Detailed job description and main responsibilities

To work collaboratively within the Multi-Disciplinary Team and with other health care professionals to ensure a consistently high quality and equitable service throughout the Health Board.

To work within and adhere to the Professional code of conduct; standards and guidance at all times, ensuring that issues of concern are escalated 
appropriately.To act at all times as a role model, presenting a professional 
approach and ensuring the standards for professionalism are set and displayed within the team.

To work autonomously, making clinical decisions within own competency and ensuring effective caseload management continuously reprioritising to meet the changing clinical demands of the service.

Promote and ensure through ongoing review that all patients are treated in line with the principle of dignity and respect and that this is embedded within other team members.

To support the Team Lead in the efficient use of resources within the budgetary allocation, including authorising expenditure.

Participate in staff recruitment and succession planning. 

Responsible for organising own workload within the requirements of the 
specialist team activities and work plan.

Be flexible in working patterns, providing support to neighbouring localities as required in support of colleagues and maintaining standards of patient care.

Ensure that lines of communication are maintained with the key working 
relationships to demonstrate politeness, courtesy, compassion and sensitivity, promoting a positive image of the Health Board.

Apply the principles of “Being Open” in communicating with patients’ families and appropriate others in all aspects relating to concerns. 

Provide expert information, knowledge, support and training on a range of care conditions, treatment options and outcomes being aware that this may be unwelcome, upsetting and in some instances, life changing to patients, and carers. Supporting patients in order that they can make informed choices. 

Act as an advocate for patients when negotiating with health and social care colleagues, with regards to the most appropriate setting in which care can be provided, accessing services as appropriate and giving consideration to other alternatives in the patient’s journey.

Ensure that electronic and paper-based patient systems are utilised 
appropriately to improve patient care. 

Ensure that patients and their relatives/carers receive accurate current 
information relevant to their need. This may include information on how to access other services to support their needs.

Exercise awareness of professional responsibilities by critical reading of current relevant literature and by demonstrating personal and professional 
development.

Delegated responsibility to undertake the first stage investigation of 
complaints, concerns, incidents in area of responsibility, ensuring that clear 
reports of findings are produced and action plans for improvement are 
developed and implemented. To discuss complaints and concerns with patients, families and others in order to seek local resolution.

Implement improvements to patient services in the light of results from 
monitoring processes, audit, patient feedback, patient surveys, complaints and CHC reports within the agreed deadline.

Implement as directed by the Team Lead the Corporate/Annual Plan and Key Health Care Standards (Annual Quality Framework/ Standards for Health Services etc.) for care within your team, within the timescales and to the specification agreed.

Develop the knowledge, skills in systems for public protection, including 
Protection of Vulnerable Adults, Domestic Abuse, links with Child Protection, Deprivation of Liberty and Mental Capacity Act. Support in the investigation of concerns under these specific policies, raising any concerns with the Team Lead.

Participate in implementing quality improvement programmes in the area of responsibility, raising any concerns with the Team Lead.

Delegate aspects of caseload to members of the Community Resource Team, taking into account their competencies and skills.

Consistently work with teams to ensure standards of patient care are high and maintain safety and quality of the patient experience.

Support the effective transfer of patient care to and from case load by ensuring that appropriate assessment, communication and liaison, facilitating safe admission and discharge.

To work specifically with Carers to ensure an equal partner approach to ongoing care. Supporting the transfer of care for palliative care patients where the transfer is complex and distressing.

Using local knowledge of managing and delivering care for patients with complex and unstable health needs within the community setting to ensure the transfer of care is safe, efficient and effective. 

Assess, plan, implement and evaluate the physical, psychological and social 
needs of Respiratory and Oxygen Therapy patients, initiating therapeutic 
treatments in collaboration with patients, carers and other health and social care professionals.

Undertake timely assessment to prevent crisis situations, reduce dependency and maximise the person's independence.

Educate and empower patients and carers to identify early signs of change in their condition and provide them with the necessary knowledge and skills to gain independence and make informed choices to safely manage their 
condition.

Support the development of written joint plans of care with other members of the interdisciplinary team as appropriate to meet individual patient care needs.

Improve patient experience through supporting the implementation of key 
frameworks such as nutrition and hydration, dignity and respect, fundamentals of care, environment of care etc. ensuring improvement actions have been taken and can be evidenced.

Plan with the patient/team a discharge plan that is followed through for each patient, involving carers, community services and other agencies when appropriate.

Contribute to the creation of a caring environment by respecting patients’ 
privacy, dignity and spiritual beliefs and ensuring that the patient and carers opinions are included in every part.

Undertake and monitor patient assessment, care planning, intervention and evaluation in partnership with the patients and their carers, working 
collaboratively with the multi-disciplinary/multi agency team.

Assist in the development of a needs-assessment of the practice population in order to shape service delivery.

Act as a responsible non-medical Prescriber prescribing in line with the 
Prescribing Formulary, Health Board/ All Wales/ NMC/ HCPC policies and 
guidance and making clinically and cost-effective prescribing decisions. 

Advise patients and carers at every opportunity in the promotion of health and prevention of illness. Support relevant Public Health and community 
development initiatives.

Support the implementation, with the Team Lead, the Powys Teaching Health Board’s Strategy for Nursing and Midwifery or Therapy Strategy.

Keep up to date with national, regional and service area developments e.g. 
NICE guidance, NSFs, research-based information.

Ensure that standards are maintained and monitored within the clinical 
environment lead programme of audit e.g. annual documentation audit.

Build and maintain effective communication and working relationships with colleagues, key working relations and other internal/external colleagues, 
promoting integrated working and exploring new approaches to meeting 
therapeutic needs of your client group.

Provide and receive complex information either oral, written or electronic and act appropriately on that data.

Support the timely collection, completion, submission and accurate recording of relevant information for patient care, service development, audit and operational management (Health Care Metrics, dashboard, FOC, Datix) 

Participate in the research and development agenda, focusing on the 
improvement to services as a result.

To promote the development of audit and research projects within the locality e.g. Fundamentals of Care, Improving Quality Together Projects.

Be responsible for own competence, identify own learning needs and 
professional /personal development by completing own personal development plan, participating in the Health Board’s appraisal system and demonstrating awareness of competencies and capabilities.

To  participate in regular review / 1-1 meetings with the Team Leader.

Maintain professional knowledge and skills through completion of relevant 
accredited courses, attendance at external courses/conferences, mandatory training, the development of an individual Development Plan and by developing and maintaining supportive networks.

Consistently develop skills, knowledge and expertise to provide appropriate patient care and information in line with current service development and service provision across health, social care and third sector providers.

Attend meetings and represent the Health Board as requested.

Ensure that all delegated staff receive regular Individual Performance Reviews and have Personal Development Plans in place centred on delivering services focused on patient/service need.

Assist, supervise, mentor and coach other members of the team and students allocated to the team.

Plan, deliver and evaluate staff, patient and carer specialist education 
programmes for use within one-to-one and group sessions.

Assist and preceptor/coach junior staff and students to develop their 
professional knowledge and skills through the meeting of appraisal objectives and personal development plans, utilising own achievements in this respect as a role model. 

Identify a personal development plan incorporating measures both through 
training and self-directed study/experiences, ensuring the delivery of evidence -based interventions and practice.

To ensure that mentorship arrangements are in place for student and post 
graduate staff in the clinical setting, providing a stimulating learning 
environment.