Transforming nursing, midwifery and health professionals roles: district nursing roles

The third in a series of brief papers on the Transforming Roles programme outlines how district nursing roles are being developed in NHSScotland.

Annex 1: Examples of responsibilities and roles in the wider community nursing team [2]


Areas Of Practice

Healthcare Support Worker ( HCSW)

Clinical Skills

Facilitation Of Learning


Service Improvement

Levels 2 And 3

Parameters for a HCSW

  • Works under direction and instruction from registered professionals
  • Supervision may be remote or direct
  • Carries out repetitive, routine and familiar tasks during their working day
  • Through experience and instruction, develops an awareness of what is normal concerning their patients’/clients’ wellbeing and reports that which is outwith normal to registered professionals
  • Can communicate both routine and sensitive information to patients, clients, relatives and staff
  • Is able to problem-solve related to the task at hand
  • As a co-producer, works with patients/clients with varying levels of dependence; at times, they may be considered a ‘lone worker’ and as such carries out and undertakes familiar tasks with minimum supervision
  • Is able to recognise patients’/clients’ response to care and recognises the basic care needs of patients/clients
  • Undertakes delegated well-defined routine clinical and non-clinical duties within limits of competency
  • Supports patients, carers and the wider team
  • Develops organisational and time-management skills
  • At all times, acts under the delegation and supervision of a registered practitioner
  • Makes non-complex decisions and reports these back to assist patient care evaluation
  • Works on their own initiative within their role remit, which consists of delegated tasks
  • Plans and prioritises their own work tasks and activities
  • In some circumstances, spends more time with patients/clients post-assessment than registered staff and is able to report to registered practitioners regarding patient/client progress
  • Shows awareness of patient advocacy and wider patient/client issues (such as home concerns)
  • Understands and is able to carry out reflective practice
  • Recognises risk in relation to care provision

Level 4

Senior HCSWs have all the attributes, skills and knowledge described for HCSWs

  • Has a generalised knowledge and understanding of their job role and related tasks and is further developed than a HCSW
  • Has a broad skill-base related to their practice
  • Possesses an awareness and relative understanding of what is normal concerning their patients’/clients’ wellbeing and reports that which is outwith normal to registered professionals
  • Following an initial assessment of the patient/client by the registered practitioner, and under guidance and supervision while following set protocols and procedures, carries out routine elements of assessment to enhance the patient/client journey
  • Communicates routine and sensitive information to patients, clients, relatives and staff
  • Has an awareness of subtle cues concerning patient/client wellbeing and responds to/takes action concerning common symptoms within agreed protocols and guidelines pertinent to their work area
  • General workload is likely to increase in complexity where familiar but less routine tasks are delegated to them
  • Recognises risk in relation to care provision and further develops risk assessment skills
  • Shows awareness of patient advocacy and wider patient/client issues; recognises and understands role boundaries and limitations
  • At all times, acts under the delegation and supervision of a registered practitioner
  • Supervises and assesses HCSWs of a lower grade and takes a role in supporting students and other health and social care staff
  • Is expected to participate in running groups and activities, giving help and support to registered colleagues
  • Supports and acts as a role model to HCSWs
  • Is able to problem-solve and take action regarding patient/client care through an awareness of policy and legislation
  • Works on their own initiative within their role remit, which may involve more advanced clinical skills and tasks than a HCSW, dependent on the area and site of their work
  • Role remit consists of delegated tasks and duties that they plan and prioritise in consultation with registered practitioners
  • Has developed organisational and time-management skills
  • At times, may be considered a ‘lone worker’ and as such carries out and undertakes familiar tasks with minimum supervision
  • Reports back to assist in broader service development and quality-assurance activities
  • Understands and is able to carry out reflective practice
  • As a co-producer, works with patients/clients with varying levels of dependence

Level 5

Works alone without direct support, undertaking and reporting on autonomous decisions made in practice

