Advanced nursing practice regulation needs 'measured debate', says NMC

27 January, 2010 | By Charlotte Santry

The Nursing and Midwifery Council says it is taking a “measured approach” to regulating advanced practice and does not see it as an urgent priority, the regulator’s chief executive and registrar has told Nursing Times.

In the meantime it is up to hospitals and community organisations to ensure staff were sufficiently skilled and received the development they needed, he said.

In an interview with Nursing Times, he said: “That’s their responsibility and most NHS organisations have pretty tight criteria about who can call themselves advanced nursing practitioners.”

“The advanced practice piece of work has never been off the agenda at the NMC, it’s just been difficult to make progress with it. There are, it has to be said, a range of views about advanced practice and whether it should be regulated.

“Despite an NMC consultation, a government white paper and a report by the Council for Healthcare Regulatory Excellence, there is still no clear consensus. There is good evidence coming from America that shows regulation can increase patient safety.”

But he warned: “However, we don’t want to over-regulate and hinder innovation, so this is why we’re opening the debate.”

No decision would be made in the near future as there were questions over how a framework could be developed to cover all four UK countries, the military, the independent sector and island territories.

Mr Weir-Hughes said: “It has to be done properly, which almost by definition means not hastily. I’d much rather do something properly that takes a little while then do something hastily and for it to be wrong.”

His priority is establishing a system for regulating healthcare support workers.

He said: “The reason, for me, the advanced nursing piece isn’t such an urgent priority as the role of the healthcare support worker is we already have regulation in place for nursing, it’s just not specific to advanced practice nursing.

“The question is whether or not there needs to be some additional regulation, but with healthcare support workers there’s nothing.”

As revealed in Nursing Times last week, Mr Dickon Weir-Hughes has said he is “single minded” about establishing a national system for healthcare support workers.

Readers' comments (18)

Ellen Nicholson | 27-Jan-2010 4:47 pm
Although I consider that regulating the HCAs is a good idea, I feel the wheel is being reinvented again. I originally qualifed as an enrolled nurse, converted to RGN, and studied for a BSc. as a Nurse Practitioner. Regulating HCAs will recognise their contribution to nursing, encourage professional cohesion and accountibility. By the same note, not regulating advanced practice, is short sighted as it allows the current practice of differing courses to be offered for advanced practice. The public & patients are not going to know if the nurse has studied to degree/masters level or studied for a few weeks, the practice, skills and knowledge acquired will be vastly different in both scenarios - advanced practice is just that - advanced and therefore to my mind requires regulation.
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Stephen Johnson | 27-Jan-2010 7:28 pm
I think its very difficult to call. I am currently undertaking the MSc in Advanced practice with colleagues from disciplines outside of nursing. Advanced practice is not unique to nursing, also the role is likely to keep on evolving so perhaps creating a definition and a separate part of the register may well be counter productive.
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Anonymous | 28-Jan-2010 2:57 am
Almost every nurse I meet tells me they're an advanced practitioner, yet when I ask them what they studied for their MSc they look at me blankly and go on to give me their own definition of what an advanced practitioner is: interestingly this includes Nurses who are not presently employed. Until there is a separate part of the register the title Advanced Practitioner must surely be a Job Title in the same manner as Staff Nurse, Charge Nurse etc.
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Anonymous | 28-Jan-2010 9:15 am
