cANP in Hepatology

1.0 Position Summary:

This role has been created as a component of delivery of the Abnormal LFTs/ Hepatology Pathway. The Abnormal LFTs/ Hepatology Pathway is one of a number of modernised care pathways developed by the HSE.
The Abnormal LFTs/ Hepatology Pathway will implement a new Hub and Spoke approach and will be delivered by Advanced Nurse Practitioners (ANPs) who will complete diagnosis and staging, elastography/venesection and motivational interviewing for behavioural change. Patients with Abnormal LFTs will be reviewed and treated quicker through the implementation of a hub and spoke Hepatology model. A collaborative multidisciplinary (MDT) approach to Alcohol Related Liver Disease and Non-Alcohol-Related Fatty Liver Disease will be adopted between regional hepatology hubs and community services such as addiction services, obesity hubs and chronic disease ambulatory care hubs. The Abnormal LFTs/ Hepatology Pathway will establish a more flexible and efficient service that is responsive to patient need and will actively reduce outpatient waiting times, emergent hospital presentations and hospital admissions.

The advanced practice service is provided by nurses who practice at a higher level of capability as independent, autonomous and expert advanced practitioners. The overall purpose of the service is to provide safe, timely, evidenced based nurse-led care to patients at an advanced nursing level .This involves undertaking and documenting complete episodes of patient care, which includes comprehensively assessing, diagnosing, planning, treating and discharging patients in accordance with collaboratively agreed local policies, procedures, protocols and guidelines and/or service level agreements/ memoranda of understanding.
The value of the nursing contribution as a distinct profession must be safeguarded and articulated in the development of new services led by advanced nurse practitioners, complementing rather than replacing current services delivered by doctors (NMBI 2017 p.9).
The advanced practice role demonstrates a high degree of knowledge, skill and experience that is applied within the nurse-patient/client relationship to achieve optimal outcomes through critical analysis, problem solving and accurate decision-making (NMBI, 2017).
Central to this is the provision of quality care, a safe environment and processes for patients by the use of evidence based clinical guidelines that address patient expectations, promote wellness and evaluate care given. The role will provide clinical leadership and professional scholarship in order to develop nursing practice and health policy at local, regional and national level. The role will contribute to nursing research to shape and advance nursing practice, education and health care policy at local, national and international levels.

The cANP (Hepatology) demonstrates advanced clinical and theoretical knowledge, critical thinking, clinical leadership and complex decision-making abilities.

The cANP (Hepatology) practices in accordance with the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (NMBI 2014), the Scope of Nursing and Midwifery Practice Framework (NMBI 2015), Advanced Practice (Nursing) Standards and Requirements (NMBI 2017), and the Values for Nurses and Midwives in Ireland (Department of Health 2016).

The cANP (Hepatology) service provides clinical leadership and professional scholarship in the delivery of optimal nursing services and informs the development of evidence-based health policy at local, regional and national levels.

The cANP (Hepatology) contributes to nursing research that shapes and advances nursing practice, education and health care policy at local, national and international levels.

2.0 Key Duties:

• Participate as an active member of the Hepatology Team

• Develop Nurse- led outpatient clinics

• Attend multidisciplinary team meetings

• Develop the interface between primary and secondary care services (General Practice, External Hospitals, Public Health Nurses (PHN)s, Practice Nurses) through clinical work, education, research and leadership

• Contribute to the continuous improvement of the quality of care experienced by patients accessing the Hepatology Service

• Advance the theory and practice of advanced nursing practice through demonstrating expert practice, autonomy in practice clinical leadership, research and audit

• Work with the healthcare team contributing to meeting health service quality/patient safety and resource needs at local and national level and within a patient-centred philosophy

The duties detailed above are not intended to be a comprehensive list of all the duties involved and consequently, the post holder may be required to perform other duties as appropriate to the post which may be assigned to him/her from time to time and to contribute to the development of the post while in office

2.0 Purpose of the Post:

The main purpose of the post is to develop the job description and supporting documentation under the direction of the Health Care Provider’s Advanced Practice Stakeholder Governance Group, to enable the individual nurse to meet the Nursing and Midwifery Board of Ireland (NMBI) Criteria for Registration as an Advanced Nurse Practitioner as set out in Advanced Practice (Nursing) Standards and Requirements (NMBI, 2017).

