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‘Major’ safety fears over lack of formal regulation for advanced nurse roles

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The lack of regulation of advanced nursing is a “major concern for public protection”, according to those involved in training staff for such roles.

Katrina Maclaine, chair of the Association of Advanced Practice Educators, said some nurses who were dismissed from university courses for failing to meet standards continued to call themselves advanced nurses and remain in their jobs.

“This is a major cause of concern for public protection”

Katrina Maclaine

Some advanced nurses were “unconsciously incompetent”, she told Health Service Journal.  

The association, a network of over 30 universities that train staff in advanced patient care, believes formal regulation of advanced nursing is needed to tackle the poor governance among employers.

Ms Maclaine’s comments follow the recent publication of research that suggested almost 600 separate job titles were being used by nurses working in advanced practice roles, with no clear link between their education level, competence or experience.

The study, led by nursing workforce expert Professor Alison Leary from London South Bank University, also revealed how hundreds of unregistered care staff were being given job titles describing them as “advanced nurses”.

Ms Maclaine, an associate professor in advanced nursing at the university, also contributed to the study.

Last week, England’s most senior nurses wrote to trusts recommending that nursing directors check if they were employing unqualified care staff with job titles describing them as “nurses”, in the wake of the research.

Ms Maclaine noted that members of her network had become increasingly concerned about advanced nursing regulation. She said: “A constant concern from course providers since the 1990s has been the lack of a regulatory framework.”

She also highlighted past proposals for a review on implementing a potential standard for advanced nursing practice. An application was made to the Privy Council in December 2005 to open a sub-part of the NMC register for advanced practice but was not taken forward. 

Likewise, the NMC’s predecessor, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, carried out a listening exercise to determine whether to set standards for advanced practice and, based on the results, made the decision in March 1997 not to do so.

Ms Maclaine said: “Many of us were hopeful with the Nursing and Midwifery Council proposals in 2005, as our experiences mounted of individuals coming on to our programmes who were already calling themselves ‘advanced nurse practitioners’ who were ‘unconsciously incompetent’.

“This highlighted the growing number of individuals who were using titles without any awareness of their lack of knowledge and skills,” she said. “With no requirement for education, this trend has increased significantly.”

“Regulation is the only mechanism for addressing both these very worrying circumstances”

Katrina Maclaine

She warned that another “extremely worrying” trend surrounded “students who we discontinue due to demonstrated incompetence and lack of adequate levels of knowledge”.

“We inform the employer. However, these students remain in their advanced practice posts in the workplace. This is a major cause of concern for public protection,” she told Health Service Journal.

“This obviously calls employer governance into question, but our members consider that regulation is the only mechanism for addressing both these very worrying circumstances,” said Ms Maclaine.

In the absence of formal regulation, the Royal College of Nursing recently launched a voluntary register for advanced nurses, as previously revealed by Nursing Times.

Nurses working in advanced roles are being encouraged to join the credentialing scheme launched by the RCN to provide them with “much-needed” recognition and to boost their career prospects.

As reported earlier this month, 51 nurses have so far received accreditation for working at an advanced level of practice through the new scheme that was piloted at the end of last year.

The college said a further 57 nurses were now having their applications assessed since the scheme officially launched in May.

In addition, government arm’s-length body Health Education England is working on an advanced clinical practice framework and apprenticeship training standards are being developed for advanced clinical practitioners separately by the Skills for Health organisation.

A draft version of the standards, published in June for consultation, revealed that trainees would potentially be taught at master’s level and be able to prescribe.

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Readers' comments (1)

  • Regulation for Advanced practitioners in nursing, midwifery and Allied Health professionals is long overdue. The changing face of practitioner roles is increasingly requiring increased knowledge and skills 'beyond the level of 'initial registration' and sometimes outside the remit of the base profession such as nursing and others. A framework for advanced practice is helpful however if this is not progressed and assessed in the context of 'proportionate risk' framework that is used by the Professional Standards Authority (in partnership with the NMC and HPC) it will not, on its own, prevent the inappropriate use of 'titles' described in this article. A move towards regulation needs to be taken seriously to enable the advanced roles to be fit for the future, safe and recognised by both the public and employers.

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