The CNS will have a pivotal role in meeting the psychological, emotional and information needs of the stoma care patient and his/her family. The role allows the CNS to offer continuity of care, pre-operative assessment, post-operative care and discharge planning. The candidate will offer follow up care for patients in the community,

families and healthcare professionals, and have a central role giving practical and psychological support thereby easing adaptation and adjustment to their altered lifestyle.  As a key member of the multidisciplinary teams responsible for stoma patients, the candidate should liaise closely with all clinicians involved in the diagnosis,

management, and ongoing care of patients attending Cavan/Monaghan Hospital who require stoma care.

The CNS in stoma care, while being autonomous must be cognisant of his/her scope of practice and the need to refer patients to other specialist services as required. The post holder will have an important educational role within the interdisciplinary team and will play a pivotal role in the development of quality initiatives. The candidate

will be expected to maintain a database for stoma patients treated.

The CNS Stoma care will deliver care in line with the five core concepts of the role set out in the Framework for the Establishment of Clinical Nurse / Midwife Specialist Posts, 4^th edition, National Council for the Professional Development of Nursing and Midwifery (NCNM) 2008

There is currently one permanent part-time vacancy (0.5 WTE) available in Cavan General Hospital.

A panel may be formed as a result of this campaign for Cavan – Monaghan Hospital from which current and future, permanent and specified purpose vacancies of full or part-time duration may be filled

Reports To: Reports to the Divisional Nurse Manager as relevant to the post / as appropriate.  Accountable to the Assistant Director of Nursing and Director of Nursing.

This campaign will run in compliance with the Code of Practice prepared by the Commission for Public Service Appointments (CPSA).

The CPSA is responsible for establishing the principles that should be followed when making an appointment. These are set out in the CPSA Code of Practice. The Code outlines the standards that should be adhered to at each stage of the selection process and sets out the review and appeal mechanisms open to candidates should they be unhappy with a selection process.

The CPSA Code of Practice can be accessed via https://www.cpsa.ie/.

Salary Scale:  CLINICAL NURSE SPECIALIST (GENERAL) 1/03/23

€56,353 €57,287 €58,076 €59,365 €60,789 €62,187 €63,585 €65,160 €66,622

The RCSI Hospital Group includes the following hospitals; 

• Beaumont Hospital
• Cavan General Hospital
• Connolly Hospital
• Louth County Hospital
• Monaghan General Hospital
• Our Lady of Lourdes Hospital
• Rotunda Hospital 

The Academic Partner for the Group is the RCSI.

RCSI Hospital Group provides a national service and a regional service to Dublin and the North East and is committed to the provision of world-class care, exceptional clinical services with respect and compassion.

Cavan & Monaghan Hospital’s Catchment Population of over 120,000 covering Counties Cavan & Monaghan, and parts of Counties Longford, Leitrim, and Meath. Cavan Monaghan Hospital is part of the RCSI Hospitals Group which covers a population in excess of 800,000.

Cavan & Monaghan Hospital provides a range of acute medical, surgical, obstetric, and gynaecological, paediatric services, day care, outpatient, diagnostic and support services.  Emergency services are provided on a 365-day, 24 hour basis.  Multi-disciplinary teams representative of medical, nursing/midwifery, health and social care professionals, management administration and general support staff play a pivotal role in the development, delivery, monitoring and evaluation of these services.  Cavan General Hospital has a total in-patient bed complement of 255 and 102 day beds.  Monaghan Hospital has a total of 54 in-patient beds inclusive of step-down and rehabilitation and 17 day beds. The total staff HSE complement is approximately 1279 in Cavan General Hospital and 159 in Monaghan Hospital.  The hospital is affiliated to the Royal College of Surgeons in Ireland (RCSI) for medical education, to Dundalk Institute of Technology for nursing education and to University College Dublin (UCD), Trinity College Dublin (TCD) and the Institute of Technology for health and social care professional education. 

