Lead Nurse - Virtual Ward/Hospital at Home

Is responsible for the delivery of excellent care and compassion in the Virtual Ward and Hospital at Home Setting. All patients admitted to the virtual ward receive a comprehensive assessment, including clinical risk, frailty, and social needs Individualised care plans are developed, agreed, and regularly reviewed using remote monitoring and clinical assessment Patients and carers are actively involved in care decisions and understand treatment plans Risk assessments (e.g. deterioration, falls, safeguarding, medicines) are completed and acted upon Clear escalation pathways are in place for deterioration, including rapid access to acute care if required Patients receive education on self-management, equipment use, and digital platforms Care is delivered with dignity, respect, and cultural sensitivity in the home setting Patients have a clear expected pathway, including admission criteria and discharge plans Discharge processes are proactive, coordinated, and timely MDT collaboration (GPs, acute teams, AHPs, social care) is embedded into all care planning Patient feedback is actively sought and used to improve services With the agreement of the patient; their family, carers, advocates or significant others are involved and updated about the patients progress. Bearing in mind confidentiality, relatives and family are regularly asked if they have any concerns about the care being provided are. Is responsible for workforce planning and resource management Develop and maintain flexible staffing models to meet fluctuating demand in the virtual ward Ensure safe staffing levels for: • Remote monitoring • Home visits • Clinical decision-making Oversee E-Rostering and workforce deployment across a geographically dispersed team Monitor demand, caseload acuity, and service capacity Escalate risks related to staffing or service delivery in line with governance processes Ensure timely recruitment and retention of staff Minimise agency use and promote a sustainable workforce model The staff on duty and whole team work flexibly and willingly not only in their own area but across the organisation as required to meet the needs of patients in accordance with roster policy and chain of command protocol They actively engage in the 6 monthly nursing and midwifery staffing and skill mix review process That any changes to service or casemix (e.g. development of a new ward-based clinic, significant increase in acuity over a period of time) are highlighted to the Matron and Nursing directorate so that proactive management of staffing and skill mix can occur The recruitment process for any impending vacancies/secondments/maternity leave is commenced without delay: i.e. impending vacancy submitted within 2 days of receipt of notice, Impending secondment submitted within 2 days of notice of secondment (NB 4 weeks notice must be worked), impending maternity leave intention to commence recruitment to be submitted at least 8 weeks before expected date of maternity leave commencement. The whole ward team is engaged in reducing sickness and maintaining a sickness level below 3% Staff sickness and absence is managed in accordance with Trust policy That any predicted future shortfalls or other concerns about the number of staff available to work are raised with the Divisional management team (Matron HON and GM) and the Nursing Directorate (AND or DN) The electronic rostering system analysis tools are accessed regularly to support monitoring of the delivery of efficient rosters. Is responsible for staff support, development and leadership Provide visible and accessible leadership to a non-ward-based workforce Ensure all staff receive: Induction to virtual ward pathways and technology. Including the allocation of preceptor/buddy or mentor Appraisals and personal development plans Clinical supervision and support Promote competencies in: • Remote assessment and monitoring • Digital systems • Acute care delivered in the home Foster a learning culture, supporting innovation, research, and service improvement Ensure compliance with mandatory training and professional standards Support staff wellbeing and resilience in a community-based environment Any performance issues including attitude, approach, attendance, professional conduct, capability etc. are effectively managed in a timely fashion and in accordance with relevant policies and procedures. All members of the team have been trained have the skills and feel confident to support bereaved and distressed patients/relatives in a kind and compassionate manner and to breaks bad news in an appropriate and empathic manner A climate exists where ideas for improvement, research and innovation are encouraged and welcomed from others and acted on. They participate and lead innovations and improvements in services including the productive programme, seeking patients and others views as appropriate and taking into account wider trust programmes for improvement and nursing development. the team works together to meet and exceed required standards to provide student placements All eligible qualified staff (i.e. all RGNs following completion of preceptorship) achieve mentorship status and mentorship update standards and are then actively involved in mentorship of students and preceptorship of junior staff. All staff are supported to achieve revalidation and professional registration requirements The team are involved in appraising best evidence for application to practice and in contributing to new evidence through research and evaluation projects in line with the nursing, midwifery and AHP research strategy. The ward team are a cohesive and supportive group who understand the importance of and know how to work as a team and support each other as a team. Is responsible for operational management & service delivery Ensure effective daily coordination of the virtual ward, including patient flow and caseload oversight Lead daily huddles / board rounds to review patient status and risks