WESTERN ISLES NHS BOARD
JOB DESCRIPTION
1
JOB IDENTIFICATION
JOB TITLE: Registered Nurse Level 1 (Mental Health)
DEPARTMENT (S): APU
JOB HOLDER REFERENCE:
NO OF JOB HOLDERS 9
2
PURPOSE
To carry out all relevant forms of required mental health and physical care and to take charge of the ward
on a frequent basis in the absence of the ward sister, and the ward manager who has continuing
responsibility.
To supervise junior staff and to teach qualified and unqualified staff, including learners,
Responsible for the assessment of individual care needs and the development, implementation and
evaluation of programmes of care.
To be the patient’s Named Nurse.
Assist the Ward Manager and Ward Sister in leading, directing and monitoring the performance and work
within the nursing team
.
To act as Nurse Mentor to student nurses and Nurse Preceptor for newly qualified nursing staff.
To provide and participate in clinical supervision as a supervised practitioner.
Identify and access evidence of best practice to contribute to the effective and comprehensive assessment,
planning and implementation stages of patient care.
To work within the structures incorporated within the Clinical Governance framework.
To lead on projects relating to mental health in accordance with national initiatives and clinical
developments
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JOB SUMMARY
The post holder takes charge of the ward in the absence of the Ward Sister /Ward Manager.
Role responsibilities are for an assigned caseload of patients with generic and diverse mental health needs
on an inpatient, day patient and outpatient basis. The post-holder will hold rights of Mental Health Officer
authorisation under Section 25:2 of the Mental Health (Scot) Act 1984.
The post holder will be responsible and accountable as the Named Nurse for the assessment of individual
care needs, initial nursing diagnosis and the development of programmes of care. This includes the
assessment, planning, implementation and evaluation of care outcomes.
Care plans will incorporate packages that meet with the complex care needs for patients who are
discharged into the community. The provision of after care arrangements will include liaison with other
statutory and voluntary agencies in planning and assessing suitable care packages that serves to enhance
reintegration.
The post-holder will be expected to a lead on special projects.
3
ORGANISATIONAL CHART
Ward Manager
APU
Clisham
Ward Charge
Nurse
RMNs (9)
THIS POST
HCA (3)
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4
MAIN DUTIES AND RESPONSIBILITIES OF THE POST
KNOWLEDGE TRAINING AND EXPERIENCE
Registered Nurse, Level 1 of the Nursing and Midwifery Council (NMC).
The post-holder will be required to continuously update his/her knowledge of nursing developments,
psychotherapeutic techniques and treatments and is required to provide evidence of Continuing
Professional Development to meet the NMC requirements in order to maintain Registration.
The post-holder is authorised to order controlled drugs for use in their normal area (ward) of work.
The post-holder is required to be trained in or to receive training in Infection Control, Health and Safety,
Fire, Moving and Handling, Immediate Life Support (ILS), Control and Restraint and Breakaway
techniques.
The post-holder is required to have knowledge and training in the Mental Health Act, Community Care
Act, Human Rights Act.
The post-holder will be required to manage the complexities arising from clinical and ethical dilemmas
and have knowledge of the contemporary ethical issues that impact on mental health nursing and health
care.
The post holder will be trained in venupunture.
ANALYTICAL AND JUDGEMENTAL SKILLS
Requires an ability to interpret patient care plans, patient observations, recognise anomalies in patients’
conditions (continuous).
Be able to accurately carry out patient orientated risk assessments, analyse results in the context of
available data and then to implement and evaluate specific interventions to manage identified risks. For
example, using the Mental Health Clinical Risk Assessment, Suicide Risk Score, Madras and Mini
Mental State to (and other risk assessment tools) to ensure appropriate levels of observation (70% of
time).
Initiates appropriate investigations and treatments, including onward referral where appropriate, in
response to clinical assessment and patient needs.
Ability to interpret and anticipate situations that require assistance from outwith the department eg police,
and line management.
Ability to assess, identify and plan for patients’ care pathway from the point of admission to discharge
(70% of time).
Ability to liaise with multi-disciplinary teams hospital and community in meeting the identified needs of
patients prior to discharge.
Ability to assess, identify and plan for patients care pathway for all patients and staff referred for HIV
Counselling.
