'ANPs use advanced critical nursing knowledge and critical thinking skills to independently provide optimum patient care through caseload management of acute and chronic illnesses throughout the hospital. They are expert in clinical practice and educated to masters level or above. We currently have 17 Registered ANPs and 10 Candidate ANPs within the adult service. We are keen to grow these numbers as ANPs are an essential part of our strategy in developing nursing supports for our patients and the healthcare journey they take with us'.
Advanced Nurse Practitioners - Gerontology
|Joshi Dookhy RANP, RGN, RNP, MSc|
|Claire Noonan RANP, RGN, NP, MSc|
|Helen Hobson ANPc, RGN|
|Cathy McHale ANPc, RGN, PG Diploma|
‘The ANPs work in collaboration with the Age Related Health Care Team and the MDT to deliver quality person-centred care with the aim of improving the healthcare experience and outcomes for older people in both acute and community setting’.
Joshi Dookhy and Cathy McHale work in the Memory Assessment and Support Service. Claire Noonan works with the Integrated care team in the community and provides an In-Reach service for patients from Nursing homes. Helen Hobson works with Stroke team in TUH.
PICTURE ORDER: Joshi Dookhy (l), Claire noonan (centre), Helen Hobson (r) - Missing: Cathy Mchale
Advanced Nurse Practitioner - Gynaecology
Coleen works in collaboration with the gynaecology team to deliver quality patient centered care, with the aim of improving the healthcare experience and outcomes for Women attending the gynacology unit at Tallaght University Hospital. Her specialities include Gynae ultrasound sonography and ambulatory hysteroscopy.
Advanced Nurse Practitioner - Respiratory
Lisa works in collaboration with the respiratory team to deliver high quality patient-centered care to patients with respiratory illness attending Tallaght University Hospital.
Advanced Nurse Practitioners - Women's Preventative Health
|Sinéad Cleary, cANP, RNP, RM, RGN|
Sinéad works in the Women’s Preventative Health Unit at Tallaght University Hospital in collaboration with the Gynae team to deliver quality women centred care, the aim of which is to reduce the incidence of cervical cancer.
Advanced Nurse Practitioners - Adult Emergency Department
|Anthony Kearney Msc, RANP, RNP, RN|
|Antoinette McIntyre Msc, ANPc, RN|
|Barry McBrien Msc, RANP, RNP, RN|
|Louise Lynam Msc, RANP, RNP, RN|
|Michele Hogan Msc, RANP, RNP, RN|
|Cian O'Bradaigh RGN, ANPc|
|Sarah O'Dwyer RGN, ANPc|
Anthony, Antoinette, Barry, Louise, Michele, Cian and Sarah currently work as registered and Candidate Advanced Nurse Practitioners in the Adult Emergency Department(ED) of TUH. These Registered Advanced Nurse Practitioners work independently with the ED Team to provide quality patient-centered care with the aim of improving the healthcare experience and outcomes for patients attending the Adult ED. In addition to this role, Barry is also an Assistant Professor in Advanced Practice in Nursing at Trinity College Dublin.
Advanced Nurse Practitioner - Dermatology
|Advanced Nurse Practitioner, Dermatology|
|Carmel Blake (RANP, RNP, RGN, RSCN)|
Carmel works autonomously in collaboration with the dermatology team to deliver quality patient centred care, with the aim of improving the healthcare experience and outcomes for patients attending with dermatology problems
Advanced Nurse Practitioner - Epilepsy
|Advanced Nurse Practitioner in Epilepsy|
|Denise Cunningham, RANP, RNP, RGN|
Denise works for the National Clinical Care programme in Epilepsy . She works in both Tallaght University Hospital and St James's Hospital. Denise also provides an Epilepsy Outreach clinic in Cheeverstown House for adults who have Epilepsy and an Intellectual Disability.
Advanced Nurse Practitioners - Cardiology
|Advanced Nurse Practitioners in Cardiology|
|Shirley Ingram RGN, NFECS, MSc RNP|
|Niamh Kelly, RNG, MSc|
Shirley & Niamh provide an advanced nurse led chest pain assessment service to patients who present to Tallaght University Hospital Emergency Department with chest pain. They work autonomously in collaboration with two clinical nurse specialists', and the Emergency & Cardiology Department Teams to deliver quality patient-centred care.
Advanced Nurse Practitioner - Acute Medicine
|Candidate Advanced Nurse Practitioner in Acute Medicine|
|Philomena McAuley, cANP, RNP, RGN|
Philomena works in collaboration with the Acute Medicine multidisciplinary team to deliver high quality patient-centred care to people presenting to the Acute Medical Assessment Unit with acute medical illnesses.
Advanced Nurse Practitioner - HSE LIaison
|Register Advanced Nurse Practitioner HSE Liasion|
|Jacqueline Sexton, RNP, RPN|
Jacqueline works autonomously in collaboration with treating teams within TUH to deliver specialist assessment and treatment of behavioural and psychiatric symptoms associated with dementia, as well as new onset or existing psychiatric illnesses to patients over the age of 65 years during their medical admission. She is also the link in the transition of psychiatric continuity of care once the patient is discharged home or transferred to a nursing home.
Advanced Nurse Practitioner - Childhood Epilepsy
|Ann Connolly MSc, RANP, RNID, RNP, RCN. |
Ann works autonomously in collaboration with neurology and general paediatric medical teams to deliver quality family centred care for children with epilepsy (and their families) who attend the National Children’s Hospital.
Advanced Nurse Practitioners - Rheumatology
|Rheumatology ANP team|
|Stephanie Naramore CANP|
|Patricia O’Neill CANP|
|Rachel Kenny CANP (Naas General Hospital )|
There are three candidate Advanced Nurse Practitioners working in Rheumatology in Tallaght University Hospital. All candidates are at various stages of completing their masters of science in advanced practice. The rheumatology service is largely out patient based. The candidates review return patients to the clinic and escalate or deescalate treatment as required.
Advanced Nurse Practitioner - Endoscopy
Raj Manoharan RGN, ANPc
Endoscopy nurse since 2017 to 2019 at TUH. Started cANP Sep 2019- TUH- Gastroenterology
Qualified Nursing in India on Operation Room Techniques 1999
Advanced Nurse Practitioner - Haemagoloy
Liz O'Connell RANP Haematology, RNP, MSc Nursing(Advanced Practice), Post Graduate Diploma Haematology Nursing, Higher Diploma Oncology Nursing, RGN.
