NEMS employ experienced Registered Nurses and Health Visitors. Our nurses typically have experience in a range of autonomous practice settings, such as practice nursing, community nursing, A&E or Walk-in Centre, 'First Contact' Practitioner roles. Many calls are about children (approximately 40% of work load) so Health Visiting and Paediatric nursing skills are also valuable. Prospective staff skills are profiled against our requirements, individual training needs assessed and customized training programmes developed. All staff new to NEMS will need training in the use of computer-decision support software used for telephone and face to face work.
For most of our clinical staff, NEMS is a second job and may be only a few hours a week. Nurses and Health Visitors are required predominantly in the out-of-hours period- see the table below.
| Days | Times |
|---|---|
Thursday afternoons | 12.30 until 6.30pm |
Weekday evenings & overnight |
6.30pm until 8am |
Weekends & Bank Holidays |
24 hours a day |
Weekends and Bank Holidays are our busiest times.
There are very few opportunities to work only 'office hours' in any clinical role. This makes it difficult to work full-time, as all the hours would be unsociable in some way or other. However, as we expand into 'in-hours urgent care' there will be opportunities for more full time posts with a mix of office hours and out-of hours work.
As the 'out of hours' doctor (GP) service, we are here to deal with urgent need when the doctor's surgery is closed - that is, problems that cannot safely wait until the patient's surgery is next open.
In order to determine the need for care, nurses at NEMS provide telephone triage to patients. Full training will be given in the use of the TAS (Telephone Assessment Software), which supports the clinical decision making process. So, telephone triage is a key skill at NEMS.
The purpose of the triage is to rapidly determine whether there is a genuinely urgent need or not, and if there is, how best to meet if. Currently, 40% of patients' needs can be met with advice alone and these calls take the longest to complete. However, a proportion of patients need to be seen face to face at NEMS and a small number require a home visit from a NEMS doctor or Urgent Care Practitioner (Paramedic, nurse, health visitor). The key requirement here is to avoid a prolonged telephone assessment that results in a face to face contact or home visit. The need to see the patient has to be determined early on in the assessment process. Home Visits are restricted to the terminally ill, and 'truly bed-bound' such as nursing home residents. Children are never visited at home.
Patients will be invited to NEMS to see either a nurse or a doctor. Nurses can complete many consultations with the use of PGD's (patient group directives) and again, full training in the use of PGD's will be provided.
We are currently developing an Urgent Care Practitioner role which allows suitably skilled paramedics and nurses to visit patients at home. Examples include confirmation of expected death, patients in care homes and uncomplicated medical problems where PGDs will cover any likely medication needs.