Advanced Practice in Midwifery Implementation Guide

Job Title: Advance Practitioner – Midwifery

Banding:

Directorate: To be added

Reporting to: To be added

About the job

The post holder will demonstrate a high level of expertise within the specialist service providing advice, education and support to staff, patients, their families and carers.

The post holder will be practising autonomously as an advanced clinical practitioner within the designated speciality area to provide patient-centred clinical care. This will encompass the skills of advanced clinical assessment, examination, diagnosis and treatment within an agreed scope of practice throughout the directorate. 

The post holder will support new ways of working that emphasises a more efficient and patient focused service, and will ensure the safe treatment, referral and discharge of patients with undifferentiated and undiagnosed presentations in their area. 

Responsibility for leading the on-going development of clinical practice and standards of care within the service, including the development of policies, procedures, protocols and guidelines in collaboration with multidisciplinary colleagues. 

The post holder will deliver a 90% clinical component to their role and 10% related to appraisal, clinical audit, teaching, continuous professional development and research.

Person Specification 

Behaviors and values

Skills and abilities 

Experience and knowledge

Qualifications and training

Specialty specific

Outcomes and deliverables of role

Key working relationships

• Divisional Nursing & Medical Teams
• Chief Nurse & Senior Nursing Team
• General & Operations Managers
• Clinical Directors
• Consultants & Medical Teams
• Clinical Governance Team
• PALS, PPI
• External partners – HEI’s, other healthcare providers, Local, regional & national networks

Delivery results/functional responsibilities

Clinical

1. Work autonomously as an advanced practitioner within the specialty, managing a caseload of patients delivering individualised direct patient care.
2. Direct responsibility for assessment, examination, investigation and diagnosis of patients within their area of work.
3. Appropriately treat patients, resulting in the safe management and appropriate referral or discharge of patients with undifferentiated and undiagnosed presentations.
4. Receive referrals via a variety of sources, including direct patient referral. Manage own caseload and clinical priorities according to agreed protocols and working practices.
5. Participate in multidisciplinary clinics, participate in ward rounds, patient reviews and multidisciplinary team meetings.
6. Undertake a variety of clinical skills and provide treatment/ advice as per specialty and scope of practice. Using agreed protocols of clinical practice and professional guidelines. This service may be provided within an acute secondary healthcare facility or in primary, community or home care settings.
7. Within scope of practice and clinical competence request and / or undertake diagnostic procedures and clinical investigations related to plans of care.
8. Utilise scope of practice to undertake Non-Medical Prescribing role and provide advice on medicine management issues associated with the patient specialty group. Work within Trust policy for Medicines Management.
9. Utilise advanced knowledge and skills relating to the specialty to provide specialist advice to other members of the multidisciplinary team on the basis of patient assessment.
10. Provide a seamless, high-quality service from referral through to assessment, diagnosis, treatment and review, referring to other specialists as required. Provide guidance to staff, patients and their families and carers on pathway navigation.
11. Lead in the development and updating of referral guidelines and policies for the service.
12. Use highly developed communication skills to effectively communicate with colleagues, patients and their relatives/carers, making reports and liaising as required with medical staff and other members of the multidisciplinary team both verbally and in writing.
13. Use professional judgement to act as an advocate for patients to ensure a patient focused approach to the delivery of care. Support and enable patients and carers to make informed decisions relating to their treatment and management. Escalate any concerns via the nursing / professional structures as required.
14. Work towards safe and timely discharge and/ or transfer of care of patients from or between hospitals and services and healthcare professionals, ensuring barriers to discharge / transfer are identified and acted upon appropriately.
15. Report and raise concerns related to Safeguarding, accessing advice and support as required. Be conversant with Trust policies for safeguarding including the assessment of mental Capacity, and consideration of Deprivation of Liberty Safeguards (DOLS) and the application of the principles of Prevent (counter terrorism awareness).
16. Ensure effective and accurate verbal or written handover of patients between healthcare professionals.
17. Ensure that high standards of all documentation are maintained, with accurate, complete and up-to-date information regarding patient care are kept in accordance with Trust standards.
18. Monitor the quality and standard of care provided by all members of the team and all staff in clinical areas. Identifying any skills or training gaps and escalating to the appropriate Senior Nurse or Matron.
19. Undertake training to develop further advanced practice roles required by the service to provide a high standard of patient care.
20. Practice within the scope of professional registration (i.e., NMC, HCPC).

