Job summary
hours per week
Do you want to be part of aninnovative, dynamic Organisation that is committed to delivering the best careby the best people? We are looking to appoint a Community Matron to work 3 daysper week, who is passionate about high quality patient centered care to joinour highly regarded Community Matron Team.
Our Matron service was rated OUTSTANDINGfor CARE by the CQC at their inspectionin June 2022. Our highly skilled teamrequire like-minded staff to join the team. Your Healthcare Community Matronswork in partnership together across the Royal Borough of Kingston Upon Thames. Youwill work with patients who have complex long-term conditions, to proactively casemanage individuals and prevent inappropriate hospital admissions.
Main duties of the job
The role will incorporate working within acommunity matron team in partnership with the primary health care and socialcare professionals. This will include providingexpert case management, clinical assessment, diagnosis and individualizedtreatment plans, as well as promoting self-management, planning interventionsin light of fluctuating disease process and reduce inconsistencies in the carepatients receive. If any of the caseload are admitted to the acute provider thenthe post holder will actively work to facilitate a timely and safe discharge.
Afull driving license and access to a vehicle are essential.
This is an excellent opportunity to further develop yourclinical and prescribing skills and knowledge of long-term conditions.
About us
Welcome to Your Healthcare CIC, we area not for profit social enterprise, proud of delivering patient-led, highquality health and social care community services for residents in the Boroughof Kingston, as part of the NHS family.
Your Healthcare is located in the SouthWest of London within the Royal Borough of Kingston. Working as a CommunityInterest Company (CIC), our status allows us to invest any surplus or profitback into front line services, where it is needed most by you, our community. Our organisationoffers access to the NHS pension scheme, staff discounts, Agenda for Changeterms and conditions.
YourHealthcare proactively supports personal and professional development throughan annual appraisal process, in-house and external training, induction andmentorship support.
Job description
Job responsibilities
ClinicalPractice/Leadership
1. To identify, assess and signpost patients withcomplex long term conditions and nursing needs within the allocated caseload inconjunction with General Practitioners, physicians within the acute sector, otherlead clinicians and social care colleagues.
2. To developpersonalised management plans including self-care strategies to meet patientscomplex health and nursing needs.
3. To leadthe introduction and use of assisted technical nursing treatments utilisingrobust evidence base to meet effective long term conditions management, andavoidance of unnecessary hospital admission for patients on the allocatedcaseload.
4. Toprescribe, administer, monitor and review medications using the locally agreedmedicines management formulary where applicable for patients with long termconditions on the caseload in ensuring such approaches are consistent with YourHealthcare's policies, procedures and standards and ensure compliance with all appropriate legislation.
5. To supportpatients with complex disease management who have repeated active hospitaladmissions to develop their knowledge and understanding about their health andwellbeing to enable self-management within individual abilities and torecognise deterioration in a timely manner.
6. Toprovide clinical practice advice, training and professional support to thecommunity nursing team.
7. Toensure that supplies and associated equipment are available to support theachievement of clinical management plans.
8. To makeindependent referrals for diagnostic tests and/or opinions and care whichrequires free, open and informed discussion at all levels from consultants toGPs and specialist services.
9. To contributeactively through data collection and analysis towards the effective managementof service delivery and development within the organisation.
10. To ensure that the community matron service is integrated with thedistrict nursing teams and to offer clinical advice on the care of patientswith complex needs as appropriate.
11. To work autonomously and as a member of themulti-disciplinary team, developing and maintaining effective workingrelationships with other agencies including acute, primary and voluntarysectors.
12. To manage a caseload and the careof patients independently whilst simultaneously recognising the limits of yourknowledge and experience and seeking support appropriately.
13. To work flexibly to meetservice requirements which may include evening and weekend working.
Personal and People Development
14. To provide an effective learning environment andmentorship for staff, and for students in training ensuring their experiencemeets their learning needs.
15. To participate in multidisciplinary team meetingsto facilitate case management reviews and ensure critical learning that informscurrent and future care pathway development.
16. Toparticipate in appraisal and clinical supervision as part of the learningculture within Your Healthcare.
17. To ensureown personal development through clinical supervision, appraisal and personaldevelopment plan, taking responsibility for own training and learning,reflection and professional registration requirements.
18. Supportthe locality manager and community nursing team in the recruitment andretention of staff in the team.
19. To provideleadership and professional support for the community nursing teams involved inreceiving referrals of long term condition patients.
20. As anindependent prescriber participate in professional development that supportson-going personal development and ensures accountability and safety inprescribing decisions.
