Clinical Nurse Specialist – Bariatric Surgery

Job Title: Clinical Nurse Specialist – Bariatric Surgery

Department: Nursing

Job Function: Nursing

Reporting to: Assistant Director of Nursing / Director of Nursing

Location: Hermitage Clinic

Role Type: Permanent, Part Time

**Please note that this is a part time role**

Job Purpose

As a key member of the Nursing team, the post holder will demonstrate excellent clinical skills, quality patient care initiatives and facilitate effective interpersonal communication with colleagues in the unit(s) and hospital. The role will provide comprehensive nursing care to patients using evidence-based practice and adjusting resources to ensure continuity of care, will act as a role model for excellence in patient care. The CNS will communicate and collaborate with the medical/nursing staff teams in the delivery of quality continuing care for the patient, including liaison with Consultants, and GP's. The position requires a strategic approach to the development of services and structures, embracing continuous quality improvement and the management of changes necessary to achieve organisational objectives. The role demands a broad range of professional skills and knowledge as well as skills in communication, leadership, teaching, education, research and counselling all in keeping with the Framework for the Establishment of Clinical Nurse/Midwife Specialist Posts, 4th edition, National Council for the Professional Development of Nursing and Midwifery (NCNM) 2008.

Job Background / Context

Blackrock Health Hermitage Clinic is a state of the art 160 bed healthcare facility ideally located on at the junction of the N4 and M50 in Lucan, Co Dublin. The hospital provides a wide range of Emergency, Ambulatory, Interventional and Diagnostic care to for Adults and some services for Children. As a member of Irelands newest private health care group, Blackrock Health we are dedicated in ensuring our mission, vision and values are our guiding principles in ensuring our patients and staff have a world class experience. A career in Hermitage Clinic will ensure you are joining a diverse, dynamic and enthusiastic team of professionals, passionate about developing services to ensure we provide the best care in the most modern of facilities. We offer new recruits an array of supports to ensure you are enabled to develop your career. Please contact us directly to review our up to date opportunities and list of benefits.

Key Responsibilities

The post holder's practice is based on the five core concepts of the Clinical Nurse Specialist role as defined by the NCNM 4th edition (2008) in order to fulfil the role. The concepts are: Clinical Focus, Patient/Client Advocate, Education & Training, Audit, Research & Quality, and Consultant.

Clinical Focus — Direct Care

The CNS will have a strong patient focus whereby the speciality defines itself as nursing and subscribes to the overall purpose, functions and ethical standards of nursing. The clinical practice role may be divided into direct and indirect care. Direct care comprises the assessment, planning, delivery and evaluation of care to the patient, family and/or carer. Indirect care relates to activities that influence and support the provision of direct care.

