AGENDA FOR CHANGE NHS JOB EVALUATION SCHEME

JOB DESCRIPTION

1. JOB IDENTIFICATION

Job Title: Principal Cardiac Physiologist

Reports to (insert title): Section Head Clinical Physiology

Department, Ward or Section: Medical Physics Department.

CHP, Directorate or Corporate Division: Clinical Support Division

Job Reference: SSMEDDRAIGRESP01

No. of Job holders: 1

Last update: 12/12/16

2. JOB PURPOSE

Line manager for Cardiac and Respiratory Physiologists and Cardiographers.

Provide professional leadership for technician in Caithness General

Provide clinical governance in relation to cardiac and respiratory physiology for outlying hospitals – Belford and Caithness General.

Budget holder for Cardiorespiratory Service.

Advisory role to Caithness, Belford and Western Isles with regards to equipment and disposables purchased which influences their budget spending.

To perform and report on an extensive range of unsupervised highly specialist Cardiac Testing. To provide a service to outlying Hospitals and GP surgeries.

3. DIMENSIONS

Budget Holder for Cardiorespiratory diagnostic Services. This includes equipment, pacing devices and service, staffing, disposables, training Also advisory and influential role in Caithness and Belford Hospital with regards to budget spending on equipment, Staffing, Disposables and Training.

The range of patients dealt with goes from paediatric to elderly. Paediatric patients include premature babies. Patients can be totally mobile or totally incapacitated, have learning difficulties, hard of hearing and/or unable to speak. Some patients have had a tracheotomy and find it difficult to communicate or perform test.

The post holder deals with inpatients, outpatients and patients from GP surgeries.

Provide advice to medical staff, nursing staff, G.Ps, Medical Physics, colleagues in other hospitals, patients and relatives.

Liaise with medical staff, nursing staff and G.P’s with regards to patients care and follow up.Communicate with multi disciplinary personnel both within and out with the hospital.

4 ORGANISATIONAL POSITION

5. ROLE OF DEPARTMENTTo perform highly specialist Clinical Physiology Tests. To analyze and report on Tests performed. To take decisions on the basis of the results obtained.

To give advice on appropriate testing to Medical Staff. The service is provided mostly to Raigmore Hospital but a service is also provided for outlying Hospitals and GP surgeries.

To maintain a high standard of training of personnel within the Department.

To provide education on cardiac testing and analysis to both non-qualified and qualified nursing and medical staff.

6. MAIN TASKS AND RESPONSIBILITIES

The post holder has to work within Hospital, departmental and Health Board policies.

The post holder also has to work within guidelines developed by the Society of Cardiological Science and Technology.

The post holder is expected to work independently as well as part of a team.

Managerial Responsibilities

Participation in meetings in order to communicate to senior managers information regarding service and equipment issues that will impact on budget or policies.

Participation in meetings for the Cardiac Managed Clinical Network / Quality Improvement Group. This involves a Multi Disciplinary Team from both acute and primary care to plan and implement policy changes to ensure the best use of resources to ease the patient journey.

Meetings with Head of Clinical Physiology in order to provide a progress report and /or information on any new policies implemented by post holder.

Meeting with Head of Clinical Physiology, Director of Medical Physics and Cardiac and Respiratory Consultants to discuss planning, organization and implementation of new policies and/ or procedures.

Regular Departmental meetings to ensure staff are aware of policies and procedures and any changes that have been made.

Meetings with staff and managers in both Caithness and Belford Hospitals to ensure they are aware of policies and procedures and to decide the impact of implementation of any changes. Meetings are also held to give advice on purchase of equipment and or disposables to ensure the best use of resources available. Assistance is also given to staff in these hospitals to write business cases to aid development of service.

Review of activity and working practice on a monthly basis at Caithness General

Regular meetings with company representatives to keep up to date with new technology / consignment checks. Organize training with companies as and when required. Attendance and involvement with the Central Supplies Agency and peers from Hospitals throughout Scotland to decide on contracts for purchasing pacemakers/ ICD’s and leads.

Staff Management

Responsible for all staff management issues. This is includes performance/ attendance issues, appraisal and PDP, organization and payment of overtime, editing and return of monthly pay sheets etc.

Advises on the organization and implementation of emergency and holiday cover for Belford and Caithness Hospitals to ensure waiting lists are kept at a minimum.Organisation and implementation of training for use of new equipment.

