AGENDA FOR CHANGE
NHS JOB EVALUATION SCHEME
JOB DESCRIPTION
1. JOB IDENTIFICATION
Job Title:
Reports to:
Advanced Nurse – Outpatient Parenteral Antibiotic Therapy (OPAT)
Assistant Divisional Nurse Manager
Operational Unit/Corporate Department: Raigmore
Department:
Nursing, Medical & Diagnostics Division
Job Reference:
SSMEDDRAIGSPEC37
No of Job Holders:
1
Dated:
May 2015 (Version 2, June 2015)
2. JOB PURPOSE
To provide expert clinical nursing interventions within the OPAT service to ensure a high quality service
is delivered to this patient group
To undertake invasive procedures as dictated by the service, but will include – insertion of vascular
access devices and diagnostic lumbar puncture. Development of the service for patients requiring long
term antibiotic therapy, including patient and community nurse training
The post holder will seek to increase the capacity for nurse led initiatives within the multi-professional
team with a particular focus on undertaking work currently being performed by medical staff.
The post holder be responsible for developing the service for patients requiring outpatient antibiotic
therapy across NHS Highland and to support other teams in rural DGH, Community Hospitals and GP
practices. The post holder will also work to support further development of the service with regard to
patients requiring short term antibiotics for skin and soft tissue infections.
The post holder will have a significant role in providing information and support for patients requiring
outpatient antibiotic therapy. They will act as a liaison point for such patients and their carers at this
stage of the pathway.
To undertake advanced level assessment in order to address complex health care needs by using expert
knowledge and clinical judgement to diagnose, initiate interventions and refer to other colleagues or
services as appropriate. This will include liaison with community staff across NHSH to monitor patient
progress. Use prescribing skills to initiate and alter therapies in line with Antimicrobial prescribing
policies and responses to treatment.
To ensure that services are delivered effectively and efficiently against predetermined clinical
performance targets linked to good practice recommendations for outpatient parenteral antimicrobial
therapy (OPAT) in adults in the UK (British Society Antimicrobial Chemotherapy, BSAC)
3. DIMENSIONS
Service Dimensions
Description of clinical area including;
Population size: Highland wide approx 290,000
Hospitals: Based at Raigmore but liaises with other hospitals as required
GP Specialist advice to GPs as required
District Health and Social Care Teams: Advanced level advice as required
4. ORGANISATIONAL POSITION
Divisional Nurse Manager
Assistant Divisional Nurse
Manager
Lead Consultant – Infectious
Diseases
Advanced Nurse OPAT
5. ROLE OF DEPARTMENT
The role of the OPAT service is to provide compassionate high quality holistic management of patients
requiring short and long term outpatient antibiotic therapy and to practice within agreed clinical pathways
promoting self management, minimising disease related complications and working toward shifting the
balance of care; providing care as close to the patient’s home as possible
This also involves providing timely and accurate information to patients & their families, in relation to their
individual needs, at each this stage of the pathway, to facilitate informed consent to tests and treatments.
The Advanced Nurse provides a clinical nurse service in Raigmore Hospital .They will work
independently and autonomously at an advanced level of nursing practice, assessing, planning and
implementing complex clinical care and judgments and taking responsibility for the care of agreed patient
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groups within the service whilst also acting as an integral member of the OPAT team.
As an integral part of the multi-professional team the aim is to also influence clinical practice, and to
provide a consultative, leadership and educational role to professional colleagues. The post holder acts
at all times within the requirements of the NMC’s code of professional conduct and NHS Highland
policies & procedures.
6. MAIN TASKS, DUTIES AND RESPONSIBILITIES
Advanced Clinical Practice
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Demonstrates a high level of autonomy & decision making skills regarding nursing assessment,
care interventions, referral and service provision for OPAT patients
Utilises critical thinking and analytical skills, incorporating critical reflection, drawing on a diverse
range of associated knowledge disciplines, higher level clinical judgement and problem solving in
decision-making to determine person centred, evidence-based therapeutic interventions including,
physical examination, ordering and interpreting diagnostic tests, assessment of the clinical
effectiveness of medication regimens; prescribing and titrating medications.
