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NMC looking for ‘sweet spot’ on advanced practice regulation

NMC looking for ‘sweet spot’ on advanced practice regulation

The nursing regulator wants to ensure any potential future regulation of advanced practice avoids confusing the public or disengaging members of the profession, a conference has heard.

Speaking at the Queen’s Nursing Institute’s annual conference this week, Nursing and Midwifery Council (NMC) executive director of professional practice Sam Foster, provided an update on the regulator’s advanced practice project and discussed the ‘balance’ it hopes to strike.

While the NMC does not currently specifically regulate advanced nurse practice, it has committed to considering whether additional regulation is needed as part of its 2020-25 strategy.

In May 2023, the NMC’s council agreed to the recruitment of a chair of an independent steering group to lead this work and to additional lines of enquiry and development options which would be presented to the council in January 2024.

However, during her update on Tuesday, Ms Foster said presenting a ‘preferred option’ for regulation by January ‘feels quite tight’ and that the deadline may be pushed back to March 2024.

‘We might just stretch that [deadline] to make sure that we get everybody’s voice heard and that we genuinely do produce this with the profession and with the public,’ she told the conference.

Potential options for the regulation of advanced practice include: retaining the ‘status quo’; using existing NMC mechanisms short of regulation; joint approaches with chief nursing officers or other regulators; introducing a test of competence; credentialling; or ‘full scale regulation’ which would see standards set and approved programmes.

Ms Foster recognised the issue that it was currently employers setting ‘the direction’ for advanced practice, and that this had led to a wide variation in titles and job descriptions.

As part of the NMC’s ongoing exploration, Ms Foster stressed it was vital that a definition of advanced practice is developed.

She said that, during a meeting with other professional regulators, the NMC committed to issuing ‘a joint statement and definition of advanced practice on behalf of the other health regulators’.

This was ‘a real step in some ways’, noted Ms Foster.

‘How can we regulate something that we haven’t defined?’ she said. ‘So, I think that is going to be really key.’

Ms Foster said there were ‘commonalities’ around what advanced practice is, including: an advanced level of knowledge base and competence, autonomous decision making, accountability, dealing with complexity, uncertainty and risk, and education to Master’s level.

‘In summary, it is about management of complete episodes of care, but it’s about that end-to-end management, that provision of continuity and that reduction of fragmented care,’ she added.

Underpinning the exploration of advanced practice was the issue of public protection, noted Ms Foster, though she recognised there was also a ‘balance of risk’ to consider.

‘We’re going to have to find that sweet spot professionally where we don’t frighten the public and we don’t disengage a whole host of talented colleagues who are practising beyond the initial scope of their practice,’ she told the conference.

‘But the driver for this is very much about what’s in it for the public, the public protection and the benefit to the public from regulating.’

A recent report commissioned by the NMC found that there was significant variation in the training, roles, and scope of practice held by nurses using the title of ‘advanced practitioner’.

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