• The person holding this post is required to support the principle that the care of the patient comes first at all times and will approach their work with the flexibility and enthusiasm necessary to make this principle a reality for every patient to the greatest possible degree.
• Maintain throughout the hospital awareness of the primacy of the patient in relation to all hospital activities.
• Performance management systems are part of role and you will be required to participate in the Group’s performance management programme.
• Provide safe, comprehensive nursing care to service users according to the Code of Professional Conduct as laid down by NMBI (Nursing Midwifery Board Ireland) and Professional Clinical Guidelines.

Practice nursing according to:

Professional Clinical Guidelines

• National and Area Health Service Executive (HSE) guidelines.
• Local policies, protocols and guidelines
• HSE code of Practice for Decontamination of reusable invasive Medical Devices.
• Current legislation 

The post holder’s practice is based on the five core concepts of Clinical Nurse Specialist in order to fulfil the role.

The concepts are: 

• Clinical Focus
• Patient / Client Advocate
• Education and Training
• Audit and Research
• Consultant  

Clinical Focus 

The Clinical Nurse Specialist (Stoma Care) will have a strong patient focus whereby the specialty defines itself as nursing and subscribes to the overall purpose, functions and ethical standards of nursing / midwifery. The clinical practice role may be divided into direct and indirect care. Direct care comprises the assessment, planning, delivery and evaluation of care to the patient, family and/or carer. Indirect care relates to activities that influence and support the provision of direct care. 

Clinical Focus- Direct Care and Indirect Care 

Throughout the life changing experience of having a stoma, the care provided by the CNS will encompass not only the physical but the psychological, spiritual, cultural, sexual and social needs of the individual. In its publication Guidelines for the Management of Colorectal cancer (2007), the Association of Coloproctology of Great Britain and Ireland emphasises the vital role played by the CNS in Stoma Care: ‘’The patient should be seen by the stoma care nurse prior to surgery and the referral should be made at the earliest opportunity to allow adequate time for preparation’’

The Clinical Nurse Specialist (Stoma Care) will: 

• Ensure a seamless specialist service for stoma patients.
• Help meet the psychological, emotional and informational needs of stoma patients at the time of diagnosis and throughout his/her treatment both as an inpatient and outpatient.
• Provide information and support to stoma patients prior to surgery, during the patients’ hospital stay, following discharge into the community and on follow up visits.
• Provide a nurse-led out-patient’s stoma care service as per the Irish Stoma Care and Colorectal Association Practice Standards Assess patients in relation to their need for referral to specialist services and refer appropriately.
• Include pre-operative assessment information and education for patients undergoing elective surgery as per the Enhanced Recovery after Surgery Programme.
• Develop a comprehensive and flexible discharge plan in conjunction with hospital and community professionals.
• Site stomas according to best practice guidelines.
  • Work as part of multidisciplinary team and with other professionals within the hospital in the provision of
  • optimal nursing care.
  • Provide specialist nursing care during the patients’ hospital stay and continuing support to patients and their families.
• Be available to all stoma care patients / and families to provide support and advice if required.
• Liaise with other stoma care nurses and ward staff relating to patient care and follow up.
• Liaise with relevant support groups including The Ostomy Association of Ireland and participate in meetings as appropriate.
• Provide post-operative stoma care and identify prevent and manage stoma complications.
• Provide stoma dilatation as required.
• Educate the patient / family / staff in relation to alternative stoma management techniques including colostomy irrigation, and colostomy plug.
• Provide a wound / fistula management service for complicated wounds and stomas.
• Give information and ongoing support to patients undergoing ileo-anal pouch procedure.
• Promote health education for stoma patients in relation to diet, exercise, travel, returning to work, family planning and pregnancy.
• Advise patients on abdominal support, prevention and treatment of parastomal hernia.
• Keep up to date with new ostomy appliances / equipment through liaison with manufacturers and suppliers as per guidelines.
• Prescribe ostomy appliances and supply details and information to the patient / family and the pharmacy.
• In conjunction with nursing, medical and allied health teams formulate discharge plans which ensure continuity of care by liaising with health care professional in the community / primary care setting and ensuring appropriate follow up.
• Ensure that patients have clear instructions regarding their follow up appointments and named person to contact in the event of problems post discharge from hospital.
• Act as a resource for patients, families and community services following discharge.
• Refer patients to other health care professionals as appropriate.

