Advanced Nurse Practitioner Critical Care Outreach

Job summary

The Advanced Clinical Practitioner (ACP) for Critical Care Outreach is a senior clinical and leadership position responsible for delivering expert autonomous assessment, diagnosis and management of acutely deteriorating adult patients across West Middlesex University Hospital. The post holder will provide advanced clinical practice within the Critical Care Outreach Team (CCOT), supporting the early recognition, treatment and escalation of deteriorating patients whilst improving patient safety and clinical outcomes.

Working as an experienced ACP, the post holder will provide clinical leadership across the deteriorating patient agenda, including development of escalation pathways, implementation of Martha's Rule, delivery of the Trust's deteriorating patient strategy and support of the NHS Sepsis Framework. The role combines 50% direct clinical practice with 50% leadership, education, workforce development, quality improvement and service transformation responsibilities.

The ACP will work collaboratively with Critical Care, Acute Medicine, Emergency Care and ward teams to ensure timely intervention for patients at risk of deterioration, reduce avoidable cardiac arrests and unplanned critical care admissions, optimise critical care capacity and improve patient flow across the organisation. The post holder will provide professional leadership for the CCOT workforce and contribute to strategic development of services aligned to Trust and national priorities.

Main duties of the job

Main Duties

• Provide expert autonomous clinical assessment, diagnosis and management of acutely deteriorating adult patients.
• Lead and support the delivery of the Trust's deteriorating patient strategy.
• Act as a senior clinical decision-maker within the Critical Care Outreach Team.
• Lead implementation, monitoring and evaluation of Martha's Rule within clinical areas.
• Support the development and delivery of deteriorating patient escalation pathways for patients, families and staff.
• Lead improvements in sepsis recognition and management in line with national guidance.
• Provide expert advice and support regarding critical illness, escalation planning, treatment limitation decisions and end-of-life care.
• Independently prescribe and manage treatment plans within scope of practice.
• Support safe admission to and discharge from Critical Care services.
• Lead quality improvement, governance, audit and patient safety programmes relating to deterioration and critical illness.
• Provide line management, professional leadership and workforce development for CCOT staff.
• Deliver education, training and competency programmes for healthcare professionals across the Trust.
• Contribute to service development, policy development and implementation of evidence-based practice.
• Participate in a 24/7 outreach service, including nights, weekends and bank holidays.

About us

Our Trust is one of England's top-performing and safest trusts. We operate two main acute hospital sites--Chelsea and Westminster Hospital and West Middlesex University Hospital--along with award-winning clinics across North West London.

Our nearly 7,500 staff care for a diverse population of 1.5m, providing full clinical services including maternity, A&E and children's services, plus specialist HIV and sexual health care. The CQC rates us Good in safety, effectiveness, care and responsiveness, and Outstanding in leadership and resource use.

We continually invest in our facilities, including a £30m expansion of critical care at Chelsea and an £80m Ambulatory Diagnostic Centre at West Mid.

We are delivering sustainable healthcare through our Green Plan. In line with Greener NHS ambitions, we aim for net zero carbon emissions by 2045. Achieving this requires collective effort. We encourage staff to reduce their impact on carbon, waste and pollution wherever possible. Every action counts to create a healthier, more sustainable future.

We are committed to equal opportunities and believe diversity drives innovation and excellence. We welcome applications from the global majority, veterans and underrepresented communities, valuing the perspectives they bring.

Job responsibilities

Clinical Practice

The post holder will:

• Provide advanced autonomous clinical assessment, diagnosis and management of patients experiencing acute deterioration or recovering from critical illness.
• Undertake comprehensive patient assessments including physical, psychological, social and environmental factors influencing health outcomes.
• Interpret and act upon complex clinical information including diagnostic investigations, arterial blood gases, imaging and laboratory results.
• Develop and implement evidence-based management plans for patients with complex and unpredictable healthcare needs.
• Independently manage a caseload of outreach patients within agreed Trust protocols and professional scope of practice.
• Prescribe medications and treatments as an Independent Prescriber.
• Support clinical teams with management of sepsis, respiratory failure, tracheostomy emergencies, non-invasive ventilation and high-flow oxygen therapies.
• Provide expert clinical advice regarding treatment escalation plans, DNACPR discussions and end-of-life decision-making.
• Promote early recognition and timely escalation of clinical deterioration through NEWS2 and other deterioration pathways.
• Respond to and support Martha's Rule activations, ensuring timely senior clinical review and escalation where concerns are identified.
• Contribute to reducing avoidable cardiac arrests, unplanned ICU admissions and critical incidents associated with delayed recognition of deterioration.
• Maintain accurate, contemporaneous patient records and documentation.

Leadership and Management

The post holder will:

• Provide professional leadership for the Critical Care Outreach Team.
• Line manage Outreach Practitioners and support staff, undertaking appraisal, performance management, attendance management and development reviews.
• Lead workforce planning, succession planning and capability development within CCOT.
• Act as a visible clinical leader and role model for advanced practice across the organisation.
• Promote effective multidisciplinary working between Critical Care, ward teams, medical staff and allied health professionals.
• Lead service improvement initiatives that deliver measurable improvements in patient safety and clinical outcomes.
• Represent Critical Care Outreach at Trust, divisional and governance meetings.
• Support investigation of incidents, complaints and patient safety events in accordance with Trust policies.
• Contribute to strategic planning and future development of outreach services.

Deteriorating Patient Strategy and Martha's Rule

The post holder will:

• Lead implementation and ongoing development of the Trust's deteriorating patient strategy.
• Ensure delivery of robust pathways for recognition, escalation and management of deteriorating patients.
• Support organisational compliance with Martha's Rule and associated patient safety requirements.
• Develop escalation routes for patients, relatives and healthcare professionals who have concerns regarding deterioration.
• Monitor key performance indicators relating to deterioration, critical care referrals, cardiac arrests and emergency escalations.
• Support organisational learning from deterioration-related incidents and reviews.
• Drive improvements in early intervention and patient-centred escalation processes.

Education and Workforce Development

The post holder will:

• Lead and support competency-based education programmes for nurses, medical staff and allied health professionals.
• Deliver education relating to recognition and management of deteriorating patients, sepsis and critical illness.
• Act as an expert resource and mentor for trainees, ACPs and clinical staff.
• Develop and facilitate outreach education programmes across the organisation.
• Support continuing professional development and advanced practice development within the Trust.
• Promote excellence in patient assessment, escalation and clinical decision-making.

Quality Improvement, Governance and Research

The post holder will:

• Lead and participate in quality improvement projects relating to deterioration, sepsis, outreach and critical care.
• Monitor and evaluate outreach activity, patient outcomes and service performance.
• Develop, review and implement policies, procedures and clinical guidelines.
• Participate in audit programmes and ensure implementation of learning from findings.
• Support data collection, analysis and reporting relating to outreach services and patient outcomes.
• Critically evaluate evidence and translate research findings into clinical practice.
• Contribute to publications, presentations and dissemination of best practice where appropriate.

Professional Responsibilities

The post holder will:

• Practice in accordance with the four pillars of Advanced Clinical Practice.
• Maintain professional registration and comply with relevant professional standards and codes of conduct.
• Demonstrate accountability for autonomous clinical decision-making.
• Maintain competence through continuous professional development and education.
• Promote equality, diversity and inclusion in all aspects of practice.
• Act as an advocate for patients, relatives and staff.
• Uphold the Trust's PROUD values and contribute to the delivery of outstanding patient care.

Person specification

Qualifications

Essential

• Current NMC or HCPC registration
• MSc Advanced Clinical Practice (or equivalent) meeting national ACP standards
• Independent Non-Medical Prescribing qualification
• Advanced Life Support (ALS) Provider/Instructor
• Intensive Care Course or equivalent critical care qualification

Desirable

• Leadership qualification
• Quality Improvement qualification
• Ultrasound qualification

Experience

Essential

• Significant experience in Critical Care, Critical Care Outreach or Acute Care setting
• Experience of autonomous assessment and management of deteriorating adult patients
• Experience of leading teams or line management responsibilities

Desirable

• Experience leading quality improvement projects
• Experience developing clinical guidelines, SOPs or pathways

Knowledge and skills

Essential

• Advanced clinical assessment and diagnostic skills
• Expert knowledge of deteriorating patient management and critical illness
• Knowledge of NHS governance, patient safety and risk management processes
• Knowledge of relevant clinical skills - NIV; high flow; tracheostomy management

Desirable

• Ultrasound-guided vascular access skills
• Point of Care Ultrasound (POCUS) skill

Leadership and communication

Essential

• Excellent communication and influencing skills
• Evidence of teaching and staff development experience
• Ability to lead service improvement and change initiatives