  • Supports patients/clients with a wide range of conditions to understand and where possible take on self-management of their condition
  • Possesses clinical assessment skills
  • Delivers anticipatory and preventive care
  • Prescribes and works to patient group directives
  • Undertakes risk assessment
  • Assesses patients, taking into account their physical, mental and social states alongside the impact of their environment and social support available to them
  • Negotiates care plans that are person-centred and focused on self-care with clear objectives, using a range of assessment tools pertinent to the patient’s needs to inform the assessment and assess risk for patients and staff
  • Articulates risk and strategy for risk assessment and management
  • Has knowledge of a broad range of conditions, local care pathways and evidence-based management experienced by patients in community and general practice settings (this includes long-term conditions such as diabetes, coronary heart disease, heart failure, hypertension and stroke, chronic obstructive pulmonary disease, arthritis, dementia and other common mental illnesses, frailty and palliative and end-of-life care)
  • Has an understanding of the presentations of multiple pathology, depression, anxiety states, frailty and delirium, predominantly in older people
  • Has knowledge of the management of uncomplicated symptoms in patients/clients with palliative or terminal care needs and enhanced communication skills to confidently manage uncertainty
  • Ensures information is recorded objectively and reported back to the community or general practice nursing team
  • Can plan ahead for potential scenarios to ensure anticipatory care needs are understood and met
  • Recognises signs of deterioration in patients and refers appropriately to ensure patient safety and avoid hospital admission
  • Collaborates effectively with other members of the multidisciplinary team or other agencies involved in the patient’s care
  • Has the ability to recognise the patient’s health beliefs and adapts behaviour-change approaches to enable self-management using extended brief interventions
  • Utilises a range of IT applications and technology where appropriate
  • Utilises critical thinking to explore and analyse evidence, cases and situations in practice
  • Draws on a range of sources in making judgements, guided by senior colleagues within defined policies, procedures and protocols
  • Supervises experienced or qualified staff and students
  • Facilitates students and others to develop their experience
  • Has ability to reflect on practice and utilise clinical supervision and other development opportunities and support
  • Has emotional intelligence and the ability to support staff at levels 2, 3 and 4 to debrief and reflect on difficult situations to improve learning and enhance self-awareness
  • Engages with appraisal and the development and activation of a personal development plan
  • Provides effective mentorship for nursing students and maintains a supportive learning environment with a range of learning opportunities
  • Shows creativity in developing learning materials for patients and adapting care to support individual needs in patients
  • Co-ordinates the management of a defined caseload, as delegated
  • Plans, implements and evaluates programmes of care to meet individual health needs
  • Has ability to prioritise a delegated caseload/workload and effectively manage time and work effectively within the team
  • Has knowledge of resource management to ensure care is clinically effective and signposted to the patient and family, ensuring principles of confidentiality and disclosure are maintained
  • Recognises personal accountability and responsibility to monitor and evaluate care to ensure optimal practice
  • Participates in personal development, appraisal and development of other team members and the links between organisation and team goals
  • Has ability to recognise poor performance and take appropriate measures
  • Acts up for the team leader when absent
  • Assists the team leader in undertaking and reviewing needs assessments and community profiles (in district nursing) or other data in general practice that reflect the demographics and case management within the caseload and broader public health issues within the local community and general practice populations
  • Demonstrates leadership through appropriate delegation and supervision of non-registered staff
  • Contributes to quality-assurance processes and service development
  • Participates in educational audit
  • Contributes to review of impact of NMaHP interventions on the wider individual/patient experience
  • Has ability to articulate the evidence underpinning patients’ care plans and interventions
  • Has ability to source evidence and appraise it to underpin practice
  • Recognises any ethical implications of audit, research, clinical trials or service-user involvement strategies
  • Uses opportunities to suggest improvements to services, or introduction of other innovations or evidence
  • Engages actively in data collection for quality assurance and takes responsibility for ongoing evaluation of delegated care

Level 6

Caseload management and care co-ordination involving clinical decision-making and accountability for highly complex patients/clients