There is no need for a separate part of the register. Like the last contributor APs should have a clear title and job description. Their Scope of Practice will be extended, clearly defined and authorised with the Trusts clinical governance department.
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Anonymous | 28-Jan-2010 11:07 am
Can anyone enlighten me as to what qualifications are necessary to enable a nurse to call her self a Nurse practioner.
I studied a BS (Hons) in clinical practice and am an autonoumous nurse in a primary care walk in centre. I have just completed the independant and supplementary nurse prescribing course at Ms level. What exactly am I ? a ordinary Nurse or a advanced nurse practitoner.
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Anonymous | 28-Jan-2010 7:06 pm
The Nmc should not shy away from it's responsibilities here. As it stands, local primary care trusts/ NHS trusts are setting their own agenda for the amount of investiture and renumeration that their employees receive. It is well known that there are huge variables here. I work under the title of'advanced practitioner' and although I may have many years experience in a variety of settings I do not have a degree. My most notable qualification is the non-medical prescribing (which I arranged myself). I view myself as a senior staff member but unfortunately I don't feel I merit such a fancy title! In my opinion to deserve to be called an advanced practitioner I do believe that it has to be reflected in the individual's recorded qualifications. A lot of people would love to develop to this level but most can't afford to self-fund and donate their own personal time, me included.
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lesley_frater@hotmail.com | 29-Jan-2010 9:12 am
It is not in the governments plan nor any organization that depends on their support for ANP to be a priority. To ensure that Darzi can continue as planned, walk-in-centres need to be staffed by nurses with training that is short and unregulated, yes they may be working at an advanced level but they need the theory that supports an advanced position. We all know that nursing is advancing but the public have to be protected by nurses using the title but who have not got the knowledge nor the skills! I'm disgusted but not surprised at the MNC!
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Anonymous | 29-Jan-2010 9:46 am
As a Specialist Nurse half way through an MSc, I realise that my practice has been enhanced far more over the years by the education I have undertaken OUTSIDE this pathway. Masterclasses, clinically focussed conferences, study days and courses, often supported by Pharma companies, have been far more relevant to my present role, and I would consider myself unqualified to be a specialist if I relied solely on the so-called gold standard of obtaining an MSc. The MSc has taught me to write a stunning essay, and quote everyone else who has written on the subject but parrotting other's work is no substitute for knowing exactly what to prescribe to a patient in crisis, and manage their clinical and emotional needs.
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tim hartley | 29-Jan-2010 10:59 am
I find the 2 latest responses interesting. Accurate and safe walk-in centre nursing involves a broad spectrum of experience and clinical knowledge and a lot of the time patients with complex health issues who CANNOT get in to see their GP come to the wic instead. Short and unregulated training would often make it impossible for their needs to be addressed in this environment and I think a lot of wic staff would be offended to be looked upon like this. I appreciate that it may not have been intended to come across in this way. As for the msc, it shows the need for shared academic/practical training to bridge theory/practice gaps. This has reflected since 'traditional training' was dissolved what seems like many moons ago now. Specialst practitioners are needed in every clinical area- not least NHS wic establishments.
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Ezesomaga Ejimogu | 29-Jan-2010 12:54 pm
To the respondent 'Anonymous | 28-Jan-2010 11:07 am. You are a highly skilled nurse but not an ANP because you do not have the requisite post gaduate qualification. Take for instance, a highly skilled nursing assistant, is she a nurse? There is no such thing as an 'ordinary nurse' if I may add.

