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Advanced nurses get standards but still wait for regulation


Patient safety concerns have pushed the government into publishing the first set of standards for advanced nurse practitioners.

However, there are already concerns that the non-mandatory guidance lacks teeth and will be ignored by some practitioners in the absence of formal regulation of advanced practice.

We have a huge workforce and there are many people who don’t recognise they need to do any learning, but just call themselves an advanced practitioner

The Department of Health position statement was published last week in an effort to address concerns that some nurses were carrying out complex and high level tasks without adequate skills and training - potentially with safety risks - and public confusion over the many advanced roles and titles.

The statement, which applies only to England, lists 28 elements, which, it says, “must be demonstrable within the [advanced] nurse’s current role” (See box).

It says it will “enhance patient safety and the delivery of high quality care by supporting local governance, assisting in good employment practices and encouraging consistency in the development of roles and posts”.

Chief nursing officer for England Dame Christine Beasley told Nursing Times: “It is a benchmark, and [about] giving people a toolkit to think about advanced practice.

“We want to minimise the titles that patients tell us they hate so much. Nurses are obsessed with titles. To our patients, we would be better off if we stuck to a few titles.”

Two of those involved in the DH review group told Nursing Times the statement would be more powerful if backed by Nursing and Midwifery Council regulation of advanced practice.

Royal College of Nursing head of nursing department Steve Jamieson, a member of the DH statement review steering group, said employers should use the standards to plan their workforce, but how far it was applied would depend on regulation and therefore the NMC.

At present, the nursing register does not distinguish between advanced nurses and other roles. The NMC has commissioned a review of the issue but it is not clear if regulation will follow this.

NMC chief executive and registrar professor Dickon Weir-Hughes told Nursing Times he expected a draft version of the review results to go before the NMC council sometime in the first half of next year.

Professor Weir-Hughes said: “There is nothing in it [the DH statement] that will conflict with what we are going to do.”

He added: “This is a really helpful statement… it has clarified their [the DH’s] position in terms of what the NMC might decide to do next.”

However, Mr Jamieson warned the standards could not be enforced “until the NMC do their piece of work”.

He said in the meantime some nurses should seek additional skills and training so they met the standards, but he did not expect people to be stripped of titles.

He said: “A lot of nurses at that level we know are competent and doing a really good job. This is not about taking these roles away from them.”

Katrina Maclaine, deputy head of the primary and social care department and principal lecturer in advanced nursing at London South Bank University, also sat on the review steering group. She said she hoped employers and nurses applied the new standards and that she saw it as a “useful first step” towards regulation.

She said: “In England, we have got a huge workforce and there are many people who don’t recognise they need to do any learning, but just call themselves an advanced practitioner.

“[The standard document] is not mandatory…. The government is reluctant to say, ‘everyone should abide by this timetable’, but hopefully this will provide a useful framework. This is a useful first step.”

The report of the former Prime Minister’s Commission on the Future of Nursing and Midwifery - published in March - said the public would be “not adequately protected” until the issue of advanced regulation was “adequately resolved”.

The report, by a team of nursing leaders, said the public “were often unclear about what skills and competencies they could expect from individual nurses and support workers, exacerbated by the plethora of job titles and role descriptions”.

Council for Healthcare Regulatory Excellence chief executive Harry Cayton said he did not believe regulation was needed.

He said: “We consider this to be a professional matter rather than regulatory. You should only regulate when you have a new risk to manage, not to define professional boundaries.”

What do the standards contain?

The DH statement includes 28 standards including the following. Nurses should:

  • Identify and implement systems to promote their contribution and demonstrate the impact of advanced level nursing to the healthcare team and the wider health and social care sector
  • Continually evaluate and audit the practice of self and others at individual and systems levels, selecting and applying valid and reliable approaches and methods that are appropriate to needs and context, and acting on the findings
  • Have high level communication skills and contribute to the development of those in their area of practice by publicising and disseminating their work through presentations at conferences and articles in the professional press

Readers' comments (3)

  • Adedapo Haastrup

    I don't believe this regulation is needed for such a large workforce as ours.I personally I 'm considering this to be a professional matter other than needing regulations and I think when the practice of some Nurses need some new risk managements The Nursing Profession as a whole does not need to be subjected to professional restrictions there by hindering growth and discouraging new recruits.

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  • Does this make ANPs academics first rather than nurses. Are these recommendations doctors have to "adhere" to. I appreciate the evolvement of the role but surely the purpose of ANPs is to act as a hybrid role between nursing and medicine. This sounds more like a nurse consultant role. I would want to be practising not researching and would like my actions to demonstrate my impact. I accept at this level there would be a need to ensure that practise is current and evidence based but please don't let the emphasis be removed from direct care as a primary function and leave research, predominantly, in the realm of academics who choose to follow that route.

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  • Mr. Harry Cayton may be correct, in his appeal to narrow- minded thinkers. Nursing and midwifery councils have the responsibility to regulate the scope of nursing practice and in that respect defining the professional boundaries of our practice at the various levels and titles. These regulations may serve as guidelines, in retrospect to incidents or research findings ( and especially for risk management), as well as,a proactive role in our professional conduct. I believe regulations of advanced nursing practice do not restrict us, rather they offer choices in our scope of practice, providing nurses with the principal tools to step up our game. I want to be an advanced nursing practitioner and to be aware of regulations governing scope of practice, while maintaining the standards required of me.
    Yes, the NMC council can and should deal with this as both a professional and regulatory matter.

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