The Framework – Level 6 – Senior Practitioner

Level 6 – Senior Practitioner

Role and responsibility

Qualifications and experience

Core Competency 1: Specialist Knowledge

Core Competency 2: History Taking, Clinical Assessment and Investigation

Core Competency 3: Analysing Data in the Diagnosis Process

Core Competency 4: Treatment and Care

Core Competency 5: Co-ordination of Care

Core Competency 6: Expert Specialist Resource

Core Competency 7: Facilitation of Learning

Core Competency 8: Leadership

Core Competency 9: Evidence, Research and Development

The framework has a section for each level of practice on level 5, level 6 and level 7. The role and responsibility of staff at each level is described along with relevant qualifications and experience. The knowledge, skills, and behaviours (KSBs) are then described for the clinical pillar of practice.

For core KSBs for each pillar of practice, please refer to the NMAHP Development Framework

Level 6 Senior Practitioner
Role and responsibility
People at level 6 require a critical understanding of detailed theoretical and practical knowledge within and/or their field and/or have management or leadership responsibilities. They demonstrate initiative and are creative in finding solutions to problems. They have some responsibility for team performance and service development, and they consistently undertake self-development. Title: Specialist/Senior Practitioner The level outline is informed by the Clinical Nurse Specialist (Paper 8)
Qualifications and experience expected for practitioners at this level of career framework
Registered as a Nurse or Midwife with the Nursing and Midwifery Council or registered with the Health and Care Professions Council Ordinary or Honours degree Graduate Diploma 60 Credits at SCQF (Grad Cert), 60 credits at SCQF 11 recommended

Core Competency 1: Specialist Knowledge
Understands the links between aetiology of the condition and symptoms/prognosis
Can discuss the aetiology/classification/staging/prognosis with the pwNC and their family member or carers
Demonstrates a clear working knowledge of anatomy/physiology/pathophysiology related to condition. Uses knowledge to formulate management plan
Can take a history and physical examination. Uses knowledge to assess and identify both typical and atypical symptoms
Can uses appropriate scales and order investigations which may enhance management
Relates specific symptoms to appropriate management options and treatment pathways
Explains and educates the pwNC/carer on how pathology relates to symptoms and discusses management options
Can identify red flags symptoms and link to differential diagnoses
Can assess and identify common risk factors associated with the condition
When required, for certain conditions with increased genetic risks, may advise family of pwNC with regards to genetic screening
Contributes and may lead on case management tasks, identifying the most suitable treatment option based on the specific needs of the pwNC
Uses pharmacokinetic and pharmacodynamic knowledge of drugs to choose the best medical treatment
Can explain risk and benefits of medications to pwNC/carer to enable informed decision making
Applies knowledge to decision making in the formulation of treatment plans
Informs pwNC/carers of pharmacological and non-pharmacological treatment options for their condition, to aid informed decision making
Able to manage own case load. Works autonomously. Is accountable for decisions
Develops expertise through the development of knowledge and conjoining this with clinical reflection
Recognises safe case load numbers
Follows local and national guidelines when making decisions related to patient care
Works according to code of professional conduct
Identifies and uses technology and information systems to both support and inform practice

Core Competency 2: History Taking, Clinical Assessment and Investigation
Is able to undertake a comprehensive, person-centred assessment. Interprets information to formulate a tailored treatment plan
Is able to adapt history to take into account the physiological, psychological, social, cultural, developmental, sexual and spiritual needs of the person
Liaises with the MDT during the assessment process to ensure efficient care is given
Is able to discuss findings of information gleaned from clinical history, along with investigations and physical examination, to pwNC/carer in a way that includes them in decision making
Uses scales and assessment tools appropriate to specific neurological condition, to enhance information gathered during the clinical history
Uses skills to perform a comprehensive physical examination with the ability to differentiate symptoms which are relevant to specific neurological condition as opposed to co-morbidities
Is able to request an agreed range of investigations appropriate to scope of practice and interpret the findings of investigations through application of knowledge of pathophysiology
Develops knowledge to be able to act on investigation findings, using appropriate guidelines and/or protocols where they exist, to aid management plan
Is able to explain investigations to pwNC/ including why investigations are necessary, what they entail and discussing the results in a manner the person will find acceptable

Core Competency 3: Analysing Data in the Diagnosis Process
Sound knowledge of neurological condition enabling critical analysis and evaluation of presenting signs and symptoms along with investigation findings to assist with diagnosis
Apply findings to relevant diagnostic criteria
Alert MDT to red flags which may lead to atypical/differential diagnosis
Able to provide information in a way that is easy to understand for pwNC/carers about the diagnostic procedure and to explain findings.
Provides emotional support during the diagnostic process

