POSITION DESCRIPTION. Position title: Clinical Resource Nurse Patient at Risk Team

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POSITION DESCRIPTION

Position title: Clinical Resource Nurse

Patient at Risk Team

Date Produced/Reviewed: June 2009

Position Holder's Name:

Position Holder's Signature :...

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Approved by:

Director of Nursing

Approval Date: June 2009 Review Date: June 2011

Position Title:

Clinical Resource Nurse

PAR Team member

Service: Acute Care Page 2 of 13

PURPOSE OF THE POSITION

The Clinical Resource Nurse, Patient at Risk (PAR) team -

• provides a 24/7 service across the organisation on the Middlemore site

• is responsible for the clinical and professional leadership support while acting as an

organisational resource to enhance clinical support for patients with, or potential for,

physiological instability.

• requires expert clinical nursing skill and knowledge.

PROFESSIONAL RELATIONSHIPS

Key: Line Management relationship

Clinical and Professional relationship

Nurse Manager Critical Care Complex

Nurse Practitioner ICU/HDU

CCC Associate Charge Nurse

Manager PAR Clinical Resource Nurse CND Acute Care

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Vision & Values

Organisational Shared Vision

Our DHB shared Vision is to work in partnership with our communities to improve the health

status of all, with particular emphasis on Maori and Pacific peoples and other communities

with health disparities.

We will do this by leading the development of an improved system of healthcare that is

more accessible and better integrated.

We will dedicate ourselves to serving our patients and communities by ensuring the delivery

of both quality focussed and cost effective healthcare, at the right place, right time and right

setting.

Organisational Values

Partnership

Working alongside and encouraging others in health and related

sectors to ensure a common focus on, and strategies for achieving

health gain and independence for our population

Care and Respect

Treating people with respect and dignity, valuing individual and

cultural differences and diversity

Professionalism

We will act with integrity and embrace the highest ethical standards

Teamwork

Achieving success by working together and valuing each other’s skills

and contributions

Innovation

Constantly seeking and striving for new ideas and solutions

Responsibility

Using and developing our capabilities to achieve outstanding results

and taking accountability for our individual and collective actions

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Approved by:

Director of Nursing

Position Title:

PAR Team member

NATURE AND SCOPE OF RESPONSIBILITIES

Key Accountability

Expectations

Clinical Practice

• Demonstrates effective co-ordination and support of the

physiologically unstable ward patient and patient at risk

• Demonstrates excellent clinical skills in the identification, assessment, care and support of the Patient at risk/Physiologically Unstable Patient (PUP)

• Provides timely response to PUP calls and clinical concerns of staff. • Ensures the provision of collaborative and timely support, education

and intervention relating to the Patient at Risk/Physiologically Unstable Patient

• Provides follow-up reviews to patients discharging from ICU/HDU and patients being transferred from EC identified as having high risk scores • Liaises with ICU, HDU, Theatre Recovery and Emergency department

in assessing PAR patients, coordinating ongoing care and ensuring patients’ appropriate placement for the provision of that care. • Demonstrates excellent clinical assessment skills and displays the

ability to utilise knowledge of the relevant pathophysiology to interpret diagnostic/ laboratory tests in identifying the Patient at Risk. Utilises these skills to plan and implement ongoing collaborative patient care.

• Documentation in clinical notes reflects appropriate clinical decision making and collaboration.

• Practices as a member of the multi/interdisciplinary team to improve outcomes for patients with physiological or potential for physiological instability.

• Demonstrates the ability to work within an interdisciplinary team in a Clinical Leadership role ensuring the provision of timely,

appropriate care and management of the Patient at Risk. • Liaises collaboratively with the ICU/HDU team to ensure

physiologically unstable ward patients receive timely review and appropriate management.

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Clinical and Professional

Leadership

• Promotes Counties Manukau District Health Board (CMDHB) as a centre of excellence for Nursing and Midwifery practice.

• Promotes the provision of person-centred care to achieve positive patient-care outcomes.

• Promotes the provision of children/ whanau centred care to achieve positive family outcomes

• Initiates and promotes effective teamwork and collaborative relationships within the inter/multi-disciplinary team and across the health services.

• Facilitates the implementation of both organisational and nursing visions, values and goals.

• Seeks and identifies situations of clinical risk and takes appropriate actions to ensure a safe environment and positive healthcare outcomes for patients/clients, families/whanau and staff. • Acts as a role model demonstrating culturally and clinically safe

nursing and midwifery practice at all times.

• Applies critical reasoning and professional judgement to nursing practice issues/decisions.

