RANP/cANP Acute Surgical Assessment unit (03.021 (2023))

JOB DESCRIPTION
    
RANP/cANP Acute Surgical Assessment unit
                  
Reference No: 03.021 (2023)

 

• Be registered on the Advanced Nurse Practitioner Division of the active Register held by Nursing and Midwifery Board of Ireland

• Be eligible to register in the Advanced Nurse Practitioner Division of the Nursing and Midwifery Board of Ireland Register by meeting the criteria for registration as an Advanced Nurse Practitioner as specified www.nmbi.ie

• Have a broad base of clinical experience relevant to the advanced field of practice.
• Demonstrates the competencies relevant to the specialist area of advanced practice.
• Possesses the requisite knowledge and ability including a high standard of suitability and clinical, professional and administrative capacity to properly discharge the functions of the role.
• Practitioners must maintain active annual registration on the Advanced Nurse Practitioner Division of the register of Nurses and Midwives maintained by the Nursing and Midwifery Board of Ireland for the role.

• Be registered in the General Division of the active Register held by Nursing and Midwifery Board of Ireland or be entitled to be so registered.
• Have a broad base of clinical experience relevant to the advanced field of practice
• Be eligible to undertake a Master’s Degree (or higher) in Nursing or a Master’s Degree, which is relevant, or applicable, to the advanced field of practice. The Master’s programme must be at Level 9 on the National Framework of Qualifications (Quality & Qualifications Ireland), or equivalent. Educational preparation must include at least three modular components pertaining to the relevant area of advanced practice, in addition to clinical practicum.

• Be currently undertaking a Master’s Degree in Nursing (Advanced Practice Pathway) or be eligible to register to undertake additional Level9 National Framework of Qualifications (Quality and Qualifications Ireland) specific modules of a Master’s Degree in Nursing (Advanced Practice Pathway) within an agreed timeframe. Educational preparation must include at least three modular components pertaining to the relevant area of advanced practice, in addition to clinical practicum.

• Possess a Master’s Degree (or higher) in Nursing or a Master’s Degree which is relevant, or applicable, to the advanced field of practice. The Master’s programme must be at Level 9 on the National Framework of Qualifications (Quality & Qualifications Ireland), or equivalent. Educational preparation must include at least three modular components pertaining to the relevant area of advanced practice, in addition to clinical practicum.

• Candidates must possess the requisite knowledge and ability including a high standard of suitability and clinical, professional and administrative capacity to properly discharge the functions of the role.

• • Professional Values and Conduct
  • Clinical-Decision Making
  • Knowledge and Cognitive Competences
  • Communication and Interpersonal Competences
  • Management and Team Competences
  • Leadership and Professional Scholarship Competences

• Acute Surgical Assessment Units (ASAU), as defined in the NCPS Acute Model of Care 2013 (RCSI Press, 2012), set out a process whereby considerable efficiency and safety benefits may accrue to acutely ill surgical patients.
• The Acute Floor refers to the area of the hospital where unplanned patients who arrive with acute medical, surgical and psychiatric conditions are assessed and treated. The ASAU constitutes one component of the Acute Floor which also includes an ED, Resuscitation Unit and Acute Medical Unit as well as an Age related assessment Unit.
• ASAUs are designed to deal with a significant throughput of acutely unwell surgical patients, but not unwell to the level where they require active resuscitation. Category 1 and 2 patients (Manchester Triage System 2014) will continue through the ED/Resuscitation streams. The ASAU provides the potential to stream surgical patients directly to specialty decision makers. Treatment may be either on the spot, by ambulatory or outpatient care or patients may require admission.
• The advanced practice service is provided by nurses who practice at a higher level of capability as independent, autonomous and expert advanced practitioners.  The overall purpose of the service is to provide safe, timely, evidenced based nurse-led care to patients at an advanced nursing level .This involves undertaking and documenting complete episodes of patient care, which includes comprehensively assessing, diagnosing, planning, treating and discharging patients in accordance with collaboratively agreed caseloads, local policies, procedures, protocols and guidelines and/or service level agreements/ memoranda of understanding.
• The RANP ASAU demonstrates advanced clinical and theoretical knowledge, critical thinking, clinical leadership and complex decision-making abilities. 

