Career & Development Framework

Career and Development Framework For Healthcare Support Workers Providing Neonatal Care in Hospital Settings in Scotland (Career Framework Levels 2 – 4)

Final Version November 2012

. [Type text] Career and Development Framework For Healthcare Support Workers Providing Neonatal Care in Hospital Settings in Scotland

(Career Framework Levels 2-4)

INTRODUCTION 1 STRUCTURE 2 Levels of Practice 2 Pillars of Practice 2 OVERVIEW PAGE 3 PILLAR OF PRACTICE: CLINCIAL PRACTICE 6 Aspect of Practice: Safe, Effective and Person Centred care 6 Aspect of Practice: Decision Making 13 PILLAR OF PRACTICE: FACILITATION OF LEARNING 14 Aspect of Practice: Learning, Teaching and Development 14 PILLAR OF PRACTICE: LEADERSHIP 15 Aspect of Practice: Team Work 15 PILLAR OF PRACTICE: EVIDENCE BASED PRACTICE 16 Aspect of Practice: Supporting Evidence Based Practice 16

APPENDICES 17

2 INTRODUCTION In summer 2010 NHS Education for Scotland in partnership with the The role parameters expressed in the above Guide have been Scottish Neonatal Nurses’ Group facilitated the development of a Career contextualized to reflect the specific nature of the Neonatal Healthcare and Development Framework for Neonatal Nurses in Scotland to Support Worker role at Levels 2, 3 and 4 of the Career Framework for provide a consistent approach to the professional development of Health (Appendix 1). The education and progression requirements of nurses from Levels 5-8 of the NHS Career Framework for Health (Skills Neonatal Healthcare Support Workers mirror the guidance on education for Health, 2006; Scottish Government, 2009). and training described in this document (p.14) and are summarised in Appendix 2.

This framework is now firmly embedded within all neonatal units in Scotland. It was recognised by those involved that there was a need to This framework was facilitated by NHS Education for Scotland in produce a framework encompassing the role and development of the partnership with representation from the Scottish Neonatal Nurses’ Neonatal Healthcare Support Worker workforce. The publication of the Group and the Managed Clinical Networks for Neonatal Services Mandatory Induction Standards for Healthcare Support Workers in (Appendix 3). It will contribute to the patient safety agenda by assisting Scotland, the Code of Conduct (Scottish Government 2009) and the those working as Neonatal Healthcare Support Workers to develop their guide to Healthcare Support Worker Education and Role Development knowledge and skills effectively and provide guidance around their roles, (Scottish Government and NHS Education for Scotland 2010) now education requirements and development. Supervisors, managers and provide strong reference points and guidance to assist the development education providers can use this document to support and develop the of this framework. This framework reflects the principles within “Getting workforce. it right for every child” which highlights the need for a “confident and competent workforce across all services for children, young people and The levels expressed are those of the NHS Career Framework for their families”1 Health which reflect role development and progression and not those of Agenda for Change which is related to remuneration. 1Scottish Government (2012) A guide to getting it right for every child Edinburgh. Scottish Government Page 6 [Type text] Each of these pillars is divided into Aspects of Practice: STRUCTURE Pillar of Practice Aspects of Practice Levels of Practice Clinical Practice  Safe, effective and person-centred care The Framework is based on levels 2-4 of the Career Framework for  Decision Making Health (Appendix 1). An overview page outlines the entry requirements, Facilitation of Learning  Learning, Teaching and Development educational requirements, examples of resources for development and Leadership  Team work the sphere of responsibility for each level of neonatal health care support workers. There is an emphasis throughout on good Evidence, research  Supporting Evidence Based Practice and development communication and team working skills.

Pillars of Practice Sphere of responsibility, key knowledge, skills and behaviours and The framework is built on existing Career Framework initiatives for post- opportunities for educational and development are outlined for each registration Nurses, Midwives and Allied Health Professionals (2012) aspect of practice. Healthcare Support Workers working in neonatal and uses the four pillars of practice described in the Post-Registration hospital settings provide care to babies delegated to them and/or Career Framework2. These have been adapted to reflect the needs of undertake other duties working within the scope of their job description this workforce. These have been used as organisers and are as follows: under direct or indirect supervision of a Registered Practitioner. Educational requirements and development resources suggested within  Clinical Practice the framework are examples to prepare the Healthcare Support Worker  Facilitation of Learning in the aspects specific to their role, as defined in their job description.  Leadership  Evidence, Research and Development. Some Healthcare Support Workers have specific roles within their job description such as undertaking elements of newborn screening programmes or administering defined oral and topical medication 2 www.careerframework.nes.scot.nhs 4 checked by a Registered Practitioner and governed within local polices. In order to be competent in their defined role, neonatal Healthcare Support Workers require to have the appropriate educational preparation and support, examples are provided in the overview pages.

