Community Nurse

Job responsibilities

Job Purpose

The role of the Weldmar Community Nurse is to work collaboratively with all members of the Specialist Hospice at Home (SHaH) team, working closely with colleagues within the hub and with primary care teams and community hospitals, providing advice and guidance to patients, carers, and professionals in other agencies to ensure the delivery of high-quality integrated services and be responsive and agile in responding to needs of patients.

The role encompasses clinical, advisory, therapeutic and education functions.

The Weldmar Community Nurse will be based within a Specialist Hospice at Home hub.

To practice evidence based expert palliative and end of life care, holding a flexible corporate caseload under the guidance of the Weldmar Community Nurse Specialist.

To provide guidance, education, mentorship and support to colleagues within the hub and other health care professionals internally and externally in order to develop and improve palliative care practice.

Act as a resource using clinical knowledge and skills for advice, guidance and support to Health Care Assistants and Assistant Practitioners within the Specialist Hospice at Home team.

Undertake regular line management with the service Assistant Practitioner and Health Care Assistant team, as per policy and in line with the needs of the individual employee.

To participate in audit and support service and practice development.

To be an integral part of the specialist hospice at home service, responding to patients needs as determined on a daily basis.

To provide support to patients/ families when patient is entering end of life.

To promote the use of AIRMID/ video technology

To deliver equitable service to all patients

Job tasks

Expert clinical care

Undertake holistic initial patient assessment using the appropriate tools and highly developed communication skills to discuss diagnosis, prognosis, symptom control and end of life issues sensitively with patients and carers in a variety of settings including clinic, own home, and other care settings.

Undertake thorough ongoing assessment of patients needs and those of carers and families, and if appropriate other members of the hub team could be allocated to undertake follow up visits.

Provide knowledge, experience and evidence-based advice on palliative care and end of live care to professionals in all settings. Identify any safeguarding concerns and refer/ escalate as required.

Empower patients/ families through education to contact Weldmar if any changes to symptoms or new concerns for patient initiated follow up (PIFU)

Provide emotional support to patients and carers and referring on for specialist counselling, psychological or psycho -social expertise as appropriate.

Provide patients and carers with appropriate written and verbal material regarding their care.

Recognise when patient is entering dying phase and ensure care and support is offered.

Hold a flexible corporate caseload within hub area.

If required administer prn medication if present in home and patient is distressed.

Support Assistant Practitioners and Health Care Assistants

Undertake holistic patient assessments as required.

Provide knowledge, experience and evidence-based advice on palliative care and end of life care to professionals in all settings. Identify `at risk family members and carers and refer to appropriate agencies, supporting with referrals if needed.

Provide guidance and support to Assistant Practitioners and Health Care Assistants, recognising any gaps in knowledge and skills.

Ensure all employees are following organisational policy and within their scope of practice.

Be non-judgemental and empower individuals to find own solutions where possible.

Provide coaching and leadership, as well as provide informal support to members of the Specialist Hospice at Home team.

To support the Head of Weldmar Specialist Hospice at Home if required.

Provide opportunities for professional development and education

Act as a role model for employees at all times.

Be patient, kind and respectful to all members of the Specialist Hospice at Home team.

Be approachable and transparent

Service and team contribution

Provide out of hours weekend cover for the advice line on a rota basis

Attend hub base at start of each day to review priorities and agreed work allocations.

North team to have a face to face meeting in one of the hubs each week, otherwise virtual meetings will be undertaken.

All hub teams to have check in meeting at the end of each day either in person at the hub or virtually to ensure all staff supported.

Attend MDT meetings to optimise team working and allow for an effective and seamless patient care

Support the development and effectiveness of the gold standard framework, attending GSF meetings in local surgeries.

Together with colleagues, actively seek and identify area where changes to practice will result in quality improvements.

Abide by all organisational policies and guidance in relation to confidentiality and information governance.

Work both as an independent practitioner and as a member of a multidisciplinary team, ensuring a seamless service for patients and those important to them

Supervise and direct members of the multi-skilled hub team to undertake appropriate delegated tasks.

Develop and maintain knowledge of other agencies and health providers within own hub area

Undertake triage of new referrals to team in absence of Weldmar Community Nurse Specialist for hub, when required.

Maintain accurate records and ensure confidentiality in line with organisational and NMC requirements

Collect, collate, evaluate and report information according to practice and organisational policy

Provide appropriate cover for colleagues during a period of absence (this may include working in a different geographical area and within any part of the specialist hospice at home service).