Monitor and improve key performance indicators including: • Admission avoidance • Length of stay • Readmission rates Ensure safe and effective use of digital technology and remote monitoring systems Maintain oversight of clinical quality and documentation standards Lead on incident reporting, investigation, and learning Ensure compliance with all Trust policies and governance frameworks Quality, safety and governance Act as a patient safety champion within the virtual ward model Ensure safeguarding processes are followed for vulnerable adults Monitor and manage clinical risks associated with home-based care Ensure infection prevention and control standards are upheld in community settings Lead audits, quality improvement initiatives, and service evaluations Ensure accurate and timely documentation within digital systems Promote a culture of openness, learning, and continuous improvement Exercise their authority as guardians of patient care to ensure that support services provide appropriate and timely responses to any issues that might adversely affect the provision of excellent care. As a patient safety champion proactively manage risk and maintain patient safety, conforming to health, safety and security legislation, policies, procedures and guidelines. Ensure the whole team complies with all policies and procedures related to infection prevention and control. Ensure the environment of care is safe, well equipped and compliant with standards for hygiene and cleanliness. Reports/ensures all accidents, incidents, near misses, faulty equipment or environmental issues immediately and exercise their authority as guardians of patient care to ensure that support services provide appropriate and timely responses to any issues that might adversely affect the provision of excellent care. Safeguards people and promotes equality in care and practice by recognising, respecting and meeting the needs and choices of individuals Safeguards children, young people and adults, escalating concerns in line with trust policy and regulatory frameworks. Ensure the whole team is aware of their responsibilities and acts in accordance with current legislation, policies, procedures and good practice relating to equality & diversity. • Take action to address behaviour that undermines equality and diversity • Communication and Partnership Working • Lead effective communication across: • Acute services • Primary care • Community services • Social care partners • Ensure patients and carers receive clear, consistent information • Manage complex and sensitive conversations with patients and families • Represent the service in meetings, network groups, and service development forums Digital and Innovation Leadership • Support implementation and optimisation of: • Remote monitoring technologies • Digital patient records • Virtual consultation platforms • Promote digital inclusion and ensure equitable access for patients • Identify opportunities to improve care pathways using innovation and technology Job description Job responsibilities Is responsible for the delivery of excellent care and compassion in the Virtual Ward and Hospital at Home Setting. All patients admitted to the virtual ward receive a comprehensive assessment, including clinical risk, frailty, and social needs Individualised care plans are developed, agreed, and regularly reviewed using remote monitoring and clinical assessment Patients and carers are actively involved in care decisions and understand treatment plans Risk assessments (e.g. deterioration, falls, safeguarding, medicines) are completed and acted upon Clear escalation pathways are in place for deterioration, including rapid access to acute care if required Patients receive education on self-management, equipment use, and digital platforms Care is delivered with dignity, respect, and cultural sensitivity in the home setting Patients have a clear expected pathway, including admission criteria and discharge plans Discharge processes are proactive, coordinated, and timely MDT collaboration (GPs, acute teams, AHPs, social care) is embedded into all care planning Patient feedback is actively sought and used to improve services With the agreement of the patient; their family, carers, advocates or significant others are involved and updated about the patients progress. Bearing in mind confidentiality, relatives and family are regularly asked if they have any concerns about the care being provided are. Is responsible for workforce planning and resource management Develop and maintain flexible staffing models to meet fluctuating demand in the virtual ward Ensure safe staffing levels for: • Remote monitoring • Home visits • Clinical decision-making Oversee E-Rostering and workforce deployment across a geographically dispersed team Monitor demand, caseload acuity, and service capacity Escalate risks related to staffing or service delivery in line with governance processes Ensure timely recruitment and retention of staff Minimise agency use and promote a sustainable workforce model The staff on duty and whole team work flexibly and willingly not only in their own area but across the organisation as required to meet the needs of patients in accordance with roster policy and chain of command protocol They actively engage in the 6 monthly nursing and midwifery staffing and skill mix review process That any changes to service or casemix (e.g. development of a new ward-based clinic, significant increase in acuity over a period of time) are highlighted to the Matron and Nursing directorate so that proactive management of staffing and skill mix can occur The recruitment process for any impending vacancies/secondments/maternity leave is commenced without delay: i.e. impending vacancy submitted within 2 days of receipt of notice, Impending secondment submitted within 2 days of notice of secondment (NB 4 weeks notice must be worked), impending maternity leave intention to commence recruitment to be submitted at least 8 weeks before expected date of