ADVANCED CLINICAL PRACTITIONER (ACP)

ADVANCED CLINICAL PRACTITIONER (ACP) A guide to establishing these roles in Paediatric Dietitians

1

Contents

Author and acknowledgements ............................................................................................................... 2

Section 1 .................................................................................................................................................. 1

Introduction ........................................................................................................................................... 2

Section 2 .................................................................................................................................................. 3

Aims of the Pack ................................................................................................................................... 3

Section 3 .................................................................................................................................................. 3

What is an ACP? .................................................................................................................................. 3

Section 4 .................................................................................................................................................. 6

How to Become an ACP ....................................................................................................................... 6

Section 5 .................................................................................................................................................. 6

Training Options ................................................................................................................................... 6

Section 6 .................................................................................................................................................. 7

Financial Implications ............................................................................................................................ 7

Section 7 .................................................................................................................................................. 7

Scoping ................................................................................................................................................. 7

Section 8 .................................................................................................................................................. 8

Human Resources ................................................................................................................................ 8

Section 9 .................................................................................................................................................. 8

Governance .......................................................................................................................................... 8

References ............................................................................................................................................... 9

Appendices: ........................................................................................................................................... 10

Author

Lisa Cooke (MA BSc RD, Bristol Royal Hospital for Children) on behalf of the BDA Paediatric Specialist Group

Acknowledgements

Thanks to Fiona Ward, Vanessa Shaw, Moira Dixon, Caroline Haines, Eleanor Johnstone, Diane Green and the Paediatric Specialist Group for helping to make this document happen. Quote from Diane, one of the first ACPs in adult metabolic disease ‘Over the past 3 years my role continues to develop and evolve based on the clinical needs of the service with the opportunity to continuously push boundaries.’

2

Section 1

Introduction There are a number of challenges within the NHS, including (1, 2):

• An aging population which brings a rising demand for services

• Higher public expectations of care

• Advances in medical and digital technologies These are met with patient safety issues as identified by the Frances Inquiry in 2013 (3) and workforce gaps - a lack of medical and nursing workforce and the demographics of current staffing show a large number are nearing retirement (4) It is important that the future workforce is able to meet the needs of the population it serves taking into account the challenges identified above. Allied Health Professionals (AHPs) and Health Care Scientists (HCSTs) make up the third largest group of staff within the NHS (5) and to date have often been overlooked as an accessible workforce to adapt, blend and offer alternative ways of expanding the NHS workforce. In each of our four home countries, AHP leads are beginning to drive the utilisation of the AHP workforce forward. In England, AHPs into Action (5) a national framework fronted by the AHP leadership team across NHS England, NHS improvement, Public Health England and Health Education England) was published in 2017. This framework set out a five-year programme focusing on the role of AHPs in supporting and transforming health, care and wellbeing. There are six work streams of AHPs into Action addressing the following priorities: 1. Leadership 2. Digital 3. Evidence into Practice 4. Workforce 5. Public Health 6. Partnerships and Engagement.

Extended roles have been developed within the individual AHP groups. While innovative within individual health care settings, they are mainly uniprofessional and often without clear role descriptions, outcome measures, transferability to other settings or robust clinical governance structures to support the role/s. To address workforce issues outlined above, service providers have been developing ACP roles. There is however a lack of clarity and consistency within these roles, therefore each of the four home countries developed frameworks to address this by outlining a definition for ACP (6,7,8,9) The multi-professional Framework for Advanced Clinical Practice in England (MPFACP) (6) outlines the following:

• Multi-professions need to be committed to working together which requires flexibility in attitude and behaviours. It also requires professionals to value and respect the distinct contribution each professional makes

• Employers need to ensure that clinicians have the professional development they need to adapt to changing circumstances

• Being able to see appropriate career pathways enables clinicians to expand contribution to healthcare and their personal job satisfaction

“Evidence consistently shows that multi-professional team working delivers better outcomes for patients and more effective and satisfying work for clinicians.”

3

The Paediatric Specialist Group (PSG) of the British Dietetic Association (BDA) believes that to ensure the ACP agenda is supported by our paediatric members, we need to ensure we have a clear understanding of the impact and opportunities this agenda offers to our profession. A grant proposal by the author of this document was submitted to the PSG in 2018 to write this supportive pack which was commissioned.

Section 2

Aims of the Pack To provide guidance and support for paediatric dietitians and their managers to engage locally with the ACP agenda.

Objectives

• To give supportive background information

• To highlight potential areas of ACP development within the current workforce and areas of clinical practice

• To discuss pathways for access points during a career in paediatric dietetics

• To understand how to access formal training

• To access a standard job description

• To access examples of packs for the necessary competencies to support roles

Section 3

What is an ACP? An ACP is an experienced, registered health care practitioner who has a high degree of autonomy and complex decision making. All of this is underpinned by an MSc degree or equivalent and encompasses four pillars of practice. Additionally, the practitioner has the ability to manage clinical care in partnership with individuals, families and carers; and to analyse and synthesise complex problems across a range of settings, often resulting in innovative solutions enhancing outcomes and patient experience. The four pillars which underpin ACP practice are: 1. Clinical Practice 2. Leadership and Management 3. Education 4. Research MPFACP describes the four pillars as follows: 1. Clinical Practice

Health and care professionals working at the level of ACP should be able to:

• Practice in compliance with their respective code of professional conduct and within their scope of practice, being responsible and accountable for their decisions, actions and omissions at this level of practice.

• Demonstrate a critical understanding of their broadened level of responsibility and autonomy and the limits of own competence and professional scope of practice, including when working with complexity, risk, uncertainty and incomplete information.

• Act on professional judgement about when to seek help, demonstrating critical reflection on own practice, self-awareness, emotional intelligence, and openness to change.

4

• Work in partnership with individuals, families and carers, using a range of assessment methods as appropriate (e.g. of history-taking; holistic assessment; identifying risk factors; mental health assessments; requesting, undertaking and/or interpreting diagnostic tests; and conducting health needs assessments).

• Demonstrate effective communication skills, supporting people in making decisions, planning care or seeking to make positive changes, using Health Education England’s framework to promote person-centred approaches in health and care.

• Use expertise and decision-making skills to inform clinical reasoning approaches when dealing with differentiated and undifferentiated individual presentations and complex situations, synthesising information from multiple sources to make appropriate, evidence-based judgements and/or diagnoses.

• Initiate, evaluate and modify a range of interventions which may include prescribing medicines, therapies, life style advice and care.

• Exercise professional judgement to manage risk appropriately, especially where there may be complex and unpredictable events and supporting teams to do likewise to ensure safety of individuals, families and carers.

• Work collaboratively with an appropriate range of multi-agency and inter-professional resources, developing, maintaining and evaluating links to manage risk and issues across organisations and settings.

• Act as a clinical role model/advocate for developing and delivering care that is responsive to changing requirements, informed by an understanding of local population health needs, agencies and networks.

• Evidence the underpinning subject-specific competencies i.e. knowledge, skills and behaviours relevant to the role setting and scope, and demonstrate application of the capabilities to these, in an approach that is appropriate to the individual role setting and scope.

2. Leadership and Management


• Pro-actively initiate and develop effective relationships, fostering clarity of roles within teams, to encourage productive working.

• Role model the values of their organisation/place of work, demonstrating a person-centred approach to service delivery and development.