The framework is cumulative in that those working at level 4 would be expected to have achieved the criteria stated at the lower levels in addition to the criteria for their current level of practice. The framework has been mapped against “Working to a Standard: a Code of Conduct for Healthcare Support Workers” (Paragraph 3) and suggested mapping against NHS KSF Core and Specific Dimensions is also provided.

OVERVIEW PAGE

5 Career Entry requirements3 Educational Requirements Examples of Development Sphere of responsibility Framework Resources Levels

Level 2 Previous relevant experience All staff joining NHS Scotland in a  A guide to Healthcare Support Care of the well baby under the desirable but not essential Healthcare Support Worker Worker Education and Role direction and supervision of a (HCSW) role as described in CEL Development which sets out the Registered Practitioner or Level 4 23 (2010) will be required to meet nationally agreed generic Health Care Support Worker national mandatory induction principles on education and role supported by a Registered standards within three months of development for HCSW Practitioner. joining NHS Scotland.  Healthcare Support Worker Work within local guidelines as http://www.hcswtoolkit.nes.scot.nh Toolkit instructed. s.uk/induction-standards--codes Following publication of the above Guide, an on-line tool-kit resource The HCSW will possess, or have which provides guidance and the opportunity to attain within an educational resources for both agreed timeframe, education at clinical and non-clinical HCSW SCQF level 6. roles

Induction and orientation programmes

Role specific in- house education e.g. Cleanliness champion, breast feeding support training, child protection, basic life support

Level 3 The Senior HCSW can The Senior HCSW will possess, or Care of babies requiring special evidence previous experience have the opportunity to attain  Healthcare Support Worker care under the direction and and/or consolidation of practice within an agreed timeframe, Toolkit supervision of a Registered as a HCSW or can evidence an education at SCQF level 7. Practitioner or Level 4 Healthcare appropriate level of knowledge Role specific in- house Support Worker supported by a and skill to care for babies education Registered Practitioner.

3 NHS Education for Scotland and The Scottish Government(2010)A Guide to Healthcare Support Worker Education and Role Development 6 Career Entry requirements Educational Requirements Examples of Development Sphere of responsibility Framework Resources Levels

requiring special care. Work within local guidelines as instructed.

Level 4 The Assistant Practitioner can The Assistant Practitioner will  Healthcare Support Worker Assessment, implementation, evidence previous experience possess or have the opportunity to Toolkit provision, and evaluation of and consolidation of practice as attain within an agreed timeframe, aspects of care of a baby requiring a Senior HCSW and/or has the education at SCQF level 8. Role specific in- house special care under direct or indirect appropriate skills and education supervision of a Registered knowledge and demonstrates Will undertake approved course of Practitioner. the depth of understanding and neonatal education. Early Years Capability ability to care for babies Framework and Education at Work within local guidelines requiring special care. SCQF Level 8 reporting to a registered practitioner.

Ability to assess and support level 2 & 3 HCSW’s with assistance of a registered practitioner.

PILLAR OF PRACTICE: CLINICAL PRACTICE

ASPECT OF PRACTICE: SAFE, EFFECTIVE AND PERSON CENTRED CARE Suggested NHS KSF Dimensions Core 1,2,3,5,6- Specific HWB 2,3,5; IK1; EF2 7 Sphere of Key Knowledge, Skills and Behaviours Mapping against responsibility “Working to Standard”4

