Our series on specialists in the multidisciplinary team continues with the immunisation nurse. Charlotte Lee, a nurse at Atos Healthcare, draws on her experience to outline the role.
What qualifications does a practitioner need and who accredits them?
Every practitioner should be a qualified nurse and be on the professional register of the Nursing and Midwifery Council (NMC). Those who deliver immunisations or advise on immunisation must show evidence of previous immunisation experience and/or training.
Are there standards for practitioners?
All clinicians who immunise or advise on immunisation have access to the Department of Health “Green Book” and updates of national policy, for example Chief Medical Officer Letters. It is good practice to ensure that internal clinical standards are in accordance with Department of Health and Health Protection Agency guidance, including the development and implementation of Patient Group Directions (PGDs) and Patient Specific Directives (PSDs). All staff are audited against these standards in the work they do.
What is the evidence base for practice (in summary)?
All healthcare professionals involved in immunisations should be able to demonstrate competence, understanding and immunisation skills along with current evidence-based knowledge of immunisation. Due to a lack of nationally agreed standardised training programmes regarding delivery and content of immunisation training, the Health Protection Agency issued national minimum standards for immunisation training in June 2005.
Typical role in multidisciplinary teams
The role of immunisation nurse fits well within the multidisciplinary OH team as immunising employees is a core function of disease prevention and health protection. Depending on job role, some employees are potentially exposed to various different infections through the course of their work. Under the Health and Safety at Work Act (1974), employers have a duty of care to ensure the health, safety and welfare of all employees while at work. The Control of Substances Hazardous to Health Regulations (1994) require that a risk assessment is made of the exposure of workers to biological agents, and employers have a duty to bring into effect measures necessary to prevent harm to workers and others who may be exposed. Where a risk of infection is recognised, and where effective vaccines are available to staff who are not already immune, immunisations are offered. Immunisation is one of several measures designed to prevent harm, and is not a substitute for general measures such as needlestick injury prevention and hand cleaning.
What skills and knowledge can the practitioner add to the multidisciplinary team?
I came to Atos Healthcare more than three years ago and was employed within the wellbeing service line as nurse coordinator for immunisations. When I was first employed, the company delivered immunisations only to prison service employees. My role then was twofold: to ensure that employees were receiving the correct immunisations following a risk assessment carried out by their employer; and to support the nurses who worked in clinic by answering clinical questions and ensuring protocols and processes were appropriate and in place. At that time, wellbeing and core OH were two separate entities with very little crossover.
As the company grew and diversified my role evolved. Atos Healthcare provides OH services to a range of businesses, including local authorities and NHS trusts, all of which have employees who require immunisations for occupational protection. Now my role includes directly managing staff, mentoring and training new staff within my own service line and core OH, continuously liaising with various clinicians and professionals within the company to ensure that we deliver clinically correct healthcare.
Main areas of responsibility
The main day-to-day responsibilities of the role are to ensure that the clinicians delivering immunisations are confident and competent in their role, that they remain up to date and that protocols, standards and processes are clinically correct and adhere to national guidelines. The nurses work independently and often in isolation so email is the main means of communication. However, on any one day there can be 20 immunisation clinics going on in various locations across the country, so it is imperative that our nurses and customers are able to access accurate clinical advice as and when required. Partnership working across the disciplines is imperative. At Atos Healthcare we have an OH helpline manned by experienced OH nurses and there is always a consultant physician rota in place. Close working with the clinical standards manager is imperative to guarantee that both staff and customers are fully supported in a clinically appropriate manner, and regular attendance at clinical governance meetings ensures immunisations is given the resource and management the discipline requires.
Where staff have a varying range of skills and experience, it is important that they feel supported and competent to carry out all aspects of their role.
Charlotte Lee, RN is clinical performance manager, Wellbeing Service Line, Atos Healthcare.