• Contributes to the development of integrated service delivery. • Actively enhances CMDHB’s nursing and midwifery practice and

performance by participating in appropriate local regional, national and international forums.

• Participates in CMDHB Credentialing process by providing assessments, education and ongoing support and supervision • Works with ICU/HDU ACNM’s, ICU registrars and ICU/HDU

• Works with ICU/HDU ACNM’s, ICU registrars and ICU/HDU Nurse Practitioner (NP) and service based inter/multidisciplinary teams to identify and appropriately manage patients who are physiologically unstable using the PUP scoring system.

• Using advanced clinical skills in addition to the PUP scoring system, identifies patients at risk and works closely with the Primary teams to monitor and implement interventions to prevent deterioration. • Promotes and Audits the PUP scoring system to improve

identification and management of Physiologically Unstable patients.

• Collaborates with nursing teams to ensure clinical leadership, nursing care delivery and implementation of CMDHB policies and practices.

• Discusses and works with Charge Nurse Managers, Shift Coordinators and ward staff to identify physiologically unstable patient needs and develop a plan of action to meet the 24/7 needs of these patients.

• Uses organisational systems and processes to communicate and feedback on clinical risk and critical incidents to appropriate senior nurses and/or medical staff

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Approved by:

Director of Nursing

Position Title:

PAR Team member

• Liaises with Duty Mangers to work towards a healthy workplace through Safe Staffing initiatives and the use of Escalation plan when required.

• Provides clinical support for after hours specialist interventional procedures

• Identifies and communicates clinical competency issues to the appropriate Clinical Manager and /or Nurse Educator.

• Provides first response to all emergency calls

Education and Clinical

Teaching

• Utilises best practice principles of teaching to maximise the effectiveness of applied learning in clinical practice within the guidelines of CMDHB Policies and Procedures.

• Supports the development of nursing staff in all areas of nursing assessment, clinical examination and planning, implementing and evaluating care.

• Identifies and communicates clinical competency issues to the appropriate Clinical Manager.

Evidence Based Practice

• Fosters inquiry, critical thinking and research skill acquisition among

the nursing workforce to advance nursing practice and patient/client care

• Works to ensure the recommended research based best practice guidelines/policies are implemented across CMDHB.

• Actively participates in the development and review of guidelines, policies and procedures for CMDHB

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Quality and Risk and

Continuous Quality

Improvement

• Evaluates the effectiveness, efficiency and safety of clinical nursing practice throughout CMDHB.

• Assists in the implementation of nursing and midwifery practice, promoting and assisting with the PDRP utilising strategies to support continuous quality improvement, maximising nursing and midwifery staff involvement in this improvement.

• Acts to identify and minimise clinical risk and enhance patient/consumer satisfaction.

• Identifies the need for and contributes to projects that enhance the clinical implementation of nursing practice utilising evidence based practice within the CMDHB framework.

• Provides quality and risk management by early identification of potential hazards, analysis and evaluation of infection control and the intervention, management and monitoring of Blood and Body Fluid accidents

• Assists in the implementation and management of initiatives to address differential access to healthcare services in CMDHB’s culturally diverse community.

• Participates in audit and review of quality monitoring systems and processes such as utilisation of the PUP tool

• Explores the ethical dimensions of nursing and midwifery practice and seeks positive outcomes in the management of ethical dilemmas.

• Undertakes future quality initiatives as required

• Liaise closely with Security and Daily Operations Unit in the provision of a Safe Staffing Healthy Workplace environment at CMDHB

• Facilitates and/or participates in debriefing of clinical incidents. • Support staff by initiating debriefing as required.

• Promote CMDHB “Zero Tolerance to Violence

• Work with staff to identify high risk clients to ensure the establishment of an appropriate management plan

Professional Development

and Clinical Competency

(Self)

• Practices professionally in accordance with legal, ethical and culturally safe standards as per CMDBH policies, procedure and guidelines within Nursing Council guidelines.

• Demonstrates professionalism within individual practice.

• Maintains and develops own clinical expertise and knowledge in specialty nursing practice.

• Participates in professional supervision as required.

• Pro-actively participates in own performance development and review.

•

Attends educational opportunities/conferences relevant to CRN PAR role and scope of the role.

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Approved by:

Director of Nursing

Position Title:

PAR Team member

Service: Acute Care Page 8 of 13 Information and systems

technology.

• Constantly seeks innovation when develops improved and effective systems

• Demonstrates use of the phone and paging systems

• Demonstrates access and use of the available clinical information systems.

• Demonstrates competency with Windows 2000 or similar.

• Is conversant with applications required for specific discipline or role. For example PIMS, Concerto, Outlook, Onestaff, Microsoft Access and RiskPro.