  • Uses a range of clinical assessment skills, including:
  • history-taking, physical examination, cognitive assessment and an approach that fosters a bio-psychosocial model
  • critical thinking and clinical decision-making
  • making objective and appropriate referrals
  • Is an independent/supplementary prescriber (V300)
  • Uses care skills, including:
  • for people with complex needs and multiple long-term conditions
  • for carers
  • specific clinical skills such as rehydration therapy, intravenous antibiotic therapy, care of central venous catheters, chemotherapy, parental and enteral feeding
  • communication
  • Delivers palliative and end-of-life care
  • Delivers anticipatory care
  • Delivers person-centred care approaches, including:
  • supporting self-management, behaviour change, motivational interviewing, compassionate care, personal outcomes, asset-/strength-based approaches and co-production
  • Role-models the values, behaviours and interactions expected, and ensures patient, family and carer feedback support these in practice
  • Understands public health
  • Uses a range of skills related to e-health and technology to enable care and support self-management
  • Understands mental health and wellbeing
  • Identifies and supports the achievement of learning needs of individuals/teams in response to service need and personal development planning
  • Evaluates the effectiveness of educational interventions
  • Participates in teaching and student selection in higher education institutions and/or other education organisations
  • Uses established models of supervision, mentorship and coaching
  • Contributes to the creation of an effective learning environment, ensuring learning opportunities for students
  • Participates in educational audit
  • Leads and manages the district nursing, multidisciplinary and multi-agency team to deliver care in the home and community
  • Works effectively across professional and agency boundaries
  • Provides leadership for quality improvement and service development to enhance people’s wellbeing and experiences of health care
  • Actively contributes to a variety of professional networks, such as managed knowledge networks
  • Recognises early signs of poor performance and takes appropriate measures to address concerns
  • Contributes to the development of local guidelines and policy where appropriate at regional and national levels
  • Provides leadership around integrated working, risk management, handling of complaints and feedback
  • Supports staff through change, including building resilience in self and others
  • Demonstrates advanced communication skills, including motivational interviewing and negotiation
  • Has knowledge regarding sources of evidence
  • Has ability to generate, manage and utilise data
  • Has ability to critically examine research, including:
  • its application to clinical practice
  • facilitating and participating in research
  • dissemination where appropriate
  • Delivers population surveillance and interventions to improve community and individual health and wellbeing
  • Provides measurement of effectiveness of care

Level 7

Senior level of advanced clinical decision-making and accountability for highly complex patients/clients

  • Provides differential diagnoses
  • Has responsibility for specific areas of service delivery
  • Undertakes advanced-level assessment, including comprehensive clinical examination to address highly complex health needs and physical and mental health assessment
  • Takes account of managing clinical risk in dealing with undifferentiated client groups across the age spectrum
  • Has freedom and authority to request diagnostic investigations and interpret and analyse results
  • Acts on the results to inform diagnosis and optimise treatment and management outcomes
  • Formulates an action plan for the treatment of the patient, synthesising clinical information based on the patient’s presentation, history, clinical assessment and findings from relevant investigations, using appropriate evidence-based practice
  • Is an independent prescriber (V300)
  • Implements non-pharmacological-related interventions/therapies, dependent on situation and technical requirements of care
  • Has the freedom and authority to admit and discharge from identified clinical areas
  • Uses new knowledge in innovative ways and takes responsibility for developing and changing practice in complex and sometimes unpredictable environments
  • Recognises the complexity of operating in multi-agency environments and the need for interdependent decision-making
  • Manages/supervises work of others
  • Provides training support and supervision of staff
  • Delivers advanced practice through educational development and delivery
  • Acts as an experienced work-based learning educator/assessor by providing advice to other practitioners
  • Designs, plans, implements and evaluates learning and development programmes
  • Engages with education providers to contribute to curriculum development and teaching
  • Takes a lead role in ensuring the application of standards and guidelines that underpin a quality learning experience
  • Analyses the range of factors that influence learning
  • Advises service/education providers on capability and capacity for student experience on placements
  • Provides strong and effective leadership across professional and organisational teams/boundaries
  • Leads or contributes to community nursing and health policy development and implementation
  • Practises with autonomy by virtue of advanced knowledge and skills
  • Offers evidence-informed advice to others on complex community nursing issues
  • Critically reviews team performance and uses results to enhance self and team-member working
  • Provides strong and effective leadership across professional and organisational team boundaries
  • Actively encourages involvement of service users to influence and improve person-centred care
  • Ensures organisational objectives are reflected in personal and team objectives
  • Establishes, leads and supports a variety of professional networks with peers across professional groups
  • Ensures the delivery of evidence-informed care and participates/leads practice development
  • Leads innovation and quality improvement
  • Is a role model for the wider team by creating a positive research culture
  • Utilises skills and knowledge of staff to support or undertake research/quality-improvement activity, such as audit and evaluation
  • Identifies, promotes, embeds and monitors the measurement of outcomes relevant to area of practice, using findings to enhance practice


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