CNM1 St Peters AHD

Position Summary:

The Transplant, Urology & Nephrology Directorate provides a national transplant service and is a regional and tertiary referral centre for nephrology and urology. There are approximately 21 transplant beds, 16 urology beds and 26 nephrology beds. There are acute and maintenance haemodialysis services providing in the region of 30,000 haemodialysis treatments annually. There is an active home therapies service, providing training for patients to carry out peritoneal dialysis or haemodialysis in their own home. There is also a Plasmapheresis service provided by haemodialysis trained staff to the nephrology, transplant, haematology and neurology services.The Directorate also includes the national organ procurement service

HAEMODIALYSIS SERVICES
The Haemodialysis Services at Beaumont Hospital comprise:
Regular Haemodialysis Programme
Acute Haemodialysis Unit - St. Peters
Intensive Care Unit - Acute Haemodialysis

Over 25,000 Haemodialysis treatments were carried out in Beaumont Hospital per annum.

The Dialysis Therapies Centre
The Regular Haemodialysis Programme is located in the Dialysis Therapies Centre above the Ashlinn Centre at the front of the hospital. The staff working in this unit has continuous responsibility for the care of currently 151 patients who attend the unit three times weekly for treatment and care. The unit is currently operational 6 days a week. There are also dedicated single dialysis rooms to facilitate isolation dialysis for out patients. Nursing staff are rotated between both the regular outpatient and acute haemodialysis unit both based in developing their skills and the needs of the unit. The nursing staff when working in the in this unit are also accountable for the provision of a backup nursing service for Plasma Exchange Therapy.

Acute Haemodialysis Unit - St. Peters The nursing staff when working in the in this unit are also accountable for the provision of an acute renal failure service to the Intensive Care Units, Isolation dialysis and the provision of a backup nursing service for Plasma Exchange Therapy.

THERAPUTIC PLASMA EXCHANGE PROGRAMME
The TPE Programme is an integral part of the services provided in the Renal Unit. The service is aimed at the management of patients with various forms of renal and neurological vascular diseases and anti-body mediated renal transplant rejection. TPE is performed by membrane separator modality. Because of its similarities with haemodialysis extracorporeal therapies the service is supported by the Haemodialysis Nursing Team

Principal Duties and Responsibilities:
It is intended that the post holder will rotate between the roles of CNM1 to both the Regular and Acute Haemodialysis Services and CNM1 to the TPE programme. Rotation will be worked out locally depending on the needs of the service and as the post holder develops their expertise in the different areas.

The post holder is expected to demonstrate team leadership and management in the maintenance and development of a high quality nursing service to the Regular Haemodialysis Unit and Acute Renal Failure service to ITU's at Beaumont Hospital and TPE service to the Renal and Neurology Departments. He/she will be responsible to assist in the day to day management of the Regular Haemodialysis Programme in co-operation with colleague Clinical Nurse Manager 11 Grades and will be expected to participate in the development of services provided in the Unit.

The job holder will assist Clinical Nurse Manager II with regard to:-

(a) Directing and co-ordinating a high quality evidence based nursing service in a multi-disciplinary environment and promoting the highest attainable standard of patient care..

(b) Rostering and supervising staff, teaching and training nursing and support staff, and ensure the economical management of resources.

(c) Enable the training and development of nursing staff in the provision of safe and effective practice through team leadership, management and practical expertise.

(d) Enable the development, implementation and evaluation of clinical practice in accordance with the Department of Nursing policy. Contributing to the development of clinical guidelines.

(e) Ensure the development, implementation and evaluation of programmes of care, the setting of standards of care and the review and update of nursing policies and procedures based on current and sound practice.

(f) Audit the work of the Department and evaluate outcomes of care.

(g) Take responsibility for the co-ordination of workload and the assignment of staff across the Haemodialysis services for the duty shifts and in the absence of CNMII & CNMIII.

DETAILS OF RESPONSIBILITIES

MANAGERIAL

In the absence of CNMII or as directed by CNMII:-

1. Maintain effective communication and professional relationships within the Haemodialysis Unit and with all areas of the TUN Directorate, and all associated clinical and administrative areas within Beaumont Hospital.

