Nursing professionals and employers have been urged to implement the Nursing and Midwifery Council’s (NMC’s) newly published ‘Principles for Advanced Practice’.
The principles set out, ‘for the first time’, what is expected of registered nurses and midwives in advanced practice positions, the regulator said.
Today’s full publication comes after the NMC was given the greenlight on its definition and principles of advanced practice in March, following several months of delay.
While the principles are advisory, the NMC has previously said it would ‘strongly encourage professionals and employers to use them to ensure people receive the best possible care’.
The principles recognise the established principles of advanced practice which are aligned to the advanced practice frameworks of all four nations:
- Clinical practice
- Education
- Research
- Leadership
- Management
The principles come as confusion remains around what advanced practice means, according to recent research commissioned by the NMC and completed by The Nuffield Trust and the consultancy firm BritainThinks.
How does the NMC define advanced practice?
The NMC has also provided a public and professional definition of advanced practice, to avoid uncertainty among both patients and healthcare staff.
The professional definition:
A registered nurse or midwife working at an advanced level is an expert professional with additional post-graduate education and experience. They use their evidence informed knowledge, skills and capability to influence, shape, deliver and lead safe and effective care, while managing risk, uncertainty and complexity.
The public definition:
A registered nurse or midwife working at an advanced level of practice is a professional who has completed extra post qualification education to increase their knowledge and skills, allowing them to deliver and lead expert, higher-level care.
The principles will inform the basis of a wider set of regulatory measures that the NMC will set out to support advanced practice care in the future.
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Professor Donna O’Boyle, acting executive director of professional practice at the NMC, said the principles provide a ‘clear foundation’ for what advanced practice should look like.
‘These principles are designed to support the transformation and delivery of care, to help meet the increasingly complex needs of those we care for, harnessing new technologies and changing ways of working.
‘Nurses and midwives working at advanced levels of practice bring expert knowledge, complex decision-making skills and strong clinical leadership closer to the people receiving care.’
What is included in the principles?
The principles are divided between those for individual professionals and those for employing organisations.
The expectations for advanced practice individuals include the delivery of safe and effective care across a range of settings and a ‘well-developed understanding’ of wider determinates of health, to enable professionals to promote health and wellbeing and prevent ill health.
Expectations for employing organisations include the provision of ‘effective governance’ to ensure care and services are being provided by suitably qualified experienced advanced practitioners with opportunities for appropriate support, supervision, training and professional development.
From Spring 2027, the NMC will launch its work to develop standards of proficiency and associated advanced practice programme standards.
Nurses and midwives who are already practising at an advanced level will be supported via ‘tailored transitional arrangements’, the NMC has said.
The regulator added that it will provide ‘robust quality assurance processes’ that will ensure the approval of advanced practice programmes that meet NMC’s standards.
‘This phased approach gives employers, educators and practitioners the clarity and time they need to embed the principles into daily practice, enabling safer, more consistent, and truly person-centred advanced level nursing and midwifery care across the UK,’ the NMC explained.
In a joint statement the chief nursing, chief adult social care nurse, and chief midwifery officers from across the UK said the principles were an ‘important first step’ in setting the standards for advanced practice.
‘We look forward to continuing to work with the NMC and colleagues across the four nations of the UK as this work continues towards additional regulation of advanced practice,’ they added.
Principles for individual professionals
All nurses and midwives on our register must practise in line with the Code. In addition, advanced level practitioners should:
1.1 Practise within their individual scope of practice and in line with their level of knowledge, experience, qualifications, training and employment role.
1.2 Demonstrate expertise, confidence, critical thinking, and evidence appraisal and synthesis within their individual scope of practice to lead and influence education, research and practice.
1.3 Demonstrate professional accountability and capability in making complex evidence-informed decisions, managing varying degrees of risk, unpredictability and uncertainty while exercising professional judgement. This includes using initiative, demonstrating significant autonomy and being accountable for their actions.
1.4 Demonstrate self-awareness with compassionate and inspirational leadership within inter-professional teams to influence practice for effective, holistic, person-centred care.
1.5 Demonstrate use of evidence informed expert knowledge to practise reflectively, identifying areas for self-improvement and improved outcomes for a diverse range of individuals, teams and people.
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1.6 Role model reflective and reflexive practice and advocate for access to individualised support and clinical supervision to ensure continuous learning, improvement and professional development across the four pillars.
1.7 Role model professional practice, advocating for and contributing to inter-professional learning and working to provide leadership and effective support and supervision to a broad range of colleagues and learners.
1.8 Use their expert, advanced level knowledge and experience to challenge themselves and others to promote and embed professional curiosity and the principles of equality, equity, diversity and inclusion in their area of practice, seeking and acting upon feedback received from peers, colleagues and the public.
1.9 Support, influence and lead projects in the environments they work in to shape a reflective learning culture where safety, quality, continuous improvement and sustainability are prioritised, including promoting allyship and advocacy for all, speaking up and raising concerns where required.
1.10 Evidence continued capability, reflective and reflexive practice, ongoing learning and professional development at an advanced level, relevant to their scope of practice through local appraisal processes and through professional revalidation requirements.
1.11 Utilise their expertise and experience to minimise environmental impacts, enhance economic growth and embed sustainable approaches to service planning, delivery and implementation.
1.12 Lead and contribute to the proactive identification and resolution of challenges to health, safety and wellbeing for individuals and population groups, shaping the design and delivery of effective services and policies that promote holistic health and wellbeing
Principles for employing organisations:
To provide an environment where advanced practice can flourish there should be:
2.1 Robust governance processes for advanced level practice in line with local and national legal, regulatory, professional and educational requirements, with clear lines of accountability and communication, appropriate resources and processes that facilitate and encourage high performance and optimise autonomy, leading to consistently improved outcomes.
2.2 A culture that supports shared learning and a high standard of working for advanced practitioners within and across inter-professional teams that is safe and effective for all.
2.3 Opportunities for individual practitioners to learn and work at an advanced level within their scope of practice, job role and setting, practising with increased autonomy across the four pillars of advanced practice with support from appropriately qualified, proficient and skilled individuals.
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2.4 Development of new and existing advanced practitioners to provide effective leadership and management that ensures co-ordinated care across professions and teams to a high standard of professional practice.
2.5 An open and honest culture for advanced practitioners with opportunities for feedback from other professionals at all levels and members of the public which then encourages reflective and reflexive evidence-informed practice and supports professional development across the four pillars.
2.6 A reflective environment that facilitates access to individualised support and/or clinical supervision for advanced practitioners across the four pillars throughout their career.
Source: The Nursing and Midwifery Council
