Candidate/Registered Advanced Nurse Practitioner Tissue Viability

The (Candidate) Advanced Nurse Practitioner (cANP) post for Tissue Viability is being developed to enhance and support the existing tissue viability clinical nurse specialist (CNS) Service at Beaumont Hospital. The post holder will be required to deliver an advanced level of clinical practice within the field of Tissue Viability. Working within local and nationally agreed frameworks the cANP will be expected to exercise independent judgement to assess, investigate, plan, implement and evaluate the clinical care and management of patients within their specialist field of practice.

It is envisaged that the post will be structured within a regular working week (Monday to Friday). During the working week, the cANP will be involved in the co-ordinating of the tissue viability programme, development and introduction of dedicated pathways to ensure service availability and timely assessments in line with local and national targets.

The cANP led Tissue Viability service will be supported within the wider organisation by medical and surgical practitioners. The benefits of this role are to provide timely initiation of treatment, comprehensive and holistic assessment, rapid access to diagnostics, reduction of presentations to the emergency department for acute and chronic wound issues, facilitate early discharges and admission avoidance. The cANP will endeavour to improve patient experience and satisfaction while promoting health and wellbeing, improving the quality of service patients receive within Beaumont Hospital.

• Improve patient experience and satisfaction • Promote health and wellbeing• Take a holistic approach to patient care• Improve the quality of service patients receive• Assess, diagnose, treat, discharge, and evaluate patients autonomously as appropriate

• Provide continuity of care• Work effectively as part of the multi-disciplinary team• Be actively involved in the continued evaluation of services through ongoing clinical audit and research

• Identification and management of treatment related side effects• Support and empower patients to self-manage their own health needs• Collaboratively agree and develop local policies, procedures, protocols, and guidelines

• Provide timely access to services • Organise, interpret, and follow up on all investigations required as part of patient pathway, ensuring they are performed in a timely manner• Establish Nurse led outpatient services, utilising ICT measures to facilitate more effective and efficient delivery of care

• Act as a communication link between the wider MDT in the management of patient issues, ensuring the appropriate services are referred to in a timely fashion

• Develop and implement specific pathways for patient specific needs, ensuring hospital compliance with local and national targets• Develop the interface between primary and secondary care services (General Practice, External Hospitals, Public Health Nurses (PHN)s, Practice Nurses) through clinical work, education, research, and leadership

• Contribute to the continuous improvement of the quality of care experienced by patients attending the clinics

• Advance the theory and practice of advanced nursing practice through demonstrating expert practice, autonomy in practice, clinical leadership, research and audit

• Work with the healthcare team contributing to meeting health service quality/patient safety and resource needs at local and national level and within a patient-centred philosophy

• Engage in on-going clinical supervision as per a Service Level Agreement. The structure, process and outcome of clinical supervision must be explicit.

• Maintain a record of clinical supervision in his/her professional practice portfolio.

• Develop 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

The duties detailed above are not intended to be a comprehensive list of all the duties involved and consequently, the post holder may be required to perform other duties as appropriate to the post which may be assigned to him/her from time to time and to contribute to the development of the post while in office

• Director of Nursing• Directorate Nurse Manager• All other nursing grades• Nurse Practice Development Co-ordinator• Prescribing site co-ordinator(s)• Medical colleagues • Inter-professional colleagues • Patients/service users/families and/or carers• Nursing and Midwifery Board of Ireland• Higher Education Institution• Nursing and Midwifery Planning and Development Unit • Centres of Nursing and Midwifery Education• National Clinical and Integrated Care Programme• National Leadership and Innovation Centre• Other relevant statutory and non-statutory organisations

The main purpose of the post is to develop the role and supporting documentation under the direction of the Health Care Provider’s Advanced Practice Stakeholder Governance Group, to enable the individual nurse to meet the Nursing and Midwifery Board of Ireland (NMBI) Criteria for Registration as an Advanced Nurse Practitioner as set out in Advanced Practice (Nursing) Standards and Requirements (NMBI, 2017).

The individual will undertake the academic preparation and develop the clinical and leadership skills, competencies and knowledge required to meet the criteria to be registered as a Registered Advanced Nurse Practitioner (RANP) with NMBI. The scope of the cANP role must reflect the incremental development of expertise and as such, the cANP cannot deliver care as an autonomous practitioner.

