1. JOB IDENTIFICATION
Job Title: Staff Nurse
– Interventional Unit
Reports to: Senior Charge Nurse
Department, Ward or Section: Cardiac & Radiology Interventional Unit
Division: Medical & Diagnostics Department
Job Reference: SSMEDDRAIGDIAG14
No of Job Holders: 8
Last Update: May 2013
2. JOB PURPOSE
1. In the absence of the Charge Nurse and Senior Staff Nurse, may take charge of nursing responsibilities within the Interventional Area.
2. On a daily basis is responsible, for the organisation and implementation of the nursing care of patients attending the area in which they are working. Works within a multi disciplinary team including non-medical staff, e.g. physiologists, radiographers.
3. DIMENSIONS
1. Nursing care and management of patients attending the Interventional Unit for diagnostic tests and
interventional procedures.
2. The Interventional Unit comprises the Cath Lab, Cath Lab bedded area and Radiology Interventional
Theatre
3. The patient population covers all ages from childhood onwards; in-patients, out patients, surgical,
medical and emergencies.
4. Care of the terminally ill patient attending for a procedure.
5. Care of patients attending from other hospitals.
6. Infection control.
7. Ordering of pharmacy and ensuring drug stock is in date.
8. Maintaining stock and checking that it is in date.

4. ORGANISATIONAL POSITION – MEDICAL DIRECTORATE
Divisional General Manager
↓
Divisional Nurse Manager
↓
Senior Charge Nurse
↓
Senior Staff Nurse
↓
Staff Nurse (this post)
↓ ↓
Staff Nurse Auxiliary Nurses
5. ROLE OF DEPARTMENT
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6. MAIN TASKS, DUTIES AND RESPONSIBILITIES
CLINICAL
1. Works as a practitioner within the Statutes & Guidelines laid down by the Nursing & Midwifery
Council.
2. Is involved with the setting and maintaining standards of care within the agreed guidelines of NHS
Highland Policies and Procedures and to ensure adherence to, delivery of, a high quality service.
3. In the absence of the Charge Nurse/Senior Staff Nurse takes charge of the ward/Dept for the
management of daily responsibilities, including work allocation, deployment and supervision of staff, to
ensure safe and effective running of the ward/dept.
4. With sound clinical knowledge demonstrates skills within the scope of professional practice.
5. Assesses the care needs of patients undergoing diagnostic tests/interventions, delivers a high
standard of care and evaluates its efficacy.
6. Through a detailed knowledge of the test/procedure to be carried out, is capable of giving the patient accurate information prior to the test, offering emotional support during the procedure and ensuring that any necessary aftercare is understood.
7. Works to the regulations concerning radiation protection contained in the Local Rules for the
Interventional Unit. The nurse must also demonstrate a working knowledge of the risks of exposure
to radiation.
8. Demonstrates an understanding of their role within the IRMER 2000 (Ionising Radiation Medical
Exposure Regulations).
9. Scrubs as assistant to the Consultant Radiologist, i.e. works with catheters, guidewires, stents,
embolisation material using aseptic techniques – for diagnostic/interventional procedures in
angiography e.g. angioplasty, stenting, embolisation, EVAR (Endovascular Aneurysm Repair) TIPSS
(Transjugular Intrahepatic Portal Systemic Shunt) etc.
10. Acts as runner/floor nurse during the above procedures. Sets up the trolleys, draws up drugs, gives
sedation as required, monitors the patient, gathers necessary equipment etc.
11. Scrubs as assistant to the Cardiologist for diagnostic cardiac catheterisations, Percutaneous Coronary
Intervention (PCI) and Pacemaker insertion. Is highly competent with catheters, guidewires, balloons
and other equipment.
12. Acts as runner and floor nurse during the above procedures – administering sedation under medical
direction, drug calculations, opening packs, being prepared to use the defibrillator if required, etc.
Develops a strong knowledge of the equipment and drugs that are likely to be used during a
procedure. Is able to maintain focus and concentration in the lab during procedures when the
condition of the patient may deteriorate at any time.
13. Is capable and trained to respond to a peri arrest or full arrest situation. (ILS level as a minimum)
14. Plans in advance for more complex procedures e.g. TIPSS, primary PCI to ensure that the theatre is prepared and necessary equipment and paperwork is available.
15. Works in the cath lab bedded area. Admits elective day patients, cares for the patient post procedure and accurately documents the care given. Contacts the appropriate personnel if the patient’s condition changes. Ensures that the patient preparation has been followed and that the requisite paperwork i.e. drug kardex, coagulation results, consent are available. Cares for patients post procedure until they are transferred back to the ward. Liaises effectively with the wards.
16. Can identify a patient who is reacting to an injection of contrast and can anticipate the drugs that will be required should the reaction progress to anaphylaxis.
17. Cares for patients receiving blood products – carries out and records necessary observations.
18. Demonstrates a working knowledge of ECGs (Electrocardiographs) to underpin working in the cath lab, and can accurately record a 12 lead ECG.
19. Administers IV sedation and other medications under medical direction during interventional procedures, in the cath lab and in the bedded area. Monitors the patient receiving conscious sedation and will take action where the patient’s condition dictates. Documents care given during the procedure.