Assists patients to achieve optimum health and well being, taking account of patient choice,
implications of lifestyle preferences, intellectual ability; promotes self care disease management ,
knowledge and recognition of signs of disease progression and advises on appropriate use of
routine professional care / advice and emergency services
Nursing lead in the provision of the OPAT service ,whilst continually developing the service based
on current evidence
Arrange discharge plans to facilitate OPAT Provision. Ensure patients continue to receive Supplies
and IV Antibiotics in order for treatment to be administered in the community
Recognise patients’ urgent health care needs and make rapid decisions to provide appropriate
clinical management on a daily basis with matters relating to OPAT
Participates in weekly OPAT MDT to monitor patients currently receiving OPAT within NHSH.
Initiates and works collaboratively with the multi-professional, multi-agency team, integrating
principles of case/care management, to plan, provide and co-ordinate care across different
settings and organisational boundaries to ensure consistent, safe effective and patient-centred
care
Demonstrates critical thinking and diagnostic reasoning skills in clinical decision making and
delivers care in line with national and local policies.
Clinical /Professional Leadership
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Contributes to the development of local and regional policy and guidelines by demonstrating
political and strategic astuteness within a multi-professional and multi-agency context
Leads and supports the development of strategies that support the implementation of guidelines
and policy at local and regional level
Collaborates with multi-professional and academic colleagues, within and own area of practice, to
initiate research projects to further the body of knowledge
Facilitates the team in learning from significant event analysis and root cause analysis and
develops, implements and evaluates action plans to support team
Shows a critical understanding of all the different roles in multi-professional and multi-agency teams
and demonstrates skilled leadership of OPAT services in own area of practice to ensure patientfocused, responsive services.
Advises the care team on the integration of evidence based assessment and care interventions
within sphere of practice, using extensive practice experience and contemporary knowledge around
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7.
8.
antibiotic use and PICC lines
Utilises negotiating and influencing skills, proactively develops and sustains new partnerships and
networks engaging professional colleagues and wider relevant organisation stakeholders to
influence and improve health outcomes and achieve service quality as described within NHS
Scotland Quality Strategy & the Highland Quality Approach
Gives and receives feedback in a constructive, open and honest manner.
Facilitating Learning
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Ensures systems & processes are in place to promote professional development of staff & promote
a positive learning environment.
Works collaboratively to develop staff through professional development plans & team development
to meet the needs of individuals requiring outpatient antibiotic therapy, their families & carers.
Leads the development of service-user focused education & information materials within area of
practice both locally & nationally.
Ensures that areas of own practice and that of others within teams comply with BSAC good
practice recommendations for OPAT patients, their families and carer.
Contributes to the development of local and regional policy and guidelines by demonstrating
political and strategic astuteness within a multi-professional and multi-agency context in the further
development of OPAT services in a remote and rural setting.
Contributes to education of community teams in OPAT providing mentorship and coaching to multi
professional colleagues, promoting a learning environment, evidence-based practice, succession
planning and building capability and capacity.
Continuously assesses and updates own professional education needs utilising the education
framework within the Advanced Practice Toolkit, NHSH Advanced practice job planning tool &
maintaining a current PDP.
Improving quality and developing practice
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Challenges existing ways of working and participates in the development and implementation of
innovative systems of follow up and future care for individuals requiring long term antibiotic therapy,
their families and carers
Evaluates & synthesises research evidence to identify relevance & applicability to practice and
implements research findings into practice
Collaborates with multi-professional & academic colleagues within and own area of practice, to
initiate research projects to further the body of knowledge
Identifies need for change taking cognisance of the implications of epidemiological, health
inequalities, demographic, social, political and professional trends and developments; developing
case for change, leading innovation and managing change.
In conjunction with multi professional colleagues, audits and evaluates clinical practice at individual
and systems levels, selecting and applying valid and reliable approaches and methods which are
appropriate to needs and context, acting on findings.
Develops robust governance systems by critically appraising the outcomes of relevant research,
evaluations and audits applying findings to improve practice contributing to the development and
implementation of evidence-based protocols, documentation processes standards, policies and
clinical guidelines.
Publishes and disseminates service and care delivery developments through presentations at
conferences and articles in the professional press.