• Provide a specialist nursing service for patients undergoing bariatric surgery who require support and treatment through the pre-operative, peri-operative and post-operative phases of care.
• Undertake comprehensive patient assessment to include physical, psychological, social and spiritual elements of care using best evidence based practice in bariatric surgical nursing.
• Accept appropriate referrals from MDT colleagues.
• Co-ordinate investigations, treatment therapies and patient follow-up, including pre-operative bloods and biochemistry, endoscopy and imaging as required.
• Communicate with patients, family and/or carer as appropriate, to assess the patient's needs and provide relevant support, information, education, advice and counselling as required.
• Provide pre-operative assessment, education and preparation for bariatric surgery, including the pre-operative diet, the liver reduction diet where indicated, expectations of the surgical pathway, length of stay and post-operative recovery.
• Educate patients on the specific dietary and behavioural requirements of their planned procedure, laparoscopic adjustable gastric banding, sleeve gastrectomy or gastric bypass, including portion sizes, eating pace, fluid intake and the importance of not missing meals.
• Provide expert post-operative nursing care including wound and drain management, analgesia optimisation, early mobilisation, assessment of oral intake and tolerance, monitoring for anastomotic leak or bleeding and prevention and early recognition of post-operative complications such as venous thromboembolism, respiratory compromise and wound infection.
• Provide guidance on band adjustments and fills where applicable, in line with agreed protocols and under the direction of the clinical lead.
• Recognise, assess and escalate post-operative complications to the surgical team without delay, including dysphagia, reflux, stricture, marginal ulceration, band slippage or erosion, dumping syndrome and hypoglycaemia.
• Where appropriate work collaboratively with MDT colleagues across Primary and Secondary Care to provide a seamless service delivery to the patient, family and/or carer as appropriate.
• Provide patients with appropriate self-management strategies and escalation pathways.
• Coordinate nurse led bariatric surgical pre-assessment, post-operative and follow-up clinics with MDT input.
• Identify health promotion priorities for the patient, family and/or carer and support patient self-care in line with best evidence. This will include the provision of educational and health promotion material, which is comprehensive, easy to understand and meets patients' needs.
• Provide a specialist nursing service for patients who have completed significant weight loss following gastric bypass, gastric banding, sleeve gastrectomy or SADI-S and who are proceeding to body contouring / body enhancement surgery as the final phase of their weight loss journey.
• Provide a specialist nursing service for patients who have completed significant weight loss following gastric bypass, gastric banding, sleeve gastrectomy or SADI-S and who are proceeding to body contouring / body enhancement surgery as the final phase of their weight loss journey.
• Support patients through the body contouring pathway
• Assess the patient's readiness for body contouring surgery, including confirmation that weight loss has stabilised, that the patient is at least 12 months post bariatric surgery where indicated, and that nutritional status is optimised prior to referral.
• Provide pre-operative education and preparation for body contouring procedures including abdominoplasty, panniculectomy, lower body lift, brachioplasty (arm lift), thigh lift, mastopexy (breast lift) and breast augmentation or reduction.
• Support the patient to understand the expected scars, drains, compression garments, swelling, activity restrictions and recovery time, and the need to avoid heavy lifting for several weeks after surgery.
• Provide expert post-operative nursing care following body contouring surgery, including wound and drain management, compression garment advice, pain and comfort management, monitoring for seroma, haematoma, wound dehiscence and infection, and early recognition of venous thromboembolism.
• Support skin integrity, wound healing and scar management in a patient group at increased risk of impaired healing and nutritional deficiency following major weight loss.

Clinical Focus — Indirect Care

• Participate in case review with MDT colleagues.
• Take a proactive role in the formulation and provision of evidence based PPPGs relating to pre-operative preparation and post-operative care for bariatric surgery patients.
• Take a lead role in ensuring the service for patients undergoing bariatric surgery is in line with best practice guidelines and the Safer Better Healthcare Standards (HIQA, 2012) or the relevant National Clinical Care Programme and JCI standards.
• Establish and maintain clear referral lines.
• Participate actively in the development and strategic planning of the bariatric surgical service, including pre-assessment, in-patient care and post-operative follow-up.
• Establish and maintain a register of patients within the CNS service and maintain a record of clinically relevant data aligned to National Key Performance Indicators (KPIs) as directed and advised by the ADON/DON/Lead Consultant.
• Develop a database that is live and contemporary in focus as well as a breakdown of activity – patients seen and treated, procedures performed and post-operative outcomes.
• Support the service in the collection and submission of data to the relevant national bariatric surgery and obesity registries and databases.

Patient / Client Advocate

• Develop and support the concept of advocacy, particularly in relation to patient participation in decision making, thereby enabling informed choice of treatment options.
• Promote a non-judgemental, respectful and person centred approach to patients living with obesity, and challenge weight stigma and bias in the delivery of care.
• Respect and maintain the privacy, dignity and confidentiality of the patient, family and/or carer, including the provision of bariatric appropriate equipment and facilities and sensitive management of the patient's size and weight in clinical areas.
• Proactively challenge any interaction which fails to deliver a quality service to patients.

Education & Training

• Maintain clinical competence in patient management within bariatric surgical nursing, keeping up-to-date with relevant research to ensure the implementation of evidence based practice.
• Provide the patient, family and/or carer with appropriate information and other supportive interventions to increase their knowledge, skill and confidence in managing their condition.
• Contribute to the design, development and implementation of education programmes and resources for the patient, family and/or carer in relation to their condition thus empowering them to self-manage.
• Provide mentorship and preceptorship for nursing colleagues as appropriate.
• Participate in training programmes for nursing, MDT colleagues and key stakeholders as appropriate.
• Create exchange of learning opportunities within the MDT in relation to evidence based bariatric surgery and weight management care delivery through journal clubs, conferences etc.
• Be responsible for addressing own continuing professional development needs.

