The role of the nurse in the UK continues to develop in response to the changing healthcare needs of our population and the challenges that these present. These include: an aging population, many of whom feel isolated; an increase in the incidence and prevalence of long term conditions, growing public demand, an increase in the availability of new health technologies and treatments, inefficient health systems and rising health costs; all at a time of financial austerity. The focus of national policy on finding innovative solutions to long standing problems, cost effectiveness, assessing the effectiveness of health interventions on patient outcomes, health protection and prevention, quality improvement and cutting costs by improving safety is therefore unsurprising. Nurses have always responded to the healthcare needs of their patients and clients and developed their roles accordingly; and the advanced nurse practitioner is no different.
The importance of advanced nurse practitioners
The concept of what is advanced practice has understandably changed over time, and will continue to do so. This is because it is dependent on what is understood to be the normal scope of practice of a nurse at the point of registration. This ‘standard’ scope of practice has developed over the years in response to both the changing health and social care needs of the population and models of healthcare delivery. Indeed this has led to a growing acknowledgement that nursing may be about to make another step change, in that many of the skills and competencies currently considered to be within the realm of advanced practice are becoming essential elements of contemporary everyday nursing practice, whether that be in a hospital setting or in the community.
There are multiple definitions and models of advanced practice and the Department of Health and the Nursing Midwifery Council have both published statements regarding the underpinning knowledge and competencies required for advanced practice. The advanced nurse practitioner is but one model and is sometimes described as a hybrid role because, although it holds true to the underpinning philosophy of nursing practice, it also encompasses a skillset traditionally considered to be that of doctors.
Examples of these skills and competencies include, but are not limited to, the ability to:
– Undertake a comprehensive and sophisticated physical and/or mental health assessment of patients with complex multiple healthcare needs and/or in crisis.
– Interpret the results of multiple different assessments and investigations in order to make a diagnosis, and plan and
– Confidently and competently make ethical, evidence based decisions and interventions when faced with complexity and assess and manage the risk associated with these decisions.
– Utilise therapies such as cognitive behavioural therapy when working with patients with mental health conditions either in isolation or associated with a physical long-term condition.
– Prescribe and work with individuals to manage their medicines.
– Work independently but also as part of a multi-disciplinary team and exercise values based leadership.
– Plan and provide skilled and competent care to meet a patient’s health and social care needs involving or referring on to other members of the healthcare team as appropriate.
Advance nurse practitioners (ANP) make an important contribution to the NHS and the role has been successfully introduced in many different settings. They are not only able to substitute for doctors, which is highly relevant in view of the growing shortage of GPs, but in doing so they often enable a patient to get the care they require more quickly, because the need to refer on to a doctor, and the associated delay, is negated.
For example, a patient who presents with an acute exacerbation of a long-term condition such as asthma, can be fully assessed, which would include taking an appropriate history and among other things conducting an examination of the chest. The findings interpreted, a decision made about the severity of the exacerbation, and then, depending on severity, and risk assessment, the appropriate medication prescribed (e.g. a bronchodilator and oral steroids). The patient may then be maintained at home, depending on response, with regular re-evaluation, or referred on. Importantly, the ANP will also spend time working with the patient to understand what has happened, why and how it might be prevented in the future. This is good for the patient but it also prevents an unnecessary referral to a GP and enables GPs to concentrate on those individuals with the most complex medical needs.
There is very little that ANPs are not allowed to do according to the law. They can assess a patient, make a diagnosis and provide treatment, just like a doctor. However they do this within a clearly defined scope of practice that is agreed with their employer, and the level of medical complexity that they deal with is usually less than that of a doctor. ANPs in primary care and the community are able to develop close, long-term relationships with their patients and work in partnership with them to help them achieve their optimum level of health.
The ANP role is not regulated so in theory anyone can call themselves an ANP. The implication of this for the profession, and more importantly the public in terms of patient safety, are eloquently debated by Brook and Rushforth (1), and is a subject worthy of further consideration by the profession. The recommendation of the International Council of Nurses, the Department of Health in England, and the equivalents in Scotland and Wales, the Association of Advanced Nurse Practitioner Educators (which consists of 40 universities in the UK), and our North American cousins (from where the role first emerged), is that preparation for the role should be a masters level academic programme. However, it is recognised that this alone is insufficient. Time in practice to develop the advanced clinical skills required for the role is also necessary, as is the support of a clinical mentor who is likely to be either a doctor or an experienced ANP.
The advancement of clinical practice is reliant on practitioners who are prepared to look to the future, visualise the potential of advanced nursing practice and pursue that vision. An ANP
requires resilience because the NHS, regardless of clinical setting
is a tough place to work. They also need to possess the courage and commitment to embark on a challenging journey of change, challenge and development. Training to be an ANP brings immense role satisfaction. It makes you better able to meet your patients’ needs in a timely manner and in a way that avoids unnecessary referral and delayed care.
What the future holds for ANPs in 2016 and beyond
As discussed previously, the ANP title is not currently regulated and therefore there is very little accurate data available regarding ANP numbers. We do, however, know that demand for the associated academic programme is growing.
By preparing ANPs through the MSc advanced clinical practice (ANP) programme at the University of Southampton Faculty of Health Sciences, my colleagues and I are addressing the current skills gap in the NHS. We believe this highly tailored programme will best prepare students to become ANPs within the future workforce and meet the changing needs of the NHS.
University of Southampton Health Science – www.southampton.ac.uk/healthsciences/
1. Brook S, Rushforth H. Why is the regulation of advanced practice essential. British Journal of Nursing 2011;20(16): 996.
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