Core Competencies for Hospital in the Home Registered Nurses

Preamble

Hospital in the Home is acute inpatient equivalent care, utilising highly skilled staff, hospital technologies, equipment, medication, and safety and quality standards, to deliver hospital-level care within a person’s place of residence or preferred (non hospital) treatment location.

Hospital in the Home (HITH) care is delivered by appropriately skilled, trained, and resourced HITH registered nurses (RN) as part of a multi-disciplinary team. Credentialing and training should reflect the specialised skill set required for HITH service delivery.

HITH RN roles are complex, encompassing care delivery, communication, accountability, and responsibilities in autonomous care-delivery settings.

HITH RN in Australia are recruited from varied nursing backgrounds. Currently there is no formal HITH specific nursing qualification. The HITH Society acknowledge that there is a lack of a formal education structure for HITH nursing and is committed to working with education providers and employers to develop a comprehensive HITH post graduate pathway.

It is recommended that all HITH staff should have access to, and be involved in, a professional development program within their organisation that is adapted to the home setting and includes: a documented learning and development plan; internal and external education opportunities; and compulsory training sessions (for example, cardiopulmonary resuscitation, anaphylaxis management when administering intravenous antibiotics and other drugs in the home setting, complex discharge planning and occupational health and safety including managing risks associated with home visits).

Individual staff members take responsibility for maintaining their own skills. Employers are responsible for ensuring health professionals meet the required professional standards.

Professional development assists staff to achieve the skills, knowledge, behaviour, and performance to provide excellence in service delivery. Demonstration of maintenance of competence (continuing professional development) is now mandated for continued registration as a health professional. Professional development is also an essential component of quality improvement and the broader enhancement of HITH nursing as a professional group.

Core competencies for HITH nursing should include:

New career HITH RN

Registered Nurses new to HITH services are recommended to have five years’ experience postgraduate. New HITH nurses must successfully complete service specific orientation modules that would typically include: recognising the deteriorating patient and escalating appropriately, venepuncture, cannulation, multiple vascular access skills and use of different infusion devices infusion types and techniques and complex wound care. This list is not exhaustive as services may add location specific competency requirements. They will provide increasing evidence used to support nursing practices for optimal patient care and should have access to more senior staff at all times to provide support if required. The new HITH Registered Nurse will require, but not are limited to the following attributes:

• Time management, ability to undertake active communication with multiple stakeholders (verbally and written), including patient’s family/carer in person and by phone/videoconference.

• Ability to liaise with referrers including ward teams, community nurses, external HITH services and virtual services.

• Developed critical thinking, analytical and problem-solving skills in assessing the patient, and patient’s health progress within planned and unplanned care.

• Forward-thinking approach to care by actively participating in and sharing potential innovations in service meetings.

• Ambition to grow clinical skills and expand professional knowledge.

• Proactive and positive team player.

• Client assessment, planning, treatment, review, discharge planning and coordination of services to patients in their own home.

• Flexibility to work in varied environments.

• Provision of safe, patient-centric care.

• Teaching and assessment qualification(s), be a preceptor and mentor.

• Undertake research and quality improvement audits and presenting the results to a wider audience.

• Portfolio holder - for instance infection control, stock control.

• Motor vehicle driving licence.

HITH Advanced Nurse (Management/Team Leader/Senior Nurse)

Advanced HITH Nurses (not including Nurse Practitioner) are recommended to have a minimum of 3 years HITH Registered Nurse experience. In a HITH career pathway, the HITH Advanced Nurse (AN) will be clinically sound and accepts responsibility and leadership for governance, oversight, and HITH service operational delivery by using clinical knowledge and management experience/skills to provide leadership and operational direction to the HITH service. As an Advanced Nurse accept accountability for the delivery of nursing care and patient experience within the framework and values of their organisation. The HITH AN is responsible for the efficient and effective management of human, financial and material resources (including logistics and supply ordering and pharmacy), leads local strategic initiatives, and constantly re-evaluates local protocols and patient care practices to ensure best practice. An Advanced Nurse will require, but are not limited to the following attributes:

• Expertise in delivering hospital level care in the home with appropriate clinical skills and have or working towards an appropriate Masters degree.

• Lead the coordination of handovers for patient admission, reviews, and discharges, Patient allocation to staff, coordination of staff numbers and staff meetings to support patient safety and quality.

• Critical thinking, analytical and problem-solving skills

• Clinical education and mentoring for junior staff and students.

• Scheduling/coordinating clinical contacts by the multidisciplinary team.

• Provide clinical leadership to staff in the provision of clinical care including advanced wound care, and vascular access education.

• Work as an advanced member of the MDT, with expert communication skills.

• Undertake collaborative Low Negligible Research (LNR) to support optimal patient outcomes.

• Publication of research outcomes, evidence of sector wide collaboration, research grants and scholarships.

• Management of unexpected absenteeism and reallocation of clinical care to ensure service provision, other staff issues, incidents and accidents.

• Support the facilitation of care progression meetings and team planning meetings within the service.

• Reporting and providing initial local response to reportable incidents.

• Constant re-evaluation of protocols and practices and patient care to ensure best practice.

• Supervise and coordinate patient care plans, ensuring delivered to applicable standards, as well as maintaining competence and educational needs of staff/team and other nurses, and delegate as appropriate.

• Subspecialty coordination (e.g., chemotherapy, wound care etc).

• Service planning, personnel management with appropriate reference or escalation to employer people and culture services where needed.

• Prescriber training (where service requires).

  
  

The HITH society have developed this position statement with wide consultation and based on the following principles:

• Pre-requisite core competency and education requirements need to be developed for safe and effective HITH nursing practice.

• HITH RNs require a career pathway from Registered Nurse new to HITH to Advanced Nurse (not including Nurse Practitioner level).

• Post-graduate education in HITH needs to be resourced appropriately and undergraduate students should have adequate exposure and opportunities to experience HITH programs.

• Tertiary education providers will need engagement from the Society and/or relevant experts in HITH, to develop a comprehensive HITH post-graduate education framework.

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