AGENDA FOR CHANGE
NHS JOB EVALUATION SCHEME
JOB DESCRIPTION TEMPLATE
1. JOB IDENTIFICATION
Job Title: Ophthalmic nurse practitioner
Reports to (insert job title): SCN Jean Martin
Department, Ward or Section: Surgical Division
CHP, Directorate or Corporate Department:
Job Reference: SSSARAIGOPTH21
No of Job Holders: 1
Last Update (insert date): 22/08/11
2. JOB PURPOSE
To provide leadership as part of a team and promote the smooth running of the ophthalmology dept
through efficient use of all available resources; including staff, equipment and room allocation. The role
involves being able to deputise for the charge nurse in their absence. To provide a nurse led ophthalmic
service within the department including the peripheral clinics: - minor operations clinics, botulinium toxin
clinics, telephone triage service, watery, itchy, dry eye clinics and ophthalmic casualty services.
In addition to provision of cataract one stop clinics, intravitreous fluorescein angiography clinics, ARMD
clinics which includes carrying out Logmar and ocular computerised technology imaging.
Contributes to staff training and is responsible for individual personal development programmes.
3. DIMENSIONS
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Assessment, treatment and discharge of patients from casualty, WIDE clinics and minor
operations service.
In conjunction with the Charge Nurse manage and lead the departmental team including staff
nurses and auxiliary staff.
Administration of prescription medication as per nurse prescribing NMC guidelines.
Daily vetting of referral letters from highland regional areas working alongside patient focus
booking services.
Developing performas for nurse led clinics at Raigmore which can be utilised in the training
carried out in peripheral clinics.
Responsibility for equipment maintenance and trialling.
Where appropriate recommend initiatives, contributing to the planning and redesign of service to
advance practice and meet changing needs.
Leadership role in ensuring hygiene and housekeeping meets the equipment of the HEI
government role.
Promote a professional patient facing for the department.
4. ORGANISATIONAL POSITION
Manager
Colleague
Colleague
Report No 1
This Job
Report No 2
Colleague
Report No 3
Colleague
Report No 4
5. ROLE OF DEPARTMENT
The department consists of the eye day case centre on ward 1A, the ophthalmology clinic and inpatients
on 4A.
It provides an integrated multi disciplinary service and comprehensive ophthalmic service for day case
patients, emergency admissions and surgery, orthoptist and optometrist services.
The eye out patient department provides a service, which includes new referrals, returns and causalities.
The ARMD service provides utilisation of revolutionary technology, which helps in the diagnosis and
treatment planning and monitoring of care with individual patients.
Part of this planning includes OCT imaging, IVF service and the provision intravitreous injections
currently carried out in the departments newly commissioned clean room.
There are many specialist clinics in the ophthalmic department: cataract clinics, medical and surgical
clinic, occulplastic, intravenous fluorscein clinics, laser clinics, minor op nurse led clinics, nurse led
botulinium toxin clinics, water itchy dry eye clinics, nurse led casualty clinics, paediatric clinics, corneal
clinics, glaucoma clinics, LVA and ocular prosthetic clinics.
The department also offers a nurse led 9 – 5 daily telephone triage service for general practitioners,
opticians and other health professionals.
In collaboration with medical staff as a result of working hours and demands on the service, the
department has had to develop a number of clinical initiatives for nurses, optometrists and orthoptists.
This has positively benefited the patient’s journey and supported the reduction of waiting times.
6. MAIN TASKS, DUTIES AND RESPONSIBILITIES
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Works as a practitioner within the statutes and guidelines laid down by the nursing and midwifery
council.
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To set the highest standards of professional practice, whilst developing clinical leadership.
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Implements and audits standards of clinical care to promote and apply evidence based practice and
the attainment of health care governance requirements. Analysis of new initiatives, attend post
graduate teaching and provide nurse education/development within the department.
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Demonstrates highly developed clinical nursing knowledge and skills such as removal of
meiobiamin cysts, administration of botulinum toxin, venepuncture and cannulation etc and acts as
a clinical adviser and educator to team members and junior doctors.
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Provide a comprehensive nurse led clinical service with:
1) Twice weekly Emergency clinics: Carrying out an accurate and patient centred consultation,
demonstrating full use of slit lamp including ability to carry out applanation tonomety. Ability to
diagnose, prepare treatment plan and provide prescription for treatment. Patients at the emergency
clinic may require removal of foreign bodies,treatment for raised intraocular pressure, red eye
conditions assessments such as uveitis, scleritis,. Corneal problems may include diagnosis such as
herpetic
ulcers,
corneal
abrasions
or
contact
related
problems.
Fundal examination (complex) or optic disc assessment (complex procedure) may be included as
part of the assessment.
Prescribe and review medication for therapeutic effectiveness, appropriate to patients needs and in
accordance with evidence practice and national protocols.
2) Once a week Botulinum toxin clinics: Administration of botulinum toxin for patients requiring
treatment for blephroplasm and hemifacial spasm. Consultation and preparing of treatment plan
for patients requiring botulinum toxin. Ability to alter individual doses and dose sites as required.
