GPs ‘would drown’ without advanced nurse practitioners

Nurses have voted to ensure the Royal College of Nursing (RCN) acts upon attempts to ‘undermine’ advanced nursing practice – warning that without these vital roles, GP practices and accident and emergency departments ‘would drown’.

In a debate held at this year’s RCN Congress in Liverpool, RCN Council chair and ANP Carmel O’Boyle highlighted recent criticisms of advanced nursing practice, including the term ‘noctar’ being used as a ‘derogatory moniker to belittle and dampen down our professional advancement’.

In recent months, there have been concerns raised by the British Medical Association (BMA) around what they describe as ‘doctor substitution’ and its suggestion that advanced practitioner roles – including nurses – pose a risk to patient safety.

The RCN has made clear in its response that ANPs are ‘not replacements for doctors’ and are ‘highly-skilled experts in their own right’.

Ms O’Boyle said ANPs did not want to be ‘pitted against’ medical colleagues.

‘I didn’t steal a doctor’s job’

She stressed that advanced nursing ‘isn’t new’ and had been around for more than 40 years.

‘I work in a nurse-led service, but I didn’t steal a doctor’s job,’ she added.

‘My service sees hundreds of patients every day, and without ANPs, those patients will be at risk, and our GPs and [accident and emergency departments] AEDs would drown.’

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She added: ‘Nurses are the fortitude in interdisciplinary teamwork, pulling together the [multidisciplinary teams] MDT with our person-centred approach.

‘Medicine traditionally has focused on pathophysiological pathways of disease, and advanced nursing practice integrates that critical diagnostic decision making with a person-centred philosophy, bridging gaps between clinical reasoning and the lived experience of the patient, their lives, environments, support systems, their wishes, science and all coming together.’

ANP and vice chair of the RCN ANP Forum Adele Parsons said recent media coverage ‘has led many within advanced practice to feel that they must speak out in defence of a role that has been established and embedded in healthcare for more than four decades’.

‘Remaining silent in the current climate no longer feels neutral, and we ask that the RCN respond to defend advanced level nursing practice.’

‘ANPs feel professionally vulnerable’

Jenny Riley, also from the ANP forum, warned advanced nurses were feeling ‘professionally vulnerable as roles are debated in public and policy spaces’.

Some felt they needed to ‘defend their capabilities and justify their role rather than getting on with the job over time’.

‘This can and will lead to a moral distress, fatigue, and loss of confidence. This impacts on retention, leaving a huge irreplaceable gap in nursing expertise for our patients, services, and profession. However, with the commitment of this resolution, we can change this,’ added Ms Riley.

She pointed to this week’s keynote address by RCN chief executive and general secretary Professor Nicola Ranger who urged advanced nurses to ‘wear their title with pride’.

‘I am proud to do so, but we need the support of the RCN to champion understanding, support professional identity, and advocate for our profession,’ said Ms Riley.

‘In doing so, we then value the unique contribution of advanced level nursing roles, supporting them to feel seen, work confidently within scope of practice, and ensure roles are understood, and most importantly, reinforce professional legitimacy and public confidence.’

Time ran out for Hannah Pollock, practice nurse and GPN Forum member, to contribute to the debate, however she shared what she would have liked to have said with Nursing in Practice.

‘Advanced nursing practice is not something we should still be trying to justify – it is something healthcare systems already rely upon every single day,’ she said.

‘Attempts to undermine it are not only outdated, they are harmful to the future sustainability of patient care.’

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She added: ‘From a general practice nursing perspective, nurses are already leading complex care whilst referring to themselves simply as just the “practice nurse”.

‘In general practice nurses are running independent clinics across multiple specialities, many of which would have sat firmly within the remit of GPs 10 or 20 years ago.

‘These nurses are not simply “supporting” care – they are delivering it autonomously. They are specialist trained, highly skilled, making independent diagnostic and treatment decisions, managing long-term conditions, and in many cases independently prescribing.

‘And they are doing this safely, effectively, and to an exceptionally high standard.

‘So, when advanced nursing practice is questioned or diminished, what is really being questioned is the expertise, judgement, and leadership of an entire workforce that modern healthcare depends upon.’

Ms Pollock added: ‘If we truly value patient access, preventative care, and sustainable primary care services, then we must stop treating advanced nursing practice as an optional extension of nursing and start recognising it as the highly skilled clinical leadership role that it already is.’

‘Advanced practice is about strengthening the team’

Heira Lansangan, from the RCN London branch, added: ‘Advanced practice isn’t about replacing doctors or any other healthcare professions. It’s about strengthening the whole team. It improves access, reduces delays, and ensures no patient is left waiting.

‘It is essential to patient safety because it’s built on years of expertise, clinical judgement, and the courage to make what matters most.’

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Also joining the debate was Adam Newton, chair for the RCN North Yorkshire branch, who works on a virtual ward.

He told congress that GPs he worked with locally ‘fully support the work we do’.

‘They push my learning, and where my learning has gaps, they’ve pushed me forward and helped me. So, I would say it’s not all doctors pushing this.’

The resolution – That this meeting of RCN Congress agrees that the RCN will act upon attempts to undermine advanced nursing practice – was carried.