• Meet the needs of surgical patients attending TUH ED.
• Address the Patient Experience Times for patients requiring surgical intervention
• Meet needs of cohort of patients with surgical conditions set out in criteria for ASAU
• Recognise the deteriorating sick patient and provide resuscitation when required
• Assess patients and begin initial evaluation, history taking, ordering and taking of blood work, order x-rays if indicated by clinical condition and alert surgical team on call of patients in unit.
• Triage GP referrals and redirect unsuitable patients
• Prepare patients for theatre and expedite care
• Ensure appropriate follow up is arranged for patients
• Coordinate urgent follow up clinics
• Coordinate patients for urgent IR procedures/imaging
• Improve access to early intervention.
• Provide continuity of care as an expert advanced nurse practitioner (RANP) with the specific skills, knowledge and education and competencies to manage a specific patient caseload.
• Act as a resource for nursing and healthcare professional colleagues within the organization.

• Providing nursing clinical expertise and knowledge in surgical interventions thus ensuring patients and families experience high quality care.
• Improving patient outcomes through health promotion and education opportunities while engaging with patients, their families, the MDT and others were appropriate.
• Developing and supporting standards of care that benefit the patients and the organisation.
• Evaluating and monitoring the quality of the service being provided through on-going clinical audit and research.
• Participating in the continuing professional development of nurses, student nurses (undergraduate and postgraduate), health care professionals and support services staff within the surgical service.

• Maintain throughout the Hospital awareness of the primacy of the patient in relation to all Hospital activities.
• Encourage recognition of the patient as an individual, ensuring patients’ needs and comfort are given priority.
• Work within the Scope of Practice
• Comply with all existing Hospital policies
• Demonstrate knowledge of the Hospital/Departmental emergency plans
• Ensure the provision of a high standard of care to the patient and families is consistent with the mission, vision, values and strategic plan of the Hospital.
• Demonstrate behaviour consistent with the Values of the Hospital.
• Reporting relationship will be to the Assistant Director of Nursing.
• Be professionally accountable to the Director of Nursing.
• Clinically accountable to the supervising Consultant/Clinical Lead in Surgery
• Reports to the Assistant Director of Nursing for the Acute FLoor

• To model a professional approach in all aspects of work being undertaken.
• Encourage recognition of the patient as an individual, ensuring patients’ needs and comfort are given priority
• To create and promote open communications, healthy working relations, and stimulate innovation in practice.
• To audit and evaluate all initiatives undertaken.

• The RANP (ASAU) engages in on-going clinical supervision as per a Service Level Agreement.  The structure, process and outcome of clinical supervision must be explicit. 
• The RANP (ASAU) maintains a record of clinical supervision in his/her professional practice portfolio.

• The RANP (ASAU) must maintain a professional practice portfolio, incorporating evidence of learning from continuing professional development, clinical supervision, reflective practice and review of his/her own scope of practice  in accordance with regulatory requirements and service need.

• Clinically – multi-disciplinary team
• Director/Assistant Director of Nursing
• Nursing and Midwifery Board of Ireland
• Higher Education Institution
• Nursing and Midwifery Planning and Development Unit
• Other relevant statutory and non-statutory organizations

• The RANP ASAU practices to a higher level of capability across six domains of competence as defined by Bord Altranais agus Cnáimhseachais na hÉireann Advanced Practice (Nursing) Standards and Requirements (NMBI 2017).

• Professional Values and Conduct
• Clinical-Decision Making
• Knowledge and Cognitive Competences
• Communication and Interpersonal Competences
• Management and Team Competences
• Leadership and Professional Scholarship Competences

• Demonstrating accountability and responsibility for professional practice as a lead healthcare professional in the care of patients attending TUH for assessment and management of surgical conditions.

• Assessment and management of patients referred to the ASAU  - see criteria
• Management of ASAU clinic for patients returning post-surgical interventions 

• Articulating safe boundaries and engaging in timely referral and collaboration for those areas outside his/her scope of practice, experience, and competence using established referral pathways as per locally agreed policies, procedures, protocols and guidelines
• Demonstrating leadership by practicing compassionately to facilitate, optimise, promote and support the health, comfort, quality of life and wellbeing of persons whose lives are affected by altered health, chronic disorders, disability, distress or life-limiting conditions.  The RANP practices according to a professional practice model that provides him/her latitude to control his/her own practice, focusing on person centred care, interpersonal interactions and the promotion of healing environments.
• The chosen professional practice model for nursing Roper Logan and Tierney model as it emphasises a caring therapeutic relationship between the RANP and his/her patients, recognising that RANPs work in partnership with their multidisciplinary colleagues.
• Articulating and promoting the RANP role in clinical, political and professional contexts by presenting key performance outcomes locally and nationally; contributing to the service’s annual report; participating in local and national committees to ensure best practice as per the relevant national clinical and integrated care programme.