• Evaluate own practice, and participate in multi-disciplinary service and team evaluation, demonstrating the impact of advanced clinical practice on service function and effectiveness, and quality (i.e. outcomes of care, experience and safety).

• Actively engage in peer review to inform own and other’s practice, formulating and implementing strategies to act on learning and make improvements.

• Lead new practice and service redesign solutions in response to feedback, evaluation and need, working across boundaries and broadening sphere of influence.

• Actively seek feedback and involvement from individuals, families, carers, communities and colleagues in the co-production of service improvements.

• Critically apply advanced clinical expertise in appropriate faciliatory ways to provide consultancy across professional and service boundaries, influencing clinical practice to enhance quality, reduce unwarranted variation and promote the sharing and adoption of best practice.

• Demonstrate team leadership, resilience and determination, managing situations that are unfamiliar, complex or unpredictable and seeking to build confidence in others.

• Continually develop practice in response to changing population health need, engaging in horizon scanning for future developments (e.g. impacts of genomics, new treatments and changing social challenges Demonstrate receptiveness to challenge and preparedness to constructively challenge others, escalating concerns that affect individuals’, families’, carers’, communities’ and colleagues’ safety and well-being when necessary.

• Negotiate an individual scope of practice within legal, ethical, professional and organisational policies, governance and procedures, with a focus on managing risk and upholding safety.

5

3. Education


• Critically assess and address own learning needs, negotiating a personal development plan that reflects the breadth of ongoing professional development across the four pillars of advanced clinical practice.

• Engage with, appraise and respond to individuals’ motivation, development stage and capacity, working collaboratively to support health literacy and empower individuals to participate in decisions about their care and to maximise their health and well-being.

• Advocate for and contribute to a culture of organisational learning to inspire future and existing staff.

• Facilitate collaboration of the wider team and support peer review processes to identify individual and team learning.

• Identify further developmental needs for the individual and the wider team and supporting them to address these.

• Supporting the wider team to build capacity and capability through work-based and interprofessional learning, and the application of learning to practice

• Act as a role model, educator, supervisor, coach and mentor, seeking to instill and develop the confidence of others.

4. Research


• Critically engage in research activity, adhering to good research practice guidance, so that evidence-based strategies are developed and applied to enhance quality, safety, productivity and value for money.

• Evaluate and audit own and others’ clinical practice, selecting and applying valid, reliable methods, then acting on the findings.

• Critically appraise and synthesise the outcome of relevant research, evaluation and audit, using the results to underpin own practice and to inform that of others.

• Take a critical approach to identify gaps in the evidence base and its application to practice, alerting appropriate individuals and organisations to these and how they might be addressed in a safe and pragmatic way.

• Actively identify potential need for further research to strengthen evidence for best practice. This may involve acting as an educator, leader, innovator and contributor to research activity ix and/or seeking out and applying for research funding.

• Develop and implement robust governance systems and systematic documentation processes, keeping the need for modifications under critical review.

• Disseminate best practice research findings and quality improvement projects through appropriate media and fora (e.g. presentations and peer review research publications).

• Facilitate collaborative links between clinical practice and research through proactive engagement, networking with academic, clinical and other active researchers.

The MPFACP explains: In order to embed ACP and ensure its sustainability, it is necessary that the organisational governance and infrastructure arrangements include consideration of the following aspects of service transition:

• Practice governance and service user safety requirements

• Adherence to legal and regulatory frameworks

• Support systems and infrastructure for delegated roles (e.g. requesting diagnostic tests, administering medicines)

• Professional and managerial pathways of accountability

• Continued assessment against, and progression through, the capabilities identified within this framework

6

• Location of advanced clinical practice within a career framework that supports recruitment and retention, and succession planning to support workforce development

• Regular constructive clinical supervision that enables reflective practice together with robust annual appraisal.

Section 4

How to Become an ACP Routes/Pathways to Becoming an ACP There are various routes to becoming an ACP in paediatrics with a dietetic background. You can:

• Undertake a 2 to 3-year ACP apprenticeship at band 7; these will be advertised vacancies on the NHS jobs website.

• Identify the need for advanced clinical practice within your current role (this may be done by yourself or by your manager), followed by an application to undertake a 2 or 3-year MSc degree in advanced clinical practice as aligned with the apprenticeship. This may be available or you may need to independently put forward a business case via your division operating plan or workforce strategy plan, engaging with your Trust’s nursing and medical workforce plan. You will need to identify where your post will bridge rota gaps arising from lack of workforce in these professions.

• Identify unique and bespoke roles within your organisation that requires a different way of working that would allow your role to be developed into an ACP post to support the workforce. Internal competencies will need to be developed, with a medical and dietetic lead assigned to sign off/assess competencies. A supporting framework would need to be developed (see appendix 1) as a pack to follow and complete, supported by additional formative study in the form of, for example: physical assessment and clinical reasoning; pathophysiology and diagnostics; and non-medical prescribing.

Other additional study modules may be required depending on the role and these would need to be considered separately. There may be gaps in a certain pillar, for example leadership, which may require formative study or work-based opportunities which are competency-based and signed off when completed.

Section 5

Training Options Apprenticeships The National Institute for Apprenticeships (10) states the following: The MSc Advanced Clinical Practice is a multi-professional apprenticeship programme for all professional, statutory and regulatory body registered practitioners in healthcare. The apprenticeship will prepare you to undertake the role of an autonomous, highly skilled practitioner who will be able to manage complete episodes of care for patients/clients. You will be encouraged to focus on advancing your knowledge and understanding of current issues related to your own field of practice, and that of the wider context of health and social care. This programme will allow you to develop a high level of specialist knowledge in your field of practice. Advanced Clinical Practice embodies the ability to manage complete clinical care in partnership with patients and carers. It includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance the patient experience and improve outcomes. This is underpinned by Masters level training that encompasses the four pillars of clinical practice with demonstration of core and area specific clinical competence (6). Module Access and Uplift

7

It may be that someone is already practicing at Masters level (or already has a Masters qualification) but does not have the formal qualifications necessary for an ACP post. A programme of training can take place on the job but still needs a competency framework. In line with the apprenticeship option it is necessary to attend Masters level modules at University to gain the required competencies. Relating back to the four pillars these modules need to cover the following:

• Leadership

• Education

• Research

• Clinical Practice

Gaps within the individual’s knowledge and experience need to be identified and the training adapted accordingly.

Section 6

Financial Implications The cost of the MSc Advanced Clinical Practice apprenticeship will vary depending on the duration and route taken. The apprenticeship levy (managed by the apprenticeship lead within the trust) will cover the cost of the study but most departments will need to have funding for the post in place, unless the organisation has already recognised the workforce need within their operating plans and funded a new post centrally. Most additional Masters modules cost between £500-£900; so, for uplift modules, this needs to be costed in. Trainee posts are paid at band 7 level during training and as competencies are realised, and upon successful completion of the training they are paid at band 8a. Therefore, adequate funds should be available at the outset.

