Advanced nursing practice - transforming nursing roles: phase two

Annex A

ANP Governance: Example from the West of Scotland Advanced Practice Academy Leadership Group

Significant discussions have taken place on the subject of governance for ANPs. The West of Scotland ANP Academy document has been included below as an example good practice. It is important to note that this is only an example and other regions may require different structures and processes.

An academy is a network of Health Boards, working together to provide oversight of Advanced Practice whilst supporting the learning and professional development of ANPs across Boards, focussing on the development and maintenance of competence and capability.

ANPs require effective clinical supervision throughout their careers, but it is particularly crucial during their early development. Supervision should include a combination of competency frameworks, academic and local education programmes, and effective supervision. Each of these are essential to evaluate the clinical competence of a practitioner. Governance structures should be embedded in to Boards' quality assurance frameworks.

The table below represents the governance framework that all ANPs within the three Health Boards that form the academy should be working to.

Clinical Competence

Competence Frameworks

• Each ANP should have a core competence framework underpinned by the four pillars of advanced practice: leadership; clinical practice; evidence, research & development; and facilitation of learning.
• The competence framework will demonstrate the ANP's core competence in comprehensive history taking, clinical assessment, differential diagnosis, investigations and treatment – including independent prescribing and admission/discharge/referral
• Each competence framework should demonstrate comprehensive and progressive evidence of practice within the ANP's clinical setting
• Any area specific competencies should be demonstrated as an addendum to the above
• A competence framework should take no longer than 3 years to complete

Competence Sign Off

• In line with the triangle of capability principle of, competence should be signed off by a lead clinician in the area of practice, peer review and line manager

Maintaining Competence

• Annual review of 10 clinical cases by line manager/senior clinician which must include evidence of reflection and learning
• Annually signed peer review form as evidence of maintenance of competence

Supervision

Line Manager Supervision

• Regular team meetings – attendance at 2 per year with action notes/minutes available to all team members
• Annual Performance Development Review (PDR) using the Knowledge and Skills Framework (KSF). 10 case notes with prescribing practice, reflection and learning points at every PDR session
• Critical companion at least once per year
• De-brief sessions following difficult/stressful cases
• Random case note reviews throughout the year
• Regular direct supervision of clinical work

Peer Supervision/Support

• Informal/ad-hoc on a shift to shift basis
• Each ANP new to post should be given a designated ANP supervisor
• Potential for linking across localities/Boards to engage in appropriate mentorship

Clinical Supervision

• Should be provided monthly as a minimum.
• Every ANP should be provided with an ANP supervisor (fully qualified/competent ANP) at the earliest opportunity
• Supervision should take place by critical companion and/or case based discussion/presentations – at a minimum of four times annually
• Supervision of prescribing practice during and following academic qualification including reflection on learning from prescribing practice
• Direct supervision of clinical work – at a minimum of annually

Education

Each ANP should complete a training needs analysis on a yearly basis to ensure that individual training needs are being met.

Academic Education

• Minimum qualification achieved within 3-5 years of taking up post
• Must achieve, as a minimum, a Post Graduate Diploma in Advanced Clinical Practice
• Must achieve an independent prescribing qualification from an accredited HEI
• Should be working towards an MSc in a subject applicable to advanced nursing practice

Continuous Professional Development

• Completion of all local mandatory training programmes
• Annual attendance at simulation training
• Immediate life support as a minimum
• Where applicable, advanced life support for first responders
• Completion of course in recognition, management and escalation of the deteriorating patient
• Attendance at local continuous professional development twice per year
• Attendance at national non-medical prescribing conferences