• Conducting a comprehensive holistic health assessment using evidenced based frameworks, policies, procedures, protocols and guidelines to determine diagnoses and inform autonomous advanced nursing care
• Synthesising and interpreting assessment information particularly history including prior treatment outcomes, physical findings and diagnostic data to identify normal, at risk and subnormal states of health
• Demonstrating timely use of diagnostic investigations / additional evidence-based advanced assessments  to inform clinical-decision making
• Exhibiting comprehensive knowledge of therapeutic interventions including pharmacological and non-pharmacological advanced nursing interventions, supported by evidence-based policies, procedures, protocols, and guidelines, relevant legislation, and relevant professional regulatory standards and requirements
• Initiating and implementing health promotion activities and self-management plans in accordance with the wider public health agenda
• Discharging patients from the service as per an agreed supporting policy, procedure, protocols, guidelines and referral pathways

• Providing leadership in the translation of new knowledge to clinical practice professional teaching sessions; journal clubs; case reviews; facilitating clinical supervision to other members of the team and also participating in RANP ASAU clinical supervision as agreed. 
• Educating others using an advanced expert knowledge base derived from clinical experience, on-going reflection, clinical supervision and engagement in continuous professional development
• Demonstrating a vision for advanced practice nursing based on service need and a competent expert knowledge base that is developed through research, critical thinking, and experiential learning
• Demonstrating accountability in considering access, cost and clinical effectiveness when planning, delivering and evaluating care.

• Communicating effectively with the healthcare team through sharing of information in accordance with legal, professional and regulatory requirements as per established referral pathways
• Demonstrating leadership in professional practice by using professional language (verbally and in writing) that represents the plan of care, which is developed in collaboration with the person and shared with the other members of the inter-professional team as per the organisation’s policies, procedures, protocols and guidelines
• Facilitating clinical supervision and mentorship through utilising one’s expert knowledge and clinical competences
• Utilising information technology, in accordance with legislation and organisational policies, procedures, protocols and guidelines to record all aspects of advanced nursing care.

• Promoting a culture of quality care
• Proactively seeking quantitative and qualitative feedback from persons receiving care, families and members of the multidisciplinary team on their experiences of the service, analysing same and making suggestions for improvement
• Implementing practice changes using negotiation and consensus building, in collaboration with the multidisciplinary team and persons receiving care.

• Demonstrating clinical leadership in the design and evaluation of services, including the implementation of findings from research, audit, metrics and new evidence.
• Engaging in health policy development, implementation, and evaluation in relation to Urology (for example key performance indicators from national clinical and integrated care programme/HSE national service plan/ local service need to influence and shape the future development and direction of advanced practice in urology.
• Identifying gaps in the provision of care and services pertaining to his/her area of advanced practice and expand the service to enhance the quality, effectiveness and safety of the service in response to emerging healthcare needs
• Leading in managing and implementing change.

• The assessment and management of patients pre surgery outlined in the ASAU criteria
• Venepuncture, IV cannulation
• Management of Anaphylaxis and resuscitation of patients
• ACLS certification
• Knowledge of preparation required for patients per surgery, interventional procedures
• Knowledge of wound management techniques
• Knowledge of stoma management
• Active management of Patient Flow

• Demonstrates an understanding of the concept of autonomy and its relationship to accountability and responsibility in advanced nursing practice.
• Demonstrates an ability to implement strategies to ensure the provision of safe, quality care and efficient use of resources.
• Develops and sustains professional relationships with other members of the multi-disciplinary team.
• Demonstrates the capacity to lead, manage and advance the nurse practitioner service locally and nationally
• Demonstrate team management skills, including the ability to demonstrate advanced nursing skills within the multidisciplinary team.
• Demonstrates the skills required to mentor, facilitate and clinically supervise nursing and other MDT students.
• Demonstrate ability to manage deadlines and effectively handle multiple tasks
• Demonstrates effective problem solving, decision making and analytical skills at an advanced practice level.
• Demonstrate effective communication skills including: the ability to present information in a clear and concise manner; the ability to facilitate and manage groups through the learning process and the ability to give constructive feedback to encourage learning.
• Demonstrate the ability to interact and consult with patients
• Demonstrate evidence of ability to empathise with and treat patients, relatives and colleagues with dignity and respect.
• Demonstrate evidence of computer skills, including use of Microsoft Word, Excel, and Email.

• Demonstrate in-depth knowledge of surgical conditions.
• Demonstrate advanced skills assessing and managing patients within the criteria for ASAU and other emergency surgical presentations
• Demonstrate advanced skills preparing patients for IR/surgical interventions, in wound and stoma management
• Demonstrate in-depth knowledge of the principles of managing an acute unit and acute patients to disposition of admission or discharge, ensuring any follow up post discharge is completed and GP informed or presentation.

