Department of Nursing – Emergency /Medical Specialty Directorate
Mater Misericordiae University Hospital Ltd., Dublin 7
Job Description
Location:
Grade:
Reports to /Accountable to:
Accountable to:
CNM2/CNS in Inflammatory Bowel Disease ( Gastroenterology Nursing)
Mater Misericordiae University Hospital – GI Unit
CNM2/CNS Grade
Directorate Nurse Manager Emergency/Medical Specialties Directorate
Professionally Director of Nursing
Purpose of the post:
The CNM2/CNS in Inflammatory Bowel Disease (IBD).Gastroenterology will
demonstrate an advanced level of knowledge and skills to improve the quality of
patient care.The post holder will support the ongoing development of the
Gastroenterology service and be responsible for ensuring the delivery of specialist
nursing within the service.
The CNM2/CNS in Inflammatory Bowel Disease (IBD) will focus primarily on patients
with Inflammatory Bowel Disease (IBD).The CNM2/CNS will co-ordinator care and
liaise between patients, families Medical Consultant and the multidisciplinary team
Telephone advice may be given to clients on how to manage their condition.
Individual cases are discussed at monthly Combined Inflammatory Bowel Disease
Clinics and treatment plans are devised.
Responsibilities:
The CNM2/CNS will be responsible for the development of excellence in the
provision of nursing care through the implementation of clinical standards of practice
and establishing competency standards for staff members. The CNM2/CNS
demonstrates a firm knowledge base and clinical expertise, functions as a clinical
resource, conducts and facilitates patient care consultation, and provides resources
to assess the impact of appropriate practice on patient outcomes.
This specialist practice will encompass a major clinical focus, which comprises of
assessment, planning, delivery and evaluation of care given to patients with IBD and
their families in the department. The specialist nurse will work closely with medical
and para-medical colleagues and may make alterations in prescribed clinical options
along agreed protocol driven guidelines. The approach to management of patients
with IBD is adapting to involve the use of specific biologic agents These specific
agents require the development and management of pre-screening protocols, preadministration education, close monitoring of patients to include progression and
regression of disease activity and to observe for and manage adverse events to
medication.
Patients receiving complex and potent therapeutic treatments require continuous
monitoring, support and education Co-ordinating blood testing and maintaining
accurate documentation is required for each patient as Leucopenia and Neutropenia
are potential side effects that require skilled monitoring.
The CNM2/CNS has responsibility as advocate, health promoter and clinical expert
to enhance professional standards of care.
Other Responsibilities:
Assistance at the High Risk Colon Cancer Screening Clinic.
Aims:
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Identify at risk cohorts and offer appropriate and evidence based
management.
Prevention of CRC through colonoscopic removal of adenomatous polyps,
the precursor to these cancers.
Early detection of CRC, which greatly increases the potential for cure.
Establish a database of high-risk individuals and families, so that we can
review data, critically evaluate outcomes and validate the efficacy of
screening for CRC.
Provide health promotion and information on cancer prevention in general.
Clinical Focus:
Direct Care
 Serves as a reliable source of information on the latest treatment of patients
with IBD whilst supporting cost-effective, safe nursing practices.
 Collaborates with the multidisciplinary team using the nursing process to
integrate the nursing perspective into a comprehensive plan of care for the
patients/family with Gastroenterology diseases.
 Identifies and prioritizes nursing care needs for a select population of
patients/families.
 Conducts comprehensive, holistic wellness and illness assessments using
established or innovative evidence-based techniques, tools, and methods.
 Act as a patient advocate through communication, negotiation and
representation of the patient’s values and decisions in collaboration with
other professionals and community resource providers.
 Provide advice and health education as appropriate with the aim of
achieving self-management of medication, diet, smoking cessation and
lifestyle modifications. Identifying health promotion priorities in the area of
specialist practice.
 Designs and evaluates innovative evidence based educational programs
for patients, families, and staff.
 Identifies, collects, and analyzes data that serve as a basis for program
design and outcome measurement.
 Establishes methods to evaluate and document nursing interventions.
 Evaluates the impact of nursing interventions on fiscal and human
resources
In-Direct Care
 Create and revise nursing policies, protocols and procedures using
evidence-based information to achieve the highest quality standards for
patient care.
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Work with Nurse Manager and other members of the Gastroenterology
service to develop nurse led initiatives that promote best patient outcomes.
Lead clinical practice and quality improvement initiatives in the
Gastroentrology service..
Work with the CNM to create a nursing care environment that stimulates
continuous self-learning, reflective practice, feeling of ownership and
demonstration of responsibility and accountability.
The Gastroenterology Nurse Specialist acts as a point of telephone
contact for patients with IBD.