Section 7

Scoping There are about 10 paediatric ACP posts in training in the UK. There are many more in adult dietetics, where some ACPs have been in post for a while. The BDA have set up a discussion forum for members that are ACP or interested in becoming ACPs. Please request to join this group my emailing [email protected]

mailto:[email protected]

8

Section 8

Human Resources Job Descriptions and Person Specifications Each trust will have its own job descriptions and person specifications for an ACP. For those ACP roles unique to dietetics, you will have to use the trust standard format and adapt it accordingly. An example is shown in appendix 2. Competencies again will be unique to each post with some commonality (see appendix 1 for an example). Bespoke competencies will need to be added by the medical and dietetic leads for the roles

Section 9

Governance A dietitian is an autonomous registered health care practitioner; a protected title regulated by the HCPC. A dietitian must be able to practise as an autonomous professional, exercising their own professional judgement, making reasoned decisions, initiating, modifying and stopping interventions. Clinical decision and reasoning must be appropriately recognised, whilst dietitians are personally responsible for and must be able to justify their decisions (11). A dietetic practitioner undertaking new practices outside their core and specialist roles, must acquire skills and training through formal training and contribute to improving outcomes for patients (6). Clinical reasoning and critical thinking are an essential part of a dietitian’s role as they become more experienced and offer a diagnostic and therapeutic treatment for many clinical conditions (7). ACP is a new role and builds on the already governed role of a dietitian as above. New ways of working are always challenging in the initial stages, but as long as the organisation surrounding the practitioner has a solid governance structure, with good supervision and mentoring, the boundaries can be pushed in a safe way. A positive learning environment with multidisciplinary support around the role can make for a great opportunity to improve patient care and outcomes. The dietitian must continue to keep within their scope of practice in line with HCPC recommendations (11) when working as an ACP – ensuring that competencies and appropriate training is sought for any new skills. They should work within a safe learning environment, keeping the patient safe and at the centre of care.

9

References 1. Health Education and Improvement Wales. A HEALTHIER WALES: OUR WORKFORCE

STRATEGY FOR HEALTH AND SOCIAL CARE (Draft). Dec 2019. Available from: https://heiw.nhs.wales/programmes/health-social-care-workforce-strategy/

2. NHS England. Next steps on the NHS five-year forward view. March 2017. Available from: https://www.england.nhs.uk/publication/next-steps-on-the-nhs-five-year-forward-view/

3. Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Feb 2013. Available from: https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry

4. Health Education England. Facing the Facts, Shaping the Future A draft health and care workforce strategy for England to 2027 (draft). March 2018. Available from: https://www.hee.nhs.uk/our-work/workforce-strategy

5. NHS England. Allied Health Professions into Action. Jan 2017. Available from: https://www.england.nhs.uk/wp-content/uploads/2017/01/ahp-action-transform-hlth.pdf

6. Health Education England. Multi-professional framework for advanced clinical practice in England. Aug 2019. Available from: https://www.hee.nhs.uk/our-work/advanced-clinical-practice/multi-professional-framework

7. National Health Service Wales. Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales. (no date). Available from: http://www.wales.nhs.uk/sitesplus/documents/829/NLIAH%20Advanced%20Practice%20Framework.pdf

8. Department of Health Northern Ireland. Advanced AHP Practice Framework. June 2019. Available from: https://www.health-ni.gov.uk/publications/advanced-ahp-practice-framework

9. NHS Education for Scotland. Transforming Nursing, Midwifery and Health Professions’ (NMaHP) Roles: pushing the boundaries to meet health and social care needs in Scotland. 2017. Available from: http://www.advancedpractice.scot.nhs.uk/uk-progress/scotland/allied-health-professionals.aspx?tab=TabResources

10. Institute for Appreticeships and Technical Education. Advanced Clinical Practitioner (degree). Nov 2017. Available from: https://www.instituteforapprenticeships.org/apprenticeship-standards/advanced-clinical-practitioner-degree/

11. The Health and Care Professions Council. The standards of proficiency for dietitians. March 2013. Available from: https://www.hcpc-uk.org/standards/standards-of-proficiency/dietitians/

12. The British Dietetic Association (2015), Extended scope, available from: https://www.bda.uk.com/publications/professional/extendedscope2015

13. Lacey, Karen P., MS, RD, CD (chair), Malone, Ainsley M. MS, RD, CNSC, LD; Fuhrman, Trisha, RD, LD, FADA, 2017, Critical Thinking Skills in Nutrition Assessment and Diagnosis, Academy Positions Committee Workgroup CNSD Practice Paper of the Academy of Nutrition and Dietetics

https://heiw.nhs.wales/programmes/health-social-care-workforce-strategy/

https://www.england.nhs.uk/publication/next-steps-on-the-nhs-five-year-forward-view/

https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry

https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry

https://www.hee.nhs.uk/our-work/workforce-strategy

https://www.hee.nhs.uk/our-work/workforce-strategy

https://www.england.nhs.uk/wp-content/uploads/2017/01/ahp-action-transform-hlth.pdf

https://www.hee.nhs.uk/our-work/advanced-clinical-practice/multi-professional-framework

https://www.hee.nhs.uk/our-work/advanced-clinical-practice/multi-professional-framework

http://www.wales.nhs.uk/sitesplus/documents/829/NLIAH%20Advanced%20Practice%20Framework.pdf

http://www.wales.nhs.uk/sitesplus/documents/829/NLIAH%20Advanced%20Practice%20Framework.pdf

https://www.health-ni.gov.uk/publications/advanced-ahp-practice-framework

http://www.advancedpractice.scot.nhs.uk/uk-progress/scotland/allied-health-professionals.aspx?tab=TabResources

http://www.advancedpractice.scot.nhs.uk/uk-progress/scotland/allied-health-professionals.aspx?tab=TabResources

https://www.instituteforapprenticeships.org/apprenticeship-standards/advanced-clinical-practitioner-degree/

https://www.instituteforapprenticeships.org/apprenticeship-standards/advanced-clinical-practitioner-degree/

https://www.hcpc-uk.org/standards/standards-of-proficiency/dietitians/

https://www.bda.uk.com/publications/professional/extendedscope2015

10

Appendices:

Appendix 1

• Paediatric ACP/Advanced Nurse Practitioner (ANP) Surgery/Orthopaedics: Role Specific Skills Record

Appendix 2

• Example trainee Advanced Practitioner Dietitian ketogenic diets (KD) - Paediatrics Advert

Appendix 1

THQ… Document Updated September 2018 R. Overend, Faculty of Children’s Nurse Education, C. Haines, Consultant Nurse BRHC 11

DRAFT

Paediatric Advanced Clinical Practitioner (ACP) / Advanced Nurse Practitioner (ANP) Paediatric Surgery/Orthopaedics: Role Specific Skills Record

Appendix 1


Summary of Completed Competencies Name of Learner Advanced Practitioner

NMC Number

Name of Learner Facilitator GMC Number

Name of Additional Mentor NMC/GMC Number

Please complete as required

Appendix 1


Record of Facilitators

Practice Facilitator(s) Signature Initials Professional Qualifications Date

Mentor(s) Signature Initials Professional Qualifications Date

Appendix 1


Introduction Welcome This competency pack has been developed to guide your learning and development as an Advanced Clinical Practitioner (ACP) or Advanced Nurse Practitioner (ANP) within the Bristol Royal Hospital for Children. It complements the ‘Paediatric Advanced Clinical Practitioner (ACP) & Advanced Nurse Practitioner (ANP) Core Competency & Professional Development Record’ and must be used in conjunction with this.

As well as direct clinical practice, your role also incorporates education, research and management and all these elements have been identified within the document as a method of demonstrating your improvement in all these domains over time. We recognise each nurse brings her own experiences and the document can help you and the Facilitator to determine areas for further learning and those competencies which you already have, creating a more individualised approach to training needs.