Patient / Client Advocate  

The Clinical Nurse Specialist (Stoma Care) will:  

• Ensure that the patient’s comforts and needs are given full priority at all times.
• Provide an efficient, effective and high quality service respecting the needs of each patient.
• With expert clinical knowledge and experience act as a patient advocate by participating in discussion on patient management issues on behalf of the patient in MDT meetings with ward staff and other health care professionals.
• Review and assess referred patients taking into account their opinions and guide them in their decision making processes.
• Communicate, negotiate and represent the plan of care for the patient within clinical medical and nursing staff.
• Develop and support the concept of advocacy, particularly in relation to patient participation in decision making, thereby enabling informed choice of treatment options.
• Respect and maintain the privacy, dignity and confidentiality of the patient, family and / or carer.
• Be aware of existing resources / services which help patient and their families e.g. community services, support groups, entitlements.
• Implement changes in healthcare in response to patient need and service demand.

Education and Training  

The delivery of education is central to the role of the CNS in stoma care. Dissemination of specialist knowledge and best practice is paramount to enhancing the patient’s experience and education of others including patients / carers, nursing and medical students, ward nurses, allied health care professionals, community nurses, nursing homes, pharmacists and non-hospital consultant doctors.

 The Clinical Nurse Specialist (Stoma Care) will:  

• Provide education sessions for patients, families, medical and nursing staff, students and health and social care professionals.
• Promote patient / carer independence through relevant teaching and support.
• Identify the needs of staff, patients and carers in relation to stoma care.
• Provide educational programmes to health care workers including nurses e.g. Colorectal Module / Theatre / Medical and Surgical Nursing.
• Facilitate nurse placements in the stoma care department for student nurses / post-graduate nurses / adaptation nurses and other health and social care professionals.
• Make available relevant published articles, teaching videos and teaching aids to the wards and the centre of education.
• Play an active role in providing teaching in a variety of settings including hospital, community, colleges, universities and incorporates.
• Be available to give expert advice as required on developments and best practice in stoma care.
• Develop, review and distribute information leaflets to patients and family members.   

Audit and Research  

The Clinical Nurse Specialist (Stoma Care) will:

• Participate in the audit of clinical care.
• Participate in and be aware of best practice, recent research and new developments in Stoma Care from a nursing perspective.
• Identify and highlight gaps in the service to improve quality of care.
• Evaluate education sessions given and amend programme in line with the result.
• Participate in relevant collaborative research as appropriate and promote awareness of evidence based practice among staff.
• Ensure that statistical and management information is provided to the Directorate Nurse Manager as required.
• Participate in external audits of services by HIQA, the NCCP and other external agencies.
• Produce an annual report for the Directorate Nurse Manager outlining:
  • The number of patients seen
  • Frequently occurring issues within the service
  • Patient satisfaction within services
  • Action plan for the following 6 months
  • Progress reports on the development of the role 

Consultant 

The Clinical Nurse Specialist (Stoma Care) will:

• Play a leading role in the design, development and evaluation of the stoma care service in Cavan Monaghan Hospital.
• Promote and provide holistic care for patients.
• Recognise the importance of health promotion.
• Develop and promote positive attitudes towards stoma care and adjustment to altered lifestyle.
• Respect culture and diversity.
• Work as an innovator and change agent within the speciality.
• Provide leadership in clinical practice and act as an expert role model for health care professional.
• Work in a complimentary role to medial colleagues and other members of the MDT. 