Work collaboratively with the primary care provider and the consultant
Gastroenterologist in providing immediate treatment..
Assist / Mentor nurses to acquire new skills, develop their careers and
effectively incorporate evidence into practice.
Audit of current nursing practice and evaluation of improvements in the
quality of patient care are essential.
Record statistics of patient care and maintain accurate records of activity
levels.
Provide information on current activity and present needs and future
trends.
Examine indicators for quality development and monitoring
Patient/Client Advocate
 Attend multidisciplinary meetings and accurately represent the patients
views and requirements.
 Offer honest choices regarding treatment options to patients with
inflammatory bowel disease in conjunction with the consultant
Gastroenterologist.
 Active participation with patient support groups, particularly the Irish
Society for Colitis and Crohn’s (ISCC) and the European Federation of
Crohn’s and Colitis Association (EFCCA) in the development of pan
European patient education programmes.
 Facilitate patient participation in decision-making process.
 Consult with other units and health care professionals to improve care.
Educational Role:
 Promotes self-care and wellness through patient education. Communicate
with relatives and significant others in order that the patient will have an
understanding of their condition thereby increasing compliance.
 Develop a structured education programme for patients and their families
to take into account learning styles, teaching styles, needs assessment
and barriers to learning.
 Participate in the educational needs of student nurses combining their
nursing theory with clinical practice in Gastroenterology care and those
nurses’ also undertaking postgraduate courses.
 Be alert to the learning needs of staff nurses, in order to promote the
importance of continued education, especially in a specialised area such
as Gastroenterology.
 Participate in in-service education programmes for all nurses pre and post
registration and other allied students.
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Demonstrate high standards of practice in specialist area and utilise skills
to educate others thus promoting good clinical practice.
Tutoring nursing staff to develop in-depth knowledge about specific
Gastroenterology topics. Provide leadership and clinical expertise to
nursing personnel by acting as a role model, demonstrating skilled nursing
practice, and acting as a resource person to nursing and clinical staff
within the hospital and the community.
In conjunction with other members of the Gastroenterology team identify,
initiate, develop, co-ordinate and participate in new educational initiatives
for staff development.
To organise and facilitate Gastroenterology study days/workshops within
the hospital
Demonstrate a high level of interest in advances in the clinical
management of gastrointestinal illnesses. Attend study days that have a
general as well as an advanced practice focus.
The clinical nurse specialist must keep up to date with current research to
ensure evidence based practice and research utilisation, must contribute
to nursing research, which is relevant to his/her area of practice.
Consultant
 Provide Nurse leadership in the specialist Gastroenterology area.
 Exercise high levels of judgement, discretion and decision making in the
clinical area
 To enhance the quality, efficiency and effectiveness of care for patients
who present with gastrointestinal disorders
 Provide a confidential and private consultation for patients, protecting
patient confidentiality at all times.
 Monitor and improve standards of care and develop practice by active
involvement in advanced clinical practice, undertaking audits and
conducting research.
 Consult and be a consultant to other nurses including students, General
Practitioners. Practice Nurses, Public Health Nurses and other health care
professionals within and outside the hospital.
 Be a source of clinical expertise and professional advice and act as a
specialist resource.
 Recommend improvements in the service.
 Work and co-ordinate in a collaborative, co-operative manner by
influencing other health care professionals and other relevant internal and
external agencies.
 To Maintain high professional standards within acceptable protocols and
national legislation
 Help to create amicable working relationships within the multidisciplinary
team.
 Promote a courteous and helpful attitude toward staff, patients and
relatives of patients.
 Assess own educational needs in relation to role and to promote personal
and professional development
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Audit & Research:
The nurse specialist must keep up to date with current relevant research to
ensure evidence-based practice and research utilisation.
The nurse specialist must contribute to nursing research, which is relevant to
his/her particular area of practice.
Actively participates in clinical audits and the implementation of findings to
improve clinical practice.
Support clinical research, which provides for evidence based practice.
To keep abreast of new developments in technology, treatment and care and
to initiate research where appropriate.
Policies and Procedures:
The Clinical Nurse Specialist must be conversant with and adhere to hospital
policies – example:
A. Health, Safety and Welfare at Work legislation
B. Hospital Fire Policy
C. Hospital Infection Control Policies
D. Data Protection and Freedom of Information Legislation
E. Hospital Grievance and Disciplinary Procedures
F. Risk Management Policies
This is an outline of this post and is subject to review. The scope of the
Clinical Nurse Specialist may change following further deliberations of the
Nursing and Midwifery Board.
The successful applicant may have to undertake additional duties and
responsibilities from time to time as requested by the Director of Nursing
through the Directorate Nurse Manager.