It is saddening and frightening that some feel that a Masters degree only teaches one to write a ''stunning essay''. Well, the old saying goes; 'you can take a horse to the stream, but you can't force a horse to drink'. Maybe we should find ways of selecting only the horses that want to drink before taking them to the stream. Or may be we should find out which stream the horse likes, in advance. Otherwise we waste resources.

I say, let us sack the professors and shut down the universities, and send everyone who wants to be a nurse to the hospitals and let them muddle through. They and the patients will be alright. Let us burn the thousands of research work and theories on nursing which have contributed to improved patient care. All of the aforementioned have come through advanced learning by nurses.

Not regulating the role of ANP allows the employers to exercise pregudice, favouritism, and nepotism. And of course, incommensurate remuneration It stifles the ambitions of hardworking nurses who may intend making the effort to train at a higher level in order to expand their minds, and subsequently pass on their skills to other nurses. It allows for a bastardization of the role of ANP, and compromises patient safety.

On the other hand, regulating this role establishes a uniform standard, and wins patient's trust and respect. And we all know how the latter two contribute to patients' adherence to treatment.

Not regulating this role runs counter to all that the NMC stands for.
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lesley_frater@hotmail.com | 29-Jan-2010 4:01 pm
To Time Hartley, concerning my comment regarding WIC staff. I of course should not have generalised regarding knowledge base of staff working in a WIC. But what I will reiterate is that just because they have extended skills does not make them Advanced Practitioners. That actually takes a degree if NP or MSc. It also takes years on continued study and autonomous practice!
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Anonymous | 1-Feb-2010 6:11 pm
I'm currently in my first year of an AP course and finding it a completely different ball park from any extended practice course I've done so far. It's a lot less about learning new tasks or skills, and actually quite hard to put my finger on something that I can feel I'm growing into but can't describe yet. Even though I've heard the NMC response regarding regulation issues and how they are apparently comfortable with the staus quo in relation to AP, I feel I'm heading into a medico-legal twighlight zone.
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Anonymous | 1-Feb-2010 10:52 pm
My comment regarding the essay writing component of the Masters programme has been a little misunderstood. I find it equally "frightening" that someone who has obtained a Masters may see this as the only qualification needed to practice as an ANP. My Masters pathway (in Clinical Practice) has definitely NOT given me the clinical skills I need to practice in my very specialist area - it is the specialist training, much obtained by undertaking courses designed for doctors actually, that has given me the competency to do this, in addition to the Masters pathway. My view is that a Masters alone is not enough, and that it gives the public and regulators a false sense of security. It does tick boxes though!
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adam WILLIAMS | 4-Feb-2010 6:30 pm
I find the NMC's decision here disappointing as I always feel something important shouldn't be put off just because it is difficult or hard to achieve.

As to the various other comments surrounding a Masters qualification not making a Nurse good by default. Of course not, the very nature of these courses are that the entry requirements are aimed at filtering those with extensive experience and a willingness to learn and develop their skills.

I believe Advanced Practice needs to be regulated, national standards drawn up, and it be registered on a separate part of the register, no matter how 'difficult' the process may be.

Let's take a leaf out of our Scottish colleagues books and star to create the frameworks. I'll start with an essential requirement being an MSc with at least five years clinical experience and probably add in the V300 as well.

As always, the comments by Ezesomaga Ejimogu are both welcome, thoughtful and extremely witty!

I just wonder why there seem to still be many around us that are sniping and snivelling at education! is it fear?

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Martin Gray | 11-Feb-2010 10:22 am
What is it about some nurses that you need a minimum of MSC to be able to do the ANP role; Adam Williams thinks this should be a MINIMUM standard, perhaps he is considering doing a PhD and sees this as what all nurses to aspire to.

I can't agree with all the comments made by Ezesomaga; in what way is a MSC better than a BSc with honours, except to writing longer essays and a lengthier dissertation with more references to others work? And I wonder just how many students do actually READ the full text of the references made in their bibliographies. Perhaps a Nurse Consultant should have a minimum of PhD with 10 years clinical experience, that would help sort the thirsty horses from those that are more like camels which drink enough to sustain them for long periods of time but are just as capable ofdoing the same job as a horse, sometimes even better.

To be able to prescriber a nurse must have that qualification recorded on their NMC record - why cannot the same be done for the ANP qualifications? The accredited universities can pass the details on to the NMC of those students that successfully pass the course, as they do with nurse prescribing. At least, in this simple way, any employer can check the NMC register on line and see at a glance if the nurse has the qualification claaimed and are in date to be able to practice at that level. It would also stop a lot of nurses calling themselves ANPs altogether as they will know their record can be checked; this check is better done on line as it will ensure people cannot present bogus degree certificates.

In some ways you could also consider this a form of regulation, although all the university courses would need to be using the same syllabus to be able to attain full regulation, along with a set criteria for registration of the ANP role continual development once qualified.

There is some re-invention of the wheel going on, and using different titles only masks the truth. HCAs could be classed as 2nd level nurses (like the old SEN) with study at diploma level while 1st level nurses are those that have attained a degree level of study.
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Anonymous | 18-Apr-2010 6:01 pm
Shameful jack-assery from the NMC who demonstrate once again that they exist to serve the requirements of the state and not the protection of the public.

The government don't want the role to be regulated - as Lesley Frater writes this is to satisfy the Darzi project and effectively dums down medicine (yes, your no longer nurses but what? ). What protection will you have in AFC when after the election when the butchery to the budget starts?

So the NMC don't feel any great urgency in forming a regulatory framework which would protect the public and the nurse. I though that's what the NMC was all about?

You believe that individual trusts can be left alone to regulate practice? When do trusts regulate anything but the monthly dictac from the ministry of health? In the current climate of cost cutting and disasters like Stafford I think your dreaming.
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Anonymous | 18-Apr-2010 6:07 pm
It's no surprise that the Royal College of Anaesthetists decided to go with their own PA role rather than belive that nursing could come up with anything credible.
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Anonymous | 19-Apr-2010 3:27 am
Martin, your right about the nurse consultant role. They should have 10 years credible experience, not 10 years in the same department. AND require a Phd. Not working towards one. It's not at all credible otherwise, just jobs for the girls. Many are called, few should be chosen.
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