‘Liz has worked in various nursing roles in the Haematology department in Tallaght University Hospital for over 20 years. She works in collaboration with both the Haematology and multidisciplinary teams to deliver quality patient-centred care.’
Advanced Nurse Practitioner - Tissue Viability
Helen Strapp RANP, RNP, RGN, RSCN, Dip Wound Healing & Tissue Repair, MSc in Nursing
Honorary Clinical Lecturer, Royal College of Surgeons in Ireland
‘The RANP Tissue Viability provides expert advice and support, professional leadership and strategic direction to the clinical team in wound management and informs national policy development. The RANP assesses, diagnoses and manages a wide range of wounds both acute and chronic. She is responsible for managing a Nurse led wound management clinic that treats on average 4,700 out patients a year.
Advanced Nurse Practitioner - Occupational Health
|Mairead Holland Flynn RANP, RNP, BSc, MBS, SHWW, Dip Quality & Leadership, Post Grad Cert Workplace Wellness, MSc Leadership|
As an RNP in occupational health & wellbeing. Mairead practices independently, with accountability for advanced levels of decision making, to independently provide the best patient care through caseload management of illness/injury.
Her role requires that she demonstrates leadership through the initiation and implementation of changes in healthcare services, in response to service needs. Furthermore, she collaborates with multiple stakeholders to promote wellness, reduce risks and offer healthcare interventions choices at an organisational level
Tallaght University Hospital (TUH) is one of Ireland’s largest acute teaching hospitals with adult, psychiatric and age-related healthcare on one site. The Hospital has over 3,000 staff with over 50 different nationalities represented on the TUH team making it an exciting and dynamic place to work.
TUH is a provider of local, regional and national specialties. It is also the national urology centre, the second largest provider of dialysis services in Ireland and a designated trauma centre. The Hospital is one of the two main teaching hospitals of Trinity College Dublin with exciting plans to enhance patient care. The Hospital is a firm believer in investing in their team and offering excellent education and research opportunities. From a teaching perspective it specialises in the training and professional development of staff in areas such as nursing, health & social care professionals, emergency medicine and surgery. TUH is part of the Dublin Midlands Hospital Group (DMHG) which serves a population of over 1.2 million across seven counties, and provides a focus for a massively-growing, urbanised area with a predominantly young population. In order to meet increased and more complex demands we are expanding horizontally and vertically off-site becoming a ‘Hospital without walls’. As a result of these ambitious developments there are wide number of opportunities for existing and future members of staff.
Additionally we provide a number of employee facilities and supports such as:
The Hospital is situated in the southwest Dublin which is the largest suburb of Dublin City, the capital of Ireland. Tallaght borders with Counties Wicklow and Kildare and is near to the foothills of the Wicklow Mountains. Using Dublin’s inner and outer orbital routes other areas of the city are accessible from the Hospital. Additionally the city centre is easily accessible by car, public transport and the Luas/Tram from the Hospital. It is also close to the M50 motorway. All national primary routes have junctions from the M50. Tallaght has experienced rapid growth in recent decades which has led to a thriving local arts, cultural and sports community. The Hospital has close access to external facilities such as shopping centres, recreational parks, restaurants, entertainment venues, Tallaght library and schools.
Tallaght University Hospital Nursing Service
The Nursing Service provided at TUH aims to create, maintain and continuously develop excellence in Nursing. It promotes, protects and improves health by providing a caring and holistic approach based on knowledge and skills in partnership with patients and their families and other healthcare professionals.
Professionally, nursing functions interdependently with other healthcare providers, all of whom share the goals of prevention of disease and disability, care of the ill, promotion and maintenance of optional health of our patients and providing supportive, compassionate, respectful and dignified end of life care. An integrated structure is provided which is conducive to the provision of high quality nursing care as well as the opportunity for the life-long learning, professional growth and development of each individual nurse throughout of continuum of care delivery. This is achieved through the effective use of resources and access to, and participation in, education and research programmes.
As one of Ireland’s largest and leading academic teaching hospitals, linked to Trinity College Hospital. We offer our nurses excellent education, research and promotional opportunities and are firmly committed to the on-going professional development of our nursing staff. This is demonstrated by the variety of courses available to staff, along with support for staff to participate in these courses. Our Centre for Learning & Development (CLD) and Nurse Practice Development Department also provide and support our nurses through a wide variety of clinical and professional educational programmes. In any one year alone there are over 140 in-house educational opportunities available. Additionally there are education opportunities in conjunction with Trinity College Dublin, TU Dublin Tallaght Campus and other higher education institutes. These opportunities include foundation courses with postgraduate, degree and masters programmes in a number of specialties’ such as
- Critical Care
- Orthopaedic nursing
- Emergency Department
- Peri-operative nursing
Additional TUH nursing services works in collaboration with the Trinity Centre for Practice and Healthcare Innovation in relation to nurse led research. As part of our strategy we support the implementation of Advanced Nurse Practitioner and Clinical Nurse Specialist roles. We are keen to grow these numbers as an essential part of developing nursing supports for our patients on their healthcare journey.
Advanced Nurse Practitioners
Advanced Nurse Practitioners use advanced critical nursing knowledge and critical thinking skills to independently provide optimum patient care through caseload management of acute and chronic illnesses throughout the Hospital. They are experts in clinical practice and educated to masters level or above. There are currently Advanced Nurse Practitioners across our services including;
- Acute Medicine- Acute Medical Assessment Unit
- Older Person: Memory Assessment & Support
- Older Person: In reach and Outreach
- Emergency Department
- Endocrinology: Diabetes
- Neurology: Epilepsy
- Gynaecology: Women’s Preventative Health
- Health Service Executive Liaison Psychiatry
- Tissue Viability
- Women's Preventative Health
- Urology LUTS
Clinical Nurse Specialist / Nurse Liaisons
Clinical Nurse Specialists/Nurse Liaisons are clinical experts in a defined area of nursing of practice who work as part of a defined inter professional clinical team/service. They have a clear focus on delivering clinical care to the patient and their families in the Hospital and in some cases in the community setting. There are currently Clinical Nurse Specialists/ Nurse Liaisons across our services including;
- Age Related/Gerontology
- Cancer Care, Cancer
- Clinical Trials Department, Cardiology
- Dermatology, Emergency Department
- Emergency Department Psychiatry
- Multiple Sclerosis
- Occupational Health
- Pain Management
- Palliative Care, Pancreatic
- Pancreatic Service
In addition as part of Sláintecare integrated services there are nursing experts in areas such as Heart Efficiency, Chest Pain, Headache (chronic), Urology and Vascular care.