Responsible for short listing of applicants and interviewing of prospective staff and deciding on appropriate interview panel.

Dealing with disciplinary issues in accordance with policies and procedures in place.

Development and planning for changes in service / expansion of service brought about by either technological advances or as a direct result of changes to physicians working hours and /or practices. Implementation of these changes.

Highly Specialised Cardiac Testing

The post holder will be expected to provide clinical service provision according to their area of advanced training or expertise, and as required by the demands of the service. This could be within the invasive or non-invasive elements of the service.

An example of work performed if the specialist role was within cardiac devices is:

1. Perform interrogation, programming, decision making and give medical staff advice on Automated Implantable Cardioverter Defibrillator (AICD) devices. As naturally patients do not like receiving shocks from their AICD, the post holder must have excellent communication and reassurance skills in order to explain the procedure to the patient, listen to their fears, and then reassure not only the patient but also their families. Ability to overcome barriers of the patient’s understanding of the complexity of the implanted device.

2. All pacemaker clinics are physiologist led and involves the performance of detailed pacemaker testing and interrogation and detailed analysis of stored data, assessment of pacemaker function, reprogramming, requesting of other cardiac testing. In the event of problems, arising from data or test results, it is the post holder’s responsibility to assess the patient symptoms, observations on the ECG, results of various tests performed on the pacemaker and the data stored within the pacemaker, then reprogram the pacemaker.

If the problem is due to structural damage/displacement or malfunction, it is the post holder’s responsibility to contact the Cardiologist. The patient is then reassessed (the length of time to reassessment depends on the type of problem occurred or the type of programming changes made) and if the problem is not resolved, further programming is performed and follow up organized. If this does not resolve the problem, it is then the post holder’s responsibility to inform the Cardiologist, as medication may need to be altered as well as reprogramming.

Due to geographical pressures the Cardiologist is often not contactable therefore it is the post holder’s responsibility to take an interim decision as to the course of action until a Cardiologist can be contacted. These decisions have a direct effect on patient care. Gives advice and reassurance to the patient. It is the post holder’s responsibility to organize clinics in outlying hospitals, organize accommodation and organize the transport of equipment and personnel to and from the clinics.

Other Duties

1. Assists with research and development by performing tests and analysis required. Work as part of a team usually with doctor or nurse involved with the research. Identify suitable patients for research purposes.

2. Responsible for assessing, ordering and authorizing (post holder is an authorized signatory and approver) of non-stock, in-stock, stationery, pacemaker systems, cardiac catheters and any other items regularly used within the department.

3. In implementing the Healthcare Science Delivery Plan agenda for integrated Clinical Physiology services as agreed in discussion with the Raigmore Senior Management Team, there will be ongoing opportunities to review the roles and remit within the existing job description. This will be to provide the best fit with the expertise of both the post holder and the Head of Clinical Physiology, to ensure the Clinical Physiology service is well placed to meet the future demands of the services it provides.

Education:

Overall responsibility for the organization and allocation of teaching within and out with the department, in accordance with local training strategy and quality assurance infrastructure of the Clinical Physiology section, Education Scotland and relevant professional and academic bodies.

Involved with the teaching of other Clinical Physiologists in the area of the post holders expertise.

Involved with the teaching of basic ECG testing performance and analysis, rhythm analysis and basic pacemaker training to qualified and non-qualified staff (from other disciplines) i.e. Hospital nursing staff, radiographers and GP practice nurses.

Provides teaching (theoretical and observational) on pacemaker implant and exercise stress testing to medical students, nursing staff and students.

Provides training and practical advice to GP practice nurses with regards to the use of Intermittent Cardiac Event Recorders, Ambulatory Blood Pressure monitors and ECG machines.

Administration:

Administration created by management duties:

Monthly pay sheet returns.

Paperwork for new employees or those terminating employment.

Recording and review of absence.

Recording of other leave – compassionate, carers and parental.

Dealing with fact finding and replying to patient complaints and incident reports.

Calculation and allocation of annual leave.

Recording and providing reports for either committees or activity and proposed spending for budget control.

Recording overtime for staff ensuring necessary payment is allocated.

Collation of data for audits on clinics held within department and Wick.

Providing finance department with all extra payments so appropriate funding is allocated from the correct budget.

Collation of monthly activity figures to be sent to IT department.

Basic programming of computer appointment and reporting system. Resolving minor problems within the system.

Auditing of pacemaker appointments.