Be able to set up accurately and safely medical devices, for example, infusion pumps, enteral, nasogastric feeding systems, pulse oxymeter, pressure relieving devices etc and an ability to recognise faults
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with complex equipment and to take appropriate measures to ensure patient and staff safety eg ECT
machine.
Be able to interpret patient drug prescriptions safely in accordance with NMC guidelines and good
practice statements/protocols and to safely calculate complex drug calculations to ensure that the correct
volume or quantity of medication is administered via the correct route. The nurse must consider the
dosage, method of administration in the context of the condition of the patient and any co-existing
therapies.
Be able to identify contra-indications associated with specific medications and to implement explicit
precautions/interventions to mediate against such contra-indications for example, bleeding and the use of
anti-coagulants, occulogyric crisis and the use of anti-psychotics.
Be able to identify the side effects of patient medications and to take remedial actions to protect the safety
of the patient. Such actions may involve the with-holding of medications, making judgements as to when
to administer/implement life saving interventions such as adrenalin in the case of anaphylitic shock.
The nurse is competent in assessing and determining the appropriateness of contacting the prescriber of
any medication prescribed to a patient. The nurse is able take cognisance of any deterioration in the
patient’s condition, the existence of any possible contra-indications to the prescribed medications, or
where the patient develops a reaction to the medicine and when judging whether the medicine is no
longer required for the patient.
Ability to assess complex symptomatology, exercise judgement on its implications and identify initial
working diagnosis.
Ability to make competent decisions in ethical and moral dilemmas arising from complex situations.
Ability to conduct physical examinations using validated assessment tool (AIMS) to determine degree of
side-effect impairment.
Ability to make judgements on risk and the requirement for an increase in patient observation levels
(continuous).
To recognise factors that influence relapse and make decisions on the nursing intervention options to be
prescribed.
Within the framework of the Mental Health Act and the Human Rights Act to utilize and apply the
Nurses Holding Power for the detention of a patient requiring compulsory treatment.
PLANNING AND ORGANISATIONAL SKILLS
To prioritise and manage inpatient caseload, day care attenders and out-patients with the ability to reorganise schedule in accordance to workload variations and emergency admissions (continuous).
To organise the work for the shift when in charge.
To plan, organise and deploy staff according to competencies and workload in order to meet patient needs
(continuous).
Ability to plan and organise the collating of all relevant patient information in advance of discharge or
transfer to ensure such details are timeously transmitted
The ability to arrange multi-disciplinary case-conferences and discharge planning meetings with other
professional groups/agencies, including family and carers.
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To plan diary and out-patient appointments in accordance with off-duty roster and other work
commitments.
To cancel and re-schedule appointments as necessary for colleagues as required eg sickness, patient
cancellations.
To plan programmes of care for discharge that will be applied in the community by CPNs, Social Work
and Voluntary agencies.
To plan and organise for patient escorts, travel arrangements and accommodation, liasing with the
receiving hospital and altering plans as required to meet with the safe transportation of the patient.
PHYSICAL SKILLS:
The post-holder is expected to have a high degree of dexterity, hand eye co-ordination, in order to
accurately perform nursing tasks, for example intra-muscular injections particularly when administering
injection during psychiatric crisis, moving and handling patients, calculating and preparing drug dosages
(e.g. insulin) operating medical devices, catheterisation, removing of sutures, wound care etc.
The post-holder is required to be competent in the use of specialised equipment for patient care and to be
able to provide instruction and demonstration to other staff, patients and relatives/carers. eg ECT
machine.
The post-holder is expected to be proficient in the use of physical restraint and breakaway techniques that
requires formal training.
RESPONSIBILITY FOR PATIENT /CLIENT CARE
To be the Patient’s Named Nurse and to be responsible for assessing, developing, implementing,
evaluating and documenting all forms of nursing care ( including basic and complex aspects of physical
treatment and care when secondary to mental health problem) given to patients. (continuous)
Always encourage patient participation in appropriate aspects of care and to involve the patient in the
planning of that care.
Always act as patient advocate and to act in accordance with the NMC’s Code of Professional Practice
that ensures the integrity of the nurse patient relationship and that patients are empowered to exercise
informed consent.
