Band 7 Respiratory Clinical Nurse specialist

Respiratory medicine at Barnet Hospital is a busy and rapidly expanding service catering to inpatients and outpatients with a broad range of respiratory conditions. The main focus of this role will be around airways disease, particularly COPD and asthma. Barnet lies at the interface of several different community teams with a large amount of COPD admissions, and the Trust also operates a severe asthma MDT which prescribes and administers asthma biologic therapies for patients in North/Central London.

The post holder will work alongside the existing respiratory CNS at Barnet and also the CNS at the Royal Free Hospital. They will assist in developing a seamless service spanning outpatient clinics, telephone/virtual clinics, ambulatory and inpatient care. It includes supporting the ward teams and in particular, the newly opened ECU and respiratory ward (Quince) in promoting excellence in nursing care to maintain and improve clinical standards. We expect the post holder to offer strong and effective leadership to ensure that all patients are treated with compassion, dignity and respect.

Main duties of the job

The post holder will empower patients and their carers to participate in the management of their conditions, thus aiming to improve the longevity and quality of their lives. The post holder will work closely with the existing respiratory CNS at Barnet and Royal Free Hampstead as well as the rest of the multi-professional respiratory team in a supported but largely independent practitioner role.

As such, this post will require specialist experience of respiratory medicine, excellent communication skills, motivation, autonomy and flexibility. It offers huge opportunities for personal and service development for the post holder and is placed in a supportive and friendly hospital.