• Continue to lead and support appropriate systems and information technology initiatives.

• Actively seeks out innovative solutions through improved IT systems.

• Supports and champions Workforce Analysis technology.

Health & Safety

To recognise individual responsibility for workplace Health & Safety underthe Health and Safety Act 1992

• At all times ensures a safe working environment and safe working practices

• Plan, lead, organise and control Health & Safety activities directed at preventing harm in the workplace, in consultation with

employees and Health & Safety representatives for area • Ensure that all accidents/incidents in the workplace are

investigated, and that hazards are recognised and adequate controls put in place.

• Provides quality and risk management by early identification, minimisation, and notification of potential hazards.

PROBLEM COMPLEXITY

The Patient at Risk Team will be required to manage complex problems of a wide and varied

nature across the organisation on a daily basis. The PAR Team will be regularly challenged by

the requirement to continually re-prioritise their workload to ensure that all patients receive

appropriate nursing and multidisciplinary assessment and intervention twenty four hours

seven days per week.

There will be demands to respond with in a time appropriate manner, maintain accuracy and

quality of information. Failure to do so would impact on the organisation in terms of patient

safety / wellbeing and organisational effectiveness. The CRN will escalate decision making in

times of clinical patient need and ensure safe and optimal staffing for patients at risk.

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SCOPE FOR ACTION

The Clinical Resource Nurse as part of the Patient at Risk Team will be empowered to make

independent recommendations and nursing responses related to physiologically unstable

patient needs and will be expected to use problem-solving skills to develop innovative

approaches to clinical issues on a daily basis. The Clinical Resource Nurse will liaise and

collaborate with the Critical Care Complex Associate Charge Nurse Managers, ICU Registrars,

ICU/HDU Nurse Practitioner, Ward Charge Nurses Midwives and the multidisciplinary team

to ensure that all patients receive interventions and care appropriate to the level of

instability.

DIMENSION OF THE ROLE

The CRN PAR through formal referrals and professional networks identifies physiologically

unstable ward adult patients and has a child focused perspective to all paediatric patients in

Middlemore Hospital.

The focus is on providing early patient assessment and timely intervention and support to the

acutely unwell or deteriorating patient through role modelling expert clinical skills, promoting

best practice, facilitating multidisciplinary collaboration, and providing education.

Due to knowledge and skill required within both Paediatric and Obstetrics specialties, the

CRN PAR Team will provide clinical and professional resource.

The CRN PAR will also provide organisational staff support and supervision as required

dependant on the presence or absence of CNM / CMMs, Nurse Educators, CND or other

senior nursing staff.

The CRN PAR will be responsible to the ACNM and Nurse Manager Critical Care Complex for

achievement of agreed objectives and operates within the confines of Counties Manukau

District Health Board. Professional Direction and Clinical support will be sought from the

Nurse Practitioner ICU and the Clinical Nurse Director.

COMMUNICATION

The Patient at Risk Team will encounter problems related to a wide variety of clinical issues

across the organisation, which will require communication, negotiation and collaboration

with a range of health professionals and management staff.

Situations may often call for tact, diplomacy and will require information to be handled in a

discreet and sensitive manner. In conflict situations will be required to exercise sound

judgement, negotiation and persuasiveness skills, toward facilitating a workable outcome.

The CRN role requires advanced communication and negotiation skills so that they can

ensure appropriate and timely clinical care can be provided in a cohesive manner from a

range of services across continuum of care.

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Approved by:

Director of Nursing

Position Title:

PAR Team member

RELATIONSHIPS

External

Internal

Committees/Groups

(Team

Responsibility

to

attend)

• Families/whanau caregivers/consumers. • Healthcare providers outside

CMDHB.

• Police / Security personnel. • Other DHBs

• CYFS

• Social workers • Correction services • General Practice teams

• All nursing, midwives and clinical staff.

• Associate Charge Nurse Managers ICU/HDU • Critical Care Complex

medical staff

• ICU/HDU Nurse Practitioner • Duty Managers.

• Security, Orderly Service. • Telephone Exchange • Director of Nursing,

Director of Midwifery, CND’s, Charge Nurses, Clinical Nurse Educators, Nurse Specialists. New Graduate coordinators. • Allied Health Staff:

Dieticians, Physiotherapists, Laboratory Staff,

Radiographers, Pharmacists / On-call Pharmacist. • Ambulance and transit

staff.

• Resuscitation Coordinator. • Bereavement Care. • Occupational Health, Social

Workers.

• Cultural Support Team • Service Managers. • Psychiatric/Crisis Team. • Multi-disciplinary teams. • Allied Health, Healthcare

Assistants.

