Highly Specialist Nurse

Job overview

The Community Neuro and Stroke Team, are a well established team, delivering highly specialist care to individuals following neurological injury, diagnosis and following a stroke.  The team comprises of highly experienced Physiotherapists, Occupational therapists, Speech & Language therapists, Nurses, Dietitian, Neuro psychologist and a forward-thinking consultant in Neuro rehab, who are all keen to share their knowledge and experience to enhance the care for people in the Wigan borough.

We are seeking a Highly Specialist Nurse with a keen interest in Stroke who would like to develop their knowledge and skills in neurological recovery.  You will work closely alongside and be supported by other Specialist staff in the team. The role will involve management of a complex patient caseload and significant contribution to service development.

This vacancy may close early if a sufficient number of quality applications are received.

Main duties of the job

To act as a highly specialist nurse for the community Stroke and Neuro team  (Stroke Pathway) delivering a high quality and efficient rehabilitation service to neuro patients of all complexity.

To be a source of expertise and undertake a significant clinical caseload to a high professional standard using specialist knowledge from theoretical and practical experience

To further use this highly specialist skill level to monitor and improve standards of care and practise by efficient use of resources and utilising clinical audit within neurosciences

Proactively and positively contribute to the achievement of patient care through individual and interdisciplinary team effort.  To monitor and improve standards in the delivery of evidence based and client centred care within the community neuro and stroke team

To provide leadership as a senior nurse in the field of neurology, assessing and treating a caseload of complex neuro and stroke patients in a variety of settings including patients own homes, wide variety of community settings including residential and nursing homes.

To take the lead in teaching, training and supervision of clinicians within their IDT working.

Detailed job description and main responsibilities

• Ensure regular review of the caseload within a patient centred interdisciplinary goal setting model, and make decisions regarding team capacity in consideration of patient complexity and identified risk.

• To be professionally and legally responsible and accountable for all aspects of your work including the management of patients in your care, working to agreed national and professional standards.
• To be recognised as a highly specialised practitioner in the field of neurology. To undertake the comprehensive specialist assessment of neurological patients, including those with complex presentations, chronic long-term conditions and rehabilitation needs. Use highly advanced analytical skills, clinical reasoning and the use of specialist assessment tools underpinned by theoretical knowledge and relevant practical experience.
• Maintain own clinical caseload to ensure continuing professional registration at a specialist level and support the Interdisciplinary team working across the service.
• To be responsible for ensuring all who refer to the service, are aware of eligibility criteria. Maintain the profile of the team across Greater Manchester at neurological rehabilitation events/meetings.
• To effectively undertake nursing assessments of complex and highly complex patients, identify their problems and needs and ensure the patients’ medical, cognitive, psychological, social, spiritual, cultural and environmental factors are considered.
• Ensure patient transfer into and out of the service is smooth and effective, with full communication of all related information to patients, carers, families, other professionals and services as necessary, across all Health, Social Services and voluntary agencies. This may require providing & receiving highly complex, sensitive or contentious information; agreement & cooperation are required across the wide range of professionals, plus patient & their family. Cognitive & communication difficulties may be present.
• To utilise examination and assessment findings using highly specialist clinical nursing skills to develop and implement a management plan, appropriate to individual patient using evidence-based practice and highly specialised knowledge.
• To participate in joint interdisciplinary goals in negotiation with the patient, and/or carer wherever possible considering risk, safety, patient choice, independence, and palliative care choice.
• To ensure that secondary prevention is considered, risk factors screened for and patients offered intervention at every opportunity and with regular follow up. Planning and Organisational Duties
• To take responsibility for devising plan of care for other interdisciplinary team members to carry out and ensure they are carried out appropriately.
• Act as a role model in the promotion of interdisciplinary team working, and challenge non-interdisciplinary team working practice, so that an interdisciplinary team working culture is maintained.
• Keep up to date with relevant clinical developments within field of Stroke in both the national and local forum.  Ensure clinical developments are implemented and evaluated in line with best practice.
• Ensure the team works closely to all local and national guidelines and any relevant new publications.  Be a fully active participant in the development, implementation & review of local Guidelines.
• To provide highly specialised advice to others regarding the management and care of patients with a neurological condition (others include: relatives/ carers, health care workers in the community, liaison within the Integrated care services, and carers and professionals in the statutory and voluntary sectors)
• Practise and promote safe moving, handling, and positioning skills specific to neuro care.
• To provide clinical support for peers and junior staff and participate in the Learning development framework training.
• To be able to relate assessment results to the presenting disease / pathology / impairment.
• To promote health and well-being and raise awareness of physical impairments via health promotion initiatives.
• To ensure informed consent can be gained and all opportunities for gaining consent within the interdisciplinary team are explored to ensure patients and relatives are fully aware of the aims and objectives of intervention.
• To produce, disseminate and update reports/guidelines/training regarding individual care plans to carers/patients and other professionals.
• To contribute to the triage of new patients, prioritisation and overview assessment of new patients referred to the service. Communications and Key Working Relationships
• To demonstrate excellent interpersonal skills, taking an active role in meetings and developments as appropriate across acute and community to support effective in reach pathways.
• To employ excellent communication skills to enable patients, some of whom may have highly challenging communication impairments, to engage in their treatment, including the use of communication aids.
• To work autonomously as part of the interdisciplinary team  to organise and attend patient related meetings e.g. case conferences, patient reviews, discharge planning meetings, goal setting discussions and review meetings by discussing own and others input around patients’ needs ensuring a well-coordinated care plan.
• To ensure a productive professional relationship is established with patients, carers and families, agreeing decision-making, which is relevant to the patient’s management, considering any communication impairment, psychological and emotional state and differing cultural attitudes and expectations.
• To work with a link worker, signing interpreter or language interpreter as necessary to aid assessment and treatment of the patient and communication with the carer(s).
• To demonstrate skills in motivating patients and/or carers to engage in the therapeutic process.
• To continue to develop negotiation skills in the management of conflict across a range of situations.
• To deal with initial complaints sensitively, avoiding escalation where possible.
• To form productive relationships with relatives/carers and patients who may be under stress and/or may have challenging communication difficulties and/or who have other psychological/social/developmental barriers to developing relationships. To take an advocacy or facilitators role in helping patients and carers to express their needs, concerns and opinions to other professionals. Ensuring incidents are managed appropriately highlighting any risks to service manager.
• To generate initiatives to ensure that the Integrated community neuro and Stroke team contributes to the public and patient involvement process.
• Work with other stakeholders across GM to improve the delivery of the Stroke pathway.