Detailed job description and main responsibilities

CLINICAL & PROFESSIONAL RESPONSIBILITIES 

• ·       Assess, plan, implement and evaluate care delivery according to individual changing health care needs using informed clinical reasoning and professional judgements when organising, implementing and monitoring programmes of care for individual patients.
• ·       Work independently when monitoring and managing a caseload of patients with NYHA Class 111-1V Heart Failure.
• ·       Lead education programmes, supporting patients to achieve independence to the patient’s maximum potential whilst working as part of a multidisciplinary team, for this cohort of patients and their carers’. 
• ·       Actively up-titrate evidence – based medication as per guidelines and when necessary, adjust dose of diuretics to improve patient’s condition and prognosis, (in conjunction with both acute physicians, General Practitioners)
• ·       Lead on the development, implementation and running of the heart failure clinics held within the community.
• ·       Actively manage problematic patients NYHA Class III and IV, monitoring their on -going management.
• ·       Facilitate patients to make lifestyle and behaviour changes in order to improve their quality of life and avoid admission/readmission to hospital.
• ·       As part of a patient’s assessment take blood samples, , weight, height, BMI and blood pressure checks including performing renal profile and routine blood monitoring 
• ·       In conjunction with patient and carer, identify other healthcare needs and refer to appropriate professional to deal with those needs.
• ·       Maintain a flexible schedule to meet the needs of individual patients referred to the Community Heart Failure Team by primary and secondary agencies according to agreed referral criteria and care pathway. 
• ·       Act as a resource and advisor for specialist heart failure advice and liaise with GP/Practice Nurses in providing continuous education, support and advice in the care of people with CHD/Heart Failure.
• ·       Actively contribute to service improvement within the Specialist Heart Failure Team, supporting quality improvement approaches to maximise the patient’s experience. 
• ·       Implement the delivery of Infection Control practice within area of responsibility, ensuring compliance to mandatory training requirements. 
• ·       Act as an advocate for self-care strategies, including the use of Telehealth and Telecare as appropriate.

ADMINISTRATIVE RESPONSIBILITIES

• ·       Keep accurate records as per Trust policy and NMC guidance. Maintain cotemporaneous record keeping.
• ·       Prioritise workload to meet the needs of patients and the CDT.
• ·       Attend meetings as required.
• ·       Provide data on performance indicators monthly to line manager e.g. number of contacts with patients etc.
• ·       Develop professional links nationally and locally acting as the advocate for the Specialist Heart Failure Service, attending appropriate professional meetings e.g. North West Heart Failure Forums
• ·       Maintain effective communication both within and outside of the clinical team to ensure that patient needs are met by the most appropriate agency.
• ·       To communicate with patients and carers to maximise their involvement and understanding of their condition, care and treatment.
• ·       Provide effective skilled communication of sensitive issues, counselling and reassurance to maximise patient and carer wellbeing.
• ·       Maintain competence in IT skills and make best use of IT systems to enhance patient care.
• ·       Maintain contemporaneous clinical records in line with Trust Clinical Records Policy.

TEACHING & TRAINING RESPONSIBILITIES

• ·       Support the service manager in ensuring the team provides care which is evidence-based and in line with local and national Clinical Guidelines and Policy
• ·       Support the monitoring of quality and practice standards within the team, supporting Care Quality Commission (CQC) outcomes. Identify and report any issues relating to poor clinical standards/clinical risk within the Heart Failure team.
• ·       To be aware of, and adhere to, policies and procedures relating to safeguarding children, and vulnerable adults.
• ·       To have in-depth knowledge of NMC standards and guidance, understand implications for, and be able to, apply to practice for example:

§  Code of Professional Conduct, standards for conduct, performance and ethics   

§  Records of Record keeping

§  Standards of proficiency for nurse and midwife prescribers

§  Standards to support learning and assessment in practice

• ·       Participate in quality initiatives, to promote the development of community nursing.
• ·       To monitor outcomes and propose changes to working practice, supporting clinical audit and evidence gathering for CQC, service checklists, patient feedback including information from patient surveys 
• ·       Develop educational programmes to meet the needs of patients with heart failure and their carers’ in the community setting. 
• ·       Contribute to the development, provision and delivery of educational programmes and resources for patients, carers, care home staff and all health care professionals to improve patient care.
• ·       Participate in the development of health promotion and health education activities, including awareness raising sessions. 
• ·       Participate in teaching of registered and non-registered staff involved in cardiac care.
• ·       Participate in clinical placement of students/staff undertaking nurse training.
• ·       Support clinical supervision, providing opportunities for staff participation in the service.

LINE MANAGEMENT/SUPERVISORY RESPONSIBILITIES 

• ·       Support the effective use of staff within the team, promoting flexible deployment of staff across the service.
• ·       Maintain minimal clinical stock levels and the effective use of clinical stock.   
• ·       To complete timely returns on an individual level relating to activity and performance.
• ·       Manage time and resources effectively, having an ability to prioritise workload and to be flexible in response to changing or urgent needs when required.
• ·       Act as the designated signatory for time claims and mileage for staff working within the team. 
• ·       Participate in the PDR process ensuring compliance for staff working within the service.
• ·       Ensure compliance for own mandatory training and for staff working in the service. 
• ·       Participate in recruitment and retention of staff.

RESEARCH & AUDIT

• ·       To contribute to new ways of working and the modernisation of nursing / public health agenda.
• ·       To support the formulation of policies/protocols/guidelines within sphere of work.
• ·       Develop areas of special interest, participate in the development of projects and assist the service manager in the implementation of projects, facilitating a quality improvement approach.
• ·       Contribute to the workforce plan ensuring a climate is created where individuals and the team are supported and empowered to achieve individual and collective development in order to be effective in their role.