Furthermore, the cANP will develop and submit their personal portfolio and all other necessary documentation to NMBI to register as a RANP.The value of the nursing contribution as a distinct profession must be safeguarded and articulated in the development of new services led by advanced nurse practitioners, complementing rather than replacing current services delivered by doctors (NMBI 2017 p.9).

The overall purpose of the post is to provide safe, timely, evidenced based nurse-led care to patients at an advanced nursing level. This involves undertaking and documenting a complete episode of patient care (assess, diagnose, plan, treat and discharge patients) according to collaboratively agreed protocols and scope of practice in the clinical setting; demonstrating advanced clinical and theoretical knowledge, critical thinking, clinical leadership and decision making skills.

The advanced practice role demonstrates a high degree of knowledge, skill and experience that is applied within the nurse-patient/client relationship to achieve optimal outcomes through critical analysis, problem solving and accurate decision-making (NMBI, 2017).

Central to this is the provision of quality care, a safe environment and processes for patients using evidence based clinical guidelines that address patient expectations, promote wellness, and evaluate care given.

The role will provide clinical leadership and professional scholarship to develop nursing practice and health policy at local, regional, and national level.

The role will contribute to nursing research to shape and advance nursing practice, education, and health care policy at local, national, and international levels.

The key responsibilities of the cANP will be to develop a higher level of capability across the six domains of competences as defined by An Bord Altranais agus Cnáimhseachais na hÉireann Advanced Practice (Nursing) Standards and Requirements (NMBI 2017).

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

The cANP practises nursing according to:• The Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (NMBI 2021) • Scope of Nursing and Midwifery Practice Framework (NMBI 2015)• Values for Nurses and Midwives in Ireland – Care, Compassion and Commitment (Department of Health 2016)• Advanced Practice Nursing Standards and Requirements (NMBI 2017)• National Health Policies and Procedures for example, HSE (2013, revised 2016) National Consent Policy

• Local policies, procedures, protocols, and guidelines

The cANP for Tissue Viability will gain increased competence in applying ethically sound solutions to complex issues related to individuals and populations by:• Demonstrating accountability and responsibility for professional practice as a lead healthcare professional.

• Collaborating with his/her supervisor and local stakeholder group to scope the caseload and scope of practice for the RANP.

• Collaborating with his/her supervisor and local stakeholder group to determine the exclusion criteria for the RANP.

• Articulating safe boundaries and engaging in timely referral and collaboration for those areas outside his/her scope of practice, experience, and competence by establishing, in collaboration with key stakeholders, referral pathways and locally agreed policies, procedures, protocols and guidelines to support and guide the service.

• Demonstrating leadership by practising 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.

• Selecting 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 will emphasise a caring therapeutic relationship between the cANP/RANP (Tissue Viability) and his/her patients, recognising that cANPs/RANP (Tissue Viability) work in partnership with their multidisciplinary colleagues.

• Articulating and promoting the advanced practice nursing service in clinical, political and professional contexts {for example 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}.

The cANP (Tissue Viability) will enhance his/her advanced knowledge, skills, and abilities to engage in senior clinical decision-making by increasing his/her capability to:

• Conduct a comprehensive holistic health assessment using evidenced based frameworks, policies, procedures, protocols and guidelines to determine diagnoses and inform autonomous advanced nursing care.

• Synthesise and interpret assessment information particularly history including prior treatment outcomes, physical findings and diagnostic data to identify normal, at risk and subnormal states of health.

• Demonstrate timely use of diagnostic investigations / additional evidence-based advanced assessments to inform clinical-decision making.

• Exhibit 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.

• Initiate and implement health promotion activities and self-management plans in accordance with the wider public health agenda.

• Discharge patients from the service as per an agreed supporting policy, procedure, protocols, guidelines and referral pathways.

The cANP (Tissue Viability) will actively contribute to the professional body of knowledge related to his/her area of advanced practice by enhancing his/her capability to:

• Provide leadership in the translation of new knowledge to clinical practice (for example teaching sessions; journal clubs; case reviews; facilitating clinical supervision to other members of the team).

• Educate others using an advanced expert knowledge base derived from clinical experience, on-going reflection, clinical supervision and engagement in continuous professional development.

• Demonstrate 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.

• Demonstrate accountability in considering access, cost and clinical effectiveness when planning, delivering and evaluating care (for example key performance areas, key performance indicators, metrics).

