District Nurse Specialist

Detailed job description and main responsibilities

Clinical Practice

The post holder will be aligned to a Place Based Team and be clinically responsible for the diagnosing, prescribing, planning and evaluation of care, ensuring provision of high standards of care to patients and their families within the community. They will work as part of an Integrated Team, working within and across professional and organisational boundaries.

The post holder will be a practitioner who can demonstrate a broad range of competencies and is able to adapt to a wide variety of clinical circumstances. They will be part of a community team where their proven ability to make high level clinical decisions will aid patient outcomes

Providing highly developed clinical leadership for all patients on the Community Nursing caseload through advanced level autonomous practice including taking managed risks, for example where the patient is kept at home, rather than hospital or hospice admittance as would previously been the practice

Provide highly specialist clinical leadership for patients on the caseload and work collaboratively with all professionals, carers and relatives to gain a deep understanding of all aspects of the patient’s physical, emotional and social situation. This includes physical examination and detailed history taking, diagnosis, prescribing, planning and evaluation of care

Provide highly specialist clinical leadership for the development and maintenance of personalised care plans for patients on the community nursing caseload, based on the full assessment of medical, nursing and care needs. This includes preventative measures and anticipation of future needs.

Order investigations and tests and interpret and act on results, using clinical guidelines and policies to support clinical decision-making.

Maintain competence in prescribing according to level of prescribing qualification i.e. Independent Prescriber and participate in regular continuing professional development in relation to the role

Prescribe medication in accordance with the local Non-medical Prescribing Policy, and local and national prescribing guidance. It is expected that all prescribers will prescribe within the limits of their individual competence

Liaise with other agencies, including the voluntary sector, to mobilise resources to meet patient needs and to support them at home securing additional support as required

Act as a resource for the PBT and community teams, providing teaching and education to them as required

To promote new research, innovation and evidence to support quality improvements and evidence based practice within the team

Clinically lead by example showing a high level of motivation and a positive attitude

Carry out regular reviews of the caseload with the Caseload Holder to maintain oversite and identify patients who are not progressing towards expected health outcomes

Support teams, individual clinicians and patients with recommendations regarding individualised treatment plans

Provide care interventions and higher level assessments for patients with highly complex conditions to ensure that patients achieve their optimum level of wellness

Responsible for the safe use of clinical equipment for the team and individual practice

Autonomous Clinical Practice

The post holder will undertake highly specialised treatment which includes but not limited to leg ulcer treatment, end of life care, wound care, continence management, management of plural drains and manoeuvring patients.

To take a comprehensive history, perform a systematic physical examination and establish baseline data to inform the development of a comprehensive care plan

Utilise highly specialist assessment, planning, treatment and evaluation skills appropriate to routine pathway

Analyse signs and symptoms, laboratory tests, investigations and other measures of function in formulating a diagnosis

Use highly complex analytical and problem-solving skills in unpredictable situations especially when developing care plans for complex and sensitive cases.

Provide evidence-based treatment plans based on sound clinical decision making, including the unique presentation of illness and response to treatment of patients on the community nursing caseload

Collaborate with the multi-disciplinary team to plan and implement treatment for acute illness/injury/chronic illness as required, using skills in nurse prescribing and medicines management

Negotiate, collaborate and support individuals and families to make sometimes difficult decisions about plans of care by empowering them to decide on the most appropriate course of action

Ensure a robust process is in place to review care and treatment plans

Take a leading role in regularly auditing and monitoring all components of care delivery

Review and develop clinical competency as required to support clinical practice, participating in ongoing personal development of self and of others

Ensure all clinical records are kept in line with SWUF and NMC guidelines

Communication

Effectively communicate and manage the delivery and reception of complex, sensitive, or potentially contentious information, utilising advanced skills in persuasion, motivation, mediation, and assurance to support team members and provide excellent care. These are particularly necessary for safeguarding concerns, challenging behaviours against team members, capacity assessments and broader social concerns.

Establish the dynamic process of understanding, reflecting, active listening and checking understanding, thus developing a therapeutic relationship with patients and their carers

Enable and support patients as active partners in the care planning process for present and future needs

Dissemination of information throughout the multidisciplinary team, taking into account the patient’s right of confidentiality

Education

Utilise communication skills and knowledge to promote patients and families abilities to make informed decisions and participate in care planning

Participate in the development of the teams’ knowledge for Routine Care Pathways

Work alongside team managers to support staff in clinical examinations and assessments unfamiliar to them

Continue to develop own expert practice

Critically evaluate research and educate the team to ensure that this theory is integrated into practice

Role model and support staff to ensure that they are clinically competent to undertake new complex skills which are maintained to ensure that patients receive the highest possible standards of care in the most appropriate environment as close to home as possible, preferably in their own home if that is their express wish

Delivering educational sessions regarding benefits of supervision, quality improvement and Learning from Experience sessions

Leadership

Contribute to the development of clinical policies, procedures and guidelines ensuring they are implemented and monitored

Participate in the clinical appraisal process, providing feedback on performance

Participate and lead on the embedding of regular clinical and safeguarding supervision for all appropriate staff

Contribute to the recruitment and selection process

Act with colleagues to identify clinical development needs within the service

Act as an advocate at all times for both patients and the service

Be a role model for other clinical members of the team, taking an active role in ensuring staff are safe in clinical practice, work with team managers to risk assess areas of practice, reporting to senior staff with education/training plans to aid the mitigation of risk as required

Embed activities within the community team to achieve organisational quality priorities

Responsible for the delivery of high-quality clinical supervision across the whole team for all team members including students.