JOB DETAILS JOB TITLE: Community Staff Nurse - Home First BAND: 5 HOURS: See Contract of Employment DEPARTMENT: Community Nursing LOCATION: To be Stafford,Cannock,Burton REPORTS TO: Clinical Lead ACCOUNTABLE TO: Integrated Service Manager WORKING RELATIONSHIPS INTERNAL: AHP and Nursing Teams, Dietetics Teams, Long Term Conditions Teams, Operational Leads, Clinical Leads, Community Nursing, Wellbeing services, Psychological services, Learning disability teams, Physiotherapy Teams EXTERNAL: Patients and Carers, Acute Trusts, Charitable Organisations, Local Hospices, Local and National Networking Groups, Local physical activity providers, community wellbeing providers. JOB PURPOSE The Community Staff Nurse will work within a Community Nursing team, contributing to the delivery of high quality evidence based treatments for patients. You will: Be competent as appropriate to the requirement of the role. Demonstrate at all times the MPFT Values. Have a professional and clinical knowledge of community nursing. Deliver care to patients who are in their own homes or residential homes, and or delivery of care to patients within a clinic setting where these are available and appropriate. Be responsible for a defined population of service users in a variety of settings across the Trust including the community and hospitals. Be skilled in the assessment of care/support needs and in the development, implementation and evaluation of care/support packages. Have supervisory responsibilities as required (e.g. work allocation) and may have some responsibility for service developments You will be part of the Community Nursing Team providing healthcare and will work in a variety of settings. This is a dynamic post that requires the post holder to work closely with uni/multidisciplinary teams/agencies in addressing a range of care/support issues across the spectrum of conditions, preventing unnecessary hospital admissions and improving the health and wellbeing of the population served. The nature of the service will be determined by local service specifications. ORGANISATIONAL STRUCTURE KEY RESPONSIBILITIES Clinical 1. To adhere to and apply the Nursing & Midwifery Council (NMC) code of conduct, and all other relevant guidance from the NMC and follow the Trust values. 2. To be professionally accountable and responsible for all aspects of own work. 3. To establish and maintain effective working relationships both within MPFT and with external organisations in order to meet service requirements and support and demonstrate the Trust's equality values. 4. To assess new service user referrals and care/support needs. Assesses service users and formulates, develops, implements and evaluates programmes of treatment /care/support for individuals, families and carers. The care/support plans may include the following: Promoting independence/self-management and maintaining safety Increased functional ability Improvement in health and wellbeing including mental health Interventions in disease/condition management Prevention and reducing of health inequalities Early supported discharge Case management/ treatment/ care plans Undertake Tissue Viability Risk Assessments Form a professional judgement of an individual's health condition Prioritise treatment and care for individuals according to their health status and needs Bladder, catheter and bowel care 5. To use professional knowledge and judgement to take into account the range of care/support packages and treatment options available. To consider each service user's personal circumstances and preferences in order to implement and adjust programmes of care and intervention. 6. To maintain and develop skills and knowledge to deliver a range of interventions and set an example of good practice to other team members including skill sharing. Take responsibility for the continuing professional development of yourself and others. 7. To maintain sensitivity at all times to the emotional needs of the service user and their carers offering reassurance and empathy. This may be in regard to the nature/prognosis of their condition and implications of the same. 8. To work with individuals and carers who may find it difficult to engage with the service or aspects of the service resulting in uncooperative or challenging behaviour that has to be managed. 9. To use professional knowledge, skills and experience when working in changing environments and across professional boundaries Agree courses of action following assessment to address health and wellbeing needs of individuals. 10. To maintain contemporaneous and accurate records as required by the Trust and in line with professional standards (e.g. NMC). This includes self-management and supervision of identified team members, giving guidance and direction where appropriate. 11. To take responsibility for the safe use and transportation of equipment between locations. To work in non-purpose built rooms involving the necessity to move furniture, therapy equipment etc. 12. To ensure that the skills of identified team members are appropriately deployed and that care is delivered by staff with the relevant education, experience and competence. 13. To deliver a high standard of intervention, whilst managing the demands of unplanned aspects of the role using innovative problem-solving techniques where appropriate. 14. To provide advice to service users, carers and professionals regarding the management and care/support of service users 15. To provide professional and clinical support and leadership to identified team members 16. To take accountability for allocated assessments, planning and implementation of care packages/ programmes of support within their caseload. Establishing a diagnosis of an individual's health condition and agreeing courses of action following assessment to address health and wellbeing needs of individuals Systems and equipment 17. Assist with the collection, analysis and evaluation of data relating to the Nursing service from a variety of clinical systems, which includes patient related outcome measures. 18. Be responsible for ensuring that equipment is safe to use by members of staff. 19. Ensure all statutory and mandatory training is completed as required. 20. Ensure an and travel claim is submitted at the end of each calendar month. 21. Undertake on-going audit of practice and service delivery to maintain quality standards within the service. 22. Maintain accurate patient records and record all clinic findings on the clinical systems in line with the NMC code of conduct. 23. Good keyboard and IT skills to enable working with a range of IT systems. 24. Responsible for safe use of equipment and stock control. 25. Confidently use diabetes blood glucose monitors and blood pressure machines Decisions and judgements 26. Evaluate the effectiveness of clinical interventions and feedback to the Clinical Leads 27. Determine onward referral on to appropriate health and social care teams. 