Advanced Practitioners must acquire an expert knowledge base, be able to make complex decision-making skills and have competence in expanded practice (ICN 2002, HEE 2017). This is shaped by the context in which they are going to practice. The NMC definition of the Advanced Practitioner (2005) sets out these key functions:

• Taking a comprehensive patient history

• Carrying out physical examinations

• Using expert knowledge and clinical judgements to identify the potential diagnosis

• Referring patients for investigations where appropriate

• Making a final diagnosis

• Deciding on and carrying out treatment, including the prescriptions of medicines

• Referring patients to an appropriate specialist

• Using extensive experience to plan and provide skilled and competent care to meet patient’s health and social care needs

• Ensuring the provision of continuity of care, including follow-up visits

• Assessing and evaluating with patients and families the effectiveness of treatments and care provided and makes changes as needed

• Working independently, although often as part of a health care team

• Providing leadership

• Making sure that each patient’s treatment and care is based on best practice

Appendix 1


It is expected that you will be able to perform all of these aspects of the role once your competence is fully evaluated. Your training is fundamental to your success, and requires integrating clinical supervision; advancement of skills; formalised education in Higher Education Institutes (HEI); coaching and feedback; and differing methods of assessment (Fig 1). We recognise the importance of our role in enabling these and encourage you to embrace the lifelong learning that a nursing career of this level of specialism requires. The document should be used in conjunction with competency assessments undertaken as part of module completion at UWE or other HEIs, previous competency work in your role as a Registered Nurse, your appraisals and your job description when discussing with your Facilitator/mentors methods that will most enable your development. You will also be rostered to attend the Trust’s Induction Programme and must attend statutory and mandatory training days, which you are responsible for organising and keeping a current record of. Practitioner Development Programme Your development programme will consist of Trust and local induction and orientation tailored to your needs. You may be expected to work a mix of shifts which complement your Facilitator/mentor’s rota in order to optimise your exposure to learning opportunities. This period will be organised by your Facilitator. This will be followed by negotiated hours of supervised practice, depending on previous experience, when you will be expected to care for children with input and support from a qualified practitioner on the clinical shift you are working.

Appendix 1


Competency Statement In order to guide the individual practitioner’s development, any theoretical and practical competence will be continuously evaluated, using assessment processes within Higher Education Institutions, the Bristol Royal Hospital for Children’s Taxonomy of Learning (see page 9) and through personal reflection. The ACP/ANP must be able to provide evidence to support any claim of competence and it is anticipated that this evidence will be collected and placed within the Advanced Practice Portfolio under the relevant section/subsections. This can be done in a variety of methods, as outlined in fig 1, and should be negotiated with your relevant assessor. If the required standard is not achieved then additional support and guidance will be provided by the ACP / ANP’s / ANP’s facilitator and mentor; academic development support can also be sought from the Faculty of Children’s Nurse Education. As a guide and minimum, Level 3 taxonomy of competency is expected for Band 6s, Level 4 Band 7s and fully trained 8a ACP/ANPs, Level 5. Individuals will likely meet a higher level of competency in some areas and this is fully accepted. Not all areas of practice may be relevant to all roles. Hence please discuss any specific areas of concern with your manager. Learners are reminded that at all times they have a responsibility to recognise limitations in their own practice, as stated in the NMC’s Code of Conduct, or equivalent, to maintain standards of practice. They must seek advice and support at the earliest opportunity if they feel unsure about their practice or their development. You are ultimately responsible for your own development and identification of your personal learning needs. This evidence should also be used to inform discussion at your annual appraisal, to demonstrate your progression and can be used as evidence of professional development for revalidation.

Appendix 1


ACADEMIC AND PRACTICE

DEVELOPMENT

SUPPORT TO SUCCEED

ROBUST ASSESSMENT

FIG 1: Theory, Practice and Support: Adapted from Advanced Clinical Framework for the West Midlands (2015) London: HEE

Appendix 1


Paediatric Advanced Nurse Practitioner Taxonomy of Learning The adapted Benner’s Taxonomy (1984) is already embedded within BRHFC as the tool for assessing competence for all Registered Nurses. This numerical scale will continue to be used for ACP / ANPs & ANPs. However, Miller’s Competency Pyramid (1990), more often used in medical assessment, is also shown to relate levels and enhance inter-professional assessment.

Stage 1 Novice

This stage applies to the ACP/ANP who has not been exposed to specific procedures, technology or equipment. This stage is mainly observational with practice performed under direct supervision. This phase should last a matter of weeks, depending on individual need.

Stage 2 Advanced Beginner

At this stage the ACP/ANP can demonstrate acceptable skills in practice. Practice is supported and guided under direct or indirect supervision. The ANP has enough knowledge, experience and exposure to take on their own clinical tasks with support from the practice facilitator or other nominated person

Stage 3 Competent

The ACP/ANP can demonstrate the skills and knowledge necessary to practice without supervision. At this stage the ACP/ANP can demonstrate knowledge and understanding of the rationale for their practice and should be able to provide some evidence to support their practice.

KNOWS: Can perform activity but not without constant supervision and some assistance

KNOWS HOW: Can perform the activity satisfactorily but requires some assistance and supervision. May require assistance in accurately recognising signs

and the significance of patient symptoms

SHOWS HOW: Can perform this activity without supervision or assistance and is able to accurately

interpret clinical findings

Appendix 1


Stage 4 Proficient

The ACP/ANP can demonstrate knowledge, skills and understanding to others in a variety of situations through multi-professional discussion and evaluation of care interventions. The ANP can give a full evidence-based rationale for actions. The ANP has the skills for effective dissemination of information to other professionals and colleagues.

Stage 5 Expert

The ACP/ANP demonstrates all the knowledge, skills and understanding of the previous stage and in addition can manage complex care situations. S/he is able to assess the type and depth of knowledge required to perform practice at determined levels, giving support and feedback to enhance learning and develop the practice of others. At this level the ANP can reflect on and can analyse their own practice as well as facilitating the reflective practice of others

DOES: Can perform this activity satisfactorily without assistance and supervision with more than acceptable speed and quality of work. Is able to use initiative and

adaptability to special problem situations

CONTENTS PAGE

GENERIC SURGICAL/ORTHOPAEDIC SKILLS ORTHOPAEDIC SPECIFIC SKILLS SURGICAL SPECIFIC SKILLS NEONATAL SPECIFIC SKILLS

• Please note the formatting of the tables below will be adapted to meet the time frame required of each individual e.g.

extend to 24, 36 or 48 months.