Education

1. Act as an expert educational resource for clinical staff, patients, and carers by providing formal and informal education. Promote and develop a positive learning environment throughout the Trust.
2. Act as mentor/ assessor to staff members and students as required, providing educational advice and support. Ensure wards / departments can access appropriate training support and guidance.
3. Lead and actively participate in the delivery of educational programmes for all grades of nursing, medical and allied health professional staff.
4. Provide support and guidance to all levels of ward staff in their clinical role.
5. Ensure that pre and post registration students receive appropriate learning experience whilst allocated to the directorate.
6. Participate in provision and identification of in-service training need for all team staff.
7. Participate in education and practice development on a Trust wide basis liaising with Trust wide educational leads to ensure overall Trust educational objectives are delivered.
8. Recognise the limits of own professional practice and competence, undertake further training and academic qualifications as required to maintain own specialist knowledge.
9. Take responsibility for ensuring personal and completion of any statutory or mandatory training as required for. Informing line manager if there is any deviance from training attendance.
10. Adapt clinical knowledge and skills to different clinical settings.
11. Participate in the annual appraisal process, delegating duties to team members as appropriate to ensure all staff within the team have personal development plans which support revalidation.
12. Maintain close links with local HEI’s and participate in in the development and delivery of new and established advanced practice programmes.

Quality & Safety

1. Support the maintenance of KPI’s NHSLA compliance, CQC compliance and local and national clinical governance initiatives in close collaboration with the directorate senior nursing, medical and management and in collaboration with clinical governance teams.
2. Maintain improvements in patient safety by supporting implementation of patient safety initiatives, prompt and appropriate response to complaints resolution and escalation where appropriate.
3. Ensure patient safety by escalating any risks with staffing or service provision to directorate management team.
4. Report any issues with quality and safety immediately to Matron or Clinical Director.
5. May be deployed to work in any part of the Trust should the need arise to ensure patient safety is maintained. Management and leadership

Leadership and management 

1. Provide highly visible and accessible professional leadership and demonstrate expert knowledge and standards of clinical practice.
2. Lead and develop a defined area of advanced practice within the designated area of practice, promoting interdisciplinary team and collaborative working practices.
3. Meet regularly with team members as a team and on an individual basis as required to support their personal and professional development.
4. Promote team working, build rapport and collaborative working practices with multidisciplinary team. Liaise with inter-hospital departments and personnel across organisational and professional groups. Ensuring effective communication and interpersonal skills with other disciplines and organisations.
5. Act as a clinical role model demonstrating high standards of advanced practice and provide support or advice to other staff when necessary.
6. Lead and support the development of the role according to changing patient’s needs, service requirements and evidence base practice.
7. Lead and actively participate in service/ departmental projects, quality initiatives and statutory accreditation processes. This will include the setting and monitoring of clinical standards of care.
8. Ensure that all resources are managed in an efficient and cost-effective manner to achieve maximum effect for patients and staff.
9. Adhere to all relevant Trust policies and procedures and to ensure that they are correctly implemented.
10. Lead in the implementation of multidisciplinary service objectives that reflect Trust strategies for patient care.
11. Demonstrate effective leadership skills, supporting the senior management team (Nurse Consultant/ Lead AP/ Matron/ Clinical Director) in service development and lead as delegated on the implementation of any of these changes.
12. Monitor standards and maintain high quality care. Report any clinical incidents via the Trust electronic reporting system and escalate issues promptly and appropriately.
13. Utilise the highest level of interpersonal and communication skills when dealing with complex, sensitive, or emergency situations.
14. Maintain an awareness of professional and ethical issues to ensure care is delivered in a professional timely and courteous manner by all members of the team, respecting the different spiritual and cultural backgrounds of colleagues, patients and relatives.
15. Escalate any concerns or complaints promptly.
16. Participate in the recruitment and selection of staff.
17. Responsibility for completing or delegating the preparation and daily review of staff duty rota’s, ensuring that the team provides most effective service provision.
18. Accountable for own practice, always acting within the Professional Code of Professional Conduct (NMC, HCPC, CSP).
19. Maintain a working knowledge of local and national professional policy and strategy.
20. Attend and when required chair multidisciplinary meetings as a representative of the service. Ensure minutes and agreed actions are communicated to stakeholders according to agreed timescales.