Updating pacing data of individual patients after attendance at clinics or implantation of new system. Producing letters for patient notes and copies to GP practices.

Occasional general admin including putting patients on the waiting list, making appointments, logging and locating patient notes within the hospital. Dealing with numerous telephone queries from within the hospital (medicals staff, nursing staff, secretaries etc;) and out with – GP’s, colleagues from other hospitals and patients.

Responsible for updating the Hospital patient administration system.

7a EQUIPMENT AND MACHINERY

Highly Technological expensive equipment/machinery is used in all testing (up to the value of £100,000). This includes small intermittent cardiac arrhythmia, 24 hour ECG and Blood pressure monitors, treadmills, sophisticated monitoring systems (e.g. cardiac catheterisation testing equipment), computerized analysis systems and patient administration systems.

Pacemaker programmers and analysers are used. Many different programmers are used from different companies. Some companies have 2 or 3 different programmers designed to deal with different generations of pacemakers. These programmers vary in their set up and style of programming. Different companies have different names for the same programmable feature but also have different ways to set up similar functions. Therefore the post holder is required to familiarize themselves with many different methods of programming, different terminology relating to similar features and different formats for setting up similar functions.

The post holder is responsible for the basic maintenance, cleaning, programming and troubleshooting of all equipment. The post holder is also responsible for regular checks on alarm systems and defibrillators. Responsible for ensuring that all emergency trolleys are regularly checked and stocked. The post holder is responsible for taking the decision to call in someone from the Medical Physics department or the company responsible, if the problem cannot be resolved.

When equipment is being assessed for purchase, the post holder allocates the various equipment/machinery from the different companies to different members of staff for assessing. Once all the equipment is assessed, the post holder convenes a meeting to discuss which item is most suitable for purchase.

The post holder discusses the prospective purchase of new equipment with Medical Physics Electrical Engineering Department with regards the long term maintenance contracts etc.

Advises GP practices on the most suitable equipment to purchase taking into account their individual needs and budget constraints.

7b SYSTEMS

The completion of pay sheets and forwards them to the pay unit. Also recording sick leave,

compassionate leave and carers leave etc;

Prepare end of month statistical reports and collate data for end of month figures.

Update the hospital patient administration system information.

Updating of patient information on the departmental patient appointment system.

Updating of pacemaker data on the computerized analysis system.

Developing, assigning and programming templates and user windows of departmental appointment and analysis system.

After a pacemaker check the post holder is required to update the patient notes as to the programming performed, action taken and length of time until next follow up.

Also it is their responsibility to provide maintenance of the system and educate and update users of the system.

The post holder is responsible for the updating of pacemaker records and the transfer of information to other Hospitals when the patient moves. It is also their responsibility to audit the system to ensure that no patients have missed their appointments.

Responsible for editing, reporting and confirming all clinical results entered into departmental data base (MUSE) prior to archiving.

Clinical information is downloaded by Raigmore, Belford and Caithness General.

All results can be viewed by medical staff, nurses and secretaries; development is underway to allow GP access.

8 ASSIGNMENT AND REVIEW OF WORK

1. Is responsible for, and accountable to the Head of Clinical Physiology for the organisation, planning, development, and delivery of the Cardio-respiratory Service, and for ensuring that all work undertaken by the service complies with statutory requirements and local and national professional standards.

2. The majority of patients are referred for testing from Consultants within the Hospital and from outlying Hospitals. Sometimes the Registrars or Senior House Officers request the tests.

3. If the inappropriate test has been requested or the criteria for the testing incorrect it is the post holders duty to organize the appropriate test, cancel or postpone the test and inform the Consultant.

4. Results of tests are always returned to the requesting Consultant or the Consultant that the patient is registered with (not registrar or SHO). If results require an urgent consultation/admission or further testing, this will be organized and the relevant Consultant or member of the medical team will be notified.

5. If the requestor has a limited cardiac knowledge it is the post holder’s role to offer advice as to the further testing required or to give a more detailed interpretation of results sent to them.

6. There is also limited direct access to investigations from GP’s. These investigations are ECGs and the Rapid Access Chest Pain Clinic. Patients are referred from GP surgeries for Exercise stress testing. On obtaining the results it is the post holder’s responsibility to refer them back to the GP, or have them assessed by a cardiologist or referred to cardiologist for angiography.