Core Competency 4: Treatment and Care
Able to communicate to pwNC/carers legal, moral, and ethical issues relating to care provision
Critically evaluates and utilises the appropriate evidence-based interventions and guidelines that inform care for specific neurological condition
Advances competence in the pharmacological management of treatment. This may include gaining supplementary or independent prescribing qualifications or the use of PGD to enable initiation of symptomatic treatment and managing side effects
Informs the pwNC/carer on chosen therapies, to include expected effects and side effects.
Advises on the importance of medicine management and drug concordance
Includes non-pharmacological strategies in treatment plan and co-ordinates appropriate referrals to MDT where agreed with pwNC
Uses holistic approach to develop a care plan with the person taking individual goals into consideration. Includes family and carers of pwNC in planning process, where consent is obtained
Is able to explain the risks and benefits, to the pwNC and carer of potential treatments and obtain consent.
Takes into account literacy levels and language barriers when obtaining consent.
Educates the pwNC/carer in specific skills and strategies to help adapt to change and foster a self-management approach
Provides counselling for pwNC/carers and empowers them through education
Signposts to resources which aim to help pwNC overcome social and organisational barriers
Educates, coaches, and supports the pwNC in specifics of neurological condition to empower the pwNC and enable informed decision making
Educates, coaches, and supports the family member and/or the carer in how to support the pwNC
Advocates for the pwNC within the MDT and external supporting services, to prevent barriers to care and ensure their wishes are being met
Determines the frequency of review according to the individual needs of the pwNC, in order to manage symptoms and assess the effects of therapeutic intervention
Provides episodic care to ensure regular support is given to pwNC and their family and/or carers
Leads in the recognition, triaging, and assessment of clinical problems and symptoms and provides guidance to HCPs
Uses innovation to develop nursing services to ensure that the service is adaptable and flexible to meet patient’s needs
Acts with expediency when pwNC shows signs of deterioration

Core Competency 5: Co-ordination of Care
Identifies as the key co-ordinator of care for the pwNC /carer across a range of health environments
Is able to communicate effectively to the MDT to ensure that the pwNC’s needs are met
Offers appropriate and timely referral services to the MDT both in primary and secondary settings
Communicates and liaises with other health and social care professionals and services to help inform admission and discharge planning
Communicates the role of the specialist nurse as a pivotal member of the MDT

Core Competency 6: Expert Specialist Resource
Demonstrates evidence of their own CPD through evaluation and reflection and participation in clinical networks
Acts as a knowledgeable, accessible and responsive source of information
Provides and shares complex information effectively and concisely for a range of situations and contexts to ensure safety and continuity of care
Tailors the communication strategy and employs advanced communication skills to discuss potentially challenging and emotive topics
Acts as an emotional support for the families and carers and is able to assist with potential conflict between the patient and their family/carers
Plays a role in educating carers to assist and support care for the pwNC
Sources a range of educational materials to support the development of pwNC, their carers and/or family members
Ability to act as a clinical advisor to non-specialist and junior staff on patient management
Provides expertise and advice to colleagues across a range of different clinical settings. This may include provision of training and the sharing of information
Identifies and supports the learning needs of the team in response to service need and personal development planning
Provides education to voluntary and non-professional groups
Undertakes teaching at higher education institutions and on undergraduate and graduate training programmes

Core Competency 7: Facilitation of Learning
Creates a reflective environment that allows learning through experience, education, research, and learning with others
Contribute to and participate in clinical supervision, Practice Supervision and facilitation of learning and support others to participate. This may also include those in undergraduate/pre-registration
Competently uses learning theories to plan, implement and evaluate learning in the local environment
Creates an effective learning environment that ensures learning opportunities for staff and students
Participation in learning needs analysis, educational audits and evaluation of educational interventions
Apply and continue to develop specialist knowledge of andragogy appropriate to specific role

Core Competency 8: Leadership
Will use national frameworks to assist and develop leadership skills in others
Actively promotes a supportive culture, where constructive feedback is received positively and regarded as a learning opportunity
Provide leadership for quality improvement and service development to enhance people's wellbeing and experiences of healthcare
Contributes to workforce development through personal and professional development of individuals and team aligned to organisational priorities
May develop own leadership skills through recognised courses
Engages in professional networking within the locality, such as within the MDT, local clinical networks, and networking across social and health care boundaries
Is able to communicate complex information at an appropriate level to a range of audiences and contexts
Display creativity and innovation in exploring and implementing possible solutions to problems and evaluating their effectiveness
Support others to take responsibility for ensuring concerns are addressed in a timely manner, applying relevant policies such as whistleblowing and complaints
Responds in a transparent and structured way to any complaints from staff about the unacceptable or unfair behaviours of other members of the team
Advocates for the pwNC among the MDT to prevent barriers to care and ensure their wishes are being met
Demonstrates the ability to use workload assessment and skill mix tools to manage resources and budgetary demands including workforce resources
Demonstrates leadership behaviours when managing people, making use of human resource policies and processes, and recognising early signs of poor performance

Core Competency 9: Evidence, Research and Development
Demonstrate the ability to search and critically appraise evidence (such as patient outcome measures, assessment tools, and treatments) that can be used to enhance patient care
Makes use of a range of tools and methodologies (such as audits) to analyse patient satisfaction and implement findings
Disseminates recent findings from relevant literature to pwNC and their family members and/or carers
Critically analyses the integration of new policy and changes to local practice
Critically reviews the evidence base for nursing management of the disease/condition
Has awareness and understanding on the various research projects (both nationally and internationally) available for pwNC.
Supports, contributes, and actively recruits to potential research studies
Enables and informs patients on the realistic expectations and concepts of clinical trials and participating in research
Involvement in nursing research projects, scientific societies, and conferences
Critically analyses and interprets the results of research and clinical trials