Service Development
21. To ensurethat robust monitoring systems are in place to identify any requiredimprovements to the quality of the patient experience and that clinical andcare standards are maintained in line with organisational policies.
22. To contributeactively and have a comprehensive understanding of national and local policyfor older people and for people with long term conditions.
23. To havea comprehensive understanding of safeguarding adults and specifically Protectingadults at risk: London multi-agency policy and procedures to safeguardvulnerable adults from abuse and the Kingston safeguarding adults local protocol.
24. Toensure that the Mental Capacity Act is implemented as part of the on-goingassessment and treatment processes for people who are case managed. This will include supporting the assessmentof capacity and best interest decision making as appropriate.
25. Participatein policy reviews and ensure dissemination to all team members.
26. Undertakesignificant event reviews and complaint investigations including thedevelopment of action plans and reflective practice.
27. Toproactively contribute to the development of care pathways across acute/primaryand community care that deliver continued improvement in community serviceprovision.
Quality
28. To participate in the training and education of qualified and unqualified staff in gaining knowledge and experience and the maintenance of fundamental nursing skills.
29. To ensure that records are kept up to date and evaluated to safeguard patients confidentiality by being aware of legal and ethical responsibilities.
30. To ensureadherence to Your Healthcare Clinical Governance requirements, NICE guidelines and professional codes of conduct.
31. To ensurethat the Care Quality Commissions Core Standards are maintained and appropriateevidence is provided to contribute to Your Healthcare's registration.
32. Toidentify and carry out appropriate audits as identified and agreed by the AdultServices Governance Sub-Group and included in the annual quality/auditcalendar.
Communication and working relationships
33. To ensure accurate and contemporaneous records arekept and collect/collate data as required by the service and the YH policy/protocolin accordance with NMC guidelines.
34. To identify patient groups by the use of case managementtools and collate evidence of admission avoidance and reduction of secondarycare use.
35. To liaise with other disciplines and statutory and voluntaryagencies to ensure that patient centred care is delivered in a manneracceptable to the patient, recognising individual cultures and beliefs.
36. To actas a representative of Your Healthcare, communicating policy, procedures andstandards in relation to care delivery and case management.
37. To workcollaboratively with internal teams and external agencies.
Person Specification
Skills & Abilities
Essential
38. Proven written and oral communication skills including ability to deal with challenging and sensitive situations.
39. Ability to identify best practice and develop action plans to resolve areas of weak practice.
40. Effective time management skills.
41. High standard of fundamental nursing care.
42. Supervision, teaching and training skills.
43. Trained Mentor - Able to plan proactively, manage and evaluate students' own learning, to negotiate learning opportunities, establish learning contracts.
44. Understanding the principles of governance, particularly in relation to their service area.
45. An understanding of systems in health and social care that is wider than their immediate role.
46. Knowledge of long term condition management and care of the elderly.
47. Understanding of the expectations of the community matron role, particularly in terms of patient/ service outcomes.
48. Ability to prioritise and organise workload effectively.
49. Problem solving skills.
50. Ability to safely manage risk.
51. Ability to demonstrate innovative practice.
52. Knowledge of equality & diversity
53. Understands confidentiality, information security & governance.
54. Able to negotiate and influence.
55. Intermediate IT skills.
56. Expanded clinical skills including but not limited to:- intravenous therapy (including management of IV long lines), cannulation, venepuncture, syringe drivers, male and female catheterisation, digital rectal examination, management of PEG and RIG tubes,
57. Audit skills
58. Counselling skills.
59. Able to manage and work effectively as part of a team
60. Able to build effective working relationships at all levels.
Personal qualities
Essential
61. Ability to work within deadlines
62. Ability to prioritise care and care delivery.
63. Ability to make decisions and deal with conflict.
64. Able to mediate and lead others.
65. Self-confidence to challenge established methods of practice in a constructive manner and have the persistence to address difficult enduring issues.
66. Constructive, enquiring, flexible approach to others and to their work
67. Change and demonstrate innovative practice.
Qualifications
Essential
68. Registered Nurse Level 1
69. Physical Assessment and clinical decision Making
70. V300 non-medical prescribing or willing to work towards.
71. Qualified mentor
Desirable
72. Working towards Masters
73. Specialist practice community nursing qualification
74. Qualification in long term condition management
Experience
Essential
75. Experience of both community and acute nursing.
76. Team management experience.
77. Previous relevant experience of working with patients with long-term conditions.
78. Knowledge and experience of managing patients with dementia and its impact on physical health
79. Negotiating and working across organisational boundaries.
80. Mentoring students and other health care professionals.
81. Experience of lone working and decision making.
Desirable
82. Experience of using research and other evidence to inform practice.