Detailed job description
and main responsibilities
Provide nursing expertise and specialist palliative care advice in symptom control and psychological support for patients with advanced, progressing life-limiting illness with complex needs, and their families, under appropriate professional support.
Act as an expert resource for patients, families/carers and health and social care professionals.
Support Advance Care Planning and other sensitive conversations utilising advanced communication skills.
Anticipate patient need, supporting prevention of avoidable crises within the context of advanced disease and disease trajectories.
Promote collaborative working and personalised care, supporting ‘what matters most’ to patients and their families.
Work collaboratively with colleagues cross-site to support clinical activity and service delivery.
Participate in and support specialist palliative care clinics (face-to-face and/or virtual), home visits and telephone advice cross-site in line with service need.
Undertake the duty nurse role (via NETCALL) as part of a rota and/or when required, supporting cross-site community service delivery, acting as a skilled resource for patients, carers and professionals, triaging appropriately and escalating to senior colleagues where required.
Support all four pillars of the Clinical Nurse Specialist (CNS) role.
Engage and support patient outcome measures and service evaluation activity.
Contribute to ongoing service development.
Act as a role model for the Specialist Palliative Care service.
Demonstrate good and effective communication skills when holding sensitive conversations with patients and their families/carers.
Demonstrate skills in managing conflict when dealing with difficult or challenging situations.
Demonstrate skills in assessment and identification of ‘what matters most’ to patients on the clinical caseload and provide support in managing personalised needs and expectation of patients and their families on the clinical caseload.
Provide specialist palliative care advice, intervention and education to patients, families and health care professionals through multidisciplinary working across primary and secondary care, including clinic settings where required.
Promote close partnership working and collaboration with the multidisciplinary teams in order to meet the identified needs of patients/carers within the palliative care service, reporting on progress and updating plans of care
Build effective working relationships with the multidisciplinary teams within and across providers, to meet patient and service needs, acting as a patient advocate and demonstrating nurse expertise.
Provide clinical expertise, specialist advice and support across service boundaries within scope of experience utilising support and supervision from more experienced colleagues as required.
Contribute to the improvement of the quality of the specialist palliative care nursing service utilising local and national standards and adapting to changes a required.
Act as a specialist resource for all aspects of palliative care.
Participate in the development, implementation, evaluation and dissemination of palliative and end of life care policies and protocols within palliative care.
Support the provision of individualised patient education and information.
Support opportunities for carers to develop skills to participate in the care of the patient.
Participate in the delivery of palliative care education.
Support clinical placements and shadowing opportunities for students in line with their learning needs and act as a mentor where appropriate.
Provide, receive, interpret and communicate complex information with a range of health care personnel.
Use professional judgment to prioritise work and identify when escalation or advice from senior colleagues is required.
Support people to access, identify, appraise and interpret complex information to enable informed decision making.
Maintain accurate, contemporaneous and confidential patient health care records and participate in audit and monitoring when required.
Effectively manage referrals to the service, their triage and discharge as part of a teams-based approach and in line with specialist palliative care frameworks and standards.
Be responsible for managing allocated day-to-day clinical workload, with support from senior colleagues as required.
Work flexibly across sites to meet changing service demands.
Deliver evidence-based, individualised and personalised care through holistic needs assessment, care planning and evaluation of care and evaluation of care interventions.
Identify patients’ and carers’ psychological, emotional and social needs, and refer on as necessary to the appropriate service within the acute or community including social services and other agencies as required.
Provide specialist palliative follow-up support to patients and families across the community pathway, utilising knowledge of disease processes, treatments and disease trajectories, with access to senior clinical support where required.
Work collaboratively with GPs, District Nurses and members of the community multidisciplinary team to support coordinated care delivery.
Communicate effectively with patients, families and carers utilising skilled and sensitive communication.
Acknowledge and respect patients/families/carers’ spiritual, religious and cultural needs and seek advice where necessary to meet these appropriately.
Assess and identify patients/carers requiring bereavement support and refer to appropriate agencies, as required.
Participate in patient care delivered through community and clinic settings.
Participate in the development of patient pathways, policies and protocols to enable changes in practice to be achieved, implemented, evaluated and disseminated.
Support the development of the specialist palliative care service to meet patient and service needs including adapting to evolving community service models in line with NHS priorities.
Person specification
Experience of working within palliative care
Essential criteria
1. Experience of palliative care - hospital or community
Qualifications and experience
Essential criteria
2. Experience of palliative care
3. Relevant post registration experience of working with palliative care patients in hospital or community settings
4. Experience of multi-professional working
5. Post registration qualification in palliative care or relevant subject or working towards
6. Evidence of good communication skills
7. Car driver
8. Ability to manage own workload, effectively and independently
9. Computer literacy
10. Broad knowledge of national and local clinical governance and service frameworks relevant to palliative care
11. Capacity and ability to work flexibly to meet the service needs with cross-site working
12. Ability to work under pressure
13. Good organisational, decision making and planning skills
14. Evidence of team working
15. Evidence of adaptability to unpredictable workloads
16. Evidence of self development and self-motivation
17. Evidence of contribution to service development
Desirable criteria
18. Advanced communication skills training
19. Non-medical prescribing qualification
20. History taking and physical assessment course
21. Experience of audit and research
22. Leadership and management experience
23. Adaptive to unpredictable workload and able to prioritise need effectively