Advanced practice in nursing.

Abstract

Advanced practice in nursing is a particular level of practice between that of a senior practitioner and consultant (Scottish Government, 2009). There are many different posts across the NHS in the UK where nurses operate at an advanced level, not all of which are clinical posts. Most organisations will have developed an advanced nursing practice strategy or plan to ensure they are aligned with relevant national government/assembly policy. Many advanced nurse practitioner (ANP) roles are critical to the delivery of high-quality nursing care. The Scottish Government’s Advanced Nursing Practice Roles: Guidance for NHS Boards (Scottish Government, 2010) sets out the strategy for advanced nursing practice for the next 5 years and beyond. The Modernising Nursing Careers Advanced Practice Toolkit, which was lead by the Chief Nursing Officer for Scotland, on behalf of the four UK Chief Nursing Officers, has clarified that advanced practice is a particular stage on a continuum between novice and expert. A ‘specialist’ can be considered as one pole on the specialist-generalist continuum and therefore does not represent a specific level of practice. Therefore both specialists and generalists can perform at an advanced level of practice. Individuals working at advanced practice level should show evidence of Master’s-level learning, such as studying at postgraduate certificate or diploma level while working towards a Master’s. All ANPs in all organisations will be expected to undertake continuing professional development (CPD) and be expected to evidence this through the annual Personal Development Plan (PDP) process. Although CPD does not have to be accredited, ANPs may wish to consider how they would evidence Master’s level learning if their initial education for the role was not at this level. For CPD, ANPs could, for example: ■ Undertake a Master’s level module or programme (PgC, PgD or Master’s) ■ Put together a portfolio of evidence to demonstrate Master’s-level thinking and submit to a higher education institution for Recognition of Prior Learning ■ Undertake a Master’s level CPD unit ■ Undertake an unaccredited or degree-level CPD unit ■ Undertake self-directed learning (reading, audit, research study, unaccredited online education), providing that learning is evidenced. There is no doubt that most appointees to ANP posts will require additional education for the role. Where an appointee has not completed an Approved Programme of Preparation (APP) for the role, they should be appointed to a training post. Different models of training posts exist and can be used. Rory Farrelly NHS Greater Glasgow and Clyde Director of Nursing Acute Services Division Each model should have the following principles: ■ Ensure that there is an APP associated with the training post ■ Make clear what the ANP trainee must achieve to complete the training post ■ Clearly set out the timescales to complete the APP ■ Ensure the ANP trainee is appropriately remunerated when the training post is satisfactorily completed ■ Ensure the ANP trainee has an agreed job plan in place that includes appropriate study leave for the APP ■ Details around clinical supervision and arrangements for supervised practice ■ Ensure the APP is fully funded at the outset ■ Organisations/service areas are at liberty to select a training post model that suits local needs. Before any new ANP role is created, there should be evidence that the service requires such a role. NHS Education for Scotland has developed the Advanced Nursing Practice Service Needs Analysis Tool (NHS Education for Scotland, 2010) that will help clinical areas to create a robust business case. One of the major challenges for workforce planners in the area of advanced practice has been the ambiguity surrounding the role. The Advanced Practice Toolkit (NHS Education for Scotland, 2010) and NHS organisations will have an advanced nursing practice strategy or plan that will aim to reduce that ambiguity, but it will ultimately be down to individual clinical specialties to specify the remit of an ANP within that specialist area. However, there must be broad parity across specialist areas and all advanced practice roles should not be developed in isolation. The organisation/service area should identify a suitable steering group that will develop a formal proposal for any new advanced practice role (or significant change to an existing role). Steering groups should include representatives of all relevant stakeholders. Advice can be sought from a range of informal and formal, local and national groups. New roles (or significant changes to existing roles) should be approved through general management and professional structures. Any development should be able to assure that a safe, effective and personand family-centred approach has been taken. BJN