• Performance Indicators are required to evaluate nursing interventions and implement initiatives to improve the quality and quantity of nursing care provided. Performance indicators should have a clinical nursing focus as well as a breakdown of activity, including patients seen and treated. In addition, Performance Indicators should identify areas of good practice that must be recognised and celebrated (HSE 2015).
• The Department of Health (2017) Framework for National Performance Indicators for Nursing and Midwifery provides a guiding framework for the development of Nursing and Midwifery Performance Indicators.
• In collaboration with the Assistant Director of Nursing, the RANP will identify and develop Nursing Performance Indicators for their area of practice, collect and collate data which will provide evidence of the impact and effectiveness of the interventions undertaken.
• The RANP (ASAU) will participate in clinical audit and evaluate audit results and research findings to identify areas for quality improvement in collaboration with nursing and multidisciplinary team colleagues (primary and secondary care).

• The RANP (ASAU) will support the principle that person-centered care comes first at all times and will approach the effective, efficient and resourceful planning, organisation and delivery of RANP (ASAU) nursing service with the flexibility and enthusiasm necessary to make this principle a reality for every patient.
• The RANP (ASAU) will adopt a professional leadership role within the clinical governance structures influencing both clinical and non-clinical processes that impact upon the experience and/or outcomes for patients within the RANP (ASAU) nursing service.
• The RANP (ASAU) will participate in the appropriate and effective management of the RANP (ASAU) service.
• The RANP (ASAU) will participate in the development of the overall service plan and in the monitoring and review of RANP (ASAU) activity against the plan.
• The RANP (ASAU) will provide innovative and effective leadership, support and advice to nursing and allied staff at all levels related to their area of practice.
• The RANP (ASAU) will participate and engage in projects and service developments by representing senior nursing on committees and groups as relevant to the RANP (ASAU) nursing service.
• The RANP (ASAU) will participate in the overall financial planning of the service including the assessment of priorities in pay and non-pay expenditure relating to the RANP (ASAU) nursing service.
• The RANP (ASAU) will promote a culture that values diversity and respect in the workplace.
• The RANP (ASAU) will manage and promote liaisons with internal and external bodies as appropriate, for example; intra-hospital service, community services, or voluntary organisations.
• The RANP (ASAU) will engage in IT developments as they apply to service user and service administration.
• The RANP (ASAU) will undertake other relevant duties as may be determined from time to time by the Director of Nursing or other designated officer.

• Ensure that the team makes the most effective and efficient use of developments in information technology for both patient care and administrative support in a manner, which integrates well with systems throughout the organisation.
• Ensure that all staff are trained in the use of computer systems, which are used in the management of patient episodes in the Hospital, e.g.: EPR, Pims, Order comms, Symphony, sap, core.

• Ensure the compliance of all your staff with the Safety, Health and Welfare at Work Act, 2005.
• Comply and enact Health and Safety responsibilities as outlined in Hospital policies, protocols and procedures relevant to your area.
• Prepare risk assessments and departmental safety statements as required.

• Ensure you are aware of your responsibility for Hygiene awareness. Hygiene is defined as “The practice that serves to keep people and environments clean and prevent infection.”
• Act as a role model and actively promote infection control and prevention and ensure that staff in your area familiarise themselves with the hospital infection control policies and guidelines as outlined in the Infection Control Manual.
• Ensure that staff in your area are aware that they work in an area where there is potential for transmission of infection.
• Ensure that all your staff are advised that they have a responsibility to prevent the transmission of infection particularly in relation to hand hygiene.

• Support the delivery of the Quality, Safety and Risk Management Programme, including the appropriate identification, reporting and management of risks and incidents throughout the hospital.

• You will be aware of the confidential nature of Hospital work and in particular, the right of patients to confidentiality.  To this end, you will not discuss workings of the Hospital or its patients or disclose any information of a confidential nature except as required to do so in the course of your work. No records, documents or property of the Hospital may be removed from the premises of the Hospital without prior authorisation. You must return to the Hospital upon request and, in any event, upon the termination of your employment, all documents or other property of the Hospital which are in your possession or under your control.

• Ensure compliance with the obligations required by the Data Protection Act 2018.

• The Hospital Structure is currently under review and therefore, reporting relationships may change. The development of Hospital Groups may require the post-holder to adopt a different reporting relationship and additional accountabilities.  Full consultation will take place in advance of any such change.