Advanced Nurse Practitioner Candidate, Diabetes, University Hospital

HSE South WestCorkPart-timePermanent

Location of Post

Diabetes Service, Cork University Hospital (CUH).

There is currently one permanent and whole time vacancy available.

A panel may be formed as a result of this campaign for Candidate Advanced Nurse Practitioner (Diabetes) from which current and future, permanent and specified purpose vacancies of full or part-time duration may be filled.

Details of Service

In line with Sláintecare (2017) and the Department of Health’s Capacity review (2018), a shift in healthcare service provision is now required to place the focus on integrated, person-centred care, based as close to home as possible. In order to enable this, the Integrated Care Programme for the Prevention and Management of Chronic Disease (ICPCD) is supporting the national implementation of a model of integrated care for the prevention and management of chronic disease as part of the Enhanced Community Care Programme (ECC). The Model of Care for the Integrated Prevention and Management of Chronic Disease has a particular focus on preventive healthcare, early intervention and the provision of supports to live well with chronic disease.

The investment in the ECC programme will be delivered on a phased basis with a view to national coverage being achieved within a two- to three- year period. Three priority areas have been identified as follows:

Structural reform of healthcare delivery within the community with Community Health Networks (CHNs) becoming the basic building blocks for the organisation, management and delivery of community services across the country;

Creating Specialist Ambulatory Care Hubs within the community to support primary care management of chronic disease and older people with complex needs; and,

Scaling Integrated Care for Older People and Chronic Disease through the recruitment of specialist integrated care teams including Frailty at the Front Door Teams.

The focus is on providing an end-to-end pathway that will reduce admissions to acute hospitals by providing access to diagnostics and specialist services in the ambulatory care hubs in a timely manner. For patients who require hospital admission, the emphasis is on minimising the hospital length of stay, with the provision of post-discharge follow up and support for people in the community and in their own homes, where required. A shared local governance structure across the local acute hospitals and the associated CHO will ensure the development of a fully integrated service and end-to-end pathway for individuals living with chronic disease.

The ECC Programme is underpinned by a set of key principles including:

Eighty percent of services delivered in Primary Care are through the GP and CHNs;
Identifying and building health needs assessments at a CHN level (approximate population of 50,000) based on a population stratification approach to include identification of people with chronic disease and frequent service users, thereby ensuring the right people get the right service based on the complexity of their health care needs;
Utilisation of a whole system approach to integrating care based on person centred models, while promoting self-care in the community;
The Older Persons and Chronic Disease Service Models set out an end to end service architecture for the identification and management of frail older adults with complex care needs and people living with chronic disease;
Learning from, and delivering services, based on best practice models and the extensive work of the integrated care clinical programmes to date, particularly in the areas of Older Persons and Chronic Disease;
Embed preventive approach to chronic disease into all services;
Availability of a timely response to early presentations of identified conditions and the ability to manage appropriate levels of complexity related to same in the community;
Resources applied intensively in a targeted manner to a defined population, implementing best practice models of care to demonstrate the delivery of specific outcomes and sustainable services; and,
The need to frontload investment, coupled with reform to strengthen community services.

The role of the ANP will differ according to the needs and configuration of existing services at the local level. The successful candidate work across the acute hospital and integrated services providing support to the integrated diabetes consultant and the ambulatory hubs and specialist teams to manage diabetes, and associated co-morbidities, within the acute and community setting, where appropriate.

Ambulatory care hubs are sites identified outside of the hospital setting that will provide access to specialist services within the community. Each hub will be affiliated with a local hospital and will serve a population of approximately 150,000 and will focus primarily on the prevention and management of complex chronic disease. These hubs will be established to support the provision of care closer to home and to facilitate ready access to diagnostics, specialist services and specialist opinions in order to enhance the delivery of patient-centred care, support early intervention and avoid hospital admission where possible.

A suite of alternative outpatient pathways, support from multidisciplinary Chronic Disease Specialist Teams and access to diagnostics including radiology and laboratory testing will support the work within each hub and the provision of the right care, in the right place, at the right time.

The Integrated Diabetes Service will support:

· A holistic, multidisciplinary approach to the care of individuals with diabetes

· Provision of a reformed outpatient services that utilise telehealth and other ICT measures to facilitate more effective and efficient delivery of care;

· Reduced waiting times for patients for hospital outpatient services;

· Timely access to specialist services and specialist opinion for patients with diabetes and associated co-morbidities ;

· Early intervention pathways/ rapid access clinics for acute, chronic or newly-presenting diabetes conditions;

· Development of pathways for the management of chronic conditions. The early assessment and implementation of pathways that will support GP-led primary care, efficient discharge back to the community where appropriate, and reduce the need for repeated hospital-based outpatient reviews;

· Provision of oversight and implementation of self-management support services for diabetes in the ambulatory care hubs;

· Increased access to diabetes specialist opinion and diagnostics for GPs;

The person appointed to this post will develop and lead the cANP services as part of the overall integrated diabetes service. The cANP will provide leadership in the provision of chronic disease ambulatory care within the ambulatory care hub and support the development of integrated services across the wider region. They will work in the acute setting as well as delivering some services and clinics in the ambulatory care hub, supporting and working with the community specialist teams. The post holder will work as part of a multidisciplinary team delivering coordinated evidence based care for diabetes patients. Please note a portion of the appointees work will be carried out “offsite”. This means that the appointee will travel to the hubs to perform duties related to the role.

