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Additional regulation of advanced nurses would be ‘unwieldy’, says RCN leader

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The head of the Royal College of Nursing has questioned whether additional regulation for nurses wanting to work at an advanced level on top of that required to be on the register is necessary, stating that a professional body is better suited to setting voluntary standards for such roles.

As has often been highlighted, there is currently no restriction on the use of advanced nursing titles and there are no national competency standards for the role set by the UK’s nursing regulator.

“I don’t know why you would want to increase regulation…It’s expensive for the nurse, unwieldy”

Janet Davies

In recent months there have been calls for specific regulation of nurses working at this higher level of practice, after research revealed hundreds of unregistered care staff were working in NHS roles under advanced or specialist nursing titles.

The chief executive of the nursing regulator, the Nursing and Midwifery Council, told the health select committee at the end of last year that a debate on the issue was needed.

The RCN’s chief executive and general secretary, Janet Davies, said this week that, while not “particularly” opposed to the possibility of the NMC introducing extra regulation for the use of advanced nursing titles, she thought it preferable for the RCN to help ensure nurses were qualified to work at this level.

Last year, the college launched a voluntary credentialing scheme for advanced nurses, which involves assessing their qualifications, experience and competence to decide whether they should be working at a higher level.

The college states applicants must have a relevant master’s qualification, non-medical prescribing rights and an active membership of the NMC in order to receive accreditation.

She said the RCN had made the decision for voluntary credentialing of advanced practitioners as a way in which individuals and organisations could be sure of standards, competence and level of education – but noted it should not be confused with fitness to practise and regulation.

Ms Davies said any further move to introduce compulsory regulation by the NMC on top of that required to be a nurse would be expensive for advanced nurses and would be potentially “unwieldy”. It could also prevent innovation in practice based on patient need rather than a nurse’s position, she suggested.

In addition, there was already an over-arching fitness to practise process for those who acted outside of their competence, because all nurses were regulated by the NMC anyway, she noted. “I don’t know why you would want to increase regulation,” she said.

“It’s expensive for the nurse, unwieldy, and doesn’t involve fitness to practise due to the fact you are already covered because you are still following the code as an advanced practitioner,” she told Nursing Times.

She emphasised that nurses were regulated as nurses, in the same way as doctors were regulated as doctors. The regulator oversees fitness to practise regardless of their position or role, she noted.

“We think credentialing is good because it shows what standard you should be at,” added Ms Davies, referring to the college’s own scheme, but also highlighting that it was down to employers to ensure that standards were ultimately met.

“The scheme helps employers and it helps individuals. It gives them that reassurance they are working at that level, that they’ve got those competences,” she said. “That’s very different to FtP, which the NMC is doing.” 

“You couldn’t have [training] standards as such because it would be restrictive”

Janet Davies

When asked whether it was beneficial for the NMC to regulate advanced nurses because it would ensure all training was standardised, she said: “You wouldn’t want to do that, that would be ridiculous, because you’ve got so many different specialties you couldn’t have one level. It’s got to be flexible.”

“You couldn’t have [training] standards as such, because it would be restrictive,” she said. “It would be very different for someone working on the street with a homeless person compared with someone working in genetics, for example.”

Ms Davies was speaking to Nursing Times on Tuesday at the University of Salford’s Future of Nursing conference.

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Readers' comments (1)

  • I am delighted the issue of advanced practice regulation is formally being reviewed by the NMC.
    With all due respect to the RCNs concern about about higher NMC fees for these nurses; may I ask how much RCN credentialing costs the nurse?

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