7. Whilst performing an ECG can be considered routine, it is the post holder’s responsibility to take detailed history of the patient’s symptoms and together with the interpretation of the ECG decide whether the patient requires to be seen my medical staff and / or should the GP be informed of the report immediately by phone or if it is for routine reporting (by post). Due to the geographical situation of the Hospital, on occasions there are no Cardiologist present to provide support, therefore decisions for follow up have to be taken autonomously by the post holder.

8. With the Rapid Access Chest Pain Clinic, often GP’s phone for advice as to whether their patient is suitable for this clinic. It is the post holder’s responsibility to decide on their suitability and advise whether the patient should be sent directly to A&E.

9. The Department follows up pacemaker patients. The post holder decides as to which programming parameters are suitable for a patient, and performs the programming without supervision. Decisions are taken by the post holder as to when their next appointment should be i.e. In 1 week, 1 month, 3 months, 1 year etc or if they should have further investigations which will be organized by the post holder or if referral to a medical clinic for further assessment is required. A report of the pacemaker follow up and any further investigations is stored in the Patient’s notes and a copy sent to their GP. If further medical intervention is required, the results will be sent to the relevant Consultant with an explanation.

10. It is also the post holder’s responsibility to decide when the patient requires to have their pacemaker replaced and to advise the consultant as to which type of pacemaker would benefit the patient most. It is necessary to arrange admission of the patient in an appropriate timescale i.e urgent or non urgent.

11. Policies and protocols are in place within the Department. If these require updating, due to new research or health and safety issues then it is the post holder’s responsibility to organise and implement the necessary changes. It is then the post holder’s responsibility to ensure that members of the department are aware of the changes and that the changes are carried out. These policies and protocols affect those working within the department and members from the department working on the wards and other Hospitals. Also implements changes to policies in Belford and Caithness General Hospitals.

12. The post holder is responsible for proposing new services for the Cardio-respiratory Department within Raigmore Hospital. The post holder also proposes new services for the Cardiac/ECG Departments in Caithness General Hospital and the Belford Hospital. The post holder is responsible for implementing these services in Raigmore Hospital and helping to implement the new services in Caithness General Hospital and Belford Hospital.

13. The post holder is expected to work unsupervised at all times and make independent decisions if necessary. The post holder is solely responsible for the analysis and reporting of results, which they perform. If a case is particularly problematic then it can be discussed with one of the Cardiac consultants. The post holder is regularly required to take independent decisions on the initial course of action on results obtained at clinics held in outlying Hospitals, where there are no Cardiologists on hand to give advice.

14. Whilst the post holder operates independently within the Hospital, the post holder keeps the senior managers informed of progress/activities and liaises with management within and outwith the Hospital to maintain good working practice. The post holder interprets organizational policies and applies them to the Cardio-Respiratory Department and the outlying Cardiac/ECG Departments at both Caithness General Hospital and The Belford Hospital.

15. At the end of each working day all investigations carried out by the post holder are reviewed by them to ensure all results have been sent out appropriately and all data systems have been updated. Ensure all staff have completed their work to a suitable standard.

9 DECISIONS AND JUDGEMENTS

1. If a policy or protocol in place is failing due to health and safety issues or new research emerges, it is the post holder’s responsibility to change the policy and provide information and organize and implement any subsequent training needs to all personnel affected by the changes. This may include staff within the department, nursing staff, medical records, portering and domestic staff.

2. In the absence of the Consultant Cardiologist it is the post holder’s responsibility to take the decision for the best means of follow-up for a patient with a problem. This can be discussed and revised if necessary on the return of the Cardiologist. In outlying hospitals which have no Cardiologist, decisions have to be taken as to the course of action when something abnormal shows up as a result of observation and analysis of pacemaker check results. Decisions have to be made by the post holder as to whether the patient requires to be admitted at the outlying hospital or transferred to Raigmore Hospital, or to refer them for further testing as an outpatient.

3. Decisions taken on programming and appropriate follow up of AICD patients.

4. The post holder is responsible for the overall running of the cardiorespiratory department whilst on a day to day basis senior staff are responsible for the running of the particular area of charge allocated to them.

5. When an emergency situation occurs e.g. unscheduled pacemaker implant, angiography, sickness etc it is the post holder’s responsibility to assess the availability of staff and equipment and the impact on the service, then decide the priority before agreeing to proceed. This will often result that attendance at meetings or appointments need to be cancelled at short notice.