2. Accept responsibility for the management of Regular Haemodialysis Programme, the acute renal failure service to the ITU's and Isolation ensuring that the nursing service to patients is maintained at the highest possible standard.

3. Prepare weekly duty rosters of deployed staff in such a way that best facilitates the workload needs of the unit and will ensure continuity of care.

4. Advise Clinical Nurse Manger III /Directorate Nurse Manager when staffing levels fall below or are in excess of that considered adequate to meet the complexity and variations in workload.

5. Allocate nursing staff with appropriate numbers, skill mix and levels of experience to meet the case load needs of the RHD Programme, ITU Acute Dialysis, Isolation dialysis and Plasma Exchange service and ensure continuity of patient care.

6. Be willing in an emergency to share personnel with other areas of the TUN Directorate or hospital

7. Guide, support and supervise the nursing staff to enable them to deliver the highest possible standard of nursing care.

8. Lead and motivate staff and influence change in response to a changing health service environment.

9. Ensure that the agreed hospital and specialist policies and procedures are known to and understood by staff and are implemented.

10. (a) Ensure the maintenance of a suitable environment for patients and staff with particular emphasis on Health and Safety. This will require that relationships with the Infection Control Team, Occupational Health Department, Fire Officer, Technical and Bio-engineering staff and providers of equipment will need to be established and maintained.

(b) Ensure that Viral Screening Policies for patients are implemented and that clinical practice guidelines for the avoidance of zero conversion infections and the management of patients with both blood borne and non blood borne infections are strictly adhered to.

(c) Investigate incidents and accidents involving patients, staff and visitors in accordance with hospital policy and report these verbally and in writing to Clinical Nurse Manager III and implement corrective action when necessary.

11. Establish effective communication with clinical support Departments (i.e. Pathology, Radiology, Operating Theatre and Rehabilitation Services) to ensure that the services required for individual patients are co-ordinated and timely delivered.

12. Be responsible for the economical ordering and utilisation of Pharmacy, Dialysis and Medical Supplies for the unit, maintaining agreed stock levels and adjusting levels according to peaks and troughs in demand.

13. Establish communications with non-clinical departments (i.e. catering, contract cleaning, linen, Portering, ward supplies and technical services) to ensure that the services to the Unit are provided to the highest possible standards which will ensure economical utilisation of such services.

14. Ensure that both non clinical and clinical including Dialysis products are discarded according to hospital policy.

15. Ensure that staff receive all the Hospital’s mandatory training programmes that includes fire safety, safer moving and handling , cardiac resuscitation training, hand hygiene, standard precautions, blood transfusion and are familiar with both the hospital internal & major disaster plans.

16. (a)Ensure the implementation of effective maintenance systems for haemodialysis equipment and other electronic medical equipment in use i.e. maintaining inventory of equipment, checking equipment before use, ensuring adequate training of staff in the correct use and care of equipment.

(b) Monitor the effectiveness of the planned haemodialysis equipment maintenance programme in consultation with the Senior Electronics Technician.

17. (a) Ensure that verbal and written nursing reporting systems are accurate and adequate and that nursing reports accompany patients who are being transferred to other units / centres in accordance with hospital policy

(b) Ensure the appropriate utilisation of the Renal Clinical Management systems with regard to the management of individual patients clinical data, audit and utilisation of data to establish clinical outcomes, standards of care and to update clinical practice.

18. Contribute to the development of operational and strategic plans to the Haemodialysis services and to the wider issues relating to the development to the Renal Unit.

19. Participate in regular ward meetings to encourage a positive staff environment and participation in the development of Haemodialysis Services.

CLINICAL RESPONSIBILITIES

1. To be an effective Practitioner able to establish and maintain a high quality evidence based nursing service.

2. Direct, supervise and support the nursing staff in the management of nursing care i.e. provide professional and specialist advice on the provision of nursing care and participate in the delivery of care.

3. Ensure clinical competency of nursing staff in performing clinical procedures and introduce new clinical practices and techniques in an appropriate manner.

4. Using a model of nursing consistent with Hospital Nursing Policy assess the health status of individual patients receiving Haemodialysis therapy.