Audit, Research & Quality

• Establish and maintain a register of patients with obesity within the CNS service.
• Identify, initiate and conduct nursing/midwifery and MDT audit and research projects relevant to the area of practice.
• Identify, critically analyse, disseminate and integrate best evidence relating to bariatric surgery and weight management care into practice.
• Contribute to nursing/midwifery research on all aspects of bariatric surgery and weight management care.
• Use the outcomes of audit to improve service provision.
• Contribute to service planning and budgetary processes through use of audit data and specialist knowledge.
• Monitor, access, utilise and disseminate current relevant research to advise and ensure the provision of informed evidence-based practice.
• Participate and cooperate with legislative and regulatory requirements regarding quality, risk and safety.
• Participate and cooperate with local quality, risk and safety initiatives as required.
• Adequately identifies, assesses, manages and monitors risk within their area of responsibility.
• Participate and cooperate with internal and external evaluations of the organisation's structures, services and processes as required.
• Initiate, support and implement nursing quality improvement initiatives in their area which are in keeping with local organisational quality, risk and safety requirement.
• Develop a culture of safety, promoting positive reporting of incidents and near misses; investigate and take remedial action on incidents or near misses involving patients and staff according to hospital policies, protocols and guidelines.

Consultant

• Provide leadership in clinical practice and act as a resource and role model for bariatric surgical nursing practice.
• Generate and contribute to the development of clinical standards and guidelines and support implementation.
• Use specialist knowledge to support and enhance generalist nursing practice.
• Where appropriate develop and maintain relationships with specialist services in voluntary organisations which support patients in the community.
• Network with other CNS in Bariatric Surgery and in related professional associations.

Essential Criteria

Knowledge / Experience

• Be registered in the general division of the Register of Nurses maintained by NMBI.
• Have at least five years recent relevant post-registration nursing experience (full-time or equivalent hours part-time) in an acute hospital setting and a minimum of two years nursing experience in the specialist area of bariatric surgery, obesity or related surgical nursing.
• Have acquired a level 8 post registration Quality and Qualifications Ireland (QQI), National Framework of Qualifications (NFQ) major academic award relevant to the specialist area or be willing to complete within two years of taking up post.
• Have a working knowledge of the Health Information and Quality Authority (HIQA) Standards as they apply to the role for example, Standards for Healthcare, National Standards for the Prevention and Control of Healthcare Associated Infections, Hygiene Standards etc. and comply with associated HSE protocols for implementing and maintaining these standards as appropriate to the role.
• Have the clinical, managerial and administrative capacity to properly discharge the functions of the role.
• Demonstrate evidence of continuing professional development.
• Demonstrate sound knowledge of current issues relating to obesity and the interventions available.
• Demonstrate evidence of up-to-date best practice in obesity and weight management, including surgery, self-directed and reflective practice.

Skills/ Competencies

• Clinical Skills
• Management skills
• Leadership skills
• IT skills
• Quality focus
• Risk Management
• Clinical audit
• Excellent interpersonal and communication skills

Desirable Skills

Knowledge/ Experience

• Experience in teaching & assessing
• Experience with JCI standards
• Post registration qualification or CPD in obesity, bariatric surgery, diabetes, endocrinology or peri-operative nursing.
• Experience of working in bariatric surgery or a specialist weight management service.
• Experience of change management and service development.
• Experience of mentoring and preceptorship of nursing colleagues.
• Advanced clinical assessment and diagnostic skills, including interpretation of investigations and results relevant to the speciality.
• Physical/health assessment skills.
• Non-Medical Prescribing or willing to work towards.
• Development of patient education resources and digital/telehealth service delivery (for example virtual clinics and remote follow-up).
• Ability to present at local and national forums and to represent the service in professional networks.

This Job Description is intended as a basic guide to the scope and responsibilities of the position and is subject to regular review and amendment. The role holder will be required to be flexible in this position and is expected to facilitate working additional hours on occasion, when requested.

Hiring organisation: Blackrock Health Hermitage Clinic

addressLocality: Lucan, Co. Dublin, Ireland

Country: Ireland

Employment type: parttime