Career Framework Level 2 Career Framework Level 3 Career Framework Level 4 Nutrition and Develop knowledge of Develop knowledge of feeding behavior of Apply knowledge of the feeding 3.2.1 Accountability elimination normal baby feeding behavior in a baby requiring special care in order to: behavior of a baby requiring special order to: care in order to: 3.2.2 Awareness  Give supplemental feeding e.g. cup  Inform and advise on feed, gastric feeding  Recognise normal gastro- 3.2.3 Integrity storage of breast milk, intestinal function, urinary tract 3.2.13 Alertness breast feeding, hand and  Verify intake requirements for enteral function and bilirubin elimination mechanical expression of feeding according to guidelines breast milk  Document findings, report deviations and take appropriate Set up and record measurement from  action  Assist the mother to breast enteral feeding pumps feed according to evidence based/unit guidelines  Inform and advise on all aspects  Administer feeds via gastric tubes of enteral feeding methods including gastrostomy tubes  Sterilise equipment and prepare formula feeds  Pass gastric feeding tubes via  Check and administer oral nutritional nose and mouth supplements which have been  Assist parents/carers in checked by a Registered Practitioner bottle feeding techniques  Assess enteral feeding needs, according to local policy devise plan and review appropriately  Measure and weigh babies,  Monitor and record input and output, record and report findings adjusting approach to feeding as per  Advise on the need for guidelines nutritional supplements as  Monitor and record input and appropriate output and report findings  Monitor growth e.g. weight, length, head circumference through  Anticipate and monitor babies at  Support a baby requiring measurement and record and report risk of hypoglycemia and findings implement preventive and where phototherapy necessary management strategies  Initiate phototherapy as directed by a Registered Practitioner

4 Scottish Government (2009) Code of conduct for healthcare support workers 8 Infant Develop knowledge of normal baby Develop knowledge of behavior of a Apply knowledge of behavior of a 3.2.1 Accountability Behaviour behaviour in order to: baby requiring special care in order to: baby requiring special care in order to: 3.2.2 Awareness 3.2.3 Integrity  Use developmental care  Recognise normal behaviour in 3.2.13 Alertness strategies: including babies of different gestations,  Recognise the need for environmental aspects, including sleep/awake states assessment, interpret positioning and handling to outcomes and optimise development  Complete available/appropriate implement strategies assessment tools and report e.g. containment, findings e.g. Neonatal Abstinence  Record and report Syndrome(NAS) and pain swaddling, sucrose, observations of behaviour assessments non-nutritive sucking, environmental  Adapt developmental care modification strategies according to the needs of individual babies e.g. babies  with NAS, in pain Recognise limits of above strategies and seek review

Vital Signs Develop knowledge of observing and Develop knowledge to modify care Apply knowledge to modify care in 3.2.1 Accountability measuring vital signs in order to: according to vital signs in order to: response to vital signs in babies requiring special care in order to: 3.2.2 Awareness  Undertake temperature, heart rate, respiratory rate  Measure and record vital signs by  Recognise the need for and/or 3.2.3 Integrity measurements intermittent and /or continuous modify vital sign monitoring methods, reporting deviations including blood pressure 3.2.13 Alertness  Observe baby’s colour according to baby’s condition  Adjust supplemental oxygen and local guidelines  Record and report according to local guidelines measurements and  Implement strategies to maintain observations of vital signs  reporting changes in oxygen and normalise vital signs within accepted parameters concentration delivered  Recognise need for, request  Initiate safe and effective oral assistance and initiate basic and nasal/pharyngeal suction as 9 life support measures clinically indicated

Hygiene Develop knowledge of hygiene Develop knowledge of skin integrity of Apply knowledge of skin integrity 3.2.1 Accountability needs needs in order to assist the a baby requiring special care in order of a baby requiring special care in mother/practitioner to: to: order to: 3.2.2 Awareness

 Perform basic care of skin;  Apply strategies to maintain and  Adapt strategies to assess, 3.2.3 Integrity “top and tail”, bedbath and manage skin integrity, including maintain and manage skin 3.2.13 Alertness bath stoma care, application and integrity removal of tapes and topical  Perform basic care of eyes applications and umbilical cord  Implement strategies to manage skin injury  Advise parents on skin care and bathing techniques

10 Infection Develop knowledge of infection Develop knowledge of infection Apply knowledge of infection 3.2.1 Accountability Prevention prevention and control in order to prevention and control in order to: prevention and control in order to: assist the mother/practitioner to: 3.2.2 Awareness and Control  Lead by example and 3.2.3 Integrity  Participate in audit activities  Comply with standard support others to comply with 3.2.13 Alertness infection control precautions infection prevention and and NHS Board policies control policies

 Perform correct hand  Participate in audit activities hygiene procedure and other through observing practice infection prevention and and monitoring compliance control measures as per local policies

 Advise visitors, staff and members of public about hygiene and visiting restrictions

Temperature Develop knowledge of temperature Develop knowledge of Apply knowledge of 3.2.1 Accountability Control control in order to assist the thermoregulation in babies requiring thermoregulation in babies mother/practitioner to: special care in order to: requiring special care in order to: 3.2.2 Awareness

 Adjust environment, clothing  Following discussions with a  Understand the 3.2.3 Integrity and equipment for babies as Registered Practitioner, initiate physiological impact and 3.2.13 Alertness directed to achieve/maintain use of specialist equipment e.g possible cause of normothermia incubator, radiant warmer, heated temperature instability cot to maintain neutrothermal  Limited use specialist environment based on  Anticipate the baby’s risk of equipment e.g. incubator, temperature assessment temperature deviations radiant warmer, heated cot to maintain neutrothermal  Use strategies to prevent environment as directed by a temperature deviation Registered Practitioner or Level 4 Healthcare Support Worker supported by a

11 Registered Practitioner

Family Develop knowledge of family Develop knowledge of family centered Apply knowledge of family centered 3.2.3 Integrity centred care centered care principles in order to: principles in babies requiring special principles in babies requiring special care in order to: care in order to: 3.2.4 Advocacy

 Work in partnership with  Be proactive in involving parents,  Act as an advocate for babies’ 3.2.5 Sensitivity parents, families/carers to families/carers in all aspects of rights provide optimum care care e.g. kangaroo care 3.2.6 Objectivity  Activate safeguarding 3.2.7 Consideration and  Be sensitive to the needs of  Support preparation for discharge procedures, seeking support parents, families /carers as required in relation to child Respect protection, vulnerable adults,  Recognise and respect domestic violence 3.2.8 Consent diversity, individual differences and perspectives  Undertake elements of discharge procedure  Be aware of role and responsibilities, seeking support as required in relation to child protection, vulnerable adults and domestic violence

Investigations Develop knowledge of Develop knowledge of investigations Apply knowledge of investigations 3.2.1 Accountability and investigations and procedures in and procedures in babies requiring and procedures in babies requiring order to : special care in order to: special care in order to: 3.2.2 Awareness procedures 3.2.3 Integrity  Assist with investigations e.g.  Assist with and/or perform  Administer medicines specified newborn blood spot screening, within local policy which have routine screening including venepuncture been checked by a Registered 3.2.4 Advocacy obtaining consent where Practitioner, via oral and this is a defined role in the topical routes 3.2.8 Consent HCSW job description e.g. 3.2.13 Alertness hearing screening  Be aware of adverse reactions to clinical investigations and procedures and report  Assist with and/or perform appropriately routine investigations e.g. blood glucose estimation, x-  Assist with, and as directed rays, skin swabs according undertake specific complex to protocols and guidelines procedures e.g. wound care, long term tracheostomy care, 12 urinalysis  Implement prescribed management plans in response to findings e.g. blood glucose estimation

 Escort babies undergoing procedures out-with neonatal unit e.g. ultrasound Equipment Develop knowledge of Develop knowledge of equipment Apply knowledge of equipment 3.2.1 Accountability used for babies requiring special care used for babies requiring special standard operating in order to:- care in order to:- 3.2.2 Awareness procedures in order to:-  Set, check and interpret  Check emergency 3.2.3 Integrity significance of equipment alarms resuscitation equipment 3.2.13 Alertness  Clean and store equipment in babies requiring special care used in the care of the baby and respond appropriately in accordance with local and manufacturer’s instructions  Set up and use equipment in the care of babies requiring special  Set up and use equipment in care e.g. vital signs monitors, the care of babies e.g. incubators, phototherapy units apnoea monitors, cots, phototherapy units

Health and Develop knowledge of health and Develop knowledge of health and Apply knowledge of health and 3.2. Awareness Safety safety in order to:- safety of babies requiring special care safety of babies requiring special in order to:- care in order to- 3.2.11 Protection

 Assess risk and report  Recognise risk in relation to care  Demonstrate risk findings provision and further develop risk assessment skills in relation assessment skills to care  Act on findings within role boundaries  Act on findings within role  Support standards of care by boundaries to ensure patient adhering to defined  Demonstrate understanding safety guidelines, policies, of: standards and protocols to support the delivery of safe, effective and person centred 13 care in conjunction with - health and safety registered practitioners - COSSH regulations (Scottish Government 2010)5

Pillar of Practice: Clinical Practice Aspect of Practice: Decision Making Suggested NHS KSF Dimensions Core 1,2,3,5,6- Specific HWB 2,3,5 IK1

Examples of Sphere Key Knowledge, Skills and Behaviours Mapping against “Working of responsibility/role to Standard”6 Career Framework Career Framework Career Framework Level 2 Level 3 Level 4 Responsibility and 3.2.1 Accountability Accountability  Deliver delegated  Contribute to the assessment,  Asses, plan, deliver care/tasks within planning and delivery of care and evaluate care 3.2.9 Confidentiality boundaries of role, within the boundaries of role, within the boundaries knowledge and skills under knowledge and skills under the of role, knowledge and the direction and direction and supervision of a skills, reporting to a supervision of a Registered Registered Practitioner or Level registered practitioner Practitioner or Level 4 4 Healthcare Support Worker Healthcare Support Worker supported by a Registered  Problem solve related supported by a Registered Practitioner to needs and tasks Practitioner and take action within the agreed parameters  Problem solve related to  Problem solve and take action of the role (NES 2010) the task at hand (NES regarding patient/client care 2010)7 through an awareness of policy and legislation (NES 2010)  Maintain clear and concise communication and documentation

 Comply with appropriate standards for 5 Scottish Government (2010)Healthcare Quality Strategy for NHS Scotland. Edinburgh. Scottish Government 6 Scottish Government (2009) Code of conduct for healthcare support workers 7 NHS Education for Scotland/Scottish Government A Guide to Healthcare Support Worker Education and Role Development 14 confidentiality, records and record keeping (Code of Conduct 4.1.6)

 Comply with the Data Protection Act

Pillar of Practice: Facilitation of Learning Aspect of Practice: Learning, Teaching and Development Suggested NHS KSF Dimensions Core 1,2,5, Examples of Key Knowledge, Skills and Behaviours Mapping against Sphere of “Working to responsibility/role Standard”8 Level 2 Level 3 Level 4 Personal 3.2.12 Development development  Develop and maintain own  Develop and maintain own  Be responsible and accountable knowledge and skills to knowledge and skills to provide for keeping own knowledge and provide safe and effective safe and effective care with support skills up to date through care with direction from a from a Level 4 Healthcare Support continuing development Level 4 Healthcare Worker or Registered Practitioner Support Worker or Registered Practitioner

 Learn from experience through observation, supervision, feedback, reflective practice techniques and evaluation

8 Scottish Government (2009) Code of conduct for healthcare support workers 15 People  Within the boundaries of  Within the boundaries of role,  Support and act as mentor and 3.2.12 Development Development role, facilitate the learning facilitate the learning of role model to Senior Healthcare of parents/families/carers parents/families/carers of babies Support Workers (NES 2010) of well babies who require special care  Assess parental/family/carer  Support and act as a role model to confidence and competence to  Identify and report where Level 2 Healthcare Support carry out baby care interventions additional support is Workers required  Contribute to multi-professional working actively participating and respecting the contribution of others Pillar of Practice: Leadership Aspect of Practice : Team Work Suggested NHS KSF Dimensions Core 1,2,4,5,6 Examples of Key Knowledge, Skills and Behaviours Mapping against “Working Sphere of to Standard”9 responsibility/role Level 2 Level 3 Level 4 Contribution to 3.2.10 Co-operation teams’ purpose  Act as a positive role  Contribute to team objectives in  Develop clinical and objectives model relation to quality initiatives leadership behaviours and skills  Support the neonatal/  Assist the neonatal/ . multidisciplinary team in the delivery of high multidisciplinary team quality care (NES 2010) in the delivery of high quality care

 Contribute to team objectives in relation to service development initiatives

 Give and receive feedback in a open, honest and

9 Scottish Government (2009) Code of conduct for healthcare support workers 16 constructive manner

 Work independently, as well as in teams, under the supervision of a registered practitioner to coordinate, delegate and supervise care for a designated group of babies Pillar of Practice: Evidence Based Practice Aspect of Practice: Supporting evidence based practice Suggested NHS KSF Dimensions Core 1,2,3,4,5 - Specific IK1

Examples of Key Knowledge, Skills and Behaviours Mapping against “Working Sphere of to Standard”10 responsibility/role Career Framework Career Framework Career Framework Level 2 Level 3 Level 4 Guidelines and 3.2.12. Development evidence based  Follow guidelines  Contribute to guideline  Recognise the need practice under the direction of development for evidence based a Registered practice, access and Practitioner or Level assess and apply 4 Healthcare Support  Perform simple audits or surveys relevant guidelines Worker supported by a Registered  Assist with clinical projects or  Apply knowledge and Practitioner research e.g. specimen collection skills in using information  Perform simple technology systems audits or surveys relevant to own work area (Skills for Health(2008)11

10 Scottish Government (2009) Code of conduct for healthcare support workers 11 Skills for Health (2008) Career Framework Descriptors 17  Develop the knowledge and skills in using information technology systems to access resources e.g. clinical guidelines and policies, relevant publications

18 APPENDIX 1

Career Framework Model

Taken with Permission from the Scottish Government Workforce Directorate “Guidance to NHS Boards on the Career Framework for Health” 11 March 2009 (Annex 2).

The diagram outlines the Career Framework Levels, the appropriate Clinical level title (in brackets), a brief clinical level descriptor and, for illustration, some possible non-clinical role examples.

Note: This diagram is a slight adaptation of the version on the Skills for Health website and from the one formally launched in 2006. These adaptations are simply to reflect generally recognised terms in Scotland, which may differ from those used elsewhere in the UK. They do not affect the substance of the Career Framework or represent a departure from the Career Framework launched in 2006.

[Type text] APPENDIX 2

Career Framework Indicative SCQF Example Articulation of Career Framework with Scottish Credit and Level Levels Qualifications Qualifications Framework Masters Degree Level 9 Level 11/12 Doctorate SVQ5 Taken from Scottish Government Health Workforce Directorate Masters Degree “Guidance to NHS Boards on the Career Framework for Health” 11 Level 8 Level 11/12 Doctorate March 2009. Annex 2, a range of post-registration courses. SVQ5 Note: The levels on the framework are indicative only. They can be Post Graduate broadly linked to qualifications and SCQF levels but this will only be a Level 7 Level 11 Certificate/Diploma rough guide – there will be exceptions. Masters Degree Ordinary or Honours Learning required at each level will vary according to the occupational Level 6 Level 9/10 Degree groups into which the role falls and the KSF outline for each particular Graduate Diploma role. However, in general, the following level(s) of qualification (in areas SVQ4 related to the work being undertaken) might be expected for roles which Diploma HE Ordinary appear at the same level of the Career Framework. Level 5 Level 8-10 or Honours Degree SVQ4 The learning required for each role should be considered in conjunction HNC with the Career Framework level descriptors. Level 4 Level 7/8 HND http://www.skillsforhealth.org.uk/workforce-transformation/customised- SVQ3 career-frameworks-services/ Level 3 Level 6/7 HNC

SVQ2 Level 2 Level 5/6

Induction Standards Level 1

20 APPENDIX 3

Working Group Membership

Elizabeth Callander Lead Midwife – Neonatology NHS Greater Glasgow & Clyde Dr Yvonne Freer Clinical Reader Edinburgh Napier University Marie Gardiner Network Manager North of Scotland Managed Clinical Network for Neonatology Denise Gray Educational Projects Manager NHS Education for Scotland Dr Claire Greig Lecturer Edinburgh Napier University Lynne Kerr Clinical Manager, Neonatal NHS Lothian Services Caroline Mearns Educational Projects Manager NHS Education for Scotland Iona Philp Network Manager South East & Tayside Managed Clinical Network for Neonatology Fiona Tait Network Manager Neonatal Managed Clinical Network, West of Scotland Alison Will Nurse Manager, Neonatal NHS Grampian Services Alison Wright Senior Nurse/Chair NHS Tayside/Scottish Neonatal Nurse Group

The group would like to thank colleagues in Neonatal Services throughout Scotland and The Royal College of Midwifes (Scottish Board) for their comments and contributions.

[Type text] This framework has been endorsed by the Royal College of Nursing.

Review date for this document: September 2015