily access to a car is essential.