We also provide an Adaptation & Assessment of Nurses for Registration with the Nursing & Midwifery Board of Ireland (NMBI) programme.
Adaptation & Assessment of Nurses for Registration with the NMBI
The NMBI requires the majority of Nurses from outside of the EU/EEA to undertake assessment prior to registration. TUH offers the clinical assessment route to registration. This provides Candidate Nurses with the opportunity to adapt to the culture of health care in Ireland in a supernumerary capacity.
The Adaptation & Assessment Department operates within the Nursing Directorate of TUH. The Nursing Directorate welcomes highly qualified, experienced, compassionate nurses from outside of Ireland.
The team is led by an Assistant Director of Nursing (ADON) there is also Clinical Facilitator/s (CF) available to teach, guide and support and an administrator.
We work closely with Human Resources, the Nurse Practice Development Department (NPDD), the Centre for Learning & Development (CLD), the recruitment agency and NMBI.
What we do
We provide pre-arrival information to ease the ‘journey’ of change.
We provide Candidate Nurses with induction to:
- The Hospital
- Key nursing responsibilities and accountability of the Nurse in Ireland
- The culture of health care in Ireland
- Professional requirements and standards
- An introduction to Ireland
Induction takes the form of blended learning: Online learning, podcasts, videos, virtual classes by ZOOM or MS teams and face to face classes in TUH
We Provide Supported Clinical Adaptation & Assessment
- Candidates undertake an assessed clinical practice placement. The clinical placement lasts for six to 11 weeks to allow the candidate to adapt to the health care system and demonstrate competence for registration as a General Nurse.
- The Candidates are preceptored, supervised and assessed for competence by Registered Nurses on general wards throughout the hospital.
- A CF visits candidates on the wards to support and guide their practice.
- The CF also provides support to the supervising Nurses
We ensure all statutory and professional standards are strictly adhered to.
We co-ordinate a Hub & Spoke model for Clinical Adaptation & Assessment for Nursing Homes on behalf of the Office of The Nursing & Midwifery Services Director, HSE. We also provide support in collaboration with NPDD for all newly registered Nurses who have trained outside Ireland.
In 2019 72 nurses were successful in gaining registration with the NMBI in TUH. A further 21 candidates were successful in 2020, despite travel restrictions from their own countries. These nurses are now working in both general and specialist clinical areas across the Hospital.
TUH’s current expansion and development is providing further opportunities for Nurses to join us in Ireland and we anticipate up to 90 nurses undertaking the programme in 2021.
Our Candidate Nurses highly value the warm welcome, knowledge, skill and experience of our existing Staff Nurses and Clinical Nurse Managers who teach, mentor, support and assess them during the adaptation period.
If you are a nurse who has trained outside of EU/EEA and wish to apply to TUH please contact CPL at email@example.com CPL manage all of our Adaptation Recruitment.
For general Adaptation & Assessment enquires you are welcome to contact us at firstname.lastname@example.org
Tallaght University Hospital Services
Nurses have an essential role in the functioning of the following clinical directorates:
- Medical Directorate: Along with general medical the medical directorate provides a range of services in specialist areas including age related care, cardiology, dermatology, diabetology, interventional radiology, neurology, oncology, renal, respiratory, rheumatology and stroke.
- Peri-operative Directorate: Along with general surgery the peri-operative department provides a range of services including trauma and elective orthopaedics, vascular Surgery, urology Services (national urology centre) and is a leading provider of upper and lower gastrointestinal specialist Surgical Services in the DMHG.
- Diagnostic Directorate: Includes the department of radiology with imaging and interventional radiology services, infection and prevention and control services and Haemovigilance services.
In addition the services include Out-Patients Department and Nurse Practice Development Department as well as the Centre for Learning & Development working across the continuum of the services. The following is a snapshot of services that make nursing integral to TUH and the services it provides.
Age Related Healthcare Department
The Hospital is a pioneer in Ireland in many aspects of specialist care in older people. The Department has led out on the first national audits of stroke and dementia care, as well as on the national hip fracture database. Team members have held national and international leadership roles in various aspects of gerontology and services are delivered by a skilled multi-professional team of allied healthcare professionals. Clinical services are wide ranging and include; acute geriatric medicine, rehabilitation, day care (Charlie O’Toole Unit), memory assessment clinic, acute stroke service, transient ischaemic attack services (in conjunction with neurology), an integrated care of older persons team, in-reach nurse liaison, gerontological ED intervention, falls service and fracture liaison services and atrial fibrillation services. In addition there is off-site rehabilitation and long-stay care units. Specialist nursing is critical to the delivery of all these services.
With an ongoing increase in the aging population in Ireland and our local area, challenges are presented however, it also presents opportunities to develop the specialist nursing gerontology team. Currently this team consists of: Advanced Nurse Practitioners, Clinical Nurse Specialists, Clinical Facilitators along with Registered Nurses who have undertaken specialist modules in Gerontology/Stroke and Staff Nurses working in the Charlie O’Toole Unit delivering a collaborative research approach based holistic Age Related Care in a specialised setting. The key to the success of this nursing team is the constant collaboration between all members of the Nursing team to ensure the provision of the highest standards of patient care.
The Hospital offers a variety of cardiac services to the public of which nursing is integral. The services include a Coronary Care and High Dependency Unit (CCU/HDU) specialising in the management of patients presenting with acute coronary syndromes, and chronic cardiac conditions. Additionally services include; catherisation laboratory, chest pain clinic, heart efficiency, cardiac rehabilitation, cardiac risk in the young and advanced lipid management. These services have numerous Advanced Nurse Practitioners and Clinical Nurse Specialists working alongside highly experienced clinical nurse managers, registered nurses and clinical facilitators who provide expert holistic nursing care.
The nursing team describe it as a great speciality whether you like acute medicine or chronic medicine as it has the best of both worlds. They see long term patients with chronic skin disease, or patients with skin cancers that require follow up. As a result they, over time, build up trusting nurse patient relationships. Patients with sudden onset of a rash also attend the service and are treated, cleared and discharged. In addition the patients with benign skin lesions, worried about cancer are reassured, supported and discharged.