3) Once a week Watery, Itchy, Dry Eye clinics: Consultation, diagnosis and discharging of patients
with dry eye syndrome, watery eyes, blocked tear ducts etc. Treatment may include sac washout a
procedure done to ascertain the patency of the lacrimal apparatus or may include epilation to
remove ingrown eyelashes.
4) Once a week Minor operation clinic: Consultation, diagnosis, health promotion and surgical
treatment. Operations include administration of local anaesthetic and removal of lid cysts and
minor entropian procedures i.e. everting sutures. Skin tags, papilomas and sebaceous cysts may
require removal and possible sending to histology for further investigation. Suturing as required
and ability to cauterise where surgery indicates.
5) Work alongside the ophthalmic nursing team carrying out virtual clinics for ARMD, carrying out
log mar assessments and OCT scanning.
6) Consult where appropriate with clinical colleagues regarding the management of patients to
initiate appropriate referral. i.e. patients with query basal cell carcinoma legions or further lid
surgery.
7) Work with patients in order to support compliance with and adherence to prescribed treatments.
Provide information and advice on prescribed or over the counter medication on medication
regimes, side effects and interactions.
8)
Able to discuss and document a patient history demonstrating use of open
ended questions and recording relevant information as per NMC guidelines.
9) Utilise dictation system Winsoft to dictate letters regarding consultation for all nurse led clinics to
pass patient information to other health professionals such as general practitioners.
10) Demonstrate and maintain expertise through professional development, implementation of
evidence-based practice and clinical supervision.
11) Responsible for vetting of letters from health professionals such as general practitioners, opticians
and in house referrals. Using clinical knowledge and skill to access whether referral should be
routine, soon or urgent. Seeking Consultant Ophthalmologist advice when required.
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Contributes to learning opportunities to ensure development of permanent and nonpermanent staff by developing comprehensive development/educational framework to ensure
acquisition of clinical skills in all nursing and auxiliary staff within the department.
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With specialist knowledge and skills develops clinical teaching sessions and programmes,
encouraging others to develop their skills ensuring all staff are competent to deliver high standards of
care.
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Is aware of health and Social Policies, National, Highland and local and participates in local service
developments through steering/working groups.
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Maintain patient records in accordance with NMC Guidelines and NHS Highland standards.
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Completes staff duty rotas via the SSTS system.
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Plays an active role in good communication between the whole of the ophthalmology department,
ensuring staff have access to relevant documented minutes and are informed with any changes
within the department and with any agreed decisions.
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Ensures that Health and safety policies and procedures are maintained and accurate up to date
records are kept i.e. regular safety policies, completion of risk assessments, moving and handling
polices, control of substances hazardous to health (COSHH).
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Assists in the recruitment of nursing staff. Assists in actively managing retention and absence
following PIN guidelines. Liaises and reports to the Charge Nurse.
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Promotes and maintains good relationships within the department and with staff of all disciplines
thought out the hospital and NHS Highland, actively participating in relevant meetings. i.e.
Glaucoma steering groups, head of service meetings, consultant meetings when requested, service
redesign meetings.
7a. EQUIPMENT AND MACHINERY
Ocular Computerised Topography
To scan the retina and macula with option
of 3D images
Slit lamps
For full examination of the eye, allows
cornea, lens and otherwise clear fluids
and membranes to be seen in detail.
Ophthalmoscope
For visualising the interior of the eye
(fundus)
Monitoring equipment for – Blood For measuring and observing patients
pressure/pulse monitor, glucometer, and condition.
thermometer.
Various Hoists
To move patients safely
Tonopens and goldman tonometers
To monitor patients intraocular pressures
Computers and printers
To print documents, scan recordings etc
Chute system
Safe transportation
IOL master
To calculate patients lens measurement
Nidex scanner
To calculate patients lens measurement
Fundus Camera
To record fundal images
Refrigerators
For safe storage of medications
Nebulisers
To give respiratory therapy
Urinary Catheters
To drain urine
Resuscitation
defibrillator
equipment
including To resuscitate and administer shock
following cardiac arrest.
7b. SYSTEMS
1. Maintains patients’ records in accordance with NMC Guidelines and NHS
Highland Standards.
2. Ensures correct use of computerised systems i.e. emails and result reporting.
3. Completes and authorises accurate staff rotas and forwards to pay units via SSTS
system. Reorganises rotas for sudden cover requirements, sickness/absence, change in workload, training
etc.
4. Forwards all vetted letters to patient focus booking.
5. In the absence of Charge nurse completes appropriate documentation relating to staff changes and
recruitment and forwards to appropriate documentation department – Nurse Manager, HR departments,
Pay Units etc.
6. Maintains Health and Safety Management System.
7. Assists Charge Nurse in the maintenance of accurate staff records relating to staff leave through annual
leave, sick leave, family friendly policies and training.