As the Named Nurse to be responsible for patient referral to appropriate clinicians e.g. dietician,
physiotherapy, O.T, Speech and Language Therapy.
Gives clinical advice on mental health and illness management to patients, and where appropriate to
relatives/carers, and which includes aspects of health promotion.
The nurse will know the therapeutic uses of the medicine to be administered to patients, its normal
dosage, side effects, precautions and contra-indications.
The nurse will be aware of the patient’s care plan and ensure that the appropriate medical or nursing
intervention is carried out on the correct patient and in accordance to the patient’s expressed needs.
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The nurse will act as main facilitator in liasing with external agencies in developing individual care
packages in preparation for discharge.
COMMUNICATION AND RELATIONSHIP SKILLS
When on duty will receive and advise on complex and sensitive information e.g. confidential information
relating to social, sexual, judicial, psychiatric and medical history.
When on duty will respond to crisis calls from individuals, community patients and their relatives/carers
requiring advice on mental health matters. Will determine serious degree of risk and implement
appropriate measures to safeguard persons well being.
Counsel patients, and where appropriate relatives/carers, in relation to mental health issues, medical
investigations and results, social difficulties and lifestyle behaviours that contribute to physical and
mental health.
Required to be able to convey distressing and unpleasant information with empathy and sensitivity to
patients and, where appropriate, to relatives/carers.
To facilitate group work where there is conflicting opinion and complexity of dynamics that requires
skilled communication techniques to maintain therapy, individual integrity and prevent potential for the
escalation of antagonistic situations.
Use tact reassurance and sensitivity when necessary to overcome barriers to understanding, for example,
in distressing situations such as attempted suicide, death, bereavement and poor prognosis.
Display a positive attitude to diverse cultures and spiritual beliefs and to facilitate different forms of
communication that embraces the philosophy of social inclusion.
Ability to use well developed interpersonal and communication skills when dealing with thought
disorder, psychosis or hostile and antagonistic situations in order to provide therapy or change behaviour.
Participate in counselling, assessing and supporting colleagues whenever required.
Attend and participate in meetings and disseminate information to staff at ward/department level.
Providing advice to GPs, voluntary and statutory agencies, police and other wards.
Communicate relevant data in verbal, written and electronic format.
Ability to use well developed de-escalation skills when faced with potentially violent incidents.
Ability to use persuasive, motivational and effective negotiating skills to gain patient concordance with
treatment plan or to manage challenging behaviour.
Ability to effectively delegate instruction to colleagues in a manner that promotes a positive working
environment and team cohesion.
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RESPONSIBILITY FOR POLICIES/SERVICE DEVELOPMENT
Follow policies in own role and comments on policies as appropriate.
Has a responsibility to develop and implement and review ward policy in partnership with Ward
Sister/Ward Manager
Has a responsibility to maintain up to date knowledge and understanding of mental health policies that
affect local practice.
To be aware of all Western Isles NHS Board policies and make colleagues and where appropriate
members of the public also aware of the existence of relevant policies.
RESPONSIBILITY FOR FINANCIAL AND PHYSICAL RESOURCES
The post-holder is expected to handle and record patient valuables and belongings e.g. clothing and
monies in accordance with Western Isles NHS Board policy whenever on duty.
Always exercise economical use of ward/department resources e.g. incontinence products and other
sundry items.
Ensure maintenance and regular weekend checking of ward equipment and reporting faults to works
department.
Always demonstrate economic utilisation of ward equipment, services, resources and facilities.
The post-holder is responsible for the safe management of escort fund when necessary.
RESPONSIBILITY FOR HUMAN RESOURCES
Is required to advise and demonstrate practice to the nursing workforce in mentoring, coaching and
training students, new staff, junior staff, etc.
To allocate and supervise work delegated to peers and junior staff (continuous throughout shift).
Required to take charge of the ward/department in the absence of the ward manager and ward sister.
To undertake the role of Nurse Preceptor to the newly registered nurse as required.
To undertake the role of Mentor to identified student nurses/learners/nursing assistants.
To always promote an environment that provides learning and growth for registered nurses and healthcare
assistants and to participate in ward learning programmes.
To facilitate the development of an environment that is conducive to promoting ‘reflective practice’ and
clinical supervision.