5. Promotes the concept of primary nursing care and nursing delivery systems.

6. Ensure that appropriate nursing care and Haemodialysis treatment is planned for individual patients based on assessment and that each patient receives appropriate care in compassing medical decisions and in conformance with established procedures and standards of care.

7. Collaborate with the medical team with regard to the effectiveness of care and the adequacy of dialysis. Institute changes in dialysis management, as required, and implement nursing or medical treatment necessary.

8. Review patient care plans for appropriate patient goals, problems, approaches and revise based on nursing needs.

9. Promote patient/family participation in care, identifying and meeting the learning needs of patients and their family.

10. Ensure the provision of timely and complete information and education for individual patients aimed at promoting independence, prevention of illness and promotion of health.

11. Ensure the provision of psychological support by nursing staff to patient and families and encourage patients who have ongoing psychological problems to self-refer to the Nurse Counselling service.

12. Ensure adequate Liaison by nursing staff with patient/family and Patient Care Co-ordinators with regard to patient's occupational and social needs.

STANDARDS AND QUALITY OF CARE

Takes all steps possible to safeguard the welfare of patients through actively leading in:-

1. Quality initiatives within the Unit with the aim of improving patient care and promoting the further development of Nursing within the speciality.

2. Identifying areas of practice which require review and update and lead in the development of evidence based practice in consultation with staff.

3. Ensure the establishment of ward management and clinical standards within realistic targets and explicit limits as set by Clinical Nurse Manager III.

4. Judge on the quality of nursing care provided i.e.:

Monitor and evaluate outcomes of nursing care for individual patients.

Check the quality of work done by individual members of the nursing team.

5. Maintain an audit of the adequacy of dialysis treatment, the incidents of vascular access infections and clinical care targets such as anaemia and bone management.

6. Participate in the collection and collation of statistical and clinical data.

7. Actively participate in the formulation of haemodialysis clinical and nursing guidelines and standard operating procedures. Attend regular Directorate clinical guidelines committee

EDUCATION - STAFF DEVELOPMENT

1. Create and maintain an environment conducive to evidence based teaching, learning and practice with the clinical practice nurse manager/ .
2. Act as an effective role model, mentor and leader of staff i.e. leading by example.

3. Take all possible steps to promote the development of staff nurses with the aim of facilitating nurses to be autonomous and expert practitioners.

4. Lead in the training and development of the Healthcare Assistant role in the Haemodialysis setting in collaboration with Clinical Nurse Manager III/Directorate Nurse Manager.

5. Identify training and development needs of individual staff assigned to the Unit and set objectives for such learning in collaboration with the clinical practice nurse manager/ dialysis instructor

6. Facilitate appropriate study days for nursing and support staff in accordance with Department of Nursing policy.

7. Identify and utilise teaching, learning and practice opportunities in the clinical setting and encourage problem based learning strategies based on patient health problems.

8. Participate in the development, implementation and evaluation of Induction/Orientation Training Programmes, Continuing Education Programmes and the Post Graduate Nephrology Nursing Programme.

9. Participate in the annual Transplant Urology and Nephrology conference. Assist with the preparation and presentation of posters for the conference and other suitable conferences throughout the year.

10. Ensure the availability of appropriate information/educational resources for patients and families aiming to encourage independence, the prevention of illness and the promotion of health for all Haemodialysis patients.

11. Actively seek research findings, which will support clinical practice and participate actively with research opportunities within the Unit.

PERSONNEL MANAGEMENT

1. Maintain a high level of staff morale, promoting team spirit and job satisfaction among nursing, multidisciplinary and support staff within the practice area.

2. Ensure that all staff practice nursing within the code set for the profession by NMBI.

3. Take all possible steps to safeguard the welfare and safety of the staff.

4. Receive with courtesy, visiting professionals and lay visitors to the Unit.

5. Monitor sick leave and late attendances, receive calls from staff reporting sick and implement the sick leave regulations in consultation with Clinical Nurse Manager III/Directorate Nurse Manager.

