Creating national standards for advanced nursing will put an end to the “devaluing” of staff and ensure their skills are recognised equally by all employers, those behind the work have told Nursing Times.
Senior members of Health Education England (HEE) have spoken to Nursing Times about their recently revealed plans to enhance the role of the advanced clinical practitioner (ACP) and standardise education programmes through a new virtual “academy”.
“We want to have some commonality of standards and skills at a set level”
They said the move would also provide opportunities to empower mores nurses to step up into senior decision-making posts at a time of when there were also doctor shortages without taking them away from the frontline.
Under the current fragmented system, nurses trained in advanced practice have sometimes been asked to drop down a band when moving jobs because the qualification did not hold as much weight in the new organisation.
Historical confusion over the role led to HEE developing the first ever national multi-professional framework in 2017 to introduce consistency, clarity and shared understanding around ACP. ACPs are educated to master’s level and the framework sets out four pillars that underpin the practice – skills, leadership and management, education and research.
However, there was still variation between education programmes depending on their location, said John Clark, region chief nurse and head of allied health professions for HEE’s Midlands and East region and senior responsible officer for ACP.
“The vast majority of advanced practice courses that are out there are run by universities,” he said. “Universities are independent businesses, and they compete against each other and they work with their local system and their local stakeholders to develop courses that their local system then wants to buy.
“We are not questioning at all that a master’s from one university is better than a master’s from another university, the master’s levelness we absolutely accept is well established. Universities have got systems and processes in the place to ensure that happens,” he told Nursing Times.
“The challenge as far as the public are concerned is they want to know who is seeing them”
He said: “What we are not sure about is, if you did an advanced practice for nurses working in a general surgical ward, say, in Suffolk, whether that would give the practitioner exactly the same skills and be working at the same level as somebody that did the masters in surgical nursing in Gloucester, for example, because the systems are different.
So, until we have the framework and until we can start to benchmark them all against each other, we have been unable to do that,” he said. “So that’s what we really want to do, we want to have some commonality of standards and skills at a set level.”
Beverley Harden, associate director of education and quality at HEE and ACP lead, said the current fragmentation between courses created an “immobile workforce” which was unable to move smoothly between organisations.
“We can’t translate their skills easily, so often they will move job and will have to go down a band or two to then prove themselves again to then climb back up again, which they report feels very devaluing and is tricky,” said Ms Harden.
“We want a systematic way of developing the workforce,” she said. “So we have more numbers, more understanding, more use of this role, and therefore more presence of this role in the system.”
Mr Clark said there was “huge demand” for ACPs of all types across the health service and that the current infrastructure needed to be revamped to enable the role to be “scaled up”.
The new academy could also take on the role of accrediting ACP courses and establish a database of professionals.
Mr Clark explained that the benefits to an employer of having ACPs on a team included the ability to help ease doctor shortages by carrying out senior clinical duties and to improve retention by enabling staff to advance in their careers without leaving the frontline.
“Quite frankly, we don’t have enough senior decision-makers and ACPs who are going to be able to take fairly heavy weight senior clinical decision in their own right,” he said. “Working as part of a team, they will be able to work interchangeably with lots of professions, in particular, the doctors and the doctors in training.
“We don’t have enough doctors, senior decisions makers looking after patients at the moment,” he said. “ACPs provide us with an opportunity to increase patient safety by providing a skilled workforce that can do some of that.”
He added: “We’ve also got a problem with retention, because clinical staff don’t have a clear career pathway and it’s actually really difficult if you are an incredibly passionate clinician that doesn’t want to leave the patient or service user’s bedside and get sucked into management or education to be able to stay in a clinical role, so this provides a real opportunity for us to develop and retain our clinical staff in clinically facing posts.”
Ms Harden said advanced clinical practice also provided a “beautiful mid-career modernisation opportunity” for nurses who may have trained some time ago and allow people to then take the next steps to become a consultant.
She said: “The beauty of this piece of work is that it starts to create a really solid foundation in the middle of a career journey, which then can also start advert one’s eyes to what that consultant opportunities offer.
“It gives us some really interesting stepping stones and the ability to develop people over time in a really considered way – we haven’t had that ability to see a career path ahead of one, we’ve sort of hiccupped through our careers rather than have a really good way of seeing how we can self-actualise,” she said.
“It’s about giving them the skills and the ability to evidence their ability to work at that level and there’s a case of how that translates into jobs in the system and how people then work and operate,” she told Nursing Times.
Although the aim of the academy is to create more standardisation among ACP education, Ms Harden said that it would not be a “one size fits all” and would still take account of independent professions and specialisms.
She highlighted that, as part of the work, leaders were reviewing the titles used be ACPs who were also specialists, admitting that the language had become “muddled”. “We have huge numbers of highly valued workforce who proudly use the title of specialist nurse or whatever it might, but the question is not what is your title, what is the level of practice you are operating at, and one of the key bits of housekeeping we are going to need to do through this work is understand the system’s appetite to say actually if you are a specialist working at an advanced level of practice, what is your title therefore?,” Ms Harden said.
She added: “The challenge as far as the public are concerned is they want to know who is seeing them and who has a right to operate in a way they are not used to those people operating in. Let’s get to a place in our lexicon to enable the public to understand who is seeing them and help with the acceptable and adoption and spread of what is a real self-actualising role for our clinical staff.”
Mr Clark said there were also plans to establish a “harmonised” system of revalidation for all ACPs from different disciplines. While nurses already have to revalidate, other staff such as allied health professionals and pharmacists do not.
“We need to make sure that once these ACPs are qualified and working in the system that they have the appropriate support systems and the infrastructure put in place that enables them to continue to be the very best professionals that they can be at an advanced level, and we don’t have that at the moment and that’s one the things we need to look at,” he said.
HEE is “co-producing” the academy with system partners including regulators, higher education institutions, professional bodies and royal colleges. The Council of Deans of Health is a key player in the agenda. Ms Harden noted that the work was based on “absolute collaboration”, rather than “competition”, but acknowledged that the decisions may not be liked by all.
“It’s a difficult and emotionally charged agenda and it’s how we do that with integrity and not be buffeted by individual or individual professional or sector needs,” she said.
Ms Harden told Nursing Times that further developments on the academy were expected early in 2019.