IHDT Nurse inPlymouth inPlymouth PUBLISHED WED 22 JAN 2025

The Complex Discharge Team have some exciting news

We are looking for someone who has the leadership skills to promote and encourage a culture of empowering patients to continue their ongoing care at home.

It is important to have strong communication and interpersonal skills, along with the capacity to work methodically and maintain composure.

We pride ourselves on being friendly, approachable, hardworking, caring, and empathetic. We all work and support each other as a team and would welcome those who strive for the best and share our vision to get patients home.

Please contact IHDT Deputy Team Leads Gemma Westran and Rebecca Steer Tel :or 431686. It is intended that the interviews will take place within 2 weeks of the closing date therefore if you have not heard from us by this time; you may assume that you have not been successful.

This role may not be eligible for sponsorship under the Skilled Worker route, please refer to the Direct Gov website for more information with regards to eligibility.

The post holder will conduct the operational and clinical responsibilities of a integrated hospital discharge nurse this will include the coordination and delivery of high quality evidence based discharge assessments and onward care planning by the team and will require a close working relationship with the Band 8 Team Manager and Band 7 Deputy Team Manager.

Based in UHP Derriford Hospital the post holder will be accountable to the IHDT Deputy Team Manager on a day to day basis for the leadership and management of the discharge team the post holders relationship with the team manager will be collaborative and seamless.

All Livewell Southwest staff are expected to able and willing to work across a 7 day service.

Job Share(s) Considered

Please note that Livewell may close the job advertisement earlier than the specified deadline if a high number of applications are submitted. Therefore, we recommend you submit your application at the earliest opportunity

About us

Responsibility for People Management

• To act as a Care Coordinator for patients/Carers and arrange for appropriate care packages to be set up
• To be responsible for assessing, diagnosing, implementing, planning and reviewing complex needs and packages of care in partnership with patients, carers and multi-professional agencies including case conferences.
• To use clinical reasoning and utilise a wide range of appropriate treatment options to formulate individualised programmes of care and to provide intervention plans for people with a wide range of complex conditions.
• To provide good quality advice and information regarding the range of realistic options available for meeting the persons care needs and to arrange for care to be set up effectively with supporting documentation.
• Be responsible for the planning, implementing, development, delivery and evaluation of care from the acute hospital into the community
• To manage and prioritise a defined caseload and delegate where appropriate to the skill mix of the team.
• Be responsible for providing and maintaining a learning environment and maximise opportunities for educational and development in the clinical area to enhance individual development and performance in the delivery of high standards. Acting as expert resource and assist in teaching knowledge and clinical skills for other health care professionals.
• Take part in the process of clinical supervision and support clinical supervision and reflective practice for team members.
• Support recruitment and selection of new staff, which may include being part of an interview panel.
• Act as mentor for new staff and students, including leading on a structured induction and training program for new members of staff.
• Support the coordination of study leave, annual leave, and rotas to ensure the service is operationally covered. Where difficulties are identified in maintaining service provision that this is escalated to senior managers of the service in team managers absence.
• Support the team manager in the supervision, line management, appraisals, mandatory training, standards and staff performance to work within the teams and supporting and investigating staff performance and absence.
• Take responsibility for your own personal and professional development, maintain competence, knowledge and skills commensurate with the role.
• To undertake all required training to develop competencies required for the role.
• To maintain effective verbal and written communication with the clinical team and to keep staff informed of changes to prescribing intervention or treatment provided to service-users.
• To work in partnership with medical staff and service-users in the development and implementation of clinical management plans related to an individuals treatment and prescribing needs.
• To establish and maintain good liaison with key stakeholders in the individuals care e.g. GP practices and other services in the area, including sharing prescribing information and rational.
• To participate in Reflective Practice, Clinical Supervision and Appraisals for Discharge Case Managers as per organisation policies.
• Identify areas of practice/role development and enable and support staff to initiate change.
• To Manage and prioritise a defined caseload and delegate where appropriate.
• To participate in policy development through professional forums and implement practice ensuring the clinical practice reflects national and local drivers.
• To be accountable for effective time and staff management within the constraints of the budget.
• To support, complete and monitor staff to ensure the submission of all necessary forms, documentation, including IT data and forward as required by the manager/organisation are undertaken in a timely manner.
• To have a flexible approach to the working week in order to meet the needs of the patient and the service.