maternity leave commencement. The whole ward team is engaged in reducing sickness and maintaining a sickness level below 3% Staff sickness and absence is managed in accordance with Trust policy That any predicted future shortfalls or other concerns about the number of staff available to work are raised with the Divisional management team (Matron HON and GM) and the Nursing Directorate (AND or DN) The electronic rostering system analysis tools are accessed regularly to support monitoring of the delivery of efficient rosters. Is responsible for staff support, development and leadership Provide visible and accessible leadership to a non-ward-based workforce Ensure all staff receive: Induction to virtual ward pathways and technology. Including the allocation of preceptor/buddy or mentor Appraisals and personal development plans Clinical supervision and support Promote competencies in: • Remote assessment and monitoring • Digital systems • Acute care delivered in the home Foster a learning culture, supporting innovation, research, and service improvement Ensure compliance with mandatory training and professional standards Support staff wellbeing and resilience in a community-based environment Any performance issues including attitude, approach, attendance, professional conduct, capability etc. are effectively managed in a timely fashion and in accordance with relevant policies and procedures. All members of the team have been trained have the skills and feel confident to support bereaved and distressed patients/relatives in a kind and compassionate manner and to breaks bad news in an appropriate and empathic manner A climate exists where ideas for improvement, research and innovation are encouraged and welcomed from others and acted on. They participate and lead innovations and improvements in services including the productive programme, seeking patients and others views as appropriate and taking into account wider trust programmes for improvement and nursing development. the team works together to meet and exceed required standards to provide student placements All eligible qualified staff (i.e. all RGNs following completion of preceptorship) achieve mentorship status and mentorship update standards and are then actively involved in mentorship of students and preceptorship of junior staff. All staff are supported to achieve revalidation and professional registration requirements The team are involved in appraising best evidence for application to practice and in contributing to new evidence through research and evaluation projects in line with the nursing, midwifery and AHP research strategy. The ward team are a cohesive and supportive group who understand the importance of and know how to work as a team and support each other as a team. Is responsible for operational management & service delivery Ensure effective daily coordination of the virtual ward, including patient flow and caseload oversight Lead daily huddles / board rounds to review patient status and risks Monitor and improve key performance indicators including: • Admission avoidance • Length of stay • Readmission rates Ensure safe and effective use of digital technology and remote monitoring systems Maintain oversight of clinical quality and documentation standards Lead on incident reporting, investigation, and learning Ensure compliance with all Trust policies and governance frameworks Quality, safety and governance Act as a patient safety champion within the virtual ward model Ensure safeguarding processes are followed for vulnerable adults Monitor and manage clinical risks associated with home-based care Ensure infection prevention and control standards are upheld in community settings Lead audits, quality improvement initiatives, and service evaluations Ensure accurate and timely documentation within digital systems Promote a culture of openness, learning, and continuous improvement Exercise their authority as guardians of patient care to ensure that support services provide appropriate and timely responses to any issues that might adversely affect the provision of excellent care. As a patient safety champion proactively manage risk and maintain patient safety, conforming to health, safety and security legislation, policies, procedures and guidelines. Ensure the whole team complies with all policies and procedures related to infection prevention and control. Ensure the environment of care is safe, well equipped and compliant with standards for hygiene and cleanliness. Reports/ensures all accidents, incidents, near misses, faulty equipment or environmental issues immediately and exercise their authority as guardians of patient care to ensure that support services provide appropriate and timely responses to any issues that might adversely affect the provision of excellent care. Safeguards people and promotes equality in care and practice by recognising, respecting and meeting the needs and choices of individuals Safeguards children, young people and adults, escalating concerns in line with trust policy and regulatory frameworks. Ensure the whole team is aware of their responsibilities and acts in accordance with current legislation, policies, procedures and good practice relating to equality & diversity. • Take action to address behaviour that undermines equality and diversity • Communication and Partnership Working • Lead effective communication across: • Acute services • Primary care • Community services • Social care partners • Ensure patients and carers receive clear, consistent information • Manage complex and sensitive conversations with patients and families • Represent the service in meetings, network groups, and service development forums Digital and Innovation Leadership • Support implementation and optimisation of: • Remote monitoring technologies • Digital patient records • Virtual consultation platforms • Promote digital inclusion and ensure equitable access for patients • Identify opportunities to improve care pathways using innovation and technology