Job responsibilities

1. Clinical Practice
   • Independently conduct nurse-led outpatient clinics for patients with chronic lung disease, including optimising treatments, liaising with consultants and others as appropriate. This will include patient education, developing personalised action plans, measurement of FeNO, performance of peak flow monitoring and checking inhaler technique.
   • Perform clinical assessment and management of complex patients with chronic respiratory disease. This may include performing oxygen assessments +/- blood gas sampling, providing nebuliser assessments and developing practitioner prescriber skills.
   • Support the severe asthma MDT to systematically assess and manage patients with severe asthma. This will include reviewing patients in the multidisciplinary severe asthma clinic, organising specialist blood and allergy tests, using validated patient questionnaires, maintaining entries into the UK Severe Asthma registry and the delivery of asthma biologics including omalizumab, mepolizumab, benralizumab in the ambulatory and/or home setting.
   • Work with relevant teams to plan and organise specific post-discharge interventions and advance care planning for individual patients. This will involve close communication with e.g. community respiratory teams, palliative care teams, general practices.
   • Liaise with other local community health-care providers to optimise support for patients from different and diverse agencies including community provider teams, multidisciplinary hub, local Breathe Easy groups.
   • To assess and manage inpatients with respiratory disease, including interface with ED and other medical specialties, in order to optimise care and facilitate timely and safe discharge.
   • Contribute to the COPD best practice tariff to ensure compliance. This includes early specialist review and implementation of COPD care bundles.
   • Support the weekly interstitial lung disease service alongside the lead consultant.
   • Be accessible for patients phoning in concerned about their condition and to provide advice or involve other clinicians as appropriate.
   • Be an ambassador for smoking cessation within the hospital, including early discussion +/- prescribing of therapies and referral onwards to local smoking cessation teams.
   • Support the new ambulatory pleural service at Barnet Hospital.
2. Leadership / Management
   • Share expertise with healthcare professionals on a local and national level through professional conferences, forums and bodies.
   • To liaise and work with other CNSs across the trust to share best practice and ideas to strengthen practice and reduce unwarranted variation in care.
   • Continually assess and monitor risk in own and others practice and challenge practice where appropriate.
   • Exercise sound leadership and inspire colleagues to improve standards and quality and to develop professional practice.
   • Develop appropriate strategies to make use of technology in the interests of patients.
   • Attend and be an active participant in relevant clinical and managerial groups at a divisional, Trust, regional and national level.
   • Act as an expert respiratory practitioner in implementing appropriate local guidance / NICE guidance across the Trust.
   • Audit of the service, particularly regarding key outcomes such as patient satisfaction and re-admission rates. This will include maintenance of appropriate databases, e.g. for oxygen toxicity or frequent hospital attenders.
   • The post holder will be expected to play a lead role in quality improvement within the service and will be supported to implement their own ideas and projects.
3. Education / Practice and Development
   • Demonstrates knowledge of contemporary clinical practice, explores new ideas and introduces evidence-based change in line with local and national initiatives.
   • Utilise specialist skills to provide training, education, information and support to staff involved in the delivery of respiratory care as well as patients and carers.
   • Act as an advisor and role model to doctors, nurses and therapists as well as students to ensure appropriate care is planned, implemented and evaluated.
   • Develop and provide written information and educational materials for patients and carers.
   • Work with the consultant team to plan and implement on-going education for nursing, medical and therapy staff as well as students (including UCL medical students).
   • To be responsible for own professional development and keep abreast of new clinical practices. Maintain a portfolio for your professional development reflecting personal professional development through attending courses and reflective practice.
   • Ensure mandatory and statutory training is current.
   • Attend National conferences eg. BTS, ARNS.
   • Act at all times in accordance with Royal Free London NHS Foundation Trust and the Nursing and Midwifery Council guidelines.
4. Research Responsibilities
   • Periodically the department helps to recruit to research studies and the post-holder may be asked to help identify or refer patients for these.
   • There will also be opportunities to take part in local research and the department has a good track record of presentations at local and international meetings the post-holder would be encouraged to become involved in these.
5. Role-specific administration
   • Case finding for COPD and asthma admissions.
   • Help to lead and ensure timely electronic data entry into the National Asthma and COPD audit (NACAP).
   • Help to lead and ensure timely electronic data entry of patients with severe asthma onto the UK Severe Asthma Registry.
   • Completing Home Oxygen Order Forms (HOOFs) for hospital inpatients prior to discharge.
   • Completing onward referrals where appropriate, for example to the National Referral Service for smoking cessation.
   • Completion of appropriate casenote documentation for inpatients and telephone conversations.
   • Where appropriate, completion of Coordinate My Care records to facilitate advance care planning in certain patients.
   • Writing and electronically signing clinic letters for outpatients.
   • Other admin as arises, for example around documentation of the severe asthma MDT.
6. General Responsibilities
   • Infection Control
     • Infection control is everyone's responsibility. All staff, both clinical and non-clinical, are required to adhere to the Trust's Infection Prevention and Control policies and procedures and The Health and Social Care Act 2008: Code of Practice for the prevention and control of healthcare associated infections and make every effort to maintain high standards of infection control at all times thereby reducing the risk of Healthcare Associated infections.
     • It is the duty of every member of staff to take personal responsibility for the prevention and control of infection, as laid down in the Trust's policies and procedures which reflect the statutory requirements of the Hygiene Code.
     • To work in close collaboration with the Infection Control Team.
     • To ensure that monitoring of clinical practice is undertaken at the agreed frequency.
     • To ensure that the ward environments are cleaned and maintained to the highest standards ensuring that shortfalls are rectified, or escalate as necessary.
     • To ensure that all relevant monitoring data and issues are provided to the Directorates Governance structures.
     • To ensure that all staff are released to attend infection control-related educational sessions and staff with specialist roles, e.g. link practitioners, are released to undertake their duties.
   • Health and Safety at Work
     • The post holder is required to:
       • Take reasonable care for the health and safety of himself/herself and other persons who may be affected by their actions or omissions at work.
       • Co-operate with the employer in ensuring that all statutory and other requirements are complied with.
   • Confidentiality & Data Protection
     • The post holder has a responsibility to comply with the Data Protection Act 1998 and maintain confidentiality of staff, patients and Trust business.
     • If you are required to process information, you should do so in a fair and lawful way, ensuring accuracy is maintained. You should hold information only for the specific registered purpose and not use or disclose it in any way incompatible with such a purpose.
     • You should disclose information only to authorised persons or organisations as instructed. Breaches of confidentiality in relation to information will result in disciplinary action, which may include dismissal. Employees are expected to comply with all Trust policies and procedures and to work in accordance of the Data Protection Act 1998. For those posts where there is management or supervision of other staff it is the responsibility of that employee to ensure that their staff receive appropriate training (e.g. HISS induction, organising refresher sessions for staff when necessary.)
   • Conflict of Interest
     • The Trust is responsible for ensuring that the services for patients in its care meet the highest standards. Equally, it is responsible for ensuring that staff do not abuse their official position, to gain or benefit themselves, their family or friends.
   • Equality and Diversity
     • The Trust values equality and diversity in employment and in the services we provide. It is committed to promoting equality and diversity in employment and will keep under review our policies and procedures to ensure that the job related needs of all staff working in the Trust are recognised. The Trust aims to ensure that all job applicants, employees or clients are treated fairly and valued equally regardless of sex, marital status, domestic circumstances, age, race, colour, disablement, ethnic or national origin, social background or employment status, sexual orientation.

• Demonstrates ability to meet the Trust values.

• First level registration.
• First Level degree.

• Evidence of post registration qualification relevant to specialty.
• Mentorship qualification.

• Substantial post-registration experience in respiratory (community/hospital/both).
• Evidence of teaching junior members of staff & assessing students in practice.
• Proven evidence of improving the patient experience.
• Current experience of line management of staff.

• Experience of working in a severe asthma service.

• Expert specialist skills for the post.
• Knowledge of current advances and pathways of care relevant to specialty.
• Excellent communication skills and ability to negotiate and influence.
• Skilled in use of computer/key board.
• Knowledge of clinical governance issues e.g. handling complaints, clinical risk management.
• Ability to problem-solve, prioritise and to work to deadlines.
• Ability to motivate staff and improve individuals and team performance.
• Ability to develop collaborative working relationships with multi professional teams.
• Able to manage stressful situations and challenge decisions to ensure that patient needs are met.
• Able to lead, manage and motivate others in complex situations.