The individual will undertake the academic preparation and develop the clinical and leadership skills, competencies and knowledge required to meet the criteria to be registered as a Registered Advanced Nurse Practitioner (RANP) with NMBI. The scope of the cANP role must reflect the incremental development of expertise and as such, the cANP cannot deliver care as an autonomous practitioner.

The value of the nursing contribution as a distinct profession must be safeguarded and articulated in the development of new services led by advanced nurse practitioners, complementing rather than replacing current services delivered by doctors (NMBI 2017 p.9).

The overall purpose of the post is to provide safe, timely, evidenced based nurse-led care to patients at an advanced nursing level .This involves undertaking and documenting a complete episode of patient care (assess, diagnose, plan, treat and discharge patients) according to collaboratively agreed protocols and scope of practice in the clinical setting; demonstrating advanced clinical and theoretical knowledge, critical thinking, clinical leadership and decision making skills.

The advanced practice role demonstrates a high degree of knowledge, skill and experience that is applied within the nurse-patient/client relationship to achieve optimal outcomes through critical analysis, problem solving and accurate decision-making (NMBI, 2017).

Central to this is the provision of quality care, a safe environment and processes for patients using evidence based clinical guidelines that address patient expectations, promote wellness and evaluate care given.

The role will provide clinical leadership and professional scholarship in order to develop nursing practice and health policy at local, regional and national level.

The role will contribute to nursing research to shape and advance nursing practice, education and health care policy at local, national and international levels.

3.0 Principal Responsibilities:

The key responsibilities of the cANP will be to develop a higher level of capability across the six domains of competences as defined by Bord Altranais agus Cnáimhseachais na hÉireann Advanced Practice (Nursing) Standards and Requirements (NMBI 2017).

• Professional Values and Conduct
• Clinical Decision Making Competences
• Knowledge and Cognitive Competences
• Communication and Interpersonal Competences
• Management and Team Competences
• Leadership and Professional Scholarship Competences

Domain 1: Professional Values and Conduct

The cANP Hepatology will gain increased competence in applying ethically sound solutions to complex issues related to individuals and populations by:

• Demonstrating accountability and responsibility for professional practice as a lead healthcare professional in the care of patients with fractures.

• Collaborating with his/her supervisor and local stakeholder group to scope the caseload and scope of practice for the cANP (Hepatology).

• Collaborating with his/her supervisor and local stakeholder group to determine the exclusion criteria for the cANP (Hepatology).

• Articulating safe boundaries and engaging in timely referral and collaboration for those areas outside his/her scope of practice, experience, and competence by establishing, in collaboration with key stakeholders, referral pathways and locally agreed policies, procedures, protocols and guidelines to support and guide the Hepatology service.

• Demonstrating leadership by practising compassionately to facilitate, optimise, promote and support the health, comfort, quality of life and wellbeing of persons whose lives are affected by altered health, chronic disorders, disability, distress or life-limiting conditions.

• Selecting a professional practice model that provides him/her latitude to control his/her own practice, focusing on person centred care, interpersonal interactions and the promotion of healing environments.

• The chosen professional practice model for nursing will emphasise a caring therapeutic relationship between the cANP (Hepatology) and his/her patients, recognising that cANP (Hepatology) work in partnership with their multidisciplinary colleagues.

• Articulating and promoting the advanced practice nursing service in clinical, political and professional contexts {for example presenting key performance outcomes locally and nationally; contributing to the service’s annual report; participating in local and national committees to ensure best practice as per the relevant national clinical and integrated care programme}.

Domain 2: Clinical-Decision Making Competences
The cANP (Hepatology) will enhance his/her advanced knowledge, skills, and abilities to engage in senior clinical decision-making by increasing his/her capability to:

• Conduct a comprehensive holistic health assessment using evidenced based frameworks, policies, procedures, protocols and guidelines to determine diagnoses and inform autonomous advanced nursing care.

• Synthesise and interpret assessment information particularly history including prior treatment outcomes, physical findings and diagnostic data to identify normal, at risk and subnormal states of health.

• Demonstrate timely use of diagnostic investigations / additional evidence-based advanced assessments to inform clinical-decision making.

• Exhibit comprehensive knowledge of therapeutic interventions including pharmacological and non-pharmacological advanced nursing interventions, supported by evidence-based policies, procedures, protocols, and guidelines, relevant legislation, and relevant professional regulatory standards and requirements.

• Initiate and implement health promotion activities and self-management plans in accordance with the wider public health agenda.

• Discharge patients from the service as per an agreed supporting policy, procedure, protocols, guidelines and referral pathways.

Domain 3: Knowledge and Cognitive Competences

The cANP (Hepatology) will actively contribute to the professional body of knowledge related to his/her area of advanced practice by enhancing his/her capability to:

• Provide leadership in the translation of new knowledge to clinical practice (for example teaching sessions; journal clubs; case reviews; facilitating clinical supervision to other members of the team).

• Educate others using an advanced expert knowledge base derived from clinical experience, on-going reflection, clinical supervision and engagement in continuous professional development.

• Demonstrate a vision for advanced practice nursing based on service need and a competent expert knowledge base that is developed through research, critical thinking, and experiential learning.

• Demonstrate accountability in considering access, cost and clinical effectiveness when planning, delivering and evaluating care (for example key performance areas, key performance indicators, metrics).

 
Domain 4: Communication and Interpersonal Competences

The cANP (Hepatology) will negotiate and advocate with other health professionals to ensure the beliefs, rights and wishes of the person are respected by gaining increased competence and capability to:

• Communicate effectively with the healthcare team through sharing of information in accordance with legal, professional and regulatory requirements as per established referral pathways.

• Demonstrate leadership in professional practice by using professional language (verbally and in writing) that represents the plan of care, which is developed in collaboration with the person and shared with the other members of the inter-professional team as per the organisation’s policies, procedures, protocols and guidelines.

• Facilitate clinical supervision and mentorship through utilising one’s expert knowledge and clinical competences.

• Utilise information technology, in accordance with legislation and organisational policies, procedures, protocols and guidelines to record all aspects of advanced nursing care.

Domain 5: Management and Team Competences
The cANP (Hepatology) will manage risk to those who access the service through collaborative risk assessments and promotion of a safe environment by:

• Promoting a culture of quality care.

• Proactively seeking feedback from persons receiving care, families and staff on their experiences and suggestions for improvement.

• Implementing practice changes using negotiation and consensus building, in collaboration with the multidisciplinary team and persons receiving care.

Domain 6: Leadership and Professional Scholarship Competences
The cANP (Hepatology) will lead in multidisciplinary team planning for transitions across the continuum of care by enhancing his/her competence and capability to:

• Demonstrate clinical leadership in the design and evaluation of services (for example findings from research, audit, metrics, new evidence).

• Engage in health policy development, implementation, and evaluation (for example key performance indicators from national clinical and integrated care programme/HSE national service plan/ local service need to influence and shape the future development and direction of advanced practice.
• Identify gaps in the provision of care and services pertaining to his/her area of advanced practice and expand the service to enhance the quality, effectiveness and safety of the service in response to emerging healthcare needs.

• Lead in managing and implementing change.

Advanced Practice Performance Management and Evaluation:

Performance Indicators (PI’s) are required to evaluate nursing interventions and implement initiatives to improve quality and quantity of the nursing care provided. They should have a clinical nursing focus as well as a breakdown of activity, including patients seen and treated. In addition, they identify areas of good practice that must be recognised and celebrated (HSE 2015).

The Department of Health (2017) Framework for National Performance Indicators for Nursing and Midwifery provides a guiding framework for the development of Nursing and Midwifery PI’s.

In collaboration with the Director of Nursing, the cANP will identify and develop Nursing PI’s for their area of practice, collect and collate data which will provide evidence of the impact and effectiveness of the interventions undertaken.

The RANP (Hepatology) will evaluate audit results and research findings to identify areas for quality improvement in collaboration with nursing management and multidisciplinary team colleagues (primary and secondary care).

Professional / Clinical:

The cANP (Hepatology) will practice nursing according to:
• Professional clinical guidelines

• National Health Policy.

• Local policies, procedures, protocols and guidelines

• Current legislation

• Values for Nursing and Midwifery – Care, Compassion and Commitment (DoH, 2016).

Education and Training:

The cANP (Hepatology) will:
• Contribute to service development through appropriate continuous education, research initiatives, keeping up to date with nursing literature, recent nursing research and new developments in nursing practice, education and management.

• Provide support and advice to those engaging in continuous professional development in his/her area of advanced nursing practice.

The cANP must develop a professional practice portfolio, incorporating evidence of learning from continuing professional development, clinical supervision, reflective practice and review of his/her own scope of practice in accordance with regulatory requirements and service need.

Selection Criteria:

Selection criteria outline the qualifications, skills, knowledge and/or experience that the successful candidate would need to demonstrate for successful discharge of the responsibilities of the post.

Applications will be assessed on the basis of how well candidates satisfy these criteria.

Mandatory:

1. Statutory Registration, Professional Qualifications, Experience, etc
(a) Eligible applicants will be those who on the closing date for the competition:
(i) Be a registered nurse/midwife with the Nursing and Midwifery Board of Ireland [NMBI]
(Bord Altranais agus Cnáimhseachais na hÉireann) or entitled to be so
registered.

(ii) Be registered in the division(s) of the Nursing and Midwifery Board of Ireland
(Bord Altranais agus Cnáimhseachais na hÉireann) Register for which the
application is being made or entitled to be so registered.
OR
In recognition of services that span several patient/client groups and/or
division(s) of the register, provide evidence of validated competences relevant
to the context of practice.

(iii) Have a broad base of clinical experience relevant to the advanced field of
practice

(iv) Be eligible to undertake a Master’s Degree (or higher) in Nursing/Midwifery or a Master’s
Degree, which is relevant, or applicable, to the advanced field of practice. The
Master’s programme must be at Level 9 on the National Framework of
Qualifications (Quality & Qualifications Ireland), or equivalent. Educational
preparation must include at least three modular components pertaining to the
relevant area of advanced practice, in addition to clinical practicum.
OR
(v) Be currently undertaking a Master’s Degree in Nursing/Midwifery (Advanced Practice
Pathway) or be eligible to register to undertake additional Level 9 National
Framework of Qualifications (Quality and Qualifications Ireland) specific modules
of a Master’s Degree in Nursing/Midwifery (Advanced Practice Pathway) within an agreed
timeframe. Educational preparation must include at least three modular
components pertaining to the relevant area of advanced practice, in addition to
clinical practicum. 

OR
(vi) Possess a Master’s Degree (or higher) in Nursing/Midwifery or a Master’s Degree which is
relevant, or applicable, to the advanced field of practice. The Master’s
programme must be at Level 9 on the National Framework of Qualifications
(Quality & Qualifications Ireland), or equivalent. Educational preparation must
include at least three modular components pertaining to the relevant area of
advanced practice, in addition to clinical practicum.

(b) Candidates must possess the requisite clinical, leadership, managerial and administrative knowledge

and ability for the proper discharge of the duties of the office.

2. Annual registration
(i) Practitioners must maintain live annual registration on the appropriate/relevant Division of
the register of Nurses and Midwives maintained by the Nursing and Midwifery Board of
Ireland [NMBI] (Bord Altranais agus Cnáimhseachais na hÉireann) for the role.

(ii) Confirm annual registration with NMBI to the HSE by way of the annual Patient Safety
Assurance Certificate (PSAC).

3. Health
Candidates for and any person holding the office must be fully competent and capable of
undertaking the duties attached to the office and be in a state of health such as would indicate a
reasonable prospect of ability to render regular and efficient service.

4. Character
Candidates for and any person holding the office must be of good character.

Desirable

• Previous managerial experience desirable

• Have completed or will be willing to complete a Professional Diploma Prescription of Medication.