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Career development: becoming an advanced nurse practitioner

Siobhan Hicks
RGN BSc
Lecturer Public Health and Primary Care (Advanced Practice)
City University London
ANP Locum
Tower Hamlets and Newham

Siobhan Hicks explains how nurses can gain advanced nurse practitioner status, and outlines the complex but positive experiences on her journey towards attaining this role

As recently as 10 years ago, the notion of student nurses enquiring about advanced practice was rare. However, now they express great interest and frequently ask me how to become an advanced nurse practitioner (ANP).

Before you decide to apply to become an ANP, access the Royal College of Nursing (RCN) Guide to the Nurse Practitioner Role, Competencies and Accreditation.1 This document clearly sets out the role, domains and competencies of the ANP in the UK and is also mapped against the NHS Knowledge and Skills Framework (DH 2004), and the standards that collaborating higher education institutions (HEIs) must meet to receive RCN accreditation.2

According to the RCN, an ANP is a registered nurse who has undertaken a specific course of study, of at least BSc(Honours) level, who:

  • Makes professionally autonomous decisions.
  • Receives patients with undifferentiated undiagnosed problems and makes an assessment of their health needs, based on highly developed nursing knowledge and skills, including skills not usually exercised by nurses such as physical examination.
  • Screens patients for disease risk factors and early signs of illness.
  • Makes differential diagnosis using decision-making and problem solving skills.
  • Develops, with the patient, an ongoing nursing care plan for health, with an emphasis on preventive measures.
  • Orders necessary investigations and provides treatment and care both individually, and as part of a team, and through referral to other agencies.

According to Christine Beasley, Chief Nursing Officer for England, ANPs should be educated at Master's level, and most academic institutions recommend that you have five years' post-qualification experience in an area relevant to your current role.3 This includes experience as a primary care community nurse, an urgent care or GP practice nurse, or within a walk-in centre. A&E and critical care experience is also very useful. In short, the ANP in primary care is a generalist, so the wider your experience before starting a course of study, the better.

Taking on further study
You should carefully measure whether you are ready to study again. A lot of nurses do not hold a first degree (Level 3), and may be reluctant to apply for a Master's; but clinical experience and evidence of previous study may be an advantage when applying for a course. In this instance, Accreditation for Prior Experiential Learning (APEL) can provide formal recognition for knowledge and skills, which can help you to gain entry to a pathway. This will need to be discussed on an individual basis with the university  to which you are applying.

If you decide you are not ready for Master's level education, there are still some BSc(Honours) nurse practitioner programmes available in the short term, although bear in mind that many of these programmes will be phased out in preference for Master's level courses in the near future. Again, check with the institution you are applying to.

Another consideration is financial support for your studies. As GP consortia are to be taking over from PCTs, it is uncertain whether funding for whole programmes of study will still exist, or whether nurses will only receive funding for certain modules, such as physical assessment and prescribing.4 This will need to be investigated at a local level by you and/or your employer, but thought should be given as to whether modular education is adequate preparation for the demanding role of the ANP.

In support of this, at the recent Association of Advanced Nursing Practice Educators (AANPE) 2011 conference in Nottingham, it was expressed by the Panel that advanced nursing practice is not just a job but a way of thinking. The difference between a nurse practitioner and an ANP is that an ANP leads the way not just clinically but also as a researcher, leader and agent of change; indeed, this may only be achieved with years of expertise and experience but also with Master's level study. Judge whether you have the time to commit to attend university, to read, research, practise new skills, take exams and prepare academic papers. You will have to negotiate with your employer to protect your time, making sure they fully understand what is expected of you, and you of them, throughout your studies or start of a new role.

For example, if a GP is your mentor, you will need to negotiate time to shadow and receive feedback from them in your working week. There may be friction from other members of the team because you will be moving away from your usual tasks or job so you will need to ensure that you have communicated clearly with them to avoid this. Finally, in my experience most of your patients will be more than happy to help you practise new skills, but the key to this is clear communication.

It is well known that nurses are prone to stress, and the decisions the ANP makes can have a significant impact on his or her health. This can be particularly evident in nurses who have inadequate preparation for the role, leading to reduced confidence in their clinical skills or clarity of goals. Your friends and family can provide you with emotional support when the going gets tough; you may also think about engaging in clinical supervision with your colleagues or peers on the course to make sense of the new world that is opening up for you and of course a strong educational foundation will give you the tools to grow from novice to expert.5

Regulation
It is unlikely the role of the ANP will be recognised by the NMC in the near future. The Council for Healthcare Regulatory Excellence (CHRE) Report to the Four UK Health Departments cast doubt upon this in 2009 by stating that the NMC Code of Professional Conduct was adequate to protect the public and that there is no need for any further regulation.

At the AANPE Conference (2011) Professor Dickon Weir-Hughes, Chief Executive of the NMC, gave a speech on the future of advanced practice, in which he said that the NMC's role is to safeguard the health and wellbeing of people who use or need the services of nurses and midwives. Their remit is not to help people with career progression, and they are not a union or royal body but a regulator.

The 2011 white paper, Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff, supports professional development and possibly regulation, but what the public and government need to know to make an informed decision to support this is evidence that regulation is necessary; to show where governance is supporting good practice and that non-governance is fostering poor practice.6
Professor Weir-Hughes gave the example of the NMC getting up to 20 'fitness to practice' referrals per day, with up to 1,500 cases going at any one time. Cases at the moment are around conduct and not competence and, currently, there are no cases
against ANPs.

Conclusion
In summary, when thinking about becoming an ANP:
Do your research into the role, the entry requirements, the university and the course you are applying to make sure it is the right one for you.

Talk to your current employer to ensure they will support you in your training and new role, find out about funding and time issues; discuss this all with your family and get support.
Finally, be positive, be persistent and be happy. Despite all the challenged involved, you have chosen one of the most rewarding jobs that a registered nurse can do. ANPs have always pushed the boundaries of nursing, and I cannot see that changing.

References

  1. Royal College of Nursing (RCN). Advanced Nurse Practitioners. An RCN Guide to the Advanced Nurse practitioner Role, Competencies and Programme Accreditation. London: RCN; 2010.
  2. Department of Health (DH). The NHS Knowledge and Skills Framework (NHSKSF) and its use in development review. London: DH; 2004.
  3. Department of Health (DH). Framework for Developing Nursing Roles: Consultation. London: DH; 2004.
  4. Department of Health (DH). Equity and Excellence: Liberating the NHS. London: DH; 2010.
  5. Benner P. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park: Addison-Wesley; 1984.
  6. Department of Health (DH). Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff. London: DH; 2011.