Setting direction and service improvement 

Research and audit

1. Participate and where required lead or assist in research projects as required, disseminating and ensuring utilisation of research results to change practice.
2. Utilise research findings in the delivery of advanced clinical patient care, developing new ways of working.
3. Be aware of research /trails being undertaken within the specialist field of practice.
4. Participate and where required lead audit projects as required by the specialty, involving collating, analysing and reporting on results of the audit process.
5. Provide support, encouragement, and advice to nursing staff undertaking audit and research.
6. Assist in the testing and evaluation of new equipment within the clinical area.
7. Collate, analyse, and present reports on varying aspects of the speciality activity as required by directorate or divisional team.
8. Ensure the results of audit and research conducted by the team are disseminated at local, regional, and national level.
9. To share best practice; through publications and attendance/presentation opportunities at conference level.

Role Title: Trainee Advanced Clinical Practitioner – Maternal Medicine and Health Inequalities

Band:

Responsible to: Consultant Midwife

Accountable to: Director of Midwifery

Key Working Relationships: Consultant Obstetricians / Anaesthetists, Physicians, Midwifery Staff

Our Vision, Mission, Values and Behaviours

To insert as trust appropriate

Job Summary:

Individual training needs will be met to achieve the level of competence and capabilities required by the post during training, and upon completion. The trainee will be paid at XX until completion of all competencies matched to the Advanced Practice Multi-Professional Framework, and completion of the master’s Programme. University attendance is supported and within the supernumerary role, supervision from an AP / Consultant Obstetrician / Consultant Anaesthetist will be provided.

The post holder is an experienced Midwife working towards a Masters’ Level Advanced Practice degree. They are a high profile, accessible and responsive leader, with managerial and clinical responsibility for the delivery of advanced practice in maternity. They will be involved in making complex decisions within their scope of professional practice, involving service users to ensure agreed standards, targets and objectives are met. 

They will, with obstetric support, assess patients, complete clinical assessments, diagnose, treat, and evaluate care. They will demonstrate safe, and expert care for patients. The post holder will demonstrate critical thinking in the clinical decision making process. They will work collaboratively with the obstetric and midwifery team to meet the needs of patients with additional medical conditions such as renal disease, cardiac disease, and diabetes, haemoglobinopathies including those experiencing health inequalities. 

On completion of a Non-Medical Prescribing module, they will prescribe medication in accordance with trust guidelines.

They will play a key role in service delivery and adherence to policies and procedures. The successful post holder will provide clinical expertise, management, and leadership to midwives in collaboration with the multidisciplinary team. 

They will, with support and supervision, lead in the provision of maternal medicine throughout the peripartum, working closely with the substantive advanced clinical practitioners and the Multi-Disciplinary Team. The post holder will be required to work within all areas where maternity patients may be housed. They will work alongside medical, midwifery and multi-disciplinary colleagues in the management of maternity patients, providing support, guidance and advice as required. 

They will be instrumental in identifying the developmental and learning needs of midwives and team members within maternal medicine. They will be an advocate for and contribute to, a culture of organisational learning. The post holder will be required to ensure evidence-based care is delivered to patients and be involved in audit, research, and service improvement.