The cANP (Tissue Viability) will negotiate and advocate with other health professionals to ensure the beliefs, rights and wishes of the person are respected by gaining increased competence and capability to:

• Communicate effectively with the healthcare team through sharing of information in accordance with legal, professional and regulatory requirements as per established referral pathways.

• Demonstrate 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.

• Facilitate clinical supervision and mentorship through utilising one’s expert knowledge and clinical competences.

• Utilise information technology, in accordance with legislation and organisational policies, procedures, protocols and guidelines to record all aspects of advanced nursing care.

The cANP (Tissue Viability) will manage risk to those who access the service through collaborative risk assessments and promotion of a safe environment by:

• Promoting a culture of quality care.

• Proactively seeking feedback from persons receiving care, families and staff on their experiences and suggestions for improvement.

• Implementing practice changes using negotiation and consensus building, in collaboration with the multidisciplinary team and persons receiving care.

The cANP (Tissue Viability) will lead in multidisciplinary team planning for transitions across the continuum of care by enhancing his/her competence and capability to:

• Demonstrate clinical leadership in the design and evaluation of services (for example findings from research, audit, metrics, and new evidence).

• Engage in health policy development, implementation, and evaluation (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 tissue viability.• Identify 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.

• Lead in managing and implementing change.

Performance Indicators (PI’s) are required to evaluate nursing interventions and implement initiatives to improve quality and quantity of the nursing care provided. They should have a clinical nursing focus as well as a breakdown of activity, including patients seen and treated. In addition, they 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 PI’s.

In collaboration with the Director of Nursing, the cANP will identify and develop Nursing PI’s for their area of practice, collect and collate data which will provide evidence of the impact and effectiveness of the interventions undertaken.

The cANP (Tissue Viability) will evaluate audit results and research findings to identify areas for quality improvement in collaboration with nursing management and multidisciplinary team colleagues (primary and secondary care).

The cANP (Tissue Viability) will practice nursing according to:

• Professional clinical guidelines

• National Health Policy

• Local policies, procedures, protocols and guidelines

• Current legislation

• Values for Nursing and Midwifery – Care, Compassion and Commitment (DoH, 2016).

The cANP (Tissue Viability) will:

• Contribute to service development through appropriate continuous education, research initiatives, keeping up to date with nursing literature, recent nursing research and new developments in nursing practice, education and management.

• Provide support and advice to those engaging in continuous professional development in his/her area of advanced nursing practice.

The cANP must develop 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.

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.

Qualifications and/ or experience

The applicant must: • Be a registered nurse with the Nursing and Midwifery Board of Ireland [NMBI] (Bord Altranais agus Cnáimhseachais na hÉireann) or entitled to be so registered.

And • Have a minimum two years post registration nursing/midwifery experience including clinical experience in Tissue Viability or relevant specialist practice.

And• Have a broad base of clinical experience relevant to the advanced field of practice

And• Be eligible to undertake a Master’s Degree (or higher) in Nursing (Advanced Practice) 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.Or • Be currently undertaking a Master’s Degree in Nursing (Advanced Practice ) or be eligible to register to undertake additional Level 9 National Framework of Qualifications (Quality and Qualifications Ireland) specific modules of a Master’s Degree in Nursing (Advanced Practice ) 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.

Or• 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.

And• 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.

• Have completed or will be willing to complete a Postgraduate Certificate in Nurse Prescribing.

• Previous managerial experience desirable.

• Evidence of continuous personal and professional development.

• Practitioners must maintain live annual registration on the appropriate/relevant Division of the register of Nurses and Midwives maintained by the Nursing and Midwifery Board of Ireland (Bord Altranais agus Cnáimhseachais na hÉireann, NMBI) for the role.

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

• 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.

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

If an appointee has previously been employed in the Civil or Public Service and that appointee is entitled to or in receipt of a pension from the Civil or Public Service or where a Civil/ Public Service pension comes into payment during the appointee’s re-employment that pension will be subject to abatement in accordance with Section 52 of the Public Service Pensions (Single Scheme and other Provisions) Act 2012.

Please note: In applying for this position you are acknowledging that you understand that the abatement provisions, where relevant, will apply. It is not envisaged that the employing Department/ Office/ Body will support an application for an abatement waiver in respect of appointments to this position.

Supplementary information:

The Hospital www.beaumont.ie Management Unit: www.beaumont.ie/hr

Name: Fionnuala DuffyTitle: Directorate Nurse Manager SurgeryEmail address: fionnualaduffy@beaumont.ieTelephone: 01 852 8339