Appendix 1

1

GENERIC SURGICAL/ORTHOPAEDIC SKILLS SPECIFIC OUTCOME

INITIALS of ASSESSOR

INITIALS of ACP/ANP

LEVEL OF ATTAINMENT AT:

3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP has a comprehensive knowledge of anatomical nomenclature and landmarks as well as relevant systems: 1. thorax 2. gastrointestinal system, liver, pancreas and spleen 3. urogenital system 4. musculo-skeletal system 5. functional and resting positions of joints 6. pain pathways: acute and chronic

The ACP/ANP can demonstrate an ability to: 1. assess regional anatomy related to any injured area 2. appreciate the importance of primary, secondary and tertiary survey 3. recognise that pain may be referred and uses methods to assess this 4. assess level of pain using appropriate age-related tools

The ACP/ANP can implement and evaluate evidence-based strategies to minimise specific complications for surgical and/or orthopaedic patients, including: 1. venous thrombo-embolism (VTE) 2. chest infection 3. UTI/urinary retention 4. pressure ulcers 5. malnutrition 6. primary and secondary wound infection 7. osteomyelitis

8. neurovascular compromise

Appendix 1

2



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

9. compartment syndrome: limb and abdominal

using their knowledge and experience to educate other staff to improve their understanding of the complications of children requiring surgical and/or orthopaedic care

The ACP/ANP can determine and describe wounds, including: 1. avulsion 2. laceration/incised 3. puncture 4. incision 5. abrasion 6. bruising 7. foreign body and seek appropriate help in determining course of action to develop and implement a management plan

The ACP/ANP is able to: 1. calculate maintenance fluids for individual patients 2. discuss the choices of fluids available and identify when they should/should not

be used 3. determine whether replacement fluids are required and give rationales 4. recognise the importance and rationales for peri-operative and post-operative

fluid restriction 5. recognises there are specific fluid requirements for infants in the perinatal and

neonatal period

Appendix 1

3



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

6. demonstrate an ability to identify the risks associated with hypo-/hyperkalaemia and can determine a plan of action based on findings

7. demonstrates an ability to identify the risks associated with hypo-/hypernatremia and can determine a plan of action based on findings

8. demonstrates ability to identify the risks associated with hypo-/hyperglycaemia and can determine a plan of action based on findings

The ACP/ANP is able to prescribe: 1. Parenteral Nutrition, made in PSU (i.e. not generic babi/kabiven) with rates pre-

determined by the Pharmacy team 2. Parenteral Nutrition which is undergoing titration in correlation to simple re-

grading of enteral feds 3. Home Parenteral Nutrition which does not require titration

The ACP/ANP can demonstrate completion of competencies relating to: 1. care of the child required procedural analgesia, such as 50% glucose and/or

topical anaesthetics 2. care of the child with a PCA/NCA 3. care of the child with an epidural 4. care of the child requiring Entonox 5. care of the child requiring intra-nasal diamorphine

The ACP/ANP demonstrates understanding of different surgical drains through: 1. identifying the differences between open vs closed drains 2. identifying the differences between active (pressure regulated) vs passive

(gravity dependent) drains

Appendix 1

4



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

3. demonstrating understanding of the rationale for elimination of dead-space 4. demonstrating understanding of risks related to removal of large volumes of fluid

such as blood, pus, serous exudate, chyle or bile 5. recognising the importance of drain patency to minimise potential accumulation

of such fluids and decrease the risk of infection

and can develop management plans using advanced clinical knowledge and skills should problems occur, recognising limitations of practice and referring to the senior team for support if needed

The ACP/ANP can demonstrate completion of competencies relating to: 1. female indwelling urethral catheterisation 2. male indwelling urethral catheterisation in the child with a functionally normal

anatomy

The ACP/ANP is able to demonstrate competency in the administration of immunisations following completion of Trust course: 1. Childhood Immunisations and Vaccinations

Appendix 1

5



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP demonstrates an ability to ensure coordinated care is achieved between multiple specialty teams: 1. for oncology patients (new diagnosis or ongoing management) 2. for infants with ‘short-gut’ syndrome who will require ongoing gastroenterological

management 3. for infants and children who have congenital cardiac lesions

and is aware that any infant, child or young person with multiple co-morbidities and/or complex needs may require additional coordinated care to minimise risk

The ACP/ANP comprehensively understands: 1. the relevance of exploring previous experiences with general anaesthetic 2. the importance of checking clinical wellness prior to theatre 3. the importance of checking any blood results which might impact on a specific

procedure

the importance of ensuring allergy status has been identified

Appendix 1

6



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP can demonstrate effective communication in ensuring that: 1. fasting status of the child prior to theatre has been determined 2. nursing staff caring for the child/carers are aware of need for fasting and

approximation of time to theatre 3. changes in timing of fasting status are communicated to the MDT 4. risk is minimised from prolonged fasting for certain children, including those:

• under six months

• with metabolic disorders

Discussion and advice should be sought from senior team members when appropriate

The ACP/ANP recognises the importance of safe care of the child with Insulin Dependent Diabetes throughout the pre-/peri- and post-operative journey and demonstrates this through: 1. locating and utilising Divisional clinical practice guidelines on the management

of diabetes and surgery 2. minimising delays with Nil by Mouth times where possible

instigating a management plan, after liaising with the senior and diabetic team, family and nursing staff in the re-introduction of fluids and diet and normalising of insulin regimes

The ACP/ANP recognises the importance of safe care of the child with Epilepsy throughout the pre-/peri- and post-operative journey and demonstrates this through:

Appendix 1

7



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

1. describing the main risk factors which can trigger the ‘seizure threshold’ of children undergoing surgical intervention in the pre-/peri- and post-operative stages

2. the importance of maintaining effective anti-convulsant treatment throughout the child’s admission

3. comprehension of the main types of anti-convulsant medications and their mechanism of action

working with the Pharmacist, senior team and neurology team, if appropriate, in ensuring the prescription of alternative anti-convulsant treatment is performed when normal administration is disrupted due to surgery

The ACP/ANP can demonstrate management of acute trauma as part of a team using APLS principles, recognition and management of patients who will need ongoing management by orthopaedic or surgical teams: 1. Primary survey 2. Secondary survey 3. Tertiary survey 4. Management of shock in this context including blood/fluid and understanding of

major haemorrhage protocol, stabilising fractures and minimal handling 5. Recognition of appropriate imaging. Limb x-rays for injured limbs and CT for

handlebar injuries, abdominal/chest signs or unconscious patients with appropriate mechanisms of injury

The ACP/ANP is able to liaise with the theatre co-ordinator, ED and/or ward nursing staff when appropriate to determine how timings for children on emergency lists are coordinated and communicated, following discussion with the senior team

Appendix 1

8



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP is able to plan, organise and manage the discharge and/or transfer for patients with uncomplicated discharge needs, accessing support from senior colleagues when required

The ACP/ANP can assess the psychological impact of orthopaedic & trauma conditions and injuries on child/carer and provides appropriate psychological support in conjunction with the Trauma rehabilitation team

The ACP/ANP can assess and determine factors relating to the child with shock: 1. comprehensive understanding of pathophysiology 2. classifications of shock 3. aetiology 4. timely recognition and escalation for senior support

The ACP/ANP can assess and determine factors relating to the child with sepsis: 1. identifying symptom onset 2. aetiology 3. prodromal symptoms 4. differences between stages of inflammatory response to infection 5. timely recognition and escalation for senior support

demonstrating awareness for the implementation of Paediatric Sepsis Six

ACP/ANP specific skill

Appendix 1

9

ORTHOPAEDIC SPECIFIC SPECIFIC OUTCOME


INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP has a comprehensive understanding of neurovascular observations and is able to promptly recognise suspected complications and manage them appropriately

The ACP/ANP can assess and determine factors relating to the child with a fracture: 1. extent of limb and soft tissue involvement 2. neurovascular integrity 3. appropriate methods to stabilise fracture 4. pan relieving measures 5. assess safe-guarding issues

can activate a management plan within scope of practice

The ACP/ANP can identify and discuss the complications of casting and identify strategies to minimise complication: 1. elevation of the limb 2. VTE prophylaxis 3. trimming/bi-valving/windowing/removing a cast 4. measures to minimise cast/splint sores

