1. JOB IDENTIFICATION Job Title: Staff Nurse Band 5 Reports to: Charge Nurse / Ward Manager Department, Ward or Section: Surgical/HDU/Day Case Unit

CHP, Directorate or Corporate Department: West Management Job Reference: MDLOCHBELFSURG04 No of Job Holders: Last Update: 12

February 2005

2. JOB PURPOSE As part of the multidisciplinary team the post holder is responsible for the assessment of care needs and the development of programmes of care, and the implementation and evaluation of these programmes ensuring the delivery of high standards of care to patients and their families.

3. DIMENSIONS Nursing care of 24 surgical beds, 2 high dependency beds and 4 day case trolley beds (including 2 paediatric beds) caring for:Emergency admissions Elective admissions for Pre and Post operative care (or other i.e. treatment/procedures) Elective admissions for investigations which require inpatient stay Patients transferred from other hospitals/wards Terminal care for patients Care of chemotherapy patients Care of paediatric patients Act as escort for emergency transfer to regional hospitals Follow Infection Control Policy and Procedures.

Staff management/Supervisory responsibilities of approx 3 Nursing Auxiliaries on a shift by shift basis. Budgetary Responsibility Aware of how to make best use of resources. Within the requirements of the Ward orders supplies to appropriate agreed levels. Following Financial Instructions is responsible for the safe keeping of patients valuables.


Assistant General Manager Clinical Co-ordinator

Charge Nurse / Ward Manager

Senior Staff Nurse / Deputy Ward Manager

Staff Nurse Grade ‘E’

Staff Nurse Grade ‘D’ This Post

Nursing Auxiliaries

5. ROLE OF DEPARTMENT To provide a safe and supportive environment to deliver a high standard of care for patients within Surgical Ward. There are 26 beds, of which 22 are general, 2 paediatric, 2 HDU, plus 4 day case trolley beds, catering for a wide range of surgical specialities pre and post operative, both major/minor, high/low dependency patients. Sub specialties are trauma, high dependency, paediatric, chemotherapy, palliative and terminal care, orthopaedics. 6. KEY RESULT AREAS                      Works as a practitioner within the Statutes & Guidelines laid down by the Nursing & Midwifery Council. Occasionally in the absence of the Ward Manager/Senior Staff Nurse takes charge of the Ward/Dept for the management of the daily responsibilities, including work allocation, deployment and supervision of staff, to ensure safe and effective running of the Ward/Dept. Is involved in setting and maintaining standards of care within the agreed guidelines of NHS Highlands policies and procedures to ensure adherence to, and delivery of, a high quality service. Is responsible for the assessment of care needs and the development, implementation and evaluation of programmes of care for patients, involving families/carers, ensures that appropriate documentation is correctly maintained. Provides support and advice to patients and their families/carers giving the knowledge required to help them understand and cope with their condition. Using evidence based practice continuously improves and develops own knowledge and acquires skills such as venepuncture, cannulation, ECG recording, catheterisation etc. Participates in the Discharge Planning process to ensure the smooth transition of the patient from hospital to community. Maintains effective communications with patients families/carers and other members of the multidisciplinary team to ensure that appropriate information is shared and patient needs are met. Leads and supervises less experienced staff/students who are providing care to patients and act as a source of advice to ensure their educational needs are met. Assists with teaching nursing colleagues and other members of the multidisciplinary team and is involved in staff Personal Development Plans to facilitate ongoing development. Organises own workload, prioritising and adjusting priority in the face of changing demands to ensure all needs are met. Is responsible for maintaining patient records within agreed standards. Maintains Ward stock levels, through ordering of stores, ensuring the economic use of all resources. Plays an active role in the continuing development of the Ward undertaking various aspects of clinical audit as designated by Charge Nurse. Attends and participates in meetings, promoting and maintaining good relationships within the Ward and with staff of all disciplines throughout NHS Highland. Maintenance and care of equipment. Participate in Ward rounds. Requirement to be multi-skilled to deal with a variety of surgical conditions e.g neurology, urology, trauma, bowel surgery, spinal injuries, terminal care, chemotherapy, paediatrics. Requirement to undertake extended roles e.g. cannulation, IV drug administration. May be required to escort patients unsupervised/supervised to regional hospitals. Will be required to care for patients in the HDU, including on occasion, ventilated patients.