Please note more post specific information on services provided, team structures, possible future developments etc. will be provided to candidates at the ‘expression of interest’ stage of the recruitment process.

Purpose of the Post

Background to the Post

As outlined above, the need to reform the healthcare services in Ireland in order to provide a more sustainable, integrated and patient-centred approach has come to the fore in recent health policies and strategies. Integrated care requires health and social care services to work together across different levels and sites in order to provide end-to-end care that meets patient need. As described in the Sláintecare report (2017), integrated care involves:

· Ensuring appropriate care pathways are developed with a focus on person-centred service planning to ensure services are built around patients;

· Supporting timely access to all health and social care services according to

· medical need; and,

· Patients accessing care at the most appropriate, cost effective service level with a strong emphasis on prevention and public health.

The cANP Diabetes will develop and lead a service for patients / service users with diabetes, with an emphasis on providing care across the acute hospital and community setting.

The registered advanced practice service is provided by nurses who practice at a higher level of capability, autonomy and provide expert advanced decision making The overall purpose of the ANP Diabetesservice is to provide safe, timely, evidenced based nurse-led care to patients at an advanced nursing level .This involves undertaking and documenting complete episodes of patient care, which includes comprehensively assessing, diagnosing, planning, treating and discharging patients in accordance with collaboratively agreed local policies, procedures, protocols and guidelines and/or service level agreements/ memoranda of understanding.

The cANP (Diabetes) demonstrates advanced clinical and theoretical knowledge, critical thinking, clinical leadership and complex decision-making abilities.

The cANP (Diabetes) practices in accordance with the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (NMBI 2021), the Scope of Nursing and Midwifery Practice Framework (NMBI 2015), Advanced Practice (Nursing) Standards and Requirements (NMBI 2017), and the Values for Nurses and Midwives in Ireland (Department of Health 2016).

The cANP (Diabetes) service provides clinical leadership and professional scholarship in the delivery of optimal nursing services and informs the development of evidence based health policy at local, regional and national levels.

The cANP (Diabetes) contributes to nursing research that shapes and advances nursing practice, education and health care policy at local, national and international levels.

The post requires a cANP (Diabetes) with the scope of practice that represents the diverse inpatient population of the hospital; reflecting diabetes care across age groups and diabetes types

In collaboration with dietetic colleagues, the cANP (Diabetes) will take a lead role in the co-ordination, delivery and reporting of diabetes self-management education for individuals with Type 1 diabetes within the hospital and associated networks.

Principle Duties and Responsibilities

The cANP (Diabetes) practices to a higher level of capability across six domains of competence as defined by Bord Altranais agus Cnáimhseachais na hÉireann Advanced Practice (Nursing) Standards and Requirements (NMBI 2017).

The six domains of competence are as follows:

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

Each of the six domains specifies the standard which the ANP (Diabetes) has a duty and responsibility to develop and demonstrate at registration.

Domain 1: Professional Values and Conduct

Standard 1

The cANP Diabeteswill apply ethically sound solutions to complex issues related to individuals and populations by:

Demonstrating accountability and responsibility for professional practice as a lead healthcare professional in the care of patients with Diabetes.

The initial caseload1 and scope of practice for the cANP Diabetes will be agreed prior to commencement in the role.

Articulating safe boundaries and engaging in timely referral and collaboration for those areas outside his/her scope of practice, experience, and competence using established referral pathways as per locally agreed policies, procedures, protocols and guidelines
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. The cANP Diabetes practices according to 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 emphasises a caring therapeutic relationship between the cANP and his/her patients, recognising that cANPs work in partnership with their multidisciplinary colleagues2

· Articulating and promoting the cANP role in clinical, political and professional contexts by 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.

Domain 2: Clinical-Decision Making Competences

Standard 2

The CANP (Diabetes) will utilise advanced knowledge, skills, and abilities to engage in senior clinical decision making by:

Conducting a comprehensive holistic health assessment using evidenced based frameworks, policies, procedures, protocols and guidelines to determine diagnoses and inform autonomous advanced nursing care
Synthesising and interpreting assessment information particularly history including prior treatment outcomes, physical findings and diagnostic data to identify normal, at risk and subnormal states of health
Demonstrating timely use of diagnostic investigations / additional evidence-based advanced assessments to inform clinical-decision making
Exhibiting 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
Initiating and implementing health promotion activities and self-management plans in accordance with the wider public health agenda

· Discharging patients from the service as per an agreed supporting policy, procedure, protocols, guidelines and referral pathways

Domain 3: Knowledge and Cognitive Competences

Standard 3

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

Providing leadership in the translation of new knowledge to clinical practice in diabetes by for example, teaching sessions; journal clubs; case reviews; facilitating clinical supervision to other members of the team
Educating others using an advanced expert knowledge base derived from clinical experience, on-going reflection, clinical supervision and engagement in continuous professional development
Demonstrating 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
Demonstrating accountability in considering access, cost and clinical effectiveness when planning, delivering and evaluating care (for example key performance areas, key performance indicators, and metrics).