8. Completion of EKSF.
9. In the absence of the charge nurse, completion of all records relating to PIN guidelines.
10.In conjunction with the charge nurse checks budget information relating to staff and supplies.
11.Produces, interprets, discusses with charge nurse in acting upon relevant statistics such as trends in
activity.
8. ASSIGNMENT AND REVIEW OF WORK
E-KSF and appraisal will be agreed with the charge nurse for clinical guidance and professional
management, work review and formal appraisal.
Service delivery will be evaluated against proposed outcomes relating to waiting list initiatives and the
patients journey
Works within statues and guidelines of the Nursing and Midwifery Council, National, Highland and local
agreed policies, protocols and procedures.
In conjunction with the charge nurse ensures that policies and procedures are initiated/revised, developed,
implemented and reviewed regularly.
Monitors waiting lists and carries out audit of service provision.
9. DECISIONS AND JUDGEMENTS
In conjunction with the charge nurse makes decisions on all aspects of clinic management of patients
attending nurse led clinics. This is carried out using comprehensive knowledge, skills and experience of
the service. All made take into account the guidance of the nursing and midwifery council, National and
local policies, procedures and protocols.
Makes autonomous clinical decisions in planning and prioritising patient care and delegation to team
members.
Recognises own limitations in the provision of clinical care and urgency of patients needs referring to
other health professionals accordingly.
Plans and alters duty rota to ensure safe level of staffing to meet the service needs.
Through training needs analysis, identifies staff training requirements and ensures staff compliance.
Responds to suggestions from staff and colleagues and helps to drive and implement changes, which will
lead to improved patient care and staff satisfaction.
10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
To work both as autonomous practitioner as well as assisting in the running of the eye clinic while
responding and satisfying the varying needs of the patients and staff.
Assist in building and maintaining networks in the peripheral clinics providing a high level of clinical
expertise and care.
Remain an active member of the multi-disciplinary team providing clinical care to ophthalmic patients.
Assist in the implementation of a development framework, which expands the skills of ophthalmic nurses
and other professionals allied to the speciality to meet service needs. Finding how changes affect ability to
remain within budget and actively look at ways to decrease expenditure within the department.
11. COMMUNICATIONS AND RELATIONSHIPS
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Establishes and maintains professional relationships with nursing colleagues, medical colleagues,
health care professionals, voluntary services to provide a planned, co-ordinated seamless service
for patients.
Utilise and demonstrate sensitive communication styles to ensure patients are fully informed and
consent to treatment.
Identifies potential and existing challenges in care options for patients, carers, using negotiation
and counselling skills to achieve reconciliation and the best outcomes for patients.
Attends regular meetings with colleagues, head of service, nurse manager, directorate accountant,
optometrists and orthoptists.
Discussing with charge nurse policy issues and when necessary amending, updating,
implementing and evaluating them.
Discussing problem solving challenges in clinical care and team development.
Liaises with other agents, drug representatives, GP’s and Opticians, patient focus booking on a
daily basis.
12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
Physical
1. Moving and handling of patients from wheelchair to examination chair and assist with walking.
2. 2. Risk assess ward area and be inventive in creating a safe working environment for all staff
whilst being sensitive to patient’s environment continuously.
3. Fine motor skills and dexterity to take blood samples, administer injections, suture removal, cyst
removal, skin tags etc removal and suturing.
4. Continuously on feet throughout clinic shift.
Mental
1. Concentration, decision making and organisation skills to cope with competing demands.
(dynamic changes in patients condition, personal issues with staff, sudden staff shortages,
unpredictable emergency admissions.).
2. Making clinical decisions of medication follow up and discharge possibilities for patients.
3. Dealing with the emotional effects of caring for patients who are losing their sight and the families
that care for them.
4. Negotiation skills to coordinate care from support agencies for these patients such as sight action
and low visual aid clinics.
5. Concentration to assess and provide patient care and manage the team with frequent interruption
either in person or by telephone i.e. the triage phone on a continuous basis.
6. Ability to prescribe drugs and calculate dosages and the teaching of staff how to administer certain
medications i.e. Fluorescein angiography.
13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB
Registered General Nurse who, whilst acting within their professional boundaries, will provide care for
the presenting form initial history taking, clinical assessment, diagnosis, treatment and evaluation of care.
They will demonstrate safe, clinical decision making and expert care, including assessment and diagnostic
skills for patients attending the ophthalmology clinic.
Recognised ophthalmic qualification or at least three years experience in both clinical ophthalmology and
with managerial practice.
Professional knowledge with clinical experience in minor surgical ophthalmic procedures, watery, itchy,
dry eye clinics, emergency clinics, botulinum toxin clinics.
Experience of nurse led clinics/initiatives and evidence of practice.
Evidence of ongoing professional development.
Relevant skills in time management, leadership and organisational skills.
14. JOB DESCRIPTION AGREEMENT
I agree that the above Job Description is an accurate reflection of my duties and
responsibilities at the date of signing.
Job Holder’s Signature:
Date:
Manager’s Signature:
Date: