Mid Notts Care Home Nurse Specialist

NHS Jobs; Town of Mansfield (NY); On-site; USD 43,000 - 60,000; Full time

Job summary

Nottinghamshire Healthcare NHS Foundation Trust is seeking a nurse/care professional to provide case management for residents in care homes at risk of deterioration, ensuring high standards of care and contributing to service development. A driving licence and DBS clearance are required, with DBS costs deducted from salary.

The role involves risk stratification, comprehensive assessments, care planning, education of carers and continuous care coordination across primary care networks and

Qualifications

• Full UK driving licence and vehicle for business use.
• DBS check required at cost (paid by employee) and enrolment in DBS Update Service encouraged.

Responsibilities

• Work within the Mid Notts Care Home team and collaborate with primary care networks to identify very high intensity users with needs using risk stratification systems and other sources of information.
• Support a caseload of high risk patients resident in the locality care homes.
• Collaborate with clients, carers and health and social care professionals to identify unmet health and social care needs and circumstances.
• Undertake full assessments establishing baseline data to inform the development of an individualised care plan to meet the clients' needs within the context of long‑term clinical management planning.
• Interpret and discuss assessment outcomes with clients and carers, using high levels of communication skills to convey complex issues.
• Develop personalised care plans and formulate action plans based on evidence‑based care and national standards, maintaining up‑to‑date records.
• Use advanced skills and specialist knowledge to support holistic assessments, analysing symptoms and diagnostic information to plan care for optimal outcomes.
• Plan and implement therapeutic interventions to help patients with complex health care problems to regain stability and independence.
• Signpost patients and liaise with relevant stakeholders; educate residents, carers and staff about early warning signs to enable rapid management of complications.
• Maintain contact with residents if care is transferred to secondary care and ensure integrated, consistent care across services.
• Support end-of-life planning and enable families to manage disability and loss, preparing them for changes in condition.
• Provide health promotion and disease prevention for patients to maximise self care and schedule follow-up visits to monitor health.

Job description

The main purpose of the role is: To provide case management for patients living in Care Homes who are at risk of deteriorating health or avoidable hospital admission. To have continuing responsibility for the maintenance of high standards of care to care home patients who are cared for by adult community services. To contribute to strategies and policies for community adult service improvement and development. To contribute to the delivery of teaching and education in care homes. To take an active role in the delivery of the Enhanced Framework for Care Homes.

Main duties and responsibilities

• To work within the Mid Notts Care Home team and in collaboration with primary care networks to identify very high intensity users with needs using risk stratification systems and other sources of information.
• Support a caseload of high risk patients resident in the locality care homes.
• To work collaboratively with clients, carers and health and social care professionals, to identify unmet health and social care needs and circumstances.
• Undertake full assessments establishing baseline data to inform the development of an individualised care plan to meet the clients needs within the context of long‑term clinical management planning in a timely manner.
• Interpret and discuss assessment outcomes with clients and carers, using high level of communication skills to communicate complex issues.
• Develop personalised care plans and formulate action plans based on evidence‑based care and national standards of care and maintain accurate and up‑to‑date records as required by the organisation.
• Use advanced skills and specialist knowledge to support comprehensive and patient focused holistic assessments, analysing presenting symptoms and diagnostic information to develop a plan of care for optimal patient outcome.
• Plan and implement therapeutic interventions to help patients with complex health care problems to regain stability and independence in collaboration with the client, carers and multi-disciplinary team.
• Signpost patients to and liaise with the appropriate key stakeholders.
• Work with residents their carers and staff to teach and educate them about the early warning signs in order to facilitate rapid management of complications in a crisis.
• Maintain contact with the resident if care is transferred to secondary care and ensure effective communication is ongoing to ensure integrated and consistent care.
• Enable residents and their families to manage disability and loss preparing them for the changes in condition and support choice about end of life.
• Provide health promotion and disease prevention services to patients who have acute/chronic conditions to maximise self care.
• Schedule follow‑up visits appropriately to monitor residents and evaluate health/illness care.
• Educate carers concerning drug regimens, side effects and interactions.
• Actively encourage service user feedback.
• Act as a positive role model, provide clinical supervision, support and advise to colleagues across the organisation.
• Establish and maintain effective team working within the Care Home Team and wider Hospice.
• Work collaboratively with colleagues to continuously improve the standard of care and to develop the service.
• To work with providers of residential care to ensure commitment to quality of service provision and to take appropriate action where there are concerns.
• Actively participate in the development of teaching and communication strategies, addressing the learning needs of colleagues, care home staff, patients and carers.
• Act as a role model, setting, monitoring and evaluating the high standards and continual improvement to the community nursing service.
• Maintain a professional image as outlined in the NMC Code of Conduct.
• Participate in relevant research and audit activity.

Please note applicants will be required to pay for their DBS check. Costs are deducted from salary following appointment. The cost of the DBS application is £20.00 (standard) or £41.00 (enhanced), this cost will be deducted from your salary over the first 2 months of employment. You are encouraged to enrol for the DBS Update Service. An annual fee of £15 per year applies.

A full UK driving licence and vehicle for business use is required for this post; however reasonable adjustments will be made for disabled individuals in line with the Equality Act 2010.

Nottinghamshire Healthcare NHS Foundation Trust