6. Independent decisions are made as to the testing and follow up of pacemaker patients with minor problems.

7. Independent decisions are made with regards to the follow up and further testing of direct access GP exercise stress testing.

8. Decisions to be made as to which training courses are suitable for individual staff to attend. Various criteria need to be assessed before the decision is taken to for a member of staff to attend a course ie. the suitability, the availability of funds, the benefit to the department and impact on the service during that member of staff’s absence. Equal consideration requires to be given to the individual training needs identified by PDP assessment.

9. Plans and organizes the Department to ensure it can perform and report on a large range of complex tests. Organises staff to maximize resources. Adjusts plans and strategies when required to improve efficiency and accuracy of staff.

10. Ensuring information is readily available to provide suitable business cases for future developments.

11. Prioritising the needs of the department to ensure the best use of the budget available.

10 MOST CHALLENGING/DIFFICULT PARTS OF JOB

1. Whilst providing clinical governance for Belford and Caithness General it is necessary to take into account the very different needs and availability of services. The distance involved when 1:1 meetings are deemed necessary. Hazardous weather conditions can make this all the more difficult.

2. Resolving conflict between staff.

3. Decisions taken with regards to whether equipment is to be repaired or replaced.

4. When Cardiologists are unavailable, a request to have a patient admitted can be turned down. This will lead to the requesting of a second opinion, which is a difficult decision to take.

5. Decisions taken at outlying clinics, as to regards the appropriate programming, follow up and referral of pacemaker patients with no cardiac back up.

6. Decisions taken from patient history and results obtained for direct access GP patients; as to whether to send report to GP, inform GP of result urgently or have the patient admitted.

7. Informing patients and relatives that particular patient will need to be admitted after test results have been obtained. Sometimes patients are unwilling to be admitted, therefore they have to persuaded and reassured.

8. Keeping up to date with ever advancing technology bearing in mind the pressures on time and resources to attend courses which are mostly held at venues not at a commutable distance.

9. It is a constant challenge to ensure all staff are informed of any changes in working practice and policy development due to the fact that all staff are seldom available at any one time, due to part time hours, staff attending theatre, in wards or on annual leave/sick leave.

10. Due to the variety of pacemaker programmers used it is difficult to learn about a new pacing function, as each company will call it a different name and have different methods of setting up these functions. The companies will also have different methods for testing and collating data from these functions. Therefore simple additions to the function of pacemakers are complex learning processes.

11. Keeping up to date with changes in Health and Safety / Employment Law and implementation of such changes.

11. COMMUNICATIONS AND RELATIONSHIPSCommunication takes place on a daily basis and may take the form of face to face, telephone conversations, emails, written reports and letters.

1. The post holder is required to communicate and discuss highly complex and sensitive information with staff and patients. This requires excellent listening, motivational and reassurance skills. Detailed service related information is related and discussed with senior managers. This requires excellent team work and negotiating skills.

2. The post holder has to be able to present information (in the form of tutorial/talk/demonstrations) to students and qualified nursing and radiography staff. Has to be able to present material to colleagues after attending courses and meetings.

3. Teaching sessions outside Raigmore Hospital to groups of nurses in outlying hospitals and GP practices with regards to performing routine ECG’s and simple interpretation.

4. Often GP practices purchase equipment which they are unsure how to utilize, therefore the post holder will arrange a teaching session for the appropriate personnel to attend.

5. Communicate with patients, patient’s relatives, medical staff of all grades, nursing staff, porters, radiographers, GPs, medical physics, stores personnel, medical records and appointments personnel, receptionists, sales representatives and engineers from companies and a variety of personnel from other Hospitals.

6. Patients: Explaining the test being performed. Reassuring them before and after tests. Explaining to the patient why the test is being performed. Answering any of the patient’s questions with regards to the test. Giving the patient results when the test results are normal and explaining that further testing is required if the results are inconclusive or positive. If necessary explaining why they need to be admitted or have further follow up. Can be difficult if patient does not wish to be admitted.

7. Patient relatives: Informing them when the patient requires to be admitted. Reassurance to AICD patient spouses about the implanted device and the effect on the patient and their surroundings. Reassuring them. Can be difficult if the relative is distressed.

8. Dealing with patient complaints, both verbal and written. Liaising with senior management with regards to the complaint and liaising/dealing with the staff involved. Implementing changes as a result of the complaint.

9. Medical staff: Communicating of results, discussion of results, advice on further testing/programming (pacemakers) and request for admission of a patient.