20. Organises the transport of patients between the wards and department.
21. Participates in the Radiology on call rota. Spends some time each year working in the Ultrasound and
CT departments to ensure knowledge of the environment and staff to facilitate working in these areas when on call.
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22. Liaises with other hospitals concerning the care and transport of their patients to the diagnostic area.
23. Demonstrates an awareness of the PIN guidelines.
24. Maintains effective communications with patients/families/carers and other members of the multidisciplinary team to ensure that appropriate information is shared and patients needs are met
25. Leads and supervises junior staff, who are providing patient care, acting as a source of advice ensuring their educational needs are met
26. Participates in developing and maintaining a positive learning environment. Undertakes teaching of students, nursing colleagues and other members of the multidisciplinary team and participates in the implementation of staff Personal Development Programmes and student mentorship to facilitate ongoing development
27. Has the ability to organise own workload prioritising and adjusting priority in the face of changing demands to ensure all needs are met in the care of the acute medical patient.
28. Is responsible for maintaining patient records within agreed standards.
29. Through an understanding of stores, maintains department stock levels ensuring the economic use of all resources.
30. Participates in Health & Safety policies and Procedures
31. Completion of Risk Assessment
32. Moving and Handling Policies
33. Control of Substances Hazardous to Health
34. In conjunction with senior staff may participate in recruitment of junior staff
35. Ensures a high standard of cleanliness throughout the department, promoting good standards of hygiene in conjunction with the Control of Infection team ensuring infection rates are minimised
36. Creates an environment for evidenced based nursing and plays an active role in the continuing development of the department undertaking various aspects of clinical audit as designated by the
Charge Nurse
37. Promotes and maintains good working relationships within the ward, the medical unit and within NHS
Highland. Actively participates in relevant meetings pertinent to and promoting the ward and the nursing profession generally.
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7a. EQUIPMENT AND MACHINERY
Utilise technical equipment, calibrating when required, checking for faults and ensuring regular maintenance. Is expected to have knowledge of all equipment used in the ward and will use equipment once provided with training, however may not have daily clinical involvement.
Equipment
Various Intravenous pumps
Angiojet device
Syringe Drivers
Intravenous lines, venflons
Butterfly devices, syringes, needles
Monitoring equipment for –
Blood pressure, temperature, pulse, oxygen saturations, blood glucose
Oxygen equipment – flowmeters, masks, nasal cannulae
Nasogastric tubes/PEG tubes
Drains – Chest, paracentesis, Various devices
Urinary Catheters – suprapubic , urethral
Various hoists, slide sheets, “PAT” slide, turn table, slide board, blocks
Ferno Trolley
Furniture – various including chairs
Resuscitation equipment including
Defibrillator
ECG machine
Glucometer
Computers (Intranet, Internet, Word)
Printers
To deliver prescribed drugs/ fluids safely
To measure and observe patients condition and act appropriately on changes in condition
To give correctly prescribed O2 concentration
To drain gastric contents or to feed into stomach
To drain fluid/air from various parts of the body
To drain urine
To move patient safely
For inter-hospital transfer of cardiac patients.
To resuscitate and administer shock following cardiac arrest. To ensure working order.
Recording heart rhythm
Monitor of patients blood glucose
1. Changes portable oxygen cylinders as required.
2. Checks and can operate the portable suction machine
3. Patient trolleys – checking oxygen and entonox cylinders to ensure that they are in working order and contain a sufficient amount of oxygen.
4. Equipment used in angiography; guidewires, catheters, stents, embolisation material etc.
5. High-pressure pump to deliver x ray contrast during angiography – ensures that the pump is filled
and all the air expelled.
6. Invasive pressure facility on monitor during some angiography procedure
7. Wears radiation film badge and finger monitors as required – to monitor radiation exposure.
8. Understands the use of the intra aortic balloon pump, and can set it up independently if required.
9. Ferno trolley can ensure the patient’s safety on the Ferno trolley.
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7b. SYSTEMS
1. Maintains patient records in accordance to the NM&C guidelines and NHS
2. Highland Standards
3. Intranet for course booking
4. Occasionally reorganises rotas for sudden changes in cover requirements, sickness/absence, change in workload, training, etc.
5. Maintains Health & Safety Management System
6. Completion of Personal Development Plans and Training Needs Analysis
7. Develops, monitors and maintains ward communication systems
8. ASSIGNMENT AND REVIEW OF WORK
1. Work area will be assigned by the Charge Nurse/Senior Staff however the post holder will have the responsibility for assessing, planning and implementing care of patients within professional guidelines.
2. The staff nurse will refer to the charge nurse/ward manger, senior staff nurse for clinical guidance and professional management, work review and formal appraisal of performance.
3. Works within statutes and guidelines of the NM&C, National, Highland and local agreed policies, protocols and procedures.
4. The Staff Nurse will delegate / allocate work to the team in absence of the senior staff.
9. DECISIONS AND JUDGEMENTS
1. In absence of Charge nurse/Senior Staff Nurse allocates work and deploys staff within agreed resources to ensure clinical needs are met.