Appendix 1

10



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP can assess and determine factors relating to the child with a compound fracture: 1. extent of limb and soft tissue involvement, including location, depth and tissue

status 2. neurovascular integrity 3. wound contamination 4. indications for antibiotic requirements 5. appropriate methods to stabilise and dress wound 6. pain relieving measures

and can develop appropriate management plans following discussion with the senior team

The ACP/ANP can assess and determine factors relating to the infant or child with limb/joint infection using: 6. symptom onset 7. aetiology 8. prodromal symptoms 9. weight bearing status, either aided or not 10. documenting joint and range of movement 11. assessing the joint for erythema, marking site as appropriate

and can develop a management plans following discussion with the senior team

Appendix 1

11



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP / ANP is able to demonstrate comprehensive understanding of: 1. Rationales for traction, including the identification of risk to the anatomy of the

affected limb/joints and associated structures if traction is applied incorrectly 2. Safe planning and preparation for traction, including psychological preparation

for the child and family 3. Ensures analgesia is administered prior to application of traction 4. Application of different types of traction: Thomas Splint/Gallows/Skin within

limitations pf practice 5. Use of weights

Importance of reviewing setting and efficacy of traction

Competencies related to T-S Frames??

Competencies related to use of mobility aids??


Appendix 1

12

SURGERY SPECIFIC SPECIFIC OUTCOME


INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP is able to assess and determine factors relating to the infant or child with ileus using: 1. symptom onset 2. aetiology 3. clinical signs 4. investigations that may determine cause 5. partial vs complete ileus

and can develop a management plan following discussion with the senior team

The ACP/ANP is able to assess and determine factors relating to infant or child with the bowel obstruction using: 1. symptom onset 2. aetiology 3. clinical signs 4. investigations to determine cause 5. partial vs complete obstruction 6. potential complications related to obstruction, including third-spacing,

perforation and/or shock and can develop a management plan following discussion with the senior team

Appendix 1

13



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP is able to demonstrate understanding of organ injury using: 1. mechanisms that make organ injury more likely, including NAI or handlebar

injury 2. clinical signs of complications such as hypovolaemic shock related to blood loss 3. recognition of the need for prompt investigative imaging, working with the

Trauma and senior teams 4. different types and grading of organ injury 5. potential complications that may occur during the initial 24-48 hours and

methods to assess for change that requires escalation to the senior team 6. effective management of pain caused by such injury

The ACP/ANP can assess and determine factors relating to the child with abdominal pain using: 1. symptom onset 2. aetiology 3. clinical signs 4. prodromal symptoms 5. differential diagnoses 6. investigations that may aid diagnosis and can develop a management plan following discussion with the senior team

Appendix 1

14



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP can assess and determine factors relating to the infant with pyloric stenosis using: 1. symptom onset 2. aetiology 3. clinical signs 4. differential diagnoses 5. investigations that may determine diagnosis and can develop a management plan following discussion with the senior team

The ACP/ANP can assess and determine different factors relating to the infant or child with differing types of hernia using: 1. symptom onset 2. aetiology 3. clinical signs 4. knowledge of the differing types of hernia and associated risks related to them and can develop a management plan following discussion with the senior team

Appendix 1

15



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP can assess and determine factors relating to the child with torsion using: 1. symptom onset 2. aetiology 3. clinical signs 4. recognition of the need for timely intervention


The ACP/ANP can assess and determine factors relating to the child with bilious vomiting using: 1. symptom onset 2. aetiology 3. clinical signs including abdominal distension 4. stooling pattern 5. differential diagnoses

6. investigations that may determine diagnosis and the urgency of these in an under 1 year old and can develop a management plan following discussion with the senior team

Appendix 1

16



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP can assess and determine factors relating to the child with intussusception using: 1. symptom onset 2. aetiology 3. clinical signs 4. prodromal symptoms 5. differential diagnoses 6. investigations that may determine diagnosis 7. Guidelines for management of a patient requiring air enema reduction or theatre and can develop a management plan following discussion with the senior team

The ACP/ANP can assess and determine factors relating to the child with hirschsprung’s enterocolitis using: 1. symptom onset 2. past history 3. clinical signs 4. differential diagnoses 5. investigations that may determine diagnosis e.g. blood tests, AXR and stool

samples 6. Principles of management of enterocolitis including admission, antibiotics and

washouts


The ACP/ANP can assess and determine factors relating to the child with skin infection using:

Appendix 1

17



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

1. symptom onset and site 2. Past history of skin conditions/infections 3. clinical signs including fluctuance 4. Infection In special sites e.g. joints, breasts, perianal and can develop a management plan following discussion with the senior team

The ACP/ANP can assess and determine factors relating to a child needing central access or with central line problems 1. Importance of the correct type of access, anaesthetic line, PICC, Hickman line,

Portacath 2. How to trouble shoot a blocked line, linogram, urokinase, plain x-ray. 3. How to unblock a line 4. How to fix a broken line 5. Management of line infection 6. Management of a patient while the central line is being fixed


Appendix 1

18



INITIALS of ACP/ANP


3 MONTHS

9 MONTHS

18 MONTHS

How to change a gastrostomy button appropriately. The ACP/ANP can assess and determine factors relating to a child with a gastrostomy/jejunostomy tube 1. Types of tubes 2. How to fix a gastrostomy/jejunostomy tube when leaking 3. How to change a gastrostomy button appropriately 4. Types of Jejunostomy and the tube associated with it. 5. Management of granulation tissue 6. Management of wound breakdown




Appendix 1

19

NEONATAL SPECIFIC SPECIFIC OUTCOME


INITIALS of ACP / ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP is able to recall and take into consideration the normal physiological changes that occur in the first month of life, which may impact on assessment findings and implementation of care: 1. Respiratory and cardio-vascular changes 2. Temperature regulation Gastro-intestinal function 3. Renal and hepatic clearance of waste products, particularly bilirubin and

medications 4. Fluid homeostasis 5. Blood glucose homeostasis

The ACP/ANP is able to assess and determine hyperbilirubinaemia through: 1. identifying clinical signs 2. interpreting conjugated and unconjugated bilirubin levels, following discussion

with senior team if needed 3. correct plotting of levels to determine course of therapy 4. collaboration with nursing staff in the activation of a management plan for

phototherapy, if appropriate 5. ensuring fluid regimens are optimised, as required, and following discussion with

senior team 6. supporting investigation of causes of pathological hyperbilirubinaemia

The ACP/ANP is able to support nursing staff in the development of care plans relating to issues such a handling, positioning and comfort to maximise developmental care in the neonate.