Professional Development 

The Clinical Nurse Specialist (Stoma Care) will:

• In conjunction within the Directorate Nurse Manager and / or the surgical cancer service manager, agree learning objective designated to meet professional development goals.
• Maintain professionalism at all times and work within The Scope of Nursing & Midwifery Practice Framework (Nursing and Midwifery Board of Ireland, 2015) and the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (Nursing and Midwifery Board of Ireland, 2014).
• Accept responsibility for own professional development and be aware of current trends and strategies in nursing, particularly in relation to the specialist area of practice.
• Attend relevant conference, workshops and seminars and disseminate changes in practice within stoma care that has implications for nursing practice.
• Develop and maintain nursing practice skills in relation to stoma care nursing.
• Discuss present performance with line manager, using job performance review.
• Maintain a personal record of professional development, using a portfolio.
• Maintain membership of relevant specialist associations in relation to all aspects of specialist practice. 

Management / Administration

The CNS Stoma Care will:

• Provide an efficient, effective and high quality service, respecting the needs of each patient, family and / or carer.
• Effectively manage time and caseload in order to meet changing and developing service needs.
• Continually monitor the service to ensure it reflects current needs.
• Implement and manage identified changes.
• Ensure that confidentiality in relation to patient records is maintained.
• Represent the specialist service at local, national and international level as required.
• Maintain accurate and contemporaneous records and data on all matters pertaining to the planning, management, delivery and evaluation of care and ensure that this service is in line with HSE requirements.
• Contribute to the service planning process as appropriate and as directed by the
• Have a working knowledge of the Health Information and Quality Authority (HIQA) Standards as they apply to the role for example, Standards for Healthcare, National Standards for the Prevention and Control of Healthcare Associated Infections, Hygiene Standards etc. and comply with associated HSE protocols for implementing and maintaining these standards as appropriate to the role.
• To support, promote and actively participate in sustainable energy, water and waste initiatives to create a more sustainable, low carbon and efficient health service. 

Health & Safety 

The CNS Stoma Care will:

• Ensure that effective safety procedures are developed and managed to comply with statutory obligations, in conjunction with relevant staff e.g. health and safety procedures, emergency procedures.
• Observe, report and take appropriate action on any matter which may be detrimental to staff and/or service user care or well-being / may be inhibiting the efficient provision of care.
• Assist in observing and ensuring implementation and adherence to established policies and procedures e.g. health and safety, infection control, storage and use of controlled drugs etc.
• Ensure completion of incident / near miss forms / clinical risk reporting.
• Adhere to department policies in relation to the care and safety of any equipment supplied for the fulfilment of duty.
• Liaise with other relevant staff, e.g. CNS infection control Occupational Therapist re appropriateness for procurement.
• Have a working knowledge of the Health Information and Quality Authority (HIQA) Standards as they apply to the role for example, Standards for Healthcare, National Standards for the Prevention and Control of Healthcare Associated Infections, Hygiene Standards, etc., and comply with associated HSE protocols for implementing and maintaining these standards as appropriate to the role.
• Support, promote and actively participate in sustainable energy, water and waste initiatives to create a more sustainable, low carbon and efficient health service.

KPIs

The Stoma Care CNS will aid:

• The identification and development of Key Performance Indicators (KPIs) which are congruent with the hospital’s service plan targets.
• The development of Action Plans to address KPI targets.
• Driving and promoting a Performance Management culture.
• In conjunction with line manager assist in the development of a Performance Management system for your profession.
• The management and delivery of KPIs as a routine and core business objective.  

PLEASE NOTE THE FOLLOWING GENERAL CONDITIONS

• Employees must attend fire lectures periodically and must observe fire orders.
• All accidents within the Department must be reported immediately.
• Infection Control Policies must be adhered to.
• In line with the Safety, Health and Welfare at Work Act, 2005 all staff must comply with all safety regulations and audits.
• In line with the Public Health (Tobacco) (Amendment) Act 2004, smoking within the Hospital Building is not permitted.
• Hospital uniform code must be adhered to.
• Provide information that meets the need of Senior Management. 

Risk Management, Infection Control, Hygiene Services and Health & Safety

• The management of Risk, Infection Control, Hygiene Services and Health & Safety is the responsibility of everyone and will be achieved within a progressive, honest and open environment.
• The post holder must be familiar with the necessary education, training and support to enable them to meet this responsibility.
• The post holder has a duty to familiarise themselves with the relevant Organisational Policies, Procedures & Standards and attend training as appropriate in the following areas:
  • Continuous Quality Improvement Initiatives
  • Document Control Information Management Systems
  • Risk Management Strategy and Policies
  • Hygiene Related Policies, Procedures and Standards
  • Decontamination Code of Practice
  • Infection Control Policies
  • Safety Statement, Health & Safety Policies and Fire Procedure
  • Data Protection and confidentiality Policies
  • Sepsis
  • Children 1^st
• The post holder is responsible for ensuring that they become familiar with the requirements stated within the Risk Management Strategy and that they comply with the Hospitals Risk Management Incident/Near miss reporting Policies and Procedures.
• The post holder is responsible for ensuring that they comply with hygiene services requirements in your area of responsibility. Hygiene Services incorporates environment and facilities, hand hygiene, catering, cleaning, the management of laundry, waste, sharps and equipment.
• The post holder must foster and support a quality improvement culture through-out your area of responsibility in relation to hygiene services.
• It is the post holders’ specific responsibility for Quality & Risk Management, Hygiene Services and Health & Safety will be clarified to you in the induction process and by your line manager.
• The post holder must take reasonable care for his or her own actions and the effect that these may have upon the safety of others.
• The post holder must cooperate with management, attend Health & Safety related training and not undertake any task for which they have not been authorised and adequately trained.
• The post holder is required to bring to the attention of a responsible person any perceived shortcoming in our safety arrangements or any defects in work equipment.
• It is the responsibility of the post holder to be aware of and comply with the HSE Health Care Records Management / Integrated Discharge Planning (HCRM / IDP) Code of Practice.  

The above Job Specification is not intended to be a comprehensive list of all duties involved and consequently, the post holder may be required to perform other duties as appropriate to the post which may be assigned to him/her from time to time and to contribute to the development of the post while in office. 

1. Statutory Registration, Professional Qualifications, Experience, etc.
(a) Candidates must at the latest date of application:

i) Be a registered nurse on the active Register of Nurses and Midwives held by An Bord Altranais agus Cnáimhseachais na hÉireann (Nursing and Midwifery Board of Ireland) or be eligible to be so registered.
And
ii) Be registered in the General Division of the register of Nurses and Midwives
Or
iii) In exceptional circumstances, which will be assessed on a case by case basis be registered in another Division of the register of Nurses and Midwives.

And
iv) Have a minimum of 1 years’ post-registration full-time experience (or an aggregate of 1 years’ full time experience) in the General Nurse division of the register.
And
v) Have a minimum of 1 years’ full-time experience (or an aggregate of 1 years’ full time experience) in specialist area of Stoma Care / Colorectal / Gastroenterology nursing.
And
vi) Have successfully completed a post-registration programme of study, as certified by the education provider, which verifies that the applicant has achieved a Quality and Qualifications Ireland (QQI), National Framework of Qualifications (NFQ) major academic Level 9 or higher award relevant to the specialist area of Stoma Care / Colorectal / Gastroenterology prior to application (equivalent to 60 ECTS or above), and in line with the requirements for specialist practice as set out by the National Council for Nursing & Midwifery 4th ed (2008). See ** Note 1 below.
And
vii) Be required to demonstrate that they have continuing professional development (CPD) relevant to the specialist area.
And
viii) Have the ability to practice safely and effectively fulfilling his / her professional responsibility within his / her scope of practice.

**Note 1: For Nurses who express an interest in CNS roles and who currently hold a level 8 educational qualification in the specialist area (equivalent to 60 ECTS or above), this qualification will be recognised up to September 2026.

And
b) Candidates must possess the requisite knowledge and ability, including a high standard of suitability and clinical leadership, managerial and administrative capacity for the proper discharge of the duties of the office.

2. Annual Registration
i) Practitioners must maintain live annual registration on the relevant division of the Register of Nurses and Midwives maintained by the Nursing and Midwifery Board of Ireland (Bord Altranais agus Cnáimhseachais na hÉireann) for the role.
And
ii) Confirm annual registration with NMBI to the HSE by way of the annual Patient Safety Assurance Certificate (PSAC).

3. Health
A candidate for and any person holding the office must be fully competent and capable of undertaking the duties attached to the office and be in a state of health such as would indicate a reasonable prospect of ability to render regular and efficient service.

4. Character
Each candidate for and any person holding the office must be of good character

Post Specific Requirements

Demonstrate depth and breadth of post-registration experience in relation to nursing practice within Stoma Care / Colorectal / Gastroenterology as relevant to the role.

Have undertaken or agree to undertake, within an agreed timeframe, the Nurse Prescribing of Medicinal Products Certificate.

Other requirements specific to the post

Access to appropriate transport.  

Candidates must:

• Demonstrate the ability to lead on clinical practice and service quality.
• Demonstrate promotion of evidence-based decision making.
• Demonstrate practitioner competence and professionalism.
• Demonstrate behaviours to practice nursing in line with the Values for Nurses and Midwives in Ireland.
• Demonstrate the ability to plan and organise effectively.
• Demonstrate the ability to build, lead and manage a team.
• Demonstrate strong interpersonal skills including the ability to build and maintain relationships.
• Demonstrate strong communication and influencing skills.
• Demonstrate initiative and innovation in the delivery of service.
• Demonstrate resilience and composure.
• Demonstrate openness to change.
• Demonstrate integrity and ethical stance.
• Demonstrate a commitment to continuing professional development.
• Demonstrate the ability to relate nursing research to nursing practice.
• Demonstrate knowledge of quality assurance practices and their application to nursing procedures.
• Demonstrate an awareness of HR policies and procedures including disciplinary procedures, managing attendance, etc.
• Demonstrate an awareness of relevant legislation and policy e.g. legislation relevant to the service area, health and safety, infection control, etc.
• Demonstrate an awareness of current and emerging nursing strategies and policies in relation to the clinical / designated area.
• Demonstrate an awareness of the Health Service Transformation Programme.
• Demonstrate a willingness to develop IT skills relevant to the role.

Technical & Professional Knowledge

Has a command over the technical/ professional skills and knowledge required within the job holder’s role and continues to upskill to maintain high professional standards and continuous professional development requirements.

Leadership and Management

Manages performance to deliver team goals; demonstrates accountability for leading, directing, monitoring, and evaluating RCSI Hospital Group services. Creates a climate in which people want to do their best. Promotes confidence and positive attitude; influences others to follow a common goal.

Building & Maintaining Relationships

Builds and maintains relationships with a network of people. Recognises the two way nature of relationships and works to develop mutually beneficial partnerships. Interacts with others in a manner that builds respect and fosters trust. 

Commitment to Quality & Risk Management

The ability to focus on understanding stakeholder’s needs and expectations and to respond effectively and efficiently to them. Has a good knowledge of and is committed to offer a quality service through the achievement of goals, accreditation standards, other organisation/department standards and risk management frameworks and guidelines.

Problem Solving & Decision Making

Identifies and solves problems by understanding the situation, seeking additional information, developing, and weighing alternatives, and choosing the most appropriate course of action given the circumstances.

Communication & Interpersonal Skills

Speaks and writes clearly, fluently, and effectively to both individuals and groups; communicates in a manner that will persuade, convince, and influence others, to motivate, inspire or encourage them to follow a particular course of action.

This Job Description is intended as a basic guide to the scope and responsibilities of the position and is subject to regular review and amendment. The role holder will be required to be flexible in this position and is expected to facilitate working additional hours on occasion, when requested.

The RCSI Hospital Group is an Equal Opportunities Employer.