The postholder will co-ordinate the care needs of patients with additional medical conditions such as renal disease, cardiac disease, and diabetes, Haemoglobinopathies including those experiencing health inequalities.

Main Duties/Responsibilities

This job description is a guide to the general scope of duties and is not intended to be definitive or restrictive. It is expected that some duties will change over time and this description will be subject to review in consultation with the postholder. They will ensure they deliver care in line with the 4 pillars of advanced practice.

Clinical

• Co-ordinate the care of maternity patients throughout the care pathway with the multidisciplinary team and clinical services to ensure the effective management of maternal medicine patients which include diabetic, renal, haemoglobinopathies and cardiac conditions and those experiencing health inequalities.
• Accountable for own actions in accordance with the Code of Professional Conduct.
• Be responsible for the maintenance and development of personal clinical skills, and act on professional judgement about when to seek help.
• Highly developed communication skills enabling the maintenance of a highquality service within a complex and challenging environment.
• Assist the medical and midwifery teams in the assessment and prioritisation of patients requiring intervention.
• Use advanced clinical assessment skills necessary within maternal medicine and health inequalities, to autonomously manage these patients’ physical and psychological needs.
• Use a range of assessment methods to work with individuals and families to facilitate their care according to their individual needs.
• Undertake procedures to facilitate efficient urgent care in the context of acute illness or sudden deterioration, within their scope of practice.
• Initiate relevant investigations such as Ultrasound, ECG and blood tests to enable timely diagnosis and facilitate early decision making.On completion of the NMP (Non- Medical Prescriber) V300, they will participate in the prescription and review of medication in line with trust guidance within their scope of non-medical prescribing. They will consider any treatment given previously for pre-existing medical conditions, which is appropriate to patient needs.
• Provide information and advice to patients on prescribed medication regimens.
• Promote and deliver evidence-based care for patients presenting to maternity.
• Support clinically where the service needs have been escalated.
• Act as an autonomous practitioner and as a trainee advanced clinical practitioner, uses professional judgement on when to seek help.
• To participate in a minimum of one clinical shift per month when the escalation policy is required.
• To participate in any existing hospital on call rotas.
• To provide support, highly specialised information, and counselling when a poor outcome of pregnancy is suspected/diagnosed.
• Ensure diagnostic results are explained.
• Ensure individualised support and advice is offered for women undergoing termination of pregnancy.
• Prioritise, organise, and manage own workload in a manner that maintains and promotes quality.
• Deliver care according to local and national guidelines ensure delivery of evidence-based care.

 Leadership and management

• Demonstrate continual evaluation of practice within the defined specialist area, making agreed changes where appropriate.
• Ensure the provision and continuing effectiveness of the Maternal Medicine referral pathway.
• Support leadership within the existing management team to ensure effective running of the Ante-natal department and be responsible for the provision of this specialist service with adherence to national standards and guidance.
• Contribute to corporate objectives, utilising local, Trust, ICS and statutory guidelines and policies.
• Work closely with the multidisciplinary team to deliver quality care and improvements to the department in line with national and local guidance.
• Continue to lead the established complex team that cares for women with medical co-morbidities and work closely with the MDT specialists for these women and those with health inequalities.
• Attend and participate in Complex Obstetric MDT meetings and assist in the coordination of care regarding specialist needs or outcomes.
• Lead in new practice and help establish a post-natal contraception service.
• Contribute and participate in the future planning of the Maternal Medicine department, including participation within the Local Maternity and Neonatal System (LMNS).
• Demonstrate effective leadership and management skills and promote collaboration between Maternal Medicine and Advanced Clinical Practitioner (AP) Midwives, Consultant Physicians, Consultant Anaesthetist and Obstetricians within Maternity Services.
• Provide highly specialised and up to date information for families, contributing to their understanding and choices for the pregnancy, relating to maternal medicine.
• Be accountable for the planning and implementation of the specialist clinics, and evaluation of the individualised care needs of women and their families,
• Liaise with the Senior Midwifery team to ensure lessons are learnt from complaints and feedback, utilising the relevant governance processes.
• Support with the development and timely review of guidelines relating to associated conditions and management in pregnancy.
• To provide clinical and professional leadership, and act as a role model / advocate for delivering individualised care needs.
• Utilise highly developed communication skills to ensure a high-quality routine service and timely management and resolution of unexpected events and situations.
• Be a knowledgeable and supportive leader and a resource for staff, advising on national, local and Trust policy and procedures/guidelines, ensuring that clinical governance is embedded in practice.
• To review patient information and ensure that literature is based on nationally accepted standards and that it is available in a variety of languages.
• The management of staff is consistent with Trust Values to the achievement of equality, equity, and peak performance.
• Coordinate MDT meetings and communicate with teams and individuals, providing opportunity for feedback.
• Assist in maintaining a safe environment, reporting all incidents to the Outpatient Modern Matron via the DATIX tool.
• Effectively manage the Maternal medicine caseload for clinic attendances, working collaboratively with the Complex Care lead and EMCERT (Enhanced Maternal Care Escalation and Response Team) lead.
• Allocate and manage own time, creating a balance between clinical and managerial duties.
• Ensure appropriate clinics are available to support acuity/referrals received as outlined within the local guidance for scheduled appointments in pregnancy.
• Be aware and support local research projects.
• Understand national initiatives relating to Maternal Medicine referral centre’s and assist in their implementation, to influence patient care and service delivery.
• Work with Ward managers and matron to ensure sufficient staff of appropriate ability, quality and skill-mix are available to meet current and future service delivery.
• Manage specifically identified services or projects as agreed with the maternity management team.
• Contribute to the development of local guidelines, protocols, clinical pathways and standards.
• Contribute to specialist forums and National initiatives.

Education

Leading and developing practice of self and others

• Share knowledge and expertise related to clinical and professional practice within and outside the organisation.
• Supervise, support, guide and assist in the development and competency assessment of midwives / student midwives and medical students from WMS.
• Facilitate collaboration of the wider team to identify individual and team learning.
• Ensure own and others clinical practise is research based.
• Act as a positive role mode
• Encourage others to make realistic self-assessment of their application of knowledge and skills, challenging any complacency or actions that are not in the interest of the public and/or users of services.
• Undertake mentorship and clinical supervision for more junior staff, assessing competence against set standards.
• Actively promote the workplace as a learning environment, encouraging everyone to learn from each other and from external good practice.
• Develop formal and informal teaching sessions and study days for midwifery and support staff in maternity and across the wider organisation.
• Assess own learning needs at an advanced level and beyond and undertake learning as appropriate.
• Provide an educational role to patients, carers, families and colleagues in an environment that facilitates learning.
• Contribute to and participate in the Trusts Education Strategy.
• Maintain a personal professional profile.
• Participate in teaching activities for medical students, midwives and junior doctors.
• Alert individuals and organisations to gaps in evidence and/or practice.

Evaluation and Research

• Initiate and participate in the maintenance of quality governance systems and processes across the organisation and its activities.
• Utilise the audit cycle as a means of evaluating the quality of the work of self and the team, implementing improvements where required.
• Evaluate patients’ response to health care provision and the effectiveness of care.
• Continuously assess and monitor risk in their own and others practice and challenge about wider risk factors.
• Use a structured framework (e.g., root-cause analysis) to manage, review and identify learning from patient complaints, clinical incidents and near-miss events.
• Critically evaluate and review innovations and developments that are relevant to the area of work.
• Continually evaluate and audit the practice of self and others selecting and applying a broad range of evaluation approaches and methods.
• Critically appraise the outcomes of relevant research, evaluations and audits and apply them to improve practice.
• Identify areas for midwifery research, sources of funding and initiate research projects. Assist the development of other midwives within the department to enable them to carry out their own research projects.

Other Associated Duties

• Any other duties/tasks reasonably expected by the Matron, Director of Midwifery, Deputy Head of Midwifery, Head of Midwifery, Clinical Director, and Group Manager
• Support the Matron in developing midwifery services and ensuring service objectives are met.
• Advise and contribute to investigations following complaints and critical incidents.
• Represent Midwifery at Trust, Regional and National level.

