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Advanced clinical practitioner role offers senior nurses 'portability'

We should not view advanced practice as stealing from the nursing workforce to fill gaps in medical rotas

We should not view advanced practice as stealing from the nursing workforce to fill gaps in medical rotas


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Advanced clinical practice has had a buzz around it. This started with the multi-professional framework for advanced clinical practice released by Health Education England (HEE) in 2017 and continued challenges in workforce planning. 

We must remember though, that advanced practice is not a new concept in the NHS. In emergency care we have had emergency nurse practitioners (ENPs) for decades. Similar concerns about blurred boundaries, clinical competence and taking senior nurses away from nursing were all muted way back then. 

Emergency care's advanced clinical practitioner (ACP) role, backed by the Royal College of Emergency Medicine (RCEM) curriculum and credentialing, has sparked similar debate, but it is a fantastic option for senior nurses and paramedics. It enables senior staff members to continue in a patient-facing role, keeping the knowledge and skills they have gained through many years of practice in the emergency department (ED).

The ability to do more for patients by developing advanced clinical skills is often a driver for nurses that comes up in interview processes. The ACP role allows for this, with career progression and development of the pillars of advanced practice: clinical, education, management and leadership, and research. 

Risk of burnout

We should not see the ACP as a role to solely fill gaps in medical rotas. These clinicians come with a wealth of knowledge and experience: their job plans as qualified and credentialed ACPs should allow involvement in leadership, education and research. 

However, with the pressures of a busy ED and without a varied job plan, these ACPs will be at risk of burnout. With this comes a risk that we lose good clinicians from practice altogether in a time where they are in such great demand. Concerns have been raised by senior emergency nurses that the ACP post poses a risk to ENP services – the mainstay in the workforce for minor injuries in ED and minor injury units. 

The ENP role is a great way for nurses to advance their practice skills: not every ENP will want to become an ACP, nor will there be enough funding and clinical supervision for this to happen. 

However, becoming an ENP is often a good starting point to develop these skills and may be a useful route into an ACP role for some. I have seen ACPs who have come with or without an ENP background and have become brilliant clinical practitioners.

Call for regulation

I hear the issue of regulation mentioned almost daily; the call for regulation for advanced practice has been debated for decades, and continues. The work of the RCN and RCEM credentialing can certainly be seen as an effective way to begin to standardise advanced level practice. This allows clinical competence and academic preparation to be articulated alongside the pillars of advanced practice to highlight that clinicians are fulfilling the requirements of the HEE ACP framework. 

The RCEM portfolio gives ACPs the portability, if they desire, to move departments with employers knowing they have achieved the recognised standard of practice. 

Emergency care's ACPs are coming from regulated professions, it is vital that we don’t lose sight of our nursing professional background; the regulators won’t if a fitness to practice query is raised against an ACP. 

I leave you with two questions: who should regulate advanced clinical practice given it is a level of practice? And do we really need regulation? They are conundrums that I don’t think I have the answer to.

Further information

Health Education England: Multi-professional framework for England


About the author

George Stephens is senior advanced clinical practitioner at Cambridge University Hospitals NHS Foundation Trust

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