10. Nursing staff: Discussion about patient’s fitness to perform tests/attend department.

11. Information is passed on to the nursing staff, if necessary, when a patient is admitted to the ward. Communication as part of a team within the Theatre and Cardiac catheterization laboratory.

12. Porters: Communicating type of transport required, assisting with the transport of a sick patient to the ward.

13. Radiographers: Communicating with them whilst working together on cases in Theatre and the Cardiac catheterization lab.

14. GPs: Conveying of test results, advise on further testing, and informing them of the reasons behind the admission of a patient to the ward.

15. Medical Physics: Informing them of broken equipment, chasing up of equipment to be returned.

16. Stores personnel: Resolving of ordered stock problems e.g. overdue delivery of stock or wrong stock delivered etc

17. Medical records/appointments: Chasing up of sets of notes, appointments that should have been made etc.

18. Receptionist: Request the receptionist to organize appointments; obtain notes and any other general duties.

19. Sales representatives and engineers from other companies: Discussion of their available supplies. Assessment of their supplies in comparison with existing supplies (either theoretically or practically). Chasing up companies for the return of broken equipment/ undelivered stock.

20. Deal with written communications received from Medical Device Agency. Ensuring that al the relevant steps are taken, in the event of receiving a warning about the slight possibility of a malfunction within a specific group of pacemakers. Ensuring that all staff are aware of the problem and ensuring that written warnings are included in the folders of patients affected. Informing and reassurance of the affected patients.

21. Personnel from other Hospitals: Mainly with medical records staff to organize outlying pacemaker clinics and liaising with colleagues with regards to patient results or requesting them to carry out tests on patients or to offer advice on various issues.

12 PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB

Physical:

Effort: Prolonged periods sitting in front of computer and /or monitoring screens requiring 100% attention and concentration. Walking between main department area and procedures area. Collecting patients from reception area and delivering both patient and result to appropriate clinic. All patient contact is hands on and requires both bending and stretching over the patient to ensure accurate placement of electrodes and other essential equipment. Within department pushing wheelchairs to procedure rooms and to clinics and X Ray and Ambulance waiting

rooms. Moving of patients from wheelchair to bed and vice versa. Helping wheelchair bound patients to use bathroom facilities. Moving of patient from trolley to theatre table/bed and vice versa.

Carrying of heavy programmers within the Hospital. Carrying of heavy programmers and heavy bags of patient files to and from cars/aeroplanes when attending outlying pacemaker clinics. As we do not have enough rooms, there is the moving of and setting up of equipment in different rooms.

Working in cramped conditions where there is not enough work surface area for he amount of staff in the department and where rooms have excess items due to lack of storage.

Occasional performance of CPR.

Skill: Speed and 100% accuracy are required for the analysis and writing of reports with the use of computer keyboard. Advanced keyboard skills are required.

Concentration is required for prolonged periods at a computer screen (this can be for up to 7 hours with short breaks).

Manual dexterity and attention to detail are required in order to set up equipment properly and safely.

As the department does not have enough procedure rooms certain equipment has to be frequently and regularly set up and dismantled in order to fully maximize resources. This is also mirrored in both theatre and the X Ray angiography suite. As we do not have dedicated theatre space, it has to be shared with other disciplines and equipment cannot remain static.

Excellent driving skills are required to drive long distance to outlying clinics, courses and meetings. Driving skills should be to a high standard, as driving conditions can often be adverse. Highly developed physical skills, a high degree of precision, dexterity and sensory skills are required for cardiac ultrasound scanning.

Mental: 100% concentration is required whilst performing and analyzing a test. High levels of concentration are required during meetings, the deciphering of documents and assessment of budgets. A week can be planned out, but due to emergencies or people on sick leave the working week may have to be rearranged on a day-to-day basis. Therefore work that was planned by the post holder could have to be postponed. This happens on a regular basis.

When working there are often frequent interruptions from personnel asking for advice/help to perform a task, patients or hospital personnel (from within the Hospital or outlying Hospitals) requesting advice, results and information. Interruption from staff to resolve problems (equipment, interpersonal and other management issues).