Responsibility for financial and/or physical resources

• To demonstrate awareness of resources, providing cost effective and quality-controlled usage of products.
• Be authorised signatory and signing off the supplies and expenses. These include off duty, staff overtime, annual leave, bank nurses and the procurement of supplies for the team.
• Exercise a duty of care in relation to the use of the organisations equipment and resources in a cost-effective manner.
• To be responsible for overseeing and monitoring and authorising of equipment.

Responsibility for administration

• The post holder may be required to use a computer, mobile phone or lone working device and will be required to adhere to Livewell Southwest policies regards their use.
• Compliance will be monitored through observation, spot checks and through incident management in line with the Organisations Incident reporting and Investigation policy.
• The post holder will be expected to oversee the standard of patients records by audit or peer review and have a regular open discussion with team members.
• To be responsible for maintaining lone working information for identified staff group and monitoring staff adherence to lone working policy and use of devices.

Responsibility for people who use our services

• To be accountable for the direct delivery of service by providing holistic evidence-based practice to patients and their carers, ensuring maximum independence and quality of life in a constantly changing environment. To achieve positive patient outcomes in partnership with multi-professional agencies.
• Utilise a range of specialised clinical skills appropriate to the needs of individual patients and the clinical setting in which they are seen. Exercising a high level of judgement, discretion and decision making in clinical care.
• Provide patients, families, and carers with tailored education, and evaluate impact of programmes. Provide advice and support, that may precipitate symptoms of acute exacerbation of underlying conditions or illness and include lifestyle changes that would be advantageous to health.
• Working within professional guidelines to make clinical decisions without supervision.
• To triage and accept appropriate routine and urgent referrals directly from other disciplines, patients, carers, and members of the public and / or refer to other agencies where appropriate. Ensuring all referrals are prioritised accordingly.
• To have a flexible approach to competing priorities in order to meet the needs of the patient and the service.
• The aim of which is ensuring maximum independence and quality of life in a constantly changing environment.
• To undertake comprehensive risk assessments of all situations associated with the care of patients to ensure nurses and the carers safety.
• To maintain and encourage patients to be discharge to their own homes, encouraging and promoting maximum independence and optimum quality of life.
• Preserve confidentiality and be aware of the Data Protection Act, Access to Health Records and Consent for Treatment.
• To supervise, monitor, develop standards of care and participate in audit collate, and analyse data.

Responsibility for implementation of policy and/or service developments

• Ensure adherence to Livewell Southwest Policies.
• Develop, review and audit guidelines/ protocols/ polices for specific aspects of own service in line with NICE guidance, best practice Guidance and professional forums and support implementation into practice ensuring the clinical practice reflects national and local drivers.
• Promote sharing of best practice with other Teams and Departments within the region.
• To be involved with the development, implementation, and monitoring of standards.
• To identify community health needs and participate in new projects, research, and audit. Supporting staff to initiate change.
• To demonstrate knowledge and understanding of relevant government targets. Providing leadership and acting as a change agent disseminating this knowledge across the organisation.
• Facilitate the development of service objectives within own area, considering relevant guidelines and the needs of the Organisation.
• To support Patient Safety Incident Investigations, after action reviews, case reviews, swarm-based huddles.
• To support the investigation of complaints with support from the Operational Manager, Clinical Nurse Specialist and Customer Services Department.
• Develop links with other professional and voluntary bodies to ensure maximum effectiveness of the service and patient care.
• Lead practice innovation and the implementation of change in relation to the own area within the Organisation.
• Develop initiatives in health promotion and disease management which includes monitoring and improving the standards of health of the community.
• Identify and undertake areas for research and evaluations within own specialty, facilitating the involvement of appropriate staff.
• To be aware of the current legislation and prescribing developments that may impact on the delivery of services to service users.
• Have a good knowledge, and apply current Medicines, Controlled Drug and Non-Medical prescribing Policies.

Other Responsibilities

• To maintain accurate patient records, which are confidential, up to date, legible and that all care given has been documented. These records must be maintained as specified in the LWSW Policies, NMC guidelines and Government directives.
• To be responsible for organising own time management on a daily basis in line with caseload demands balancing patient needs with the non-clinical aspect of the role.
• To participate in an annual appraisal of their work in line with the Knowledge and Skills Framework (KSF) where the job description will be reviewed, and objectives set. In line with the annual development plan the post holder will be expected to undertake any training or development required to fulfil their role.
• To remain updated and competent and ensure that clinical practice is evidence based.
• Assume responsibility for own professional development and personal knowledge.