6. Handle staff complaints, grievances and disciplinary matters in accordance with hospital policy and report to Clinical Nurse Manager III/DNM as necessary on serious or unresolved issues.

7. Carrying out development and performance review interviews with individual post-graduate nursing staff, using job performance review in accordance with unit policy.

8. Ensures that the work of the ward clerical staff is carried out to the required standard and liase with the Renal Unit Clerical Supervisor with regard to training and development needs of staff.

WARD AUXILLARY STAFF

1. Ensures that the work of the ward auxiliary staff that includes both the Health Care Assistants and Household Staff is implemented to the required standard as per job specification.

2. Ensure that the systems for induction and training of auxiliary staff are implemented in a satisfactory manner.

3. Supervise, support and encourage auxiliary staff in the implementation of their role and ensure that nursing staff know and understand these roles.

SELF DEVELOPMENT

1. Have a creative outlook enabling progress to be made towards the ultimate objective of reaching standards of excellence in the delivery of nursing care and in the co-ordination of multi-disciplinary care.

2. Maintain and update knowledge of relevant professional development and all current trends in the speciality of renal nursing, and an awareness of future trends.

3. Develop personal skills in renal nursing with a "hands on" nursing commitment.

4. Attend and participate in staff development programmes and represent Renal Nursing as a speciality at meetings and conferences, as required.

5. Discuss present performance and future needs with Clinical Nurse Manager III/Directorate Nurse Manager, using Job Performance Review in accordance with unit policy.

ADMINISTRATIVE

1. Ensure the correct completion of unit records and reports.

2. Actively promote the utilisation and further development of clinical and administrative computerisation.

3. Assist in the preparation of the Annual Departmental Report.

4. Participate in the administration of unit budgetary/management.

THERAPUTIC PLASMA EXCHANGE PROGRAMME
In conjunction with the TPE Programme CNM2, the other CNM1’s working within the Haemodialysis Service and the CNMIII in charge of Haemodialysis services, develop and co-ordinate the TPE Programme. This will involve liaison with Consultant Medical Staff, Registrars and other relevant multidisciplinary staff regarding the establishment of policies and procedures for this service, the scheduling of patient treatments and treatment prescriptions. It will also involve the development of an active training programme for haemodialysis nursing staff in Plasmapheresis and related techniques.

The job description indicates the main functions and responsibilities of the post and is subject to review and amendment. Other specific work not covered in this job description may also be assigned by the Director of Nursing from time to time.

Selection Criteria:

Selection criteria outline the qualifications, skills, knowledge and/or experience that the successful candidate would need to demonstrate for successful discharge of the responsibilities of the post.

Applications will be assessed on the basis of how well candidates satisfy these criteria.

Mandatory:

1. Statutory Registration, Professional Qualifications, Experience, etc
(a) Eligible applicants will be those who on the closing date for the competition:
(i) Are registered in the relevant division of the Register of Nurses & Midwives
maintained by the Nursing and Midwifery Board of Ireland [NMBI] (Bord
Altranais agus Cnáimhseachais na hÉireann) or entitled to be so registered.

(ii) Have at least 3 years post registration fulltime experience (or an aggregate of 3
years post registration full time experience) of which 1 year post registration full
time experience (or an aggregate of 1 years post registration full time experience)
must be in the speciality or related area.

(iii) Have the clinical, managerial and administrative capacity to properly discharge
the functions of the role.

(iv) Candidates must demonstrate evidence of Continuing Professional Development.

2. Annual registration
(i) On appointment, Practitioners must maintain live annual registration on the relevant
division of the Register of Nurses and Midwives maintained by the Nursing and
Midwifery Board of Ireland (Bord Altranais agus Cnáimhseachais na hÉireann).

(ii) Confirm annual registration with NMBI to the HSE by way of the annual Patient
Safety Assurance Certificate (PSAC).

3. Health
Candidates for and any person holding the office must be fully competent and capable of
undertaking the duties attached to the office and be in a state of health such as would indicate a
reasonable prospect of ability to render regular and efficient service.

4. Character
Candidates for and any person holding the office must be of good character.

Desirable Skills

Plasmapheresis experience is desirable or willingness to undertake a training programme.