Transforming nursing, midwifery and health professions roles: advance nursing practice

Paper 2: Advanced nursing practice

This series of brief papers on the Transforming Roles programme aims to update stakeholders on the professions’ contribution to the wider transformational change agenda in health and social care in Scotland. The second paper outlines guidance for employers on developing advanced nursing practice in NHSScotland.

Background

The Chief Nursing Officer is committed to maximising the contribution of the nursing, midwifery and health professions ( NMaHP) workforce and pushing the traditional boundaries of professional roles. The Transforming Roles programme aims to provide strategic oversight, direction and governance to:

• develop and transform NMaHP roles to meet the current and future needs of Scotland’s health and care system
• ensure nationally consistent, sustainable and progressive roles, education and career pathways.

Phase 1 of Transforming Roles focused on nursing roles.

The Transforming Roles Advanced Practice Group was tasked with providing strategic oversight, direction and governance to the development and transformation of advanced nurse practitioner roles. The aims were to:

• meet the current and future needs of Scotland’s health and care system
• bring together informal nursing role developments emerging from policy or service imperatives to ensure nationally consistent, sustainable and progressive nursing roles and career pathways.

Advanced nurse practitioners – definition

Advanced nurse practitioners ( ANPs) are experienced and highly educated registered nurses who manage the complete clinical care of their patients, not focusing on any sole condition.

ANPs have advanced-level capability across the four pillars of practice:

• clinical practice
• facilitation of learning
• leadership
• evidence, research and development.

They also have additional clinical-practice skills appropriate to their role.

Advanced practice represents a level of practice, rather than being related to a specific area of clinical practice. ^[1] Advanced and specialist practitioners may be functioning at an extremely high level of practice, but with a different clinical focus.

Education preparation and role overview

ANPs are educated at Master’s level and are competent to work at advanced level as part of multidisciplinary teams across all clinical settings, depending on their area of expertise.

They are clinical leaders with the freedom and authority to act, and accept responsibility and accountability for those actions. Indeed, advanced practice is characterised by high-level autonomous decision-making, including assessing, diagnosing and treating (including prescribing for) patients with complex multidimensional problems. ANPs have the authority to refer, admit and discharge within defined clinical areas.

Annex 1 provides an overview of core ANP competences.

Clinical supervision

ANPs need effective clinical supervision to develop, maintain and continuously improve their practice. This may be achieved through competence frameworks and locally agreed supervision models.

Career Framework level

ANP posts should be aligned to Level 7 of the Career Framework for Health and reviewed against a minimum of Agenda for Change band 7. It will be appropriate for some posts to be set at a higher band, depending on role and function, and types and levels of responsibility.

Guidance for taking advanced nursing practice forward

Guidance for NHS boards and employers on taking advanced nursing practice forward is provided in Annex 2. The Transforming Roles Postgraduate Education and Development Group will oversee the development of appropriate pathways leading to advanced practice. These will be supported by flexible and sustainable models of education to ensure consistency and relevance to service needs.

Next steps

Phase 2 of this work stream will aim to support employers further by:

• developing clinical competences in a number of areas of practice
• creating linked networks to support and develop advanced practice and ANPs
• supporting, developing and implementing ANP roles in the community nursing team, ensuring succession-planning and implementing career and development pathways in NHS boards
• considering further how professional accountability infrastructures for ANPs can be embedded across all settings and employers
• supporting the implementation of phase 1 to ensure all existing and developing ANP roles meet national standards
• supporting NHS boards/integrated joint boards to work with the Scottish Government to map the current ANP workforce and provide a robust baseline for future workforce planning
• ensuring the Scottish Government requires all NHS boards to report at least annually the numbers and fields of practice of ANPs.