Contractual Responsibilities

Confidentiality 

The post holder must maintain confidentiality, security and integrity of information relating to patients, staff and other Health Services business.

Health and Safety

All staff must be familiar with the Trust Health and Safety Policy, including a thorough understanding of personal responsibilities for maintaining own health and safety and others. 

Risk Management 

All staff need a basic working knowledge of risk management to enable them to participate in identification and control of all business risks that they encounter in their area of work.

Equal and Diversity 

Everyone has the opportunity to be treated with dignity and respect at work and has a clear responsibility to comply with the detail and the spirit of the Dignity at Work Policy. 

Infection Control and Prevention 

The Trust is committed to minimising any risks of healthcare associated infection to patients, visitors and staff. All employees are required to be familiar with and comply with Infection Prevention and Control policies relevant to their area of work.

Safeguarding Vulnerable Adults and Children 

The Trust is committed to ensuring the safeguarding of vulnerable adults and children in our care. All employees are required to be familiar with their responsibilities in this area and to raise any concerns as appropriate.

Conflict of Interest 

The Trust is responsible for ensuring that the service provided for patients in its care meets the highest possible standard. Equally, the trust is responsible for ensuring that staff do not abuse their official position for personal gain or to benefit their family or friends. The Trust’s Standing Financial Instructions require any officer to declare any interest, direct or indirect, with contract involving the Trust. Staff are not allowed to further their private interests in the course of their NHS duties. 

Working Time Regulations 

The ‘Working Time Regulations 1998 require that you should not work more than an average of 48 hours in each working week. For example, in a 26-week period you should work no more than 1248 hours. Employees may choose to opt out by providing written notification as appropriate.

The above duties and responsibilities are intended to represent current priorities and are not meant to be an exhaustive list. The post holder may from time to time be asked to undertake other reasonable duties and

responsibilities. Any changes will be made in discussion with the post holder according to service needs.

Advanced practice is delivered by experienced, registered health and care practitioners, characterised by a high degree of autonomy, complex decision making and leadership within their area of practice. This is underpinned by a master’s level award or equivalent that encompasses the four pillars of clinical practice, leadership and management, education, and research, with demonstration of core capabilities and area specific competence. Professionals working at the level of advanced practice will exercise autonomy and decision making in a context of complexity, uncertainty, and varying levels of risk, holding accountability for decisions made.

Currently, there is a lack of consistency in how the titles ‘advanced practitioner’ and “advanced clinical practitioner” are used. In this document the term advanced clinical practitioner/ practice (AP) is used. NHS England’s national Centre for Advancing Practice has been established to lead the advanced and consultant practice agenda. Its aims are to:

• Establish and monitor standards for education and training
• Accredit advanced practice programmes
• Support and recognise practitioners
• Grow and embed advanced practice and consultant workforce

The Regional Faculties for Advancing Practice have been developed to work with local systems (ICBs and NHS providers) to identify demand, commission high quality education and training and support the supervisory needs of learners.

Is my organisation ready to implement and support advanced practice?

Many employers have expressed a wish for support to develop advanced practice roles and this Advanced practice readiness checklist has been developed to help employers to self-assess their organisational readiness for advanced practice trainees and identify possible next steps. The Checklist is based on the key principles of the Multi–professional framework for Advanced Clinical Practice in England and has been developed for advanced practice leads (or other senior education leads responsible for advanced practitioners) at an organisational level, with input from individual trainees and supervisors.

Organisations should rate their readiness on a scale of 1 to 4 for each domain, where 1 signifies there is no evidence and 4 signifies that the factor is fully embedded within the organisational infrastructure and governance. It is anticipated that the results of the checklist may help employers and advanced practice leads identify areas for improvement to help ensure both the success of advanced practice training for their staff and fully realise the potential benefits of embedding new advanced practice roles within clinical pathways.