• Other personnel across CMDHB.

• Senior Nurse Group. • Patient Safety Committee. • Mortality and Morbidity

Meeting.

• Medicine Advisory Committee • NZNO./ PACT • PDRP progression

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PERSON SPECIFICATION

ESSENTIAL

HIGHLY DESIRABLE

EDUCATION • Registered Nurse with current NZ practicing certificate.

• Postgraduate certificate/diploma in acute, emergency or critical care specialty nursing practice.

• Clinical Master’s degree. • Qualified Critical Care Nurse

EXPERIENCE/ KNOWLEDGE

• Advanced practice in acute setting. • Minimum 5 years post registration. • Minimum proficient competence on PDRP

in acute, emergency or critical care practice

• Knowledge and understanding of the Treaty of Waitangi and implications in nursing practice.

• Knowledge of current nursing professional development issues. • Ability to access and utilise available

clinical information systems.

• Experience in multi-disciplinary clinical teamwork

• Maintained Expert level of clinical competence on PDRP in acute, emergency or critical care practice • Extensive advanced practice across

specialties.

• Extensive nursing management of physiologically unstable patients (Cardiac and Haemodynamic). • .Experience in interdisciplinary team

work

SPECIFIC SKILLS • Experience in problem solving, priority setting, and implementing plans/goals. • Advanced assessment skills

• Experience in negotiation and conflict management

• Basic knowledge and understanding of Medico-Legal and Ethical responsibilities • Ability to work autonomously while still

being a member of a team

• Advanced interpretation of laboratory, cardiac, and chest radiology.

• Audit / Research skills

PERSONAL and PROFESSIONAL QUALITIES

• Patient / Healthcare consumer focus. • Works within defined scope of practice of

a Senior Nurse and has clear

understanding of direction and delegation as per NZ Nursing Council guidelines. • A genuine interest and commitment to

quality and service.

• The capacity to demonstrate strong clinical leadership.

• A commitment to the development of the nursing profession within Counties Manukau District Health Board. • A professional development plan. • Ability to promote effective teamwork

and collaborative relationships within the multidisciplinary team and across health

• Demonstrated ability in the development and management of staff.

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Approved by:

Director of Nursing

Position Title:

PAR Team member

• A commitment to improving nursing practice and standards of care.

ORGANISATIONAL COMPETENCIES

Description

Leadership • Ability to develop and communicate the vision for the future, inspiring a belief in and commitment to the goals of the organisation / team. • Ability to articulate the CMDHB vision and values and help facilitate

change.

• Is able to draw together a range of perspectives within the CMDHB multidisciplinary team.

People Management • Leads, communicates expectations and agreed goals, providing ongoing feedback and objectively evaluates nursing performance.

• Able to recognise and acknowledge achievements of others.

• Ability to inspire collaborative efforts among the interdisciplinary team. Teamwork • Works collaboratively with other CMDHB team members to achieve

organisational objectives.

• Seeks out opportunities to support others in achieving their goals. • Recognises and respects individual differences.

Cultural Approach • Understands the significance of the Treaty of Waitangi.

• Displays cultural/spiritual sensitivity and a willingness to work positively with organisational strategies to improve healthcare opportunities for the culturally diverse CMDHB community.

Self Management • Sets high personal standards/goals and maximises opportunities to achieve these.

• Displays drive and energy and persists in overcoming obstacles. • Is proactive and displays initiative.

• Adapts to growth and facilitates change. • Understands personal limitations.

• Can work to deadlines to achieve outcomes. Patient/Client/

Population Focused

• Takes action to fully comprehend the needs of patient/client populations and actively promotes such needs and priorities. • Utilises a multidisciplinary approach to meet patient needs. Communication /

Interpersonal Skills

• Expresses information effectively, both verbally and in writing. • Adjusts language and style to the recipients and considers their frame

of reference.

• Ability to utilise information technology within CMDHB.

• Creates opportunities to network throughout CMDHB and with other Healthcare providers.

• Communicates with empathy, integrity, consideration and respect. Innovation • Actively reflects on practice, utilising critical thinking to explore new

opportunities/models of care and develop creative and effective solutions to improve outcomes.

• Applies skilled analysis and sound reasoning in problem solving / decision making.

Flexibility / Adaptability • Ability to communicate, adapt, negotiate effectively and creatively, within a hugely varied scope of practice while meeting the needs of a diverse client base, as a member of a multi-disciplinary team. Planning and • Able to establish timeframes, identify possible barriers to these,

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Monitoring realistically allocate resources and accomplish goals.

• Able to self-evaluate/critique, monitor progress and address problems to achieve outcomes