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


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)

  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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    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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  • 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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  • 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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  • 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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