Domain 4: Communication and Interpersonal Competences

Standard 4

The cANP (Diabetes) will negotiate and advocate with other health professionals to ensure the beliefs, rights and wishes of the person are respected by:

Communicating effectively with the healthcare team through sharing of information in accordance with legal, professional and regulatory requirements as per established referral pathways
Demonstrating 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
Facilitating clinical supervision and mentorship through utilising one’s expert knowledge and clinical competences
Utilising information technology, in accordance with legislation and organisational policies, procedures, protocols and guidelines to record all aspects of advanced nursing care.

Domain 5: Management and Team Competences

Standard 5

The cANP (Diabetes) 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 quantitative and qualitative feedback from persons receiving care, families and members of the multidisciplinary team on their experiences of the service, analysing same and making suggestions for improvement
Implementing practice changes using negotiation and consensus building, in collaboration with the multidisciplinary team and persons receiving care.

Domain 6: Leadership and Professional Scholarship Competences

Standard 6

The cANP (Diabetes) will lead in multidisciplinary team planning for transitions across the continuum of care by:

Demonstrating clinical leadership in the design and evaluation of diabetes services by for example, findings from research, audit, metrics, new evidence)
Engaging in health policy development, implementation, and evaluation for diabetes nursing services by 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 diabetes care
Identifying 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
Leading in managing and implementing change.

Education and Training

The cANP Diabetes 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.

KPI’s

The identification and development of Key Performance Indicators (KPIs) which are congruent with the Hospital’s service plan targets.
The development of Action Plans to address KPI targets.
Driving and promoting a Performance Management culture.
In conjunction with line manager assist in the development of a Performance Management system for your profession.
The management and delivery of KPIs as a routine and core business objective.

PLEASE NOTE THE FOLLOWING GENERAL CONDITIONS:

· Employees must attend fire lectures periodically and must observe fire orders.

· All accidents within the Department must be reported immediately.

· Infection Control Policies must be adhered to.

· In line with the Safety, Health and Welfare at Work Acts 2005 and 2010 all staff must comply with all safety regulations and audits.

· In line with the Public Health (Tobacco) (Amendment) Act 2004, smoking within the Hospital Buildings is not permitted.

· Hospital uniform code must be adhered to.

· Provide information that meets the need of Senior Management.

· To support, promote and actively participate in sustainable energy, water and waste initiatives to create a more sustainable, low carbon and efficient health service.

Risk Management, Infection Control, Hygiene Services and Health & Safety

· The management of Risk, Infection Control, Hygiene Services and Health & Safety is the responsibility of everyone and will be achieved within a progressive, honest and open environment.

· The post holder must be familiar with the necessary education, training and support to enable them to meet this responsibility.

· The post holder has a duty to familiarise themselves with the relevant Organisational Policies, Procedures & Standards and attend training as appropriate in the following areas:

o Continuous Quality Improvement Initiatives

o Document Control Information Management Systems

o Risk Management Strategy and Policies

o Hygiene Related Policies, Procedures and Standards

o Decontamination Code of Practice

o Infection Control Policies

o Safety Statement, Health & Safety Policies and Fire Procedure

o Data Protection and confidentiality Policies

· The post holder is responsible for ensuring that they become familiar with the requirements stated within the Risk Management Strategy and that they comply with the Group’s Risk Management Incident/Near miss reporting Policies and Procedures.

· The post holder is responsible for ensuring that they comply with hygiene services requirements in your area of responsibility. Hygiene Services incorporates environment and facilities, hand hygiene, catering, cleaning, the management of laundry, waste, sharps and equipment.

· The post holder must foster and support a quality improvement culture through-out your area of responsibility in relation to hygiene services.

· The post holders’ responsibility for Quality & Risk Management, Hygiene Services and Health & Safety will be clarified to you in the induction process and by your line manager.

· The post holder must take reasonable care for his or her own actions and the effect that these may have upon the safety of others.

· The post holder must cooperate with management, attend Health & Safety related training and not undertake any task for which they have not been authorised and adequately trained.

· The post holder is required to bring to the attention of a responsible person any perceived shortcoming in our safety arrangements or any defects in work equipment.

· It is the post holder’s responsibility to be aware of and comply with the HSE Health Care Records Management/Integrated Discharge Planning (HCRM / IDP) Code of Practice.

Informal Enquiries

Nora Twomey, Assistant Director of Nursing, CUH

Nora.Twomey@hse.ie

087 218 6170

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