Dermatology is a multi-disciplinary service however it involves nurse led treatments with dermatology Clinical Nurse Specialists having significant autonomy of which consultants are supportive. Treatments provided by the nursing team include; phototherapy, patch allergy testing, dermojet treatment for alopecia along with cryotherapy and photodynamic therapy for the treatment of pre-malignant skin lesions. This nursing team also treat in-patients and provide education to the nursing colleagues regarding the important topical treatments and infection prevention for these patients. The nurses have also been supported by the consultants and the organisation to perform skin surgery. Education of the patients in all aspects of their conditions and care is an important part of their work to help empower the patient and improve their quality of life. A close link exists with tissue viability, a nurse led service, as both specialities deal with the skin and as the services complement one another. All in all the service is a great speciality for diversity and autonomy.
In TUH the Diabetes Services provides a comprehensive specialised service for those with Type 1 Diabetes and those with complex Type 2 Diabetes from 16 years and over. Specialist diabetes services are wide ranging and include: diabetes/renal care, continuous insulin pump therapy, pre-pregnancy planning care, Type 1 Diabetes group education, Young Adult Clinic, Transition Clinic for patients transferring from the paediatric service and a Foot Protection clinic. These specialist services are a tertiary referral centre and provide care within a designated Day Care Centre as well as in-patient care as required. Nurse specialists play a significant role in co-ordinating this transition. In addition TUH is one of the largest renal services in the country which leads to complex renal diabetes patients being transferred from other jurisdictions for their diabetes care to the Hospital.
The fundamental activity in the Diabetes Day Centre is to empower through education, enabling patients with diabetes to make informed decision about their diabetes. The nursing team consists of three Clinical Nurse Specialist, four registered nurse posts and one health care assistant attached to the Hospital service. There is a Community Diabetes Nurse employed by Health Service Executive Community Care area 7 who works one day a week in the Hospital. Two of the Clinical nurse specialists working in the Hospital are also registered nurse prescribers. This all demonstrates how integral nursing, alongside their multidisciplinary team colleagues, are to delivering care and support for those with diabetes in this complex diverse service.
TUH has one of the busiest Emergency Department’s (ED) in Ireland with a catchment population of over 650,000 people. The ED is a designated Trauma Unit, one of two within the recently established national central trauma network. The ED receives regular emergency transfers from across the country as we are currently the only hospital in the city with the facilities for helicopters to land on the Hospital site.
The department includes designated zones/areas including; triage, ambulatory care, resuscitation, assessment and treatment cubicles, and psychiatric assessment rooms. In addition the Rosheen Suite provides a non-clinical space for families to be together, away from the busy ED upon the delivery of bad news.
The nursing team, who are an integral part of the department, consists of Clinical Nurse Managers, Advanced Nurse Practitioners, registered nurses and Clinical Facilitators to support and educate staff. Working in a specialist area, such as Emergency Nursing, requires commitment to continued learning and professional development.
Oncology and Haematology Service
The Hospital has an Oncology and Haematology Service where we treat patients with a wide variety of cancer diagnosis – solid tumours, malignant and non-malignant haematological conditions. There are specific dedicated day wards for both Oncology and Haematology (Charlotte Haematology Day Ward) specialities as well as dedicated inpatient beds for those requiring admission. Day services includes ambulatory care, blood testing and specific treatments such as chemotherapy, blood transfusions and walk-in services for patients who become unwell unexpectedly as well as a rapid access clinics to deal with acute issues.
The nursing team consists of Clinical Nurse Specialists, Advanced Nurse Practitioners, Clinical Nurse Managers and registered nurses and are an integral part of the service. Their roles are wide ranging including; administration of treatments (e.g. Systemic Anticancer Therapies (SACTs), supportive transfusions), caring for patients pre and post stem cell transplants, ongoing education and support of patients their partner/families on their specific disease, possible treatment options, possible side effects and management, comprehensive after care service. In addition the nursing team is involved in very productive clinical trials which are conducted within the departments, providing early access for patients to the latest cancer treatments.
TUH, is one of the largest providers of kidney care and renal replacement therapy in Ireland. We aim to deliver high quality and innovative care to our patients and to provide a stimulating and supportive environment for staff with excellent professional development opportunities. Nurses are integral and work as part of a multidisciplinary team providing the best holistic, individualised, co-ordinated and evidenced based care to patients aiming to promote self-care, maintenance of good quality of life and reduce complications of renal disease. This highly experienced and skilled nursing team, with a network of specialist nurses, work across a wide range of services such as:
- Haemodialysis Unit: which is a purpose built unit, providing hospital based dialysis treatment. A new state of the art expanded unit opened in October 2020.
- Home Therapies Service: which supports the delivery of peritoneal dialysis and haemodialysis at home and provide education and support patients to participate.
- Vartry Renal Unit: provides day care procedures and treatments such as intravenous iron therapy, kidney biopsy, vascular access insertion and removal, Hepatitis B vaccination, peritoneal catheter insertion, blood pressure monitoring.
- In patient services: provides inpatient care to the newly diagnosed and acutely unwell renal patient aiming to provide treatment, support, education and training to enable patients to return to self-care at home.
- Renal Transplant Clinical Nurse Specialist: advises and supports patients on all issues of transplant pre and post-transplant.
- Vascular access Clinical Nurse Specialist: co-ordinates a streamline service underpinning the preparation of vascular access required for commencing Haemodialysis
- Anaemia and Pre-dialysis Clinical Nurse Specialist: supports patients in relation to anaemia
For nurses interested in respiratory care, TUH has plenty of opportunities. Whether your interests are in acute or chronic respiratory nursing, we have what you're looking for. From the Intensive Care Unit, the medical wards, outpatients, Acute Medical Unit, Acute Medical Assessment Unit to the ED and into the community we see a wide range of respiratory patients in every aspect of care. Future plans for the service include a dedicated respiratory unit with a unit specifically dedicated to patients on Non Invasive Ventilation.
In the respiratory department we are interested in encouraging the development of our service further. We now have a registered respiratory Advanced Nurse Practitioner, Clinical Nurse Specialist, a Chronic Obstructive Airways Disease Outreach Clinical Nurse Specialist, a pulmonary fibrosis nurse and an integrated care Clinical Nurse Specialist post with plans to expand our team further. As an example of innovation within the service, working closely with the respiratory physiotherapists the Chronic Obstructive Airways Disease Outreach service was developed which provides ‘Hospital at Home’ service for patients who present with an acute exacerbation of Chronic Obstructive Airways Disease providing:
- Safe planned early discharge option, for patients who meet certain inclusion/exclusion criteria, which focuses on management during their acute exacerbation period in the patients’ home.