Contribute to service development by identifying and reporting gaps in service

Attend the daily multi agency huddle as required.

Act as a clinical supervisor, following appropriate training.

Education, Training, Research and Audit

Provide advice, coaching and guidance to other health professionals in relation to palliative care, and identify local palliative care training needs

Participate in the development and delivery of training and education in palliative care

Develop and maintain own expertise by keeping an up-to-date awareness and

understanding of current research, knowledge and practice in order to underpin best practice.

Undertake quality improvement initiatives such as audit, research and service development projects.

Communication and Working Relationships

To establish and maintain effective positive communication with each member of the area hub team. Respecting the contribution each member brings, ensure the team works collaboratively and compassionately.

Undertake ongoing assessments using communication skills to discuss diagnosis, prognosis and end of life issues sensitively with patients and carers. Act with the patients permission as their advocate empowering them to take control through informed decision making.

Undertake patient visits with other members of the Specialist Hospice at Home team as required.

Develop and maintain effective relationships with patients, their carers and close family, and professional colleagues.

Support all members of the Specialist Hospice at Home team as required.

Line manage direct reports, ensuring regular 1:1 meetings and ad hoc meetings are arranged to ensure they are supported to deliver and their individual needs are considered.

Develop and maintain productive joint working and advisory relationships with colleagues internally and key contacts within other organisations and agencies

Proactively participates in opportunities for shared learning and personal and professional development, including clinical supervision and external networks

To be able, following the necessary specific training, to have advance care planning conversations with patients about their wishes for end of life care and in particular decisions about whether resuscitation is appropriate or not.

Demonstrate skills in conflict resolution and competent negotiation skills when dealing with difficult or challenging situations.

Assess for complicated grief and refer families and carers in bereavement to the appropriate professionals for follow up where necessary.

To ensure a duty of candour is followed when giving information to patents and their carers.

Qualifications

Essential

• Registered Nurse
• Post registration qualification in palliative care/cancer/other life limiting conditions at diploma/degree level
• Evidence of continuous professional development
• Understanding of end-of-life care issues
• Knowledge of the pathology of disease processes for life limiting illnesses
• Knowledge and understanding of the management of complex symptoms
• Underpinning knowledge of the end-of-life tools which improve patient care i.e. Gold Standards Framework, ACP.
• Principles of clinical supervision and reflective practice
• Knowledge of principles of research and audit
• Understanding of clinical governance
• Awareness of health and social care agendas

Experience

Essential

• Significant post registration experience within one or more relevant clinical fields (end of life, palliative care, life limiting, community nursing etc.)
• Minimum of one year relevant (palliative care or other clinical speciality with significant palliative care input)
• Experience of providing coaching, guidance and support within a clinical environment.
• Previous line management experience desirable.

Other Requirements

Essential

• An Enhanced plus barred list Disclosure and Barring Service (DBS) Check: which will disclose any spent and unspent convictions and cautions (subject to filtering), as well as any relevant police information plus a check of the relevant Barred List/s. It may disclose other information that the police consider is relevant to the role and level of check applied for.
• Commitment to the values and ethos of Weldmar Hospicecare
• Act as an advocate and ambassador for the Charity
• Commitment to and understanding of equality and diversity and how this translates into good practice
• Understands and conforms to Weldmar Hospicecare infection prevention and health and safety policies and actively promotes best practice at all times.
• Commitment to own continued personal development
• Ability to travel which requires a full valid driving licence and business insurance (if applicable)

Skills and Abilities

Essential

• Holistic assessment skills for the health and wellbeing of patients with a life limiting/palliative diagnosis and their families
• Able to work out in the community without direct supervision
• Analytic and creative thinking skills and ability to apply these to all areas of own work (e.g. patient assessment, education provision, service development)
• Written communication skills, including ability to write up patient assessments, draft reports and educational materials
• Excellent interpersonal skills, including ability to provide advice, guidance, coaching and education and to influence change
• Ability to plan and organise own workload with varied complexity
• Ability to work alone but also as part of a multi-professional team
• Good time management, prioritisation and organisational ability
• IT competency with email, internet, Word and PowerPoint.
• To be flexible and demonstrate the ability to adapt to the changing needs of the service
• Work positively with all members of the Specialist Hospice at Home team.

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).