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ROLE MODEL

'Advanced practitioners have to be developed - it is a long journey'

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Martin Carberry’s education programme is revolutionising critical care, as Laura Armstrong has discovered

Martin Carberry, consultant nurse in NHS Lanarkshire, is pioneering the advanced nurse practitioner in critical care (ANPCC) role. There is only one such fully trained practitioner in the UK, so Mr Carberry set up an educational and professional development programme to change that.

As junior doctors’ hours have reduced, the role of advanced nurse practitioners has expanded but they don’t always fulfil their potential. Mr Carberry saw the need for an ANPCC role in 2005, when he shadowed junior doctors.

“The task was to establish what work skills they have that another person could do to support them. Would it have to be a doctor or could another member of clinical staff do the job?”

He found that 80% of the work done by junior medical staff in intensive care could be done by an ANPCC.

“The prescribing role took a lot of time. It was a lot of work that other staff could do,” he says. An ANPCC could do it with training so, based on observations in the hospital, Mr Carberry helped create a curriculum.

“We looked at assessments and what competency programme would train ANPCCs to support the medical team. It was informed by work in the Department of Health, with a little help from NHS Scotland. National Education Scotland helped with recruitment assessment, but it was mostly done with the health board and local university.”

Recruitment occurred in Lanarkshire and applicants went through three stages, including psychometric testing, a clinical exam and competency-based interview.

“We wanted to make sure they felt confident and were appropriate. It was very effective - we’ve proven that with retention rates.”

After this was completed in 2008, the first programme started with five trainees. Laura Armstrong, an advanced nurse practitioner trainee at Hairmyres Hospital in Lanarkshire, will be one of the first five graduates, each of whom will come out with an advanced practice qualification and a master’s degree. Three ANPCCs will follow in the next year.

Through extensive classes and clinical practice, trainees improve their knowledge and skills over two or three years. As Mr Carberry explains: “They have to be developed to do the role; it is a long journey and quite demanding. Every week they develop crucial skills in a competency framework of advanced assessment and clinical management.”

The programme offers university education in non-medical prescribing and a comprehensive clinical competency framework. The trainees assess and plan clinical management of critically ill patients and learn advanced techniques through three modules. A consultant mentor coaches them through the process.

“[Trainees] keep skills and retain nursing experience in critical care - it is career development. They fulfil their potential for a more advanced role,” Mr Carberry says. Ms Armstrong agrees: “It’s given me more in-depth knowledge and skills; my confidence has increased.”

She goes on to say: “My day-to-day role means doing many tasks associated with medical staff, like physical examination, treatment planning, prescribing and practical procedures such as arterial and central venous catheterisation.” As such, the ANPCCs took over part of the junior doctors’ work and their acceptance by the team was sometimes difficult; competition created negative attitudes.

“It’s been challenging; everyone was unsure what our role was and some had a hard time accepting us,” Ms Armstrong says. “I struggled to get into the role for about six months but, once I got over those challenges and was accepted, it got better. Others started saying the unit couldn’t run without us.”

Similar programmes are being developed elsewhere in the UK.

“We want to have a national curriculum with transferable standards,” says Mr Carberry, so a trainee practising in one area can train and practise in another.

“Many boards in Scotland are interested. There’s demand to modernise the critical care workforce. I hope to see nationally agreed education and development in place.”

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Readers' comments (2)

  • The ANP role is going to grow & grow. I cannot wait to commence my training.

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  • This is both sensible, and also it is definitely within the territory where the boundaries between nurses and doctors are beginning to become blurry.
    An experienced ANP would, logic suggests, often be a 'better bet for the patient' than a fresh F1 would be.
    I cannot help thinking, despite the difference in traditional nursing and medical 'roles and mindsets', that at some future time it might be possible for those advanced nurses who wish to, to undergo relatively limited further training and to then 'morph into a variety of doctor, who carry the title of doctor' - but I could be wrong, about that.

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