Appendix 1

20

NEONATAL SPECIFIC SPECIFIC OUTCOME


INITIALS of ACP / ANP


3 MONTHS

9 MONTHS

18 MONTHS

The ACP/ANP is able to liaise with the infant and mother’s midwifery team regarding issues related to current or ongoing concerns relating to care: 1. To ensure all neonatal checks have been completed 2. To determine any pertinent social history which may impact on care delivery or

discharge planning




Example Advanced Practitioner Dietitian ketogenic diets (KD) - Paediatrics Advert Grade NHS Agenda for Change: Band 7 (Band 8a on completion of MSc / proven competency). Contract; Permanent Hours; Site; Town; Salary; band 7 8a on completion of MSc We are looking for a highly motivated and enthusiastic experienced clinical professional to work within the paediatric service as a trainee Advanced Practitioner for Ketogenic diets. The post holder will undertake a 2-year master’s programme in Advanced Clinical Practice to enable them to work towards independent, autonomous clinical practice as an Advanced Clinical Practitioner after training. The post holder will be allocated a medical supervisor and Senior AHP mentor to ensure successful achievement of the clinical skills required to fulfil the role of Advanced Clinical Practitioner. The trainee will be identifiable in their new role as an Advanced Clinical Practitioner in training. As part of the training programme the post holder will be released for 2 days per week (15 hours) for study / placements required to successfully complete the programme. On completion of the 2-year programme from University, they will exercise advanced clinical expertise, levels of judgement, discretion and decision making in clinical care demonstrated through the Trust advanced competency framework, whilst maintaining a professional portfolio. They will provide advanced clinical skills and advice demonstrating a sound understanding of the issues related to the identification, assessment, diagnosis, treatment and management of the client group. Working closely with the multi-disciplinary team the post holder will be actively responsible for the paediatric Ketogenic Diet service – screening and clinics. The post holder will develop an Advanced Clinical Practitioner Ketogenic Diet paediatric clinic. Applicants should have 5 years post-graduate experience including 3 years in paediatrics including management of epilepsy using Ketogenic diets. An awareness of working to local and national guidelines is essential. As this is a University teaching hospital the post holder will be expected to participate in the education of the multidisciplinary team and have a willingness to extend and develop their knowledge, skills and competencies. You will be supported by the paediatric dietetic team and will be expected to participate in providing leadership and training to staff.

Appendix 1

1

Person specification;

Summary Guidelines for an ACP trainee Post in Ketogenic dietetics as a minimum you will Currently be a Band 7 paediatric dietitian with recent experience in ketogenic diets

• Have delivered MDT paediatric dietetic training both internally and externally

• Have evidence of advanced/ Masters level post graduate paediatric dietetic CPD e.g. master’s modules

FACTORS ESSENTIAL Necessary for safe & effective performance in the job

DESIRABLE

METHOD OF ASSESSMENT

Educational/ qualifications/ registration

• BSc. or MSc. in Dietetics OR

• BSc. in relevant science & Post Graduate Diploma or MSc. in Dietetics

• Registration via Healthcare Professions Council

• Evidence of Advanced / masters level post graduate training e.g. masters level BDA paediatric modules,

• Advanced training in Ketogenic diets e.g. keto school

• Registered member of the British Dietetic Association

• Involvement in paediatric interest group

CV & evidence

Knowledge and Experience

• Substantial paediatric clinical dietetic experience in ketogenic diets

• Understanding of difference approach to teaching children/carers.

• Specialist knowledge of dietetic assessment and treatment techniques

• Evidence of ongoing Continual Professional Development in dietetics

• Experience of and commitment to interdisciplinary team working.

• Experience of supervision of registered dietitians, students and assistants

• Evidence of contribution to clinical education and in-service training of less experienced staff/students and assistants

• Understanding of clinical effectiveness and its implications for services including experience of quality issues, audit and evidence-based practice.

• Delivered MDT paediatric dietetic training both internally and externally and at a national level

• Evidence of presenting at local, regional and national level conferences

• Evidence of participation in research and audit

• attended a clinical educator’s course

CV references and interview questioning

Appendix 1

2

Clinical Skills / Abilities

• Advanced-interpersonal and communication skills especially with children

• Good Leadership/ organisational/planning/prioritisation skills

• Empathetic and able to motivate and negotiate to encourage reluctant/ challenging patients and handle sensitive situations

• Ability to work as part of a team

• Well-developed concentration, analytical and problem-solving skills

• Able to work autonomously with ability to seek guidance appropriately with individuals or in a group setting

• Ability to reflect and critically appraise own practise

• Effective written communication skills e.g. clinical records, reports to other health care professionals and external agencies.

• Advanced Presentation, Word processing and IT skills

• Able to participate in emergency/weekend/7-day cover rotas

• Car driver

By application presentation, interview questioning and references

JOB DESCRIPTION POST: Trainee Clinical Practitioner (ACP) Ketogenic Diet Service DEPARTMENT: Paediatric Ketogenic Diet Service and Children’s Neurology Service GRADE: Band 7 (Subject to AFC Review) throughout training period HOURS: Full time RESPONSIBLE TO: Dietetic Team lead Accountable to Paediatric Dietetic and SALT service manager LIAISES WITH: Patients/Families/Carers, Clinical Service Lead, Deputy Chief Nurses, Consultant Medical team, Divisional General/Directorate Managers, Medical Directors, Risk Management, Ward and Department Clinical teams, Multidisciplinary team, Students, Community Health and Social Care teams, GP’s, Higher Education Institutes (HEIs), Research and Development Directorate, Clinical Audit, local Clinical Governance teams

RESPONSIBLE FOR: KD Clinical Lead WORKBASE:

JOB PURPOSE The post holder will undertake a 2-year master’s programme in Advanced Clinical Practice to enable them to work towards independent, autonomous clinical practice as an Advanced Practitioner during training. The post holder will be allocated a medical supervisor and Senior paediatric Dietetic mentor to ensure successful achievement of the clinical skills required to fulfil the role of Advanced practitioner. The trainee will be identifiable in their new role as an Advanced Clinical Practitioner in training. As part of the training programme the post holder will be released for 15 hours (2 days) per week for study / placements required to successfully complete the programme. On completion of the 2-year programme, s/he will exercise advanced clinical expertise, levels of judgement, discretion and decision making in clinical care demonstrated through the Trust advanced competency framework, whilst maintaining a professional portfolio. S/he will provide advanced clinical skills and advice demonstrating a sound understanding of the issues related to the identification, assessment, diagnosis, treatment and management of the client group. S/he will monitor and lead improvements to standards of care through, supervision of practice, clinical audit, evidence-based practice, teaching and supporting professional colleagues and the provision of skilled professional leadership. S/he will lead the implementation of relevant research into practice contributing to the further development of the evidence base through research and audit. S/he will contribute to clinical governance within the service by leading audit and research as part of the MDT within the area of expertise.

1

MAIN DUTIES AND RESPONSIBILITIES Under supervision during training the trainee will: Exercise advanced clinical expertise, levels of judgement, discretion and decision making in clinical care demonstrated through Trust advanced competency framework Provide advanced clinical skills and advice demonstrating a sound understanding of the issues related to identification, assessment, diagnosis, treatment and management of the client group. Monitor and lead improvements to standards of care through supervision of practice, clinical audit, evidence-based practice, teaching and supporting professional colleagues and the provision of skilled professional leadership Lead the implementation of relevant research into practice contributing to the further development of evidence base through research and audit Contribute to the Clinical Governance agenda within the service by leading audit and research as part of the multi-disciplinary team within the area of expertise Act in accordance with the relevant Code of Professional Conduct. Leadership, Management & Consultancy The post holder will be expected to:

• Contribute and lead the development of MDT/team objectives for the area of expertise.

• Act as a role model of standards of behaviour and professionalism, through commitment to the integration of policies and procedures within role and workplace.

• Contribute to local and regional clinical networks and speciality specific groups, working in partnership with other key professionals.

• Analyse relevant local, regional and national policy, within area of expertise, advise on impact for service, leading the implementation of changes and evaluation of processes in partnership with the MDT.