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May be required to work under minimal supervision in the Day Case Unit. Adhere to and implement all Infection Control guidelines. Be aware of Health and Safety responsibility to provide a safe environment for patients and staff. Adhere to correct moving and handling techniques/correct use of aids e.g. hoists and all aspects of patient safety in accordance with NHS Highland Policy. Act as discharge co-ordinator/bed manager in absence of Ward Manager/Senior Staff Nurse. Organise and attend case studies as required. Act as Link Nurses for department e.g. infection control. Understanding of dealing with spillages e.g. chemotherapy. Following training, function as a supervisor for Student Nurses and new members of staff within the ward. Willingness to undertake computer training. Arrange transfers to other wards/departments/hospitals. Provision of health promotion and health education within the unit. Outwith pharmacy hours take responsibility for obtaining drugs from pharmacy. Carry out Last Offices and prepare deceased for viewing by relatives/families in the mortuary viewing room.

7a. EQUIPMENT AND MACHINERY The Staff Nurse is expected to have a knowledge of all equipment used in the Ward however may not have daily clinical involvement.

Equipment Various Intravenous Pumps Syringe Drivers Intravenous lines, venflons Butterfly devices, syringes, needles. Monitoring equipment for – Blood Pressure, temperature, pulse, cardiac output, glucose. Oxygen equipment – Flowmeters, masks, nasal cannulae Suction equipment Humidifier Nasogastric, Nasojujenal tubes. Stoma devices PEG Feeding (Peralaneous Endoscopic Gastronomy). Drains –Chest, Various Suction Devices Pulse oximetry Urinary Catheters – Suprapubic, urethral. Nebulisers. Various hoists, slides, pat slides, turntables Traction equipment Use of cricket/patient chair transport Resuscitation equipment including Defibrillator ECG Monitors Ventilator Central venous pressure lines Ophthalmoscope/Oroscope Sigmoidoscopes Proctoscopes Doppler Machine Electric Beds/pressure relieving mattresses Electric Fans Spinal boards, vacu-mats, cervical collars

Use } } To deliver prescribed fluids and/or drugs safely } } To measure and observe patients condition and act appropriately on changes in condition. To give correct prescribed Oxygen concentration. To assist removal of secretions To humidify oxygen therapy To drain gastric, small bowel contents. Removal of bowel contents To feed direct to stomach. To drain fluid/air from various parts of body. To monitor oxygen saturation To drain urine. To give respiratory therapy. To move patients safely. For orthopaedic cases Patient transportation To resuscitate and administer shock following cardiac arrest. To monitor heart rhythm To mechanically assist patient ventilation To monitor central venous pressure Examination of eyes/ears For internal examination. To check blood flow in limbs. Safe movement of patients. To keep environment cool To immobilise patients with potential spinal injury

Bear Hugger To warm patients Epidural pumps, patient controlled analgesia pumps For pain management Tracheostomy tubes For airway management Bladder scanning Bladder irrigation Feeding pumps Meal trolleys Computers (Internet, Intranet & Word, Budgetscan) Printers, Fax machine To monitor amount of urine in the bladder To wash out the bladder Administration of feeds

7b. SYSTEMS 1. 2. 3. 4. 5. 6. 7. 8. 9. Maintains patients records in accordance with Nursing & Midwifery Council Guidelines and NHS Highland standards. Ensures correct use of computerised systems i.e. Patient Administration System, Immediate Discharge Letter. Patient Administration System – Recording discharges, deaths, transfers. Personal Development Plans. Ward Communication Systems. Aware of duty rotas/completion of timesheets Manual collation of statistics on requests for various projects e.g. QIS Use of hospital Intranet to book places on courses and study days. Ward takes on the role of hospital switchboard from 2130 – 0800 Mon-Fri and 2130 – 0900 Sat/Sun

8. ASSIGNMENT AND REVIEW OF WORK The Staff Nurse will be responsible to Ward Manager for clinical guidance and professional management, work review and formal appraisal of performance. Works within statutes and guidelines of the Nursing & Midwifery Council, National, Highland and local agreed policies, protocols and procedures. Workload will be assigned by the Ward Manager or Senior Staff Nurse however the Staff Nurse will have responsibility for managing a defined workload within professional guidelines. Named Nurse policy in operation.