- Outreach programme where patients receive education and interventions to aid them to monitor and manage their condition thus preventing further exacerbations and optimising patients to live well with Chronic Obstructive Airways Disease.
- Interdisciplinary service with direct and indirect clinical input from the Clinical Nurse Specialist and Senior Physiotherapist in Chronic Obstructive Airways Disease Outreach. The Outreach Clinical Nurse Specialist expertly assesses, plans and implements a care plan for patients presenting with an uncomplicated acute exacerbation of Chronic Obstructive Airways Disease.
The TUH Endoscopy Unit, as part of the university affiliated Department of Gastroenterology, provides high quality care for the full spectrum of Endoscopy procedures. It provides both basic and advanced diagnostic and therapeutic procedures for a number of specialist conditions accepting referrals internally and external to the Hospital from General Practitioners and other hospitals. The services consists of a dedicated and dynamic multidisciplinary team providing a high quality service in a friendly and warm environment ensuring the dignity and holistic care of all our patients
Procedures include; oesophago-gastro-duodenoscopy, colonoscopy, sigmoidoscopy, double balloon endoscopy, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound or echo-endoscopy, bronchoscopy, trans-oesophageal echocardiogram and associated therapeutic interventions.
As part of these innovations we have developed dedicated specialist nurses providing support care in; pre-assessment, Irritable Bowel Syndrome, Upper Gastrointestinal, Haemochromatosis, Small Bowel Capsule Endoscopy.
There is an Endoscopy Advanced Nurse Practitioner along with a candidate Advanced Nurse practitioner with in the service.
Nursing staff are vital members of Critical Care multidisciplinary teams. The role of the Critical Care Nurse is essential to the process of delivering evidenced based care to critically ill patients. The role and responsibilities of the nurse providing person centred care in the Critical Care environment is complex and varied. A Critical Care Nurse is someone who has advanced-level knowledge, skills and competencies to deliver quality and safe holistic care to the critically ill patient.
General and Vascular Surgery Services
General and vascular surgical services in TUH are wide ranging and we are leaders in the field of minimally invasive surgery in benign, malignant and non-cancer surgery. Patients from across the country are referred for access to the specific expertise available. The services include a number of sub specialities; elective surgical care (outpatient, inpatient and day surgery), vascular, colorectal and upper gastrointestinal, lower gastrointestinal, laparoscopic, hepatopancreatobiliary surgery and endovascular surgery.
TUH has established itself as a leading centre in the use of minimally invasive colorectal surgical techniques. The unit has a national and international reputation as a centre of excellence in the areas of laparoscopic techniques and trans-anal endoscopic microsurgery (TEMS). In addition, working closely with the well-established gastroenterology department, they provide surgical input for the full spectrum of benign and malignant colorectal disease. Nursing is supported in ongoing learning and have been supported, as part of this team, in expanding their roles including developing specialist nurse roles in colorectal cancer, coloproctology and stoma care.
Upper Gastrointestinal and Hepatopancreatobiliary (HPB)
This service continues to expand and thus this put pressure on delivering their out-patient services in a time frame that they wished to. The nursing team and consultants looked for innovative ways to address this. They developed a nurse led Virtual Reality Outpatients, the first of its kind in Ireland, via web technology enabling real time visual and audio patient assessment over the internet. Patients are return general surgical patients who require minimal examination (inspection sufficing) and where histology or radiology reports require discussion with the patient. The service has the option of out of office hours appointment times eliminating the need for time off work to attend appointments and there are no travel costs or long waiting times in clinic.
The nursing team is supported in any ongoing learning required and it is a positive example of supported professional development of nurses which not only benefits themselves but also the patient, the service and the Hospital system.
Vascular Surgery Unit
The Vascular Unit in TUH provides in-patient and out-patient vascular surgery services plus an outreach service provided in the Naas Vista Clinic. The service provides holistic innovative non-operative treatment, open surgery, and endovascular surgery for a varying disorders including; aortic disease, carotid disease, peripheral arterial disease, superficial and deep venous problems, venous and lymphatic disorders. In addition the service works collaboratively with our stroke in relation to carotid disease and renal services for primary and revision vascular access. The tissue viability nursing service work closely with this service.
Reeves Day Surgery Centre
This dynamic service facilitates pre-assessment, day surgery, minor operations/procedures locally, pre and post-operative care and day treatments and investigations across the continuum of care. One of the collaborative innovations, in the department, is pre assessment.
The pre-assessment service, is a nurse-led holistic service, which currently assesses more than 75% of Day of Surgery Admissions and inpatients requiring elective surgery across the continuum of all surgical services including general, vascular, gynaecological and orthopaedic. They provide assessment, pre-operative education and advice and organising additional investigations as required. This reduces patient fears/anxieties and supports optimising patient’s health prior to surgery. They also identify high risk patients for anaesthetist assessment.
Our gynaecology service treats women over the age of 14 with benign gynaecology problems, fibroids, urinary incontinence, prolapse, menstrual dysfunction and ovarian cysts and is a specialised endometriosis centre. We offer an outpatient hysteroscopy service for investigation of abnormal uterine bleeding. There is also a joint endocrine/ gynaecology clinic for patients with polycystic ovary syndrome and there are close links with the endocrine and gynaecology services in the Coombe Hospital.
The service has currently developed advanced nurse practitioner pathways in:
- Gynaecology: working in collaboration with the gynaecology team to deliver quality patient centred care, with the aim of improving the healthcare experience and outcomes for women attending the service. Specialisms include; gynaecological ultrasound, sonography and ambulatory hysteroscopy.
- Women’s Preventative Health: working in collaboration with the Gynaecology team to deliver quality women centred care, the aim of which is to reduce the incidence of cervical cancer
TUH provides an innovative service to the women we provide a service to and have also reached out to integrate with our community by providing expertise , supports and advise in the community setting. TUH also has one of the 15 national colposcopy clinics located on site which provides quality assured colposcopy services for women who require follow up investigation and treatment if/ when necessary.