• Maintain professional registration and practice through CPD.

• Maintain personal standards of conduct and behaviour consistent with Trust and associated Regulatory Body guidelines.

• Allocate, coordinate, monitor and assess own workload and that of individuals or the service, ensuring resources are deployed appropriately.

• Take a proactive role in shaping the development of current and future service pathways, whilst engaging with appropriate internal and external stakeholders.

• Demonstrate fiscal awareness by ensuring the appropriate use of resources in order to meet service/client’s needs.

• Participate in the implementation and delivery of the standards set within the Trusts

• Quality Strategy.

• Promote, champion and actively participate in key Trust initiatives.

• Recognises and acts as an advocate for patients, carers, service and organisation.

• Improve practice and health outcomes through the use of best practice standards and quality improvement processes/ models.

2

Clinical Practice The post holder will:

• Successfully complete the Masters of Advanced Clinical practice, incorporating Non-Medical prescribing qualification

• Assess, diagnose, plan, implement and review programmes of evidenced based care for the client group.

• Utilise advanced clinical reasoning skills and assessment techniques:

• Identify the problem/ diagnose

• Set appropriate treatment aims and objectives with patient

• Competently plan and carry out realistic programmes of investigation and treatment using best practice based on best evidence

• Revaluate programmes of treatment accordingly to assess impact and outcome

• Relate findings to presenting pathology

• Undertake advanced skills appropriate to role, ensuring clinical competencies are maintained in accordance with the Trust framework for advanced practice.

• Provide advice, information and support to Trust staff caring for specific client group.

• Provide advanced knowledge advice and support to client group.

• Identify local, demographic, cultural and environmental factors that influence the health and quality of life for client group.

• Contribute to the coordination and effective management of the admission and discharge process.

• Incorporate advanced practice, in line with the framework of the Trust and associated Regulatory Body.

• Ensure that child protection and vulnerable adult legislation is adhered to within own practice and service.

• Lead on the development of/ evaluate policies/guidelines/protocols for advanced and specialist clinical practice and take responsibility for updating and monitoring policies/guidelines/protocols specific area of expertise.

• Demonstrate a visible clinical profile, providing expert advice and demonstrating high levels of clinical competence in the delivery of patient care as directed by the Clinical Service Lead.

• Prepare accurate and concise reports both verbally and written.

• Communicate the needs of the client groups effectively within the MDT and the Trust.

• Deploy effective communication strategies to ensure that information and knowledge is imparted sensitively according to the needs of patients, staff and students in training.

• Continually review and evaluate own role and clinical practice informing the annual review process with the Clinical Service Lead.

• To act as a non-medical prescriber in line with Trust policy and Regulator Body guidance, ensuring prescribing activity is based upon evidence based best practice.

• Be an active member of relevant Trust committees and groups contributing to developing/ implementing local/national strategy.

• Plan and manage own workload and the workload of the service, in a flexible manner, ensuring that service provision meets the needs of clients.

• Keep relevant records and submit reports in a professionally acceptable manner.

• Promote a positive relationship with all stakeholders within the service.

• Contribute to the clinical governance process, including adverse incident reporting/investigation and the management of complaints, as appropriate.

• Collect and collate data as required by the area of expertise in order to inform internal and external professional and operational bodies.

• Relate complex communication processes to individual situations.

• Be involved in peer review of own practice and that of others.

3

Education & Development The post holder will:

• Develop and deliver specific and relevant specialist teaching activities for all disciplines and grades of staff, client group and carers within the Trust in relation to their area of expertise.

• Review and evaluate all teaching programmes and lead on/contribute to the development of new programmes when a need is identified.

• Identify own development needs in line with service requirements within personal development plan whilst using the Trust Advanced Practice Framework and Regulatory Body requirements.

• Maintain and develop the specialist skills and knowledge required whilst working at an advanced level through reflective practice, attendance of Trust mandatory training, appropriate in-service training, informal teaching and relevant local, regional and national educational activities.

• Ensure personal, peer support and clinical supervision needs are met.

• Act as mentor and resource person for all trainee Advanced Clinical Practitioners within your clinical area as appropriate.

• Provide clinical supervision both within and external to the organisation in order to support development of individuals and practice.

• Ensure mentorship training is updated annually.

• Ensure clinical environment is conducive to supporting the education and learning of all staff.

• Provide an environment that encourages client centred involvement where clients are facilitated to ask for help, advice and education.

• Attend and aim to actively participate and contribute to Trust annual advanced clinical practice conference.

• Contribute to clinical governance outcomes.

Research & Development The post holder will:

• Evaluate clinical practice through audit of service, developing and managing strategies to address any shortfalls.

• Demonstrate knowledge of current research in all aspects of his/her work and to advise others on the implementation of relevant research findings

• Develop skills to lead the development of research proposals with the multidisciplinary team specific to the specialty.

• Initiate and/or become involved in research projects in response to identified service needs.

• Disseminate and promote use of evidence-based practice in area of expertise locally, regionally, nationally and internationally as appropriate

• Disseminate audit results/research findings locally, regionally and nationally through Quality Improvement programmes, local/ regional/ national/international publications as appropriate

• Implement research findings appropriate to practice

• Demonstrate awareness of, promote and support the Trusts Research and Development Strategy

• Proactively promote and support the Trust NMAHP Research Strategy.

4

INFECTION CONTROL IT is a requirement for all staff to comply with all infection control policies and procedures as set out in the Trust’s Control manual. The postholder is responsible for ensuring all their staff attends mandatory training, including infection control and to provide support to the Director of Infection Control. HEALTH AND SAFETY The Trust has a statutory responsibility to provide and maintain a healthy and safe environment for its staff to work in. You equally have a responsibility to ensure that you do nothing to jeopardize the health and safety to either yourself or of anybody else. The Trust’s Health and Safety policies outline your responsibilities regarding Health and Safety at Work. The post holder must not willingly endanger him/herself or others whilst at work. Safe working practices and safety precautions must be adhered to. Protective clothing and equipment must be used where appropriate. All accidents/incidents must be reported to your Senior Manager and documented as per Trust Policy, including the reporting of potential hazards. SAFEGUARDING Ensure that the policy and legislation relating to child protection and Safeguarding of children, young people and vulnerable adults are adhered to. It is the responsibility of all staff to report any concerns to the identified person within your department/division or area of responsibility. SECURITY The post holder is required to maintain confidentiality at all times in all aspects of their work. TEAM BRIEFING The Trust operates a system of Team Briefing, which is based on the principles that people will be more committed to their work if they fully understand the reason behind what is happening in their organisation and how it is performing. NO SMOKING POLICY The Trust operates a no smoking policy, which applies to all staff, patients and visitors and extends to the hospital grounds as well as internal areas.

THE TRUST IS AN EQUAL OPPORTUNITES EMPLOYER This job description indicates the main functions of the post holder and may be subject to regular review and amendment in the light of service development. Any review will be undertaken in conjunction with the post holder and in line with Trust policy.

Published: 2020

Review Date: 2022

©2020 The British Dietetic Association

3rd Floor, Interchange Place, 151-165 Street, Birmingham, B3 2TA

email: [email protected]

Commercial copying, hiring or lending without the written permission of the BDA is prohibited.

bda.uk.com

mailto:[email protected]

Documents

ADVANCED CLINICAL PRACTITIONER (ACP)