2. Makes autonomous clinical nursing decisions in planning and prioritising patient care and delegation to team members.
3. Assesses patients ’ condition to establish any change involving other members of the multidisciplinary team as required.
4. Recognises own limitations in the provision of clinical care and urgency of patients ’ needs referring to other healthcare professionals accordingly.
5. Frequently assesses patient condition and plans, implements and evaluates programmes of care.
6. Support staff training needs.
7. Responds to suggestions from staff and colleagues and helps to drive and implement changes which lead to improved patient care and staff satisfaction.
10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
1. The ability to give good direct patient care to all patients prioritising and re-prioritising in the face of changing demands within existing resources.
2. Maintaining up to date clinical skills and knowledge
3. In the absence of the band 6/7, provide nursing cover to ensure the effective operation of the dept
4. Maintaining knowledge and skills across a diverse range of ever changing diagnostic/interventional procedures. Working in both radiology and cardiology requires the nurse to have a good understanding of very different types of interventional procedures and to have the flexibility to move between areas – often within the same day.
5. Maintaining concentration in the cath la b where a patient’s condition can change dramatically
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requiring prompt resuscitation.
6. Requirement to work over time at the end of the shift occasionally.
7. Coming in on call, where there is not the same level of support.
8.
The nature of the department requires staff to be able to assess patients rapidly and with very little information. This demands good clinical judgement and strong interpersonal skills.
9.
Working directly with several Consultants means staff are required to be aware of the different approaches, techniques and equipment adopted by the individual Consultant.
11. COMMUNICATIONS AND RELATIONSHIPS
1. Establishes and maintains professional relationships with nursing colleagues, medical colleagues, healthcare professionals, voluntary services to provide a planned, co-ordinated seamless service for patients.
2. 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.
3. Communicates with support departments e.g. Estates, Supplies, Human Resources, Health &
Safety
4. Ensures effective communication with all team members which proves challenging because of the number of staff/professions within the multi disciplinary team.
12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
PHYSICAL
1. Frequent moving and handling of patients – in bed, onto trolleys, from bed to chair, assist with walking etc.
2. Hand washing/cleansing between each patient.
3. Washing and cleaning patients.
4. Frequent checking of equipment attached to patients e.g IV fluids, IV pumps, catheters, drains, syringe pumps, ECG machines etc.
5. Risk assess ward area and be inventive in creating a safe working environment for all staff whilst being sensitive to patients needs continuously.
6. Fine motor skills and dexterity to take blood samples, administer injections, work with fine guidewires / catheters, insert venflon devices to set up IV access, calibrate equipment and computer keyboard skills.
7. Frequent need to walk, stand and bend during shift to provide patient care.
8. Frequent transferring of patients and belongings to and from wards and departments.
9. Occasionally assess the risk of violent/aggressive/challenging behaviour of patients and visitors, and deal with it appropriately.
10. Wearing a heavy lead coat and thyroid collar.
11. Standing still for long periods whilst in the theatres – wearing lead protection.
12. Moving patients during examinations on x ray tables of a fixed height.
MENTAL/EMOTIONAL
1. Concentration, decision making and organisational skills to cope with competing demands (dynamic changes in patients condition, personnel issues with staff, sudden staff shortages)
2. Recognising patients urgent health care needs and making appropriate instant decisions to provide appropriate clinical management
– frequently
3. Dealing with emotional effects of caring for patients and their families who may be distressed /
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anxious / worried
4 Dealing with the emotional effects on patient / family and yourself when bad news is being given
5 Concentration required when checking documentation / patients notes and calculating drug dosages, whilst subject to frequent interruptions from patients / relatives / team members
6 Concentration over a long period – 2-3 hours for complex cases – when scrubbed in angiography.
7 Maintaining professional standing and relationships within a large multi-disciplinary team.
8 Occasionally undertakes last offices and supports relatives.
ENVIRONMENTAL
1. Exposure to bodily fluids, faeces, disposal bed pans / urinals / sputum, emptying of catheter bags – frequently.
2. Exposure to, occasional, verbal aggression.
3. Exposure to hospital environment, eg unnatural light, dry conditions, noise (phones, sluices etc), etc
4. Exposure to radiation.
5. Working all day in rooms with no natural light, little ventilation or air conditioning.
6. Working in dim light.
13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB
1. RGN
2. Evidence of further education/CPD eg short courses
3. Evidence of team working skills with ability to work using own initiative
4. Effective listening and interpersonal skills
5. Time management skills
6. Is prepared to develop their knowledge of cardiac and vascular anatomy
7. Reads and understands the Local Rules regarding radiation protection.
8. Understands the risks posed by radiation.
9. Understands their responsibilities under IRMER.
10. Understands the concept of conscious sedation, the drugs used and the risks involved.
11. Understands the risks and treatment of anaphylaxis in relation to the administration of x ray
contrast.
12. Understands the importance of asepsis in angiography and learns the correct technique for
gowning and gloving when scrubbed.
13. Should be prepared to undertake the Radiology nursing course and participate in cardiology study days.
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:
Manager’s Signature:
Date:
Date:
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