Appendix 1
PROCESS FOR MANAGING PATIENTS WITH IBD
Patients are
referred to G.I
Clinic
Review by Doctor
and IBD Nurse
IBD Proforme is
completed
IBD chart compiled
Contact details if
IBD Nurse given
to patients should
they require
advice
Yes
Patient’s details
added to database
Patients with severe/
non-responsive disease
attend IBD Clinic
Colonoscopy
Does the
Patient require
colonoscopy?
Yes
No
Follow up
review in
clinic
organised
Does the patient
need treatment?
Yes
Treatment regime
discussed with patient.
All pre-treatment
screening planned.
Appendix 2
Name
Dose
Route
Duration
Monitor
Prednisolone
40mg OD
(+ calcichew
1 OD)
1g TDS
800mg TDS
2-2.5mg/kg
? 1/2 dose x
1week
po
Reduce by
5mg/week
po
Po
po
Long term
Long term
Medium-Long
term
1-1.5mg/kg
? 1/2 dose x
1week
Methotrexate
Active:25mg
weekly
Maintenance:
15mg weekly
Mycophenolate 15mg/kg/day
Mofetil
Infliximab
5mg/kg
po
Medium-long
term
Dexa < 3/12 first
attack then yearly if
further dosing
Renal 6/12
Renal 6/12
Pre Tx: TPMT, LFT
TPMT:
Normal - std dose
Hetero – 50% dose
Homo – C/I
FBC weekly x 1/12
FBC monthly x 2/12
Then quarterly
?6-TG levels
As for Imuran
im/sc
Medium-long
term
po
Cyclosporin
UC only
2-4mg/kg
daily
iv
Medium-long
term
Fistulating CD0,2,6 weeks
Luminal CD- 8
weekly x 1yr
UC - ?single dose
1 week
Cyclosporin
UC only
?2mg/kg
daily
?PCP
prophylaxsis
400mg TDS
500mg BD
po
6 months; bridge
to imuran
po
po
Pouchitis: 1 week
Pouchitis: 1 week
Pentasa
Asacolon
Imuran
6-MP
Flagyl
Ciproxin
iv
Pre Tx: LFT if
abnormal – Liver Bx
FBC
>1.5g - ??
Pre Tx:
CXR ,Mantaux
Pre Tx: Renal,
Cholesterol,LFT,
CyA level daily
(200-300ng/ml),
renal daily
Pre Tx: Renal,
Cholesterol,LFT
Renal, LFT, CyA
level weekly
Appendix 3
Total Number of Patients on Infliximab
Total Num bers of patients on Inflixim ab 2006
Number
25
20
15
10
5
0
01-Jan Feb-06 Mar-06
Apr-06 May-06 Jun-06
Jul-06
Aug-06 Sep-06
Oct-06 Nov-06 Dec-06
Month
Total No of patients on Inflixim ab 2007
Number
40
30
20
10
0
Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07
Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07
Month
Appendix 4
Total Number of patients on Humira
Total No of Patients On Humira 2007
12
10
Number
8
6
4
2
0
Jan-07
Feb-07
Mar-07
Apr-07
May-07
Jun-07
Jul-07
Aug-07 Sep-07
Oct-07
Nov-07 Dec-07
Oct-08
Nov-08
Month
Number of Patients on Humira 2008
20
18
16
Number
14
12
10
8
6
4
2
0
Jan-08
Feb-08
Mar-08
Apr-08
May-08
Jun-08
Jul-08
Aug-08
Sep-08
Dec-08
Month
Total Number of Patients on Humira 2009
45
40
35
Number
30
25
20
15
10
5
0
Jan-09
Feb-09
Mar-09
Apr-09
May-09
Jun-09
Jul-09
MOnth
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Department of Nursing
Division of Medicine
Mater Misericordiae University Hospital Ltd., Dublin 7
Person Specification
Clinical Nurse Manager /Specialist in Inflammatory
Bowel Disease Nursing
JOB TITLE
Clinical Nurse Manager/Specialist in Inflammatory Bowel Disease Nursing
GRADE
Equivalent to Clinical Nurse Manager 2
WHOLE TIME
39 hours per week
REPORTS TO
Directorate Nurse Manager
ACCOUNTABLE TO
Professionally to the Director of Nursing
ESSENTIAL
QUALIFICATIONS &
EXPERIENCE:
Presently registered in the General Division of Live Register of Nurses maintained by
The Irish Nursing and Midwifery Board (or eligible to be so registered)
Have a minimum of 5 years full time post-registration experience in acute medical
and surgery nursing and a further of 2 years full time equivalent in Gastroenterology
nursing, and demonstrate evidence based practice in the speciality
Be educated to Post Graduate Diploma level or above in Gastroenterology Nursing.
Have proven clinical and professional managerial ability, leadership, communication
and organisation skills