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My Story as a Trusted Assessor Nurse

I'm Cherish Cadelina, currently working as a Trusted Assessor under the Wirral Community Health and Care NHS Trust, based at Wirral University Teaching Hospital. I arrived in the UK in 1999 and worked in the Acute Care Admission Unit for 15 years. I initially moved to the Social Care sector in a Clinical Lead role and later progressed to a Clinical Service Manager. I became an Interim Care Home Manager then I moved back to the NHS in 2015 as a Clinical Coordinator.

Consequently, an opportunity came to support the Wirral Community Trust to lead and establish the first Trusted Assessor Service in the Wirral when (the then) NHS Improvement first introduced it in 2017. I was involved in developing its service level agreement, including the design of its electronic referral in the hospital system and outline of its current electronic universal care home pre-admission assessment tool embedded in the Wirral Social Care system.

I'm proud to say the service was fully operational and established long before the government mandated the use of the Trusted Assessor Approach during the first wave of the pandemic.

What is a Trusted assessor?

Our Trust adopted a model for its Trusted Assessors to be Registered Nurses in a Band 7 Role. Trusted Assessors function autonomously, with a senior-level experience in leadership and clinical skills to review, follow-up, and complete either the full assessment or the re-assessment of a patient admitted to or discharged from a care home. They facilitate a timely, safe and quality discharge experience.

Until the government finds the 'silver bullet' on fully integrating the different services and systems across the NHS and Social Care, the Trusted Assessors serve as the 'bridge' for now to coordinate care on both teams. Hence, the expectation is to function at a senior level with an in-depth understanding of the different processes, pathways, and challenges experienced in the health and social care sectors.

What's your typical day?

My shift usually starts at 9 am, with a quick look in the hospital's system for new referrals. After this, I will review the most recent clinical notes of patients in my follow-up list, so I know who to prioritise to visit and identify any potential discharges for the daily Command Centre meeting.

I will also check my work and the service's email and reply to urgent messages. If I have any outstanding referrals from the day before, you will see me in the wards first thing in the morning to review patients and will have plans outlined in time for the Consultant's round. Sometimes, I will have a referral to review patients with complex care needs on behalf of the funding authority panel.

At 09:30, I join the different Leads at the Command Centre. If I receive a referral for a patient needing full assessment (depending on the case's complexity), I will be analysing clinical documents, completing electronic notes, and liaising with their families and the Multidisciplinary Team (MDT) from 10 am to 12 noon.

If I have no urgent referrals or urgent meetings to attend to, you will see me in the different wards/units (where I feel vibrant!). Here, I review patients for proactive discharge, planning and ringing the various care home teams to provide an update on their residents. I have my calls routinely forwarded to my work mobile as I'm always up and about on the different floors of the hospital.

Before the pandemic, I reviewed patients in the other hospital site, jumping into the intra-site van to check patients in the rehabilitation units, which I still do but only remotely for now. I spend the rest of the afternoon monitoring for new referrals or reviewing new patients, including a regular update to the Command Centre or the MDT as necessary. I also arrange discharges, follow up on decisions of the nominated care home providers and complete any outstanding electronic clinical notes.

Every Wednesday is my Uni day for my MSc in Advanced Clinical Practice; I'm currently doing my final module in Dissertation. My shift finishes at 5 pm (I do a Monday to Friday rota), but before signing off, I will look briefly at the patients' notes to plan for my caseload for the following day.

Cherish with the Occupational Therapist Lead and Physiotherapist team (MDT)

Why did you choose this area of Nursing?

I have always been passionate about Elderly care. After my two years of experience in the social care sector, I fully appreciated how fragile the system was in supporting care home discharges.

I also realised the significance of the gap in the clinical information provided in their care needing assessment, which is the core of delivering quality, individualised care. Hence, the Trusted Assessor Service in the Wirral is very much grounded in promoting proactive, integrated discharge planning and leading an excellent discharge experience not only for the patients and their families but also for the receiving care home too.

How were you able to get this job?

I applied for it, did a presentation and attended a joint interview with the Clinical Lead of (the then) Integrated Gateway Team of the Community Trust and (the then) Overall Care Home Providers' Lead of Wirral.

What skills do you need to become a Trusted Assessor?

A Trusted Assessor should have an extensive experience in the clinical areas with knowledge and skill in reviewing and monitoring patients' improvement and or their deterioration.

They should have a good grasp of the different pathways, processes, and policies of the various services of the hospital and the community so they can recommend care plans underpinning current guidelines/procedures to support an early discharge and ideally prevent re-admission.

A compassionate and authentic leadership built with integrity and clear core values are essential in this role too. They should have a vision of what they want to achieve along with the drive, spirit and commitment to match.

What are the challenges of a Trusted Assessor?

The biggest challenge is gaining the trust and confidence not only of the care home providers but also the MDT across the hospital network. As Trusted Assessors, we are the eyes, ears, and brain in assessing their service users.

Let me paint a picture of how I gained the trust of my colleagues and providers.

Initially, providers will say, "Thank you, Cherish, we still want to see the patient ourselves." as opposed to now, "If Cherish thinks we can look after this patient, then yes, I am happy to accept!"

Previously, Trusted Assessors weren't known in the ward; now, they directly refer the patient to us as needed. From "Who/what is a Trusted Assessor" to "Please refer patient to the Trusted Assessor" in their ward round's plan or the Integrated Discharge Team's note, where most of the time, they will ring me to discuss issues or plan of action.

What is next for you? Any plans for progression?

I would like to be an Advanced Nurse Practitioner, hopefully in the future and for the Trusted Assessor Service to become an ANP-led service. This will allow me to review and discharge care home patients (with the different MDT) from the A/E department as sort of an in-reach-‘front-door' support.

Do you have any advice for other nurses who want to pursue the same specialism?

Find your passion! Grab all the opportunities you can get (or create one!) to gain experience in acute care or medical wards and support these experiences with knowledge and competence. Ask for an opportunity to gain Clinical and Diagnostic Skills via an advanced module and or a chance to get a Master's level education.

Learn about your patients, and know them very well- both as a patient and as an individual. Understand their clinical symptoms and gain confidence in managing them with a relevant care plan.

Gain insight and awareness of the different Health and Care policies and their overall goals and objectives, including the challenges and historical issues they're experiencing. Choose the right mentor and role models in your practise. Find out what makes them excellent, learn about their good habits and recognise the undesirable behaviours too.

Build relationships! Ask. Learn. Read. Above all, whatever you want to pursue, find your balance, chase your passion, and seek the very ground to nurture your profession.


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