A Clinical Nurse Specialist in Endometriosis works as part of a collaborative specialist team to provide a quality[JC1] service to women with severe endometriosis Providing a nationally recognised service, receiving referrals from across the country. The team now comprises of a gynaecologist, a colorectal surgeon and Clinical Nurse specialist. The recruitment of a CNS in Endometriosis represents a pioneering advance in nursing practice with regards to women’s health and the post did not previously exist in Ireland. An MDT Endometriosis clinic with sonography facility was established, a CNS led clinic was also established which provides assessment, education and support and, a CNS phone clinic is held twice weekly and the CNS coordinates all imaging, reports and presents at MDT. An OPD pathway for this patient cohort reduces OPD attendances. This service provides a more streamlined clinical pathway for women with severe endometriosis to increase the efficiencies and quality for this complex patient group and ensuring women have a positive experience of care and reduces ALOS. The number of patients seen, reviewed and treated has increased year on year. In the future TUH would wish to develop a recognised national specialist centre for the management of severe endometriosis.
TUH also provides a nurse led hysteroscopy service. One of the Advanced Nurse Practitioner Candidates (ANP c ) has completed a Post Graduate Diploma in Diagnostic Hysteroscopy and Therapeutic Management and become the 3rd Nurse hysteroscopist practicing in Ireland and sole nurse hysteroscopist in the Dublin region. This results in patients from suitable cohort undergoing hysteroscopy in the OPD setting and avoiding admission as a day case procedure. She also practices independently in the service of insertion / removal of Mirena intrauterine systems and is involved in training of other health care professionals and GPs in this role.
In addition to this she has commenced a Nurse Led ring pessary clinic which provided access for women in a timely manner and results in freeing up of medical slots for more complex cases.
The nurse specialists, along with other members of the MDT, in Women’s Health also provide education sessions in the community setting and have attended off site to provide this service. Future plans are in place to grow on this educational and support needs and provide an increased number of sessions in 2020. Feedback has been very positive and requests have been received for further engagement.
The Operating Theatre Department is a leading provider of General, Upper and Lower Gastrointestinal surgical services, the largest provider in the DMHG of Urology, Trauma and Elective Orthopaedics and Vascular surgery and is the only provider of spinal surgery in the DMHG. The department currently consists of as ‘check in’ area, anaesthetic rooms, theatres, recovery rooms, Post Anaesthetic Critical Care Unit, day of surgery admission lounge, and a post-surgical unit. Services are provided across the continuum including elective and trauma services. Each makes its own demands whether it is different technology, management of medications or specimens, patient care and positioning and preparation or traffic management, cleaning and infection control which results in a diverse highly skilled nursing team.
The service supported the development of anaesthetic nurses roles who completed specialised education and training in relation to providing specific support and assistance prior to surgery, administration of anaesthetic, during surgery which includes set up and monitoring. The anaesthetic nurses also provide clinical services to interventional radiology and are part of the Emergency Response Team.
Reeves Day Surgery Centre
The opening of the Reeves Day Surgery Centre is a recognition of the changing direction of healthcare provision, the facility has four theatres and 25 recovery beds. Across the road from the main hospital the Centre will eliminate long wait times for routine day surgery and increase elective day surgery activity. This is an exciting development for the department that enables the theatre nursing team to continue to provide efficient and effective services to their patients. With this development there is also a need for additional theatre trained nurses.
Acute Pain Service
The Acute Pain Service which is based in the department is part of the anaesthesia, critical care and pain medicine services provides advice and clinical support on the most appropriate management of patients with acute pain throughout the continuum of care. This team is multidisciplinary and comprises Consultant Anaesthetist, Clinical Nurse Specialists, and Clinical Pharmacist. The nursing team is supported in ongoing learning and professional development in order to keep up to date in this complex critical patient care service.
TUH is a major regional centre for elective and trauma orthopaedic surgery in Ireland. The specialty relates to the diagnosis and treatment of disorders, conditions and injuries of the skeletal system and the muscles, joints and ligaments associated with it. It is a leading centre for major joint replacement and spinal surgery and is a renowned centre for excellence in acetabular fractures and this received referrals nationally. The team is multidisciplinary including a highly motivated dedicated nursing team including an arthroplasty specialist nurse, which is integral to the service, provides current evidenced based holistic care.
Tissue Viability/Wound management is becoming more complex due to patients having multiple co–morbidities, advances in surgical techniques and earlier discharge from hospital. The varied specialities within the hospital results in a demanding patient caseload with diverse wound care requirements. The tissue viability nursing service work in collaboration with the vascular, medical, orthopaedic and surgical teams delivers quality patient centred care, with the aim of improving the healthcare experience and outcomes for patients with acute and chronic wounds. This nursing service provides expertise across the continuum of care within our organisation. This service also conducts the Wound Management Clinic which is a nurse led clinic, managed by an Advanced Nurse Practitioner (ANP), with nurses’ expert in the specialism, and is committed to delivering high quality wound care to all our patients. They provide a safe, friendly and caring environment where we can treat wounds as effectively as possible. Our goal is to provide treatment, support and education to patients, ensuring the patient is at the centre of their care. On average it treats over 4,000 outpatients a year.
The ANP expanded role demonstrates both the service and the organisations support of this integral service, working autonomously, in collaboration with the nursing service and multi-disciplinary team across the continuum of care. The remit includes assessing, diagnosing and managing a wide range of wounds both acute and chronic care with reviewing in-patients, assessing their wounds, diagnosis and developing a treatment plans. The ANP Tissue Viability expertise is recognised both internally and national providing expert advice and support, professional leadership and strategic direction to the clinical team in wound management and informs national policy development.
The urology department is the national urology centre and has a dedicated and motivated team who deliver a high quality holistic service for patients with a wide range of urological conditions ranging from kidney stones to cancer, spinal injuries and pelvic floor dysfunction and reconstruction. It is a busy department and nurses can be confident that they will develop their skills. The department includes inpatient, theatre and a much envied purpose built, self-contained, designated outpatient department. Services provided within the outpatients department include consultations, procedure clinics flexible cystoscopies which are used for diagnosis, surveillance and treatment of patients.
Expanded specialised nursing roles are varied and supported such as:
- Nurse led clinic which facilitates changing of both urethral and suprapubic catheters, self-intermittent catheter training and bladder instillations for bladder cancer and painful bladder syndrome.
- Nurse led prostate clinic.
- Nurse-led lower urinary track symptoms clinic.
- Nurse services for percutaneous tibial nerve stimulation, extracorporeal shock wave lithotripsy, transurethral ultra sound and biopsy.
- Clinical nurse specialist in urodynamics.
- Urology cancer co-ordinators.