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RESPONSIBILITY FOR INFORMATION AND RESOURCES
To always maintain patient records and documentation e.g. care plans, charts/investigations, test results
etc within the ward.
To maintain and ensure appropriate storage of documentation relevant to practice eg strategies, local
health plans, guidelines and policies.
To create reports to assist in department investigations, complaints or special projects.
RESPONSIBILITY FOR RESEARCH AND DEVELOPMENT
Participate in the data collection of clinical audits relating to good practice guidelines (SIGN, QIS,
CRAG, Infection Control etc), national standards, local audit programmes etc.
The post-holder is required to research up to date evidence of good practice.
FREEDOM TO ACT
Accountable for own professional practice without supervision but uses Ward Sister Manager as
reference point for advice and guidance when required.
Able to act within established parameters e.g. acknowledgement of personal competencies, extended
scope of practice which are clearly defined by the NMC’s code of conduct, and the Western Isles NHS
Board’s operational policies and protocols.
5
SUPPORTING EVIDENCE
PHYSICAL DEMANDS OF THE JOB
The ability to use mechanical hoists safely and effectively in the movement of patients and equipment.
Is required to move patients from and between wards, , x-ray and other departments on an occasional
basis within shifts.
Is often required to move patients within the ward to accommodate patient activity e.g. new admissions
and changing patient conditions.
There will be occasions that the post-holder will have to manoeuvre heavy equipment (such as chairs,
bedside cabinets etc) within the ward, and between wards in confined spaces during emergency situations
e.g. psychiatric crisis, accessibility to patient if being ‘specialled’, to medicate patients who require to be
restrained.
There will be occasions where the post-holder will have to move heavy patients (average male patient
weight 13-14 stones) and equipment without the recourse to hoists during emergency situations e.g.
cardiac arrest, patient falls where the environment prohibits the use of hoists or more frequently
behaviourally challenging situations when the patient refuses to move.
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Is required to use control and restraint in the event of managing aggressive and violent incidents.
MENTAL EFFORT
The post-holder will be required, on every shift, to prioritise caseload and work demands in the face of:
(i)
(ii)
(iii)
unpredictable work patterns
changing patient dependency levels
frequent interruptions such as telephone enquiries, demands of other patients and
relatives/carers, demands from other staff such as doctors, peers etc, and
emergency situations such as responding to psychiatric crisis.
(iv)
Periods of intense concentration are often required to facilitate the mental and physical examination of
patients and the carrying out of patient assessments using verbal and non verbal language. Concentration
may be particularly intense when the patient is distressed and or is experiencing difficulties in cooperating with instructions and having difficulties communicating, for example is psychotic and
delusional, post stroke, head injury, toxic confusional states associated with endocrine disorders,
infection, medication etc.
Intense concentration is also required throughout all psycho- therapeutic counselling where analysis,
confrontation and challenge of thinking is core to the interpretation and formulation of diagnosis and
defining of health needs.
In addition to:
 Carry out patient observations (e.g. assessment of cognitive functioning, mental health , suicidal
intent, wound care assessment, assessment of levels of consciousness ie sedated and post
anaesthetic ) in stressful environments e.g. during staff shortages, busy workloads etc.
 Observe unpredictable patient behaviours that may present risks such as potential for falls,
absconding, self- harm or potential harm to others.
 Manage the unpredictability associated with people (patients/members of the public) who are
exhibiting behavioural difficulties and who are unknown to staff.
 Specialing i.e. a one to one nurse patient ratio.
 Manage bed occupancy on a daily basis and within shifts.
 Carrying out intricate and or personal interventions e.g. catheterisation, removing sutures,
carrying out wound care.
 Nursing unco-operative and challenging patients
EMOTIONAL EFFORT
The post-holder will be expected to manage the following situations:





Exposure to emotional and distressing situations such as imparting distressing and upsetting
information to patients, relatives/carers, peers, junior staff and learners on a daily basis.
To counsel distressed patients and relatives on coming to terms with their illness/disability on a
shift to shift basis.
Daily exposure to nursing and caring for the patient who is suicidal.
Daily exposure to nursing and caring for patients under the influence of alcohol or drugs.
Required to provide peer support following adverse incidents such as sudden and unexplained
death, exposure to aggression and violence at least once a week.