Participates in clinical supervision and seeks networking opportunities to further own professional
knowledge and development
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7a. EQUIPMENT AND MACHINERY
General office equipment including computers, printers, e-mail, NHS Highland Intranet and Internet,
word processing, computing skills, results reporting, power point presentations, laptops, mobile
phones

Is expected to have knowledge of relevant equipment used on the ward and able to use equipment
once provided with training although will not have frequent clinical involvement
Monitoring
equipment
for
blood To measure and observe patients
pressure, temperature, pulse, oxygen condition and act appropriately on
saturations
changes in condition
Oxygen
masks,
equipment–
flow
meters, To give correctly
concentration
prescribed
O2
Infusion devices – infusion pumps/ - To administer intravenous medications
syringe drivers
Vascular
access
PICC/Mid/CVC/PVC
Resuscitation
defibrillator
lines
equipment
– To administer intravenous medications
including To resuscitate and administer shock
following cardiac arrest
Medical/nursing notes trolley
7b. SYSTEMS
1. Works as a practitioner within the statutes & guidelines laid down by the Nursing & Midwifery
Council (NMC).
2. Maintains patients’ records in accordance and NHS Highland standards with NMC guidelines.
3. Completes quarterly job planning tool regarding caseload analysis, education and administration
data for local service information.
4. Sets objectives for self on an annual basis in relation to the job description and personal job plan
5. Provides telephone answering machine checking service
6. Utilises computerised systems to support practice e.g. PAS, SCI-Clinical, Email, results
reporting.
7. Provides service activity reports to Line Manager as required
8. Participates and acts upon relevant statistics such as audit, to enhance delivery and quality of
patient care
1.
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8. ASSIGNMENT AND REVIEW OF WORK
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Clinical workload will be delegated by medical colleagues against patient demands.
Education, learning and development needs of the post holder are identified via e-KSF and
PDP&R process. The post holder will undertake annual review and agree objectives with Assistant
Nurse Manager or deputy. Performance against these objectives will be reviewed on a regular
basis.
Works within the statutes and guidelines of the NMC, National, Highland and locally agreed
policies, protocols and procedures.
Anticipates and develops strategies to resolve service challenges / needs, involving appropriate
colleagues such as; peers, Lead Nurse, General Manager, Accountant, and Consultants / Clinical
Director.
Attends and participates in speciality meetings, staff meetings, and nurse development meetings.
9. DECISIONS AND JUDGEMENTS
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Makes autonomous clinical decisions in the management of the caseload and individual patient care
including admission to and discharge from caseload, planning and prioritising patient care and
referral to other agencies, taking account of the guidance of professional codes and employer’s
policies and procedures.
Is professionally accountable for his/her own actions without direct supervision.
Clinically recognises own limitations in care provision and refer to other health professionals
accordingly
Autonomously identifies, prioritises and manages clinical governance and educational workload.
Makes autonomous clinical decisions, identifying, analysing and synthesising relevant information,
utilising knowledge, skills and experience of OPAT services taking account of the guidance and
standards of the NMC and National, NHSS Highland and local policies, procedures and protocols.
Recognises own limitations in the provision of clinical care and urgency of patient needs referring to
other health care professionals accordingly.
10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
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Difficult communication issues – e.g. dealing with bad news, Inter-professional interface/working
Demands of managing unrealistic expectations of colleagues, patients and carers.
Dealing with emotional/sensitive issues in a noisy/quiet/busy ward environment and/or when the
patient’s equipment or physical condition makes two-way communication difficult.
Demand of having limited backfill to relieve for holidays/study/sickness.
On-going evaluation of this new role and the scope of invasive interventions which can be
undertaken safely and competently by an advanced nurse
Developing and sustaining the service and nursing practice while responding to and meeting the
varying needs of the patients, relatives and staff.
Dealing with problems that have a high degree of complexity, providing advice to other health care
professionals in the management of acute situations, using information delivered over the phone.
Challenges associated with non-concordance of patients with prescribed treatment.
Prioritising a varied and demanding workload
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11. COMMUNICATIONS AND RELATIONSHIPS
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Establishes and maintains effective communication and liaison with patients, carers and
professionals across the statutory and voluntary service network to promote seamless care to
patients.
Acts as patient advocate and facilitate discussion between patients/families/health care
professionals to achieve best possible outcomes for patients. May also be to achieve a compromise
or to diffuse volatile situations
Deals with complex issues (e.g. breaking bad news, poor prognosis) and early recognition and
intervention of actual/potential problems at the diagnostic stage of care
Acts as advisor and consultant to colleagues, both medical & nursing at all levels.
Participates in meetings as appropriate with colleagues/managers/team leaders/ for the purpose of
developing, planning and managing the OPAT service
Networks locally, regionally and nationally by telephone, e-mail, attendance at conferences /
seminars / meetings to discuss and share new innovations in practice and to develop clinical
guidelines.
Observes confidentiality in accordance with NMC and NHS Highland policies.
Prepares and delivers formal and informal presentations/lectures/educational material to both
professional and non professional audiences.
Video conferences with consultants and other members of the health care team throughout
Highland & Scotland when appropriate.
Establishes and maintains professional relationships with a wide range of health care professionals,
third sector agencies, Hospital, Care Home and other care institutions as appropriate to provide a
planned, co-ordinated seamless service for patients.
Identifies potential and existing challenges in care options for patients, carers and staff, using
negotiation and counselling skills to achieve reconciliation and the best outcomes for patients.
Participates in clinical meetings with nursing and medical colleagues.
Participates in regular meetings with colleagues such as Consultants, Nurses, AHPs, for the
purpose of planning, managing, evaluating and developing OPAT services and improving patient
care.
12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
Physical and Environmental
Demands of ensuring good liaison with other health care professionals in the acute hospital setting
Environmental
Working within an acute hospital setting which may involve noise, lack of privacy, lack of space or
physical and equipment barriers.
Exposure to bodily fluids:
Undertaking invasive clinical procedures which include exposure to blood, pleural aspirate and diagnostic
tissue
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Mental (on a daily basis)
Must recognise patients’ health care needs, which can be urgent and therefore require rapid decision
making in order to provide appropriate clinical management.
Assessment of patients’ and carers’ needs requires continuous mental concentration, which may be
frequently interrupted by pagers/telephone calls/other persons/environment.
Independent working and the need to continually self-reflect on clinical decision making and
knowledge and skill requisite to ensure safe practice.
Working both as a lone practitioner and in a ward situation continually risk assesses situations to
ensure personal safety and the safety of others involved.
Communicating, co-ordinating and negotiating across health care professions requires diplomacy,
concentration and skill.
Confidence to react appropriately and manage unpredictable questions, behaviours and attitudes
from audiences when delivering presentations/lectures.
Emotional (on a daily basis)
Communicating sensitive/unpleasant information to patients and families.
Demands of dealing with family and human dynamics.
Demands of making decisions on appropriate clinical management, which may involve invasive
procedures
Coping with unpleasant materials/odours e.g. wound exudate
Demands of dealing with patients/families who have unrealistic expectations/complaints about care.
Demands of liaising with/confronting people who may be involved in patients’ complaints.
Demands of dealing with/confronting a colleague/team member with regard to clinical decision
making, performance or behaviour.
13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB
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First level registered nurse
Significant post-registration experience, with substantial time spent at Band 6 or above.
Is able to demonstrate ability and competence to assess patient suitability for participation in OPAT
Has the knowledge, skills and ability to assess patients for the most appropriate vascular access
device for antibiotic delivery
Is able to demonstrate competence to insert vascular access device ie PICC/Mid line
Is able to demonstrate competence to perform technical diagnostic procedures ie Lumbar puncture
Independent Non Medical Prescriber
Higher degree MSc or professional knowledge at degree level supplemented by specialist training,
experience and short courses to Masters degree equivalent.
Teaching experience is essential, qualification desirable.
Knowledge of, and ability to interpret and apply all relevant NHS Highland and
professional policies, procedures and guidelines relating to national and local OPAT services
Communication, education and diplomacy skills to provide consultancy advice regarding clinical
management to professional colleagues.
Psychological assessment & intervention skills (non-directive interventions), exploratory skills
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(active listening, questioning, verbal and non-verbal communication, reflection), self understanding
and action skills
Health promotion and health education approach to care utilising a motivational approach to self
care
Understanding of the research process and ability to participate in research projects and the
implementation and dissemination of research findings
I.T. skills – E. mail, word processing, power-point presentations, ability to search inter and intranet.
Knowledge and ability to successfully lead and manage change in working practices.
Good level of physical health and stamina, gross and fine motor fitness and dexterity.
An efficient manager of time, of a team & of a clinical case-load.
Team Leadership / Service development 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:
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