Infection Prevention & Control Service
Infection Prevention & Control is the discipline and practice of preventing and controlling the spread of infection and infectious diseases in a healthcare service which is a challenge for hospitals today by promoting best practice. The Infection Prevention & Control Team support Clinical care and best practice in relation to provision of the highest standards of patient focused care. Equally, it is recognised that Infection Prevention & Control (IPC) is the responsibility of every member of staff and must remain a high priority for every healthcare worker to ensure the best outcome for patients.
We work as a multidisciplinary team with all healthcare workers, patients and visitors to ensure that an effective infection prevention and control service is provided. Nursing is integral within this team with an Assistant Director of Nursing and a number of infection prevention and control specialist nurses who are motivated, expert and innovative.
Key roles include:
- Providing expert advice throughout the organisation.
- Providing healthcare worker best evidence based practice education to colleagues.
- Providing governance and monitoring.
- Evaluating nursing and multidisciplinary processes.
- Active surveillance of alert organisms.
- Providing support and communicating effectively in relation to infection prevention and control on an ongoing basis and emergent basis such as with the COVID pandemic.
- Conducting zero harm campaigns to raise awareness.
- Delivering formal training sessions to all staff.
- Investigation and management of outbreaks.
- Providing education and support to staff on a regular basis.
- Providing education and support to patients/relatives such as hand hygiene.
- Conducting audit and participating in research as required.
- Providing advice to hygiene services on environmental hygiene and liaising closely with patient flow.
The Department of Radiology provides expertise in the full range of specialist diagnostic imaging and interventional services with a patient focussed holistic approach. The service is provided by the team of radiographers, radiologists, specialist registrars, dedicated nursing staff, administrative staff and medical physics. They provide radiologic investigations to support varied and complex episodes of patient care throughout the organisation’s continuum of care delivery.
There are a number of sub-specialties in which nursing plays a role one of which is interventional radiology. Nursing is integral throughout these interventions such as urologic, gynaecologic, vascular and oncologic interventions under ultrasound, Computed Tomography (CT) and fluoroscopic guidance, musculoskeletal ultrasound and interventions, cardiac CT and Magnetic Resonance Imaging (MRI), neuroradiology, gastrointestinal (GI), genitourinary (GU) including women’s imaging and prostate imaging with fused MRI/ultrasound trans rectal biopsy and CT colonography. In line with the Hospital’s strategy the service has expanded to include an off-site primary care direct access radiology service which is managed by the department.
Adult Out Patients Department
Adults Outpatients in TUH offers a flexible and varied working environment, running up to approximately 140 clinic’s every week. Clinics include medical, surgical, orthopaedic, gynaecology, rheumatology, ear/nose/throat, oncology, vascular, and ophthalmology and recently the extension of the department to an off-site building, which holds diabetic and endocrine clinics, is another example of the organisations expansion of a hospital without walls. There are eight suites within the main outpatients department, each holding six to ten rooms in each suite with the off-site facility consists of two floors dedicated to diabetic and neurology care. Opportunity is given to the nursing team to work in the different clinical areas, to ensure a varied learning and working environment. Registered nurses and care assistants work closely with medical practitioners, clinical nurse specialists and advanced nurse practitioners, supporting each other to deliver a high standard of care to the large volumes of patients using the service. There are also specialised and nurse led clinics run in the department. Staff aim to ensure confidentiality, safe patient care and efficient service to all patients during their visit.
The role of the Haemovigilance Officer (HVO) is dynamic and ever changing, with many facets. They have a huge impact within transfusion medicine. This is evident from the increased investigation and reporting of serious adverse transfusion events and reactions. The result of this is the greater identification of transfusion related errors, with the added benefit of increased patient safety.
Haemovigilance incorporates both clinical and non-clinical components including covering some of the following:
- Actively participating on the Blood Transfusion Team and the Hospital Transfusion Committee providing full, transparent and detailed reports on serious adverse transfusion events and reactions.
- Co-ordination of the reporting system to National Haemovigilance Office (NHO).
- Provision of patient information on transfusion issues, and the development of Patient Information Leaflets.
- Provision of Education for Nursing and Medical staff.
- Audit and surveillance of transfusion practice.
- Policy development on transfusion and transfusion related issues.
This service is integral to all clinical services and healthcare professional including nursing in TUH. In recent years the Haemovigilance Officer’s within our organisation have a clinical background in nursing with significant experience across the continuum in nursing and care delivery. In this, the organisation recognises the value of nursing expertise and enables the education and professional development required to deliver the service and utilisation of their previous nursing experience to enhance the service.
Nurse Practice Development
The further education and professional development of our nursing staff is very important to the TUH nursing service and is encouraged and supported. We have a supportive innovated Nurse Practice Development Team who consist of an Assistant Director of Nursing, Nurse Practice Development Advisor, Informatics Nurse, Clinical Placement Co-ordinators and Clinical Facilitators. As well as General Clinical Facilitator there are projected funded posts in VTE prevention and Sepsis and Delirium.
This service supports nursing across the continuum of care and aims to:
- Focus on patient centred care.
- Promote and facilitate change.
- Develop individual skills and competence.
- Support ward staff involvement in specific projects.
- Facilitate service wide initiatives in collaboration with interdisciplinary staff.
- Identify and prioritise clinical issues and assist clinicians in resolving such issues.
- Promote a bottom up approach to change.
- Facilitate and promote the management and improvement of services.
- Facilitate and promote auditing/continuous quality improvement.
- Maximise the most effective clinical learning environment.
In order to do so many diverse roles are required:
- Facilitating, evaluating, developing, implementing, monitoring nursing practice.
- Managing continuous quality improvement programmes in such a way as to support and ensure the delivery of the highest standard of patient focused, holistic care throughout the Hospital.
- Clinical Placement Co-ordinators ensuring that the clinical areas in the Hospital, to which undergraduate general candidate nurses along with Intellectual Disability, Mental health candidate nurses and international student nurses (approximately 450 annually) are assigned for clinical placements, provide optimum learning environments and are capable of meeting the learning objectives set by the third level educational institutes.
- Overseeing the organisation of pre-registration clinical placements.
- Coordinating the development, implementation, monitoring and evaluation of the structures and processes to support safe nurse prescribing (medicinal products and referral for radiological procedures) which meets the requirements of both the organisation and is compliant with the requirements and standards of the Nursing and Midwifery Board of Ireland and the Health Service Executive.
- Promoting research development and research in practice.
- Support and facilitate the development of specialists’ posts and advanced practice roles to meet the service needs and promote professional development, life-long learning and career pathways.