Frequent exposure to aggressive and abusive patients, relatives/carers, members of the public.
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


Occasional exposure to severely challenging behaviour in highly emotional circumstances eg
holding patients against their will under the terms of the Mental Health Act, patients with
learning disability aggravated by their mental illness.
Exposure to, and exploring the emotional issues intrinsic to mental health problems and illness.
Frequent exposure to emotional distress when undertaking intimate and intrusive physical and
psychological care and treatment.
WORKING CONDITIONS
Daily/weekly contact and exposure to body fluids such as faecal matter, blood stained fluid, sputum,
soiled linen, infective materials etc.
Organising and undertaking decontamination of known and potentially infected areas and equipment on a
regular basis.
Considerable exposure to hazards eg patients under the influence of alcohol and drugs, have command
delusions or unpredictable behaviours.
Daily exposure to potential for violence and aggression as forensic patients may be required to be
detained within the ward as a place of safety prior to transfer to a more suitable treatment facility.
Exposure to unpredictable situations with patients referred to the service by the Criminal Justice System
for treatment and behavioural reports.
6
STANDARD ELEMENTS
Confidentiality
All personal health information is held under strict legal and ethical obligations of confidentiality. NHS
Staff must follow guidance (NHS Code of Practice on Protecting Patient Confidentiality) before
disclosing any patient information. All staff must respect confidentiality of all matters that they may
learn relating to their employment, other members of staff, patients and their families.
Health and Safety:
Assist in maintaining own and others’ health, safety and security.
This involves:
a) Complying with NHS Western Isles’ health and safety policies, procedures and participating
in mandatory training.
b) Maintaining a safe working environment and reporting any issues of concern as
appropriate.
NHS Western Isles attaches the greatest importance to the health and safety of its employees.
It is the Board policy to do all that is reasonable to prevent personal injury and hazard to health by
protecting staff and others including the public from foreseeable hazards compatible with the
provision of proper services to patients. The Board expects its entire staff to take reasonable care
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of their own health and safety and that of others who may be affected by their acts or omissions at
work. More detailed information is given in departmental safety policies where appropriate.
Supporting equality, diversity and rights.
This involves:
(a) Acting in ways consistent with the Board’s policies and procedures.
(b) Treating those you come into contact with equitably and with respect.
(c) Recognising the need for aids or adaptations.
JOB DESCRIPTION AGREEMENT
I, (Print Name)………………………………………………….. confirm that the job description(s)
/person specification(s) attached have been discussed with me and are an accurate and up-todate account of the duties and responsibilities and skills/qualifications required to undertake the
post.
Job Holder’s Signature:
Date
Head of Department Signature:
Date
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WESTERN ISLES NHS BOARD
PERSON SPECIFICATION
Job Title:
Registered Mental Health Nurse
Department:
APU
Location:
Western Isles NHS Board
FACTOR
EXPERIENCE
QUALIFICATIONS,
TRAINING, RESEARCH
PUBLICATIONS
ESSENTIAL
At least twelve months post
registration experience within an
acute psychiatric setting .
DESIRABLE
Current NMC registration on
level 1 of the NMC register.
Degree in Mental Health Nursing
or equivalent training and
experience
Further education in a related
field of nursing.
Counselling skills accreditation
CBT experience
Good communication skills
KNOWLEDGE AND SKILLS
Group work skills
Community Care Act
Mental Health Act
Working knowledge of mental
health policies and procedures
Risk Assessment
Counselling Skills
Clinical Governance within
mental health
Champion in Infection Control
Certification.
Nurse Prescribing
Willingness to train as Nurse
Mentor to student nurses and as
Nurse Preceptor to newly
qualified nurses.
KNOWLEDGE AND SKILLS
(Cont’d)
Trained in Immediate Life
Support (ILS) Moving and
Handling, Control and Restraint
and Breakaway.
Keyboard Skills
Infection Control and Health and
Safety training
DISPOSITION
Good interpersonal skills.
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Sense of humour.
Able to work autonomously and
also as an effective team member.
Pleasant disposition.
Effective leadership skills.
Ability to reflect analytically ones
own practice.
OTHER
Will rotate between day and night
shifts.
Will work in other ward areas
where demand dictates.
.
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Non judgemental.