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Advanced practice is here to stay – but does it mean leaving nursing behind?

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Advanced nurse practitioners are having a moment. This week a milestone was reached: the first national training framework for all health and care professionals working at an advanced level was published.

There have also been indications the Nursing and Midwifery Council would consider regulating ANPs. (NMC chief executive Jackie Smith told a group of MPs this week that the regulator believes a debate on the issue is needed.)

Earlier this year the Royal College of Nursing launched the first (voluntary) accreditation scheme for nurses working at an advanced level.

And national workforce planners are paying increasing attention to the contribution of advanced clinical practitioners from all disciplines; just last month it was announced A&E departments are set to train more under proposals to improve emergency care staffing.

At a debate in London this week, one of the nurses who runs the esteemed nurse-led Cuckoo Lane Surgery in the west of the city pointed out that “nurses are now beginning to legitimise advanced practice”.

The implications of this are great for those who want to enhance the care they can provide – but what about those who believe a shift towards advanced practice takes the profession further away from the core of nursing?

“When does advanced clinical practice stop being nursing?”

This was the key issue debated at London South Bank University: when does advanced clinical practice stop being nursing?

NHS Improvement’s Professor Mark Radford argued nurses working at this level had rightly blurred the clinical boundaries between the two professions: “The idea that medicine has primacy over nursing has been shattered by examples in advanced practice,” he said.

The difference between the professions at this level was more to do with the way people worked, rather than the care they delivered, he said.

So when can advanced practice no longer be considered nursing? “The point at which an advanced practitioner appropriates medical power by taking on skills that they think elevates their status within their organisation,” said Professor Radford.

Carol Sears, joint director of Cuckoo Lane Surgery, said ANPs at her practice were “nurses to the core of our professional identity”.

She argued advanced practice was not new; it had been around for years, just not recognised.

Her mother had worked at an advanced level as a nurse, she noted – on a burns unit after World War Two, and later as a district nurse, and then in A&E.

“Why have professionals working in this area not been given the same funding and training opportunities as other roles?”

“But as we have become more and more experienced and more expert practitioners, it’s not always been recognised or respected for what it is,” she said. “Now we are beginning to legitimise that expert practice,” she added.

Advanced practice had always been, and continues to be, a way of building on traditional nursing skills, as opposed to replacing them, she said.

At Cuckoo Lane - where nurses had done this by building diagnostics and prescribing into their practice - “we are not trying to be mini doctors, we are just providing what patients need in primary care,” she said.

The debate moved on to a vast range of issues that all seemed to come back to the difficulty of defining exactly what advanced practice is and where its limits lie. For instance, what are the implications for ANPs potentially being used to fill doctor shortfalls? Is there a risk to patient safety without regulation? Why have professionals working in this area not been given the same funding and training opportunities as other roles?

But the audience of nurses was clear on one thing, as shown by the applause given to an ANP in the room who summed up his position: “I don’t feel I’ve ever stopped being a nurse. I do all of the things that would previously have been seen as a medical role – with the heart of a nurse.”


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