28. Contribute and discuss case management in a multi-disciplinary forum based 29. Contribute to the development and quality improvement practices of service 30. Participate in Audits and make service changes in consultation with the wider team. 31. The post holder will be expected to fully participate in changes to working practice. This may be for the benefits of patients and families and the service Communication and relationships 32. Undertake an appraisal with line manager annually. 33. Engagement in annual Personal Development Review and development of an agreed Personal Development Plan. 34. Identify own learning needs and objectives by regular IPR. Attend all study days and courses identified and required including mandatory updates. 35. To be responsible for identifying own training needs, for the maintenance of competency and for keeping self-updated on clinical and professional issues in line with evidence based practice. 36. Receive and share sensitive, confidential information concerning patients/clients requiring empathy, persuasion and reassurance. 37. The post holder may engage with patients, clients, visitors, carers, colleagues, students or members of the public. These may be from a variety of different services such as Local authority, Education, and external trusts. 38. To be able to facilitate communication to patients and families/carers where communication barriers or disabilities exist 39. Providing evidenced based written information and ensuring easy access to advice and information for patients and carers. 40. Maximise the involvement of patients and their carers in all relevant decisions about diagnosis care and treatment. Physical demands of the job 41. Carrying equipment from car to clinic/patients' homes. 42. Daily use of VDU. Standard keyboard skills required. 43. There is light physical effort required for this post with a combination of sitting, walking carrying equipment. There may also be a requirement for the post holder to stand for frequent periods of time and car travel Most challenging/difficult parts of the job 44. Understanding lone working buddy system to maintain safety 45. Provide unwelcome news to clients with regards to condition progression, Deal with difficult situations including patients and families who are struggling to cope with signs and symptoms and may be experiencing depression and anxiety. 46. Working in isolation within the client's home. 47. The post holder will be exposed to body fluids e.g. blood and there is a potential for a needle stick injury. 48. Frequent interruptions within working day which may change direction of work at short notice. 49. Good levels of concentration will be required frequently. 50. Work pattern may be unpredictable on occasions. 51. The post holder may be exposed to dealing with some verbal aggression and confrontation from patients/clients, their families or carers. JOB STATEMENT Infection Control Maintain an up to date awareness of the infection control precautions relevant to your area of work and implement these in practice. As a minimum, this must include hand hygiene, the use of personal protective equipment, the use and disposal of sharps and communicating the importance to patients, prison staff and other health care staff you are working with. Details of the precautions and sources of advice and support to assess and manage infection control risks are provided through mandatory training which all staff must attend at intervals defined in the Trust policy on mandatory training and can be found in the Trust's infection control policies and national guidance, such as that published by NICE. Learning and Development As an employee of the Trust, you have a responsibility to participate, promote and support others in undertaking learning and development activities. This includes a proactive approach to ensuring you meet the statutory/mandatory training requirements of your role, and engaging in PDC / appraisal processes in line with Trust policy and guidance. Health and Safety As an employee of the trust you have a responsibility to abide by the safety practices and codes authorised by the trust. You have an equal responsibility with management, for maintaining safe working practices for the health and safety of yourself and others. Constitution, Competence and Capability As an employee of the Trust you have a responsibility to promote and abide by the rights and responsibilities outlined in the NHS Constitution. You are additionally expected to adhere to Organisational/National/Regulatory Codes of Practice relevant to the role you are employed to undertake. At all times it is expected that you will limit the scope of your practice to your acquired level of competence and capability. Dignity at Work Statement ENS is committed to treating all of our staff with dignity and respect. You are responsible for behaving in a way that is consistent with the aims of our Equality and Diversity Policy. This includes not discriminating unfairly in any area of your work and not harassing or otherwise intimidating other members of staff. Safeguarding Children and Vulnerable Adults All Trust employees are required to act in such a way that at all times safeguards (and promotes) the health and well-being of children and vulnerable adults. Familiarisation with and adherence to Trust Safeguarding policies is an essential requirement of all employees as is participation in related mandatory/statutory training. Environmental Sustainability and Net Zero As an employee of the Trust you have a responsibility to be familiar with policies and procedures relating to environmental sustainability and the Net Zero agenda. You are actively encouraged and supported to explore and implement sustainable ways of working within your role to reduce carbon and minimise the environmental impact of health and social care. PERSON SPECIFICATION QUALIFICATIONS & TRAINING Degree in nursing or equivalent. Registration with NMC. Commitment to work toward Mentorship qualification (998-997). Working towards Mentorship qualification (998-997). EXPERIENCE Relevant experience/placements to the role including assessment and management of long-term conditions and wound care. Ability to manage time and caseload effectively. Supporting service users, families and carers in dealing with people with nursing needs Working in a multidisciplinary team. Experience in the delivery of healthcare Relevant placements including surgical, medical, palliative care Evidence of/willing to undertake post- registration training relevant to the post. SKILLS, KNOWLEDGE & ABILITIES Evidence of clinical knowledge relevant to the post, with knowledge of care planning. Understanding of Information Awareness of standardised assessments and outcome measures. Awareness of relevant NSF's and NICE guidance Governance, Data Protection, NMC standards and Safeguarding Vulnerable Adults Basic IT Skills Ability to work independently and within a team. Presents information effectively both formally and informally in a variety of forms Presents sensitive or confidential information with discretion Writes accurate notes of important conversations and meetings Ability to assess clinical risks and find ways to mitigate them.