9. DECISIONS AND JUDGEMENTS Occasionally in the absence of Ward Manager/Senior Staff Nurse allocates work and deploys staff within agreed resources to ensure needs are met. Accountable for own practice. Participates in multidisciplinary meetings Assists with formulation of departmental policies May need to make advanced complex decisions in some situations e.g. resuscitation, HDU, in the absence of the nurse in charge. Assesses patients condition to establish any change involving other members of the multidisciplinary team as required. Continuously assesses patient condition and plans, implements and evaluates programmes of care.

10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB Balancing the expectations of the public with the human resources available. The ability to give good direct patient care to all patients prioritising and re-prioritising in the face of competing demands. Dealing with violent, aggressive and challenging behaviour both verbal and physical. Unpredictable workload – proactive planning required. Requirement to be multiskilled Escorting critically ill patients to other hospitals Day/Night rotation

May be required to work unsupervised Exposure to hazardous substances e.g. chemotherapy Risk of infection Maintaining up to date clinical skills and knowledge.

11. COMMUNICATIONS AND RELATIONSHIPS Communicates and listens to the patient, family/carers. Establishes and maintains professional relationships with nursing colleagues, medical colleagues, health care professionals, voluntary services to provide a planned, co-ordinated seamless service for patients/management. Communicates with support departments e.g. Estates, Supplies, Human Resources, Health & Safety Liaise with other hospitals re transferring patients. 12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB Physical Skills: Administer intravenous injections and/or intra-muscular injections, syringe pumps and infusions. Insertion of urinary catheters, nasogastric tubes Removal of sutures, staples, dressings Removal of wound drains, chest drains and central lines Calibrate equipment and computer keyboard skills Physical Demands: Patient movement with use of mechanical aides, manoeuvre patients. Push patients on trolleys, wheelchairs to and from Theatre and other departments. Stand/walking for the majority of shift. Continuous checking of equipment attached to patients e.g. IV infusion, catheters etc. Care of patients personal hygiene Handwashing between patients Escorting sick patients to other hospitals and working in cramped conditions in ambulance and helicopter. Mental Demands: Dealing with patients in severe pain, including children Dealing with Child Protection issues – neglect, abuse Concentration required when checking documents/patient notes and calculating drug dosages, whilst subject to frequent interruptions from patient/relatives/team members. Concentration required when observing patient behaviours which may be unpredictable. Required to have a wide knowledge base Exposure to violent, aggressive patients and relatives, both verbal and non verbal Dealing with stressful situations involving patients with acute mental health problems and the associated potential unpredictable behaviour. Dealing with patients under the influence of alcohol/drugs and the associated potential unpredictable behaviour.

Emotional Demands: Communicating with distressed/anxious/worried patients/relatives. Caring for the terminally ill. Caring for patients following receipt of bad news. Exposed to distressing situations e.g. sudden death Required to be multiskilled to deal with a variety of emergency surgical conditions Risk of infection. Working Conditions: Exposure to body fluids, faeces, emptying bed pans/urinals, catheter bags, several times each shift. Exposure to verbal aggression, daily on occasions. Exposure to chemotherapy Caring for patients in unkempt physical condition requiring undressing and washing as part of their care. Risk assess the ward area in order to provide a safe working environment Day/Night rotation 13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB First Level Registered Nurse. Recent post registration experience in surgical is desirable. Motivated and energetic. Calm personality with good sense of humour Evidence of ongoing post registration education. Evidence of team working skills with ability to work using own initiative. Effective listening and interpersonal skills. Time management skills. The ability to develop knowledge and clinical skills.

14. JOB DESCRIPTION AGREEMENT I agree that the above Job Description is an accurate reflection of my duties and responsibilities at the date of signing. Job Holder’s Signature: Manager’s Signature: Date: Date:

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