- Developing learning programmes in collaboration with the Centre of Learning & Development via classroom, clinical skills, eLearning and blended learning.
Centre for Learning and Development
Learning is a way of life at TUH and to ensure that way of life is nurtured and developed appropriately the team in the Centre for Learning & Development work to develop education programmes which meet the needs of our staff including nursing. No building can be supported up by only one pillar, it requires a foundation and a number of supports to make the building structurally sound.
Similarly, Learning and Development requires a number of pillars to ensure that its foundation is responsive to the developmental and clinical needs of both patients and staff.
Nurses have access to an array of education programmes that enable them ]part of the Centre of Learning strategy we are employee focused and aim to provide educational experiences that promote career progression and enhance the quality of care delivered to patients. For nurses, the completion of the undergraduate programme is considered a solid foundation from which the Centre for Learning and Development can facilitate further growth and progression with programmes and support such as:
- New staff are assisted to settle into the day to day workings of the organisation through a structured induction programme.
- Clear educational pathways for nurses working in various clinical settings have been designed by the Registered Nurse Tutors, relevant nurses in specialist and advanced practice posts, Clinical Nurse Managers, nurse practice development and the Clinical Facilitation Team within the Centre for Learning & Development.
- NMBI accredited modular programmes have been devised to enhance the knowledge and skills of Registered Nurses in a number of specialties.
- Support is provided Registered Nurses to undertake further university based education and have developed close Collaborative academic partnerships with most Dublin universities in particular, Trinity College Dublin, our education partner. Fields of study range from the MSc. Specialist Nursing to sponsored fellowships in Leadership which are generously sponsored by The Meath Foundation.
- Support is provided nurses returning to structured third level education such as programmes in the use of software packages e.g. Microsoft Word, Outlook, Excel and PowerPoint are provided and Academic Writing workshops.
- Support in developing skills in research is provided.
- Education in Good Clinical Practice for Research is provided which also promotes the progression of nursing roles towards Advanced Practice.
- Support the provision of employee wellbeing programmes
Along with providing support and programme’s we facilitate the programme’s via a Learning Management System and have robust communication pathways in order to ensure all information in relation to these programmes is available to all staff.
School of Nursing and Midwifery, Trinity College Dublin
Research: Trinity Centre for Practice and Healthcare Innovation collaboration with Tallaght University Hospital
The TCPHI is a research centre within the School of Nursing & Midwifery, Trinity College Dublin. A research capacity-building programme was developed with TUH in 2014. Since then, it has developed high-quality nurse-led research that has improved practice and patient care. The Research Fellow facilitating the research ideas of nurses is Dr Karin O’Sullivan and the Principal Investigator is Dr Catherine McCabe. The collaboration is funded by the Meath Foundation and the Adelaide Health Foundations. The aim of this research collaboration is to develop nurse-led research and each research team includes a nurse from TUH, an academic from TCD School of Nursing and Midwifery and Dr Karin O’ Sullivan. Any nurse (registered nurse, Clinical Nurse manager, Clinical Nurse Specialist, Advanced Nurse Practitioner) who has an interesting topic for research can contact the TCPHI to discuss this.
Many nurses have presented the results of their research at the Trinity Health and Education International Research Conference. Examples of completed and current research along with publications can be found at: https://www.tcd.ie/tcphi/research-collaboration/tallaght-university-hospital/index.php
As one of Ireland’s largest and leading academic teaching hospitals, linked to Trinity College Dublin (https://nursing-midwifery.tcd.ie/), we not only collaborate on undergraduate nursing education (https://nursing-midwifery.tcd.ie/undergraduate/) but also on post-graduate education. This post-graduate education supports their ongoing learning of our nursing teams along with their professional development affording them participate in innovated career pathways and projects. The School of Nursing and Midwifery has a broad range of postgraduate courses (https://nursing-midwifery.tcd.ie/postgraduate/). Specialist courses are delivered in partnership include:
- Cardiovascular Nursing
- Cancer Care and Haematology Nursing
- Gerontological Nursing
- Emergency Department Nursing
- Intensive Care Nursing
- Orthopaedic Nursing
- Perioperative Nursing
- Renal Nursing
Students have the option of doing a postgraduate certificate or postgraduate diploma or Masters in any of these strands. Other courses include:
- Mental Health
- Community Nursing
- Advanced Nurse Practitioner Course
- Nurse Prescribing.
The Adelaide Health Foundation
The Adelaide Health Foundation is a voluntary foundation. They are committed to supporting education, policy and research to advance and promote equitable health and healthcare in Ireland, with a particular focus on TUH and the community it serves. The Foundation’s support is delivered in a practical way through direct support of service developments and patient care initiatives. As part of The Adelaide Health Foundation’s commitment to supporting nurses in TUH, the annual Scholarship programme offers professional development and contributes to the development of nursing practice in the hospital. Student nurses are also supported financially through our nursing bursary scheme. See www.adelaide.ie for more information about the Foundation and detail of the support they provide to the Hospital and its staff.
The Meath Foundation
The Meath Foundation was established in 1998 following the closure of the Meath Hospital and the opening of TUH. The Foundation is an independent charitable legal entity, entirely separate from the Hospital. The Foundation’s mission is to Honour the traditions of the past through the continuous support of world class research, education, quality improvement and arts at Tallaght University Hospital. To achieve this mission there are have four funding pillars available to staff, they are Research; Education; Quality Improvement; Arts and Health. Since 2002 The Meath Foundation has awarded grants for Research. Since 2002 they have awarded over €4M supporting 113 projects. The application process is open to all staff of the Hospital.
Tallaght University Hospital Foundation
Tallaght University Hospital Foundation is a recently established Foundation whose primary objective is to support, promote and enhance the services provided by TUH and the community it serves. The Foundation fosters and promotes fundraising and engages with donors, the community, hospital staff and volunteers to raise and distribute funds for innovative health solutions. They are committed to working with integrity and acting responsibly towards donors and supporters. The Tallaght University Hospital Foundation is an autonomous charitable legal entity, entirely separate from the Hospital.
TUH is a multi-disciplinary, inclusive and friendly environment, offering employment for nursing in a wide range of areas. Every member of the TUH team is valued and the Hospital embraces the importance of work life balance for all employees The Hospital prides itself on having a caring motivated workforce who collaborate with patients and their families along with our health partners dedicated to improving quality of care delivery and supporting the Hospitals values and vision. Need a back page cover please can you please have a look at the inside back cover of the annual report and if we can fit it please do as the inside back cover please