As there is a difficulty in the obtaining of qualified staff or locums willing to work in Inverness, there are often long periods after a member of staff leaves, during times of prolonged sick leave and maternity leave where the workload is excessive. This also extends to reception duties where often no cover is provided and time that has been allocated for clinical duties has to be spent covering reception. Due to government targets, waiting lists are required to be kept below certain levels. Therefore it is required to add extra appointments and put aside other essential work including administrative, teaching and training, auditing and time to fully implement changes and new methodology. This results in added stress and anxiety as to when time can be found to do these tasks.

In addition extra appointments are made out of hours. These additional appointments occur over a prolonged period, which can be as long as 12 months Over this length of time it becomes both mentally and physically exhausting.

Identification of serious cardiac abnormalities/disease; regularly distressing, occasionally highly distressing conditions. Frequently dealing with patients for whom the prognosis is poor, or who are critically ill, or are terminally ill. Interacting with patients in such situations, or with relatives, can be emotionally demanding.

Occasionally coping with highly traumatic circumstances such as performing investigations on severely injured victim of a road accident, or on a clinically dead patient kept on a ventilator to preserve organs for transplant. Working with patients who have barriers to communication and understanding, including those who are confused, agitated or aggressive. Switching off ICDs in dead bodies in the wards, mortuary or funeral directors.

Emotional: Conveying to a patient and relatives that the patient requires to be admitted and the reasons for this. Patients can get distressed as the doctor sometimes gives the patient distressing news, and due to commitments is unable to spend time with the patient. The post holder then has to deal with an emotional patient. Sometimes patients are terminally ill or die during a procedure (such as switching off ICDs in dying patients), which is emotionally distressing.

Dealing with children who are ill, as well their parents and siblings can be upsetting.Also with patients who attend the department regularly over a long period, particularly pacemaker patients, it can be upsetting when they die.

The post holder has to participate in outlying clinics which often span over 2-3 days. This means that the post holder is away from family and dependants for which provision for child care etc. has to be made.

Working with patients who have barriers to communication and understanding, including those who are confused, agitated or aggressive.

Environmental: Occasionally it is necessary to cancel appointments at short notice – for example due to equipment failure, as many of our patients travel a distance to attend, they have often already left and cannot be contacted. On arrival the patient has to be informed that we cannot do the test and sometimes they can get quite angry. The situation has to be controlled and the patient calmed.

Patients can get irate because they cannot have an appointment at the date and time, which suits them best. These patients have to be calmed and reassured either face to face or by phone. Occasionally there is a patient who comes for a test and is irate because they have had a long wait, at the clinic, which they are attending, or they are looking for an argument for no apparent reason. These patients require calming and persuasion to do the tests. Occasionally staff from other departments can get irate because we cannot fit in an appointment which suits other tests which the patient is required to have performed.

Patients can have infectious diseases, be infested with parasites, be incontinent, cough up phlegm, vomit or be MRSA positive. These patients can be dealt with in both the department and the ward.

Dealing with patients who are deaf or, have limited English or who have learning disabilities require much more time to explain procedures and to obtain history from.

Whilst travelling to outlying clinics, the weather can be unpredictable eg. Snow, fog, heavy rain etc. This can cause delays and stress from poor driving conditions.

Accommodation provided for outlying clinics can sometimes be substandard eg. Hospital student accommodation or a smoking room for a non-smoker. Sometimes accommodation can be a distance from the Hospital creating problems with transport.

13 KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB.

1. Degree level equivalent training.

2. HNC/BTEC in Physiological measurement.

3. Professional Exams as appropriate to area of expertise (eg. ASCT, BPEG, BSE etc.)

4. Professional registration or eligibility to be registered with an appropriate professional body – eg Clinical Scientist registration with HCPC, or voluntary registration with the SCST or Academy for Healthcare Science.

5. In house training and assessment.

6. Expectation that the post holder has gone on courses, which have improved their existing skills to a higher postgraduate level. The many relevant day and residential courses, which have been attended, have also been assessed.

7. At least 10 years post qualification experience with at least 4 of these years with good management experience.

8. Be fully competent in all the advanced cardiac testing mentioned.

9. Have a high level of management skills and a high level of computing skills, including word, power point and programming skills.

10. Have excellent communication skills, both oral and written. Have good negotiating, persuasive, motivational and reassurance skills.

11. CPD are also required to be up to date and documented, which includes teaching, training and certificated updating of skills.

14 JOB DESCRIPTION AGREEMENTI agree that the above Job Description is an accurate reflection of my duties and responsibilities at the date of signing.

Job Holder’s Signature: Date:

Manager’s Signature: Date: