Adjustments and Developments of Roles for Non ... - Library

POLICY FOR THE ADJUSTMENT ANDDEVELOPMENT OF ROLES FORNON-REGISTERED STAFFApproved By : Professional Advisory ForumClinical Governance ExecutiveDate : January 2003Review Date : January 2004 (extended to July 2006)Originator : U.H.L. Policy GroupTrust Reference : B1/2003

UNIVERSITY HOSPITALS OF LEICESTERTHE POLICY FOR ADJUSTMENTS AND DEVELOPMENTS OFROLES FOR NON-REGISTERED STAFF1. INTRODUCTIONThis document sets out the University hospitals of Leicester (U.H.L.)N.H.S TrustsPolicy for Adjustments and Developments in the role and responsibility of non-Registered staff. The policy gives directives for the safe and effective provision ofpatient care and recognises the development of new and innovative roles, and newways of working (D.O.H. 2001). Staff who are currently undertaking an adjusted ordeveloped role should, in collaboration with their professional head, ensure thatsupporting policies, procedures and training as set out below are developed andimplemented as soon as possible.Collaboration and co-operation between all staff in the day to day management ofexpanded roles is essential. A flexible standardised approach, and the recognitionof the needs for negotiation between the multi-disciplinary team and professionalgroups about parameters of practice and teamwork, will enhance the benefit ofpatients. This policy reflects the emphasis upon Role development and new waysof working within making a Difference (DOH 1999), and the NHS plan (DOH 2000).2. BACKGROUNDThe N.H.S. plan endorsed the need to change the way staff work and the way theyare managed in order to deliver modern patient centred services. Themodernisation agenda also heralds a new division of labour with the introduction ofnew roles throughout the clinical professionals and new classes of multi-skilledpractitioners. Hence, clinical work will now be organised to enable staff to exercisethe full range of their knowledge and skills to the advantage of the patient.Over the last decade expansion of nursing and therapy roles have evolved inresponse to a complex mixture of pressures from a professional and politicalperspective (Cameron 2000, Humphries and Masterton 2000). Expansion anddevelopment of professional roles and their support staff are therefore consideredan important part of service development within the Trust, and complement theChanging Workforce Programme pilot projects. As with any change it is essentialthat such role developments are carefully planned, managed, supported andevaluated.1

3. AUTHORISED STAFF3.1 All staff who develop and expand their role will be employed to work clinically in asupportive partnership with a registered practitioner.3.2 Support staff must:• Only develop their role in relation to the designated area of clinical work.• Have undertaken appropriate training for the identified role development and becompetent to practice. (see section 5).• Accept responsibility for their actions.• Maintain up to date knowledge and skills required for the role.• Be familiar with and demonstrate an understanding of all relevant policies andprocedures relating to their clinical role.4. THE DEVELOPMENT AND EXPANSION OF SUPPORTIVE ROLES• The development and /or expansion of roles for support staff is essentiallyintroducing a clinical function not normally undertaken by non-registeredpersonnel. Developments in practice should stem from changes and innovationsin health care based on a sound body of knowledge and research, and to meetservice need.• Registered Practitioners must be satisfied that each aspect of the roleexpansion is directed to meeting the needs and serving the interest of thepatient as identified in a comprehensive needs assessment.• Registered Practitioners must also ensure that enlargement or adjustment of thesupport role must be achieved without compromising or fragmenting existingfundamental aspects of care.• All support staff wishing to develop their role must ensure that they will have theopportunity to undertake the skills required in practice on a regular basis.• Inappropriate delegation and substitution from and to others, whichcompromises patient care and professional practice, must be avoided.• Ongoing evaluation and audit of the role development must be undertaken bythe appropriate clinical area, in collaboration with the clinical standards andmonitoring team, and based upon standards and outcomes.• A comprehensive Risk Assessment should be undertaken in collaboration with aclinical Risk Advisor.2

5. THE PROCEDURE FOR THE DEVELOPMENT OF ROLES FOR SUPPORTSTAFF (figure 1)• Practitioners and managers wishing to introduce or develop an expandedsupport role must initially discuss the proposed change with their professionalhead, line manager and/or appropriate clinical lead within their specificdirectorate.• Collaboration and negotiation between the professional groups and the multidisciplinaryteam regarding the parameters of practice is essential.• An initial proposal should be developed and submitted to Senior Nurse, ClinicalPractice Development (Nursing) and professional head(other professionals)who will advise on the membership of a working group, facilitate the wayforward, and assist in the development of policies and guidelines to supportpractice.• In collaboration with the Trust’s Education Forum, a competency based trainingand assessment programme will be developed, and subsequently approved.• The finalised policy and practice guidelines will be presented to the ProfessionalAdvisory Forum(Nursing), or clinical support services forum (AHP andRadiographers) for discussion and agreement and Clinical Governanceexecutive (as appropriate) for final ratification.• Once approved the expanded role will be entered on the Trust’s Support Roledatabase in the Directorate of Nursing/ clinical support services.• Once approved, the policy details will be entered on the Trust’s Policy Registerwithin the Corporate and Legal Affairs Directorate.• Any additional adjustments or changes must be submitted to the ratifying bodiesabove for further approval.• An annual review of the role must be undertaken by the initial working group.• The role development should be shared and disseminated both internally andexternally.6. EDUCATION AND TRAININGStaff wishing to develop their practice must:• Have completed a Trust approved competency based Training and Assessmentprogramme and follow the process set out in section 4.• Staff transferring from another Trust must provide evidence of the trainingprogramme undertaken and complete a summative practical assessment.• Have evidence of assessment and competency in their role adjustment, signedby an approved assessor.3

• Accept responsibility for updating skills and knowledge, as appropriate. Thereis an expectation that the activity will be undertaken on a regular basis tomaintain competence.• The requirement for record keeping in relation to when training is undertakenand assessment completed lies with both the individual staff member and theDirectorate.7. LEGAL LIABILITYThe Trust as an employer, will assume vicarious liability for the actions of all staff,including those on honorary contracts, providing that:• Staff have undergone any training identified as necessary for the developmentof the role.• An appropriate policy and procedure has been agreed and followed, and thatthe member of staff has been fully authorised by the Trust to undertake therole.• The provision of this policy has been followed by the member of staff at alltimes.4

REFERENCESCameron,A. (2000). “ New Role Developments in context”. In Developing new clinicalroles. Ed Humphries,D and Masterton, A . Churchill Livingstone.Humphries,D. Masterton,A (2000), Developing new clinical roles, ChurchillLivingstone.Department of Health (1999), Making a Difference, Department of Health, London.Department of Health (2000), The N.H.S. plan, Department of Health, London.Department of Health (2001), Changing Workforce Programme, Human ResourceDirectors Bulletin.5

The Procedure for the Development of support rolesDefine Area of role and function to be Developed.Approval to proceed from appropriate professional head/line manager, clinician and risk advisor.Prepare and submit an initial Proposal to Senior Nurse Clinical Practice Development.Set up a multi-professional Working Group as advised by above.Develop Training and Assessment Programme in collaboration with Trust’s Education Forum.Submit Final Proposal and Practice Policy to Professional Advisory Forum/clinicalsupport services forum and Clinical Governance ExecutiveDetails to be entered on the Trust’s Policy Register within the Corporate and LegalAffairs Directorate, and role database in nursing directorate/clinical support services.Implement Adjustment/Development of Role.On completion, prepare a report and present at Trust Forums.Publish Work for wider dissemination.Annual Update and Review by initial working group.6