Careful planning is vital for the next generation of emergency care clinicians

Reflection and forward planning would help nurture the emergency care clinicians of the future rather than stifling them with what is expedient

Reflection and forward planning would help nurture the emergency care clinicians of the future rather than stifling them with what is expedient

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I am an advocate of role development and the establishment of independent non-medical roles in urgent and emergency care.

I’m old enough to remember a time when ambulance technicians did little more than ferry patients to the ‘casualty’ department to be undressed and have their basic observations taken by a staff nurse or state enrolled nurse and then wait to be seen.

Those were the days when a patient with a fractured neck of femur might have to wait several hours in a waiting room.

In my classroom I have nurses, paramedics, physiotherapists and pharmacists who are hell-bent on taking on a more independent role in practice, to the extent that about 75% of the cohort are self-funding and undertaking their studies in their own time.

Scramble for advancing practice

While as a wizened old boffin I generally have nothing but admiration – and a little envy – for this youthful zeal, I have started to have some reservations about the scramble for advancing practice in urgent and emergency care.

The role of the advanced clinical practitioner (ACP) was well-fostered and nurtured initially in places such as the Heart of England NHS Foundation Trust, but regional rollout seems to be less well-prepared.

The role of the ACP in primary and secondary care seems to be poorly defined, poorly planned and based on expedience rather than professional development.

Core skills for the specialist

Because the service requirements of the role are so diverse there is concern that the content of the master’s level awards that are the educational bedrock for practice is too generic and does not always provide the core skills for specialist practice that the student requires.

The needs of a paramedic, pharmacist nurse or physiotherapist often overlap but they are just as often critically different, and a one-size-fits-all approach to advanced practice can be counterproductive.

The role is sometimes filled by ambitious individuals who aspire to great heights but are professionally and educationally unprepared to undertake the role effectively.

A certain degree of professional experience and undergraduate-level learning is critical to the success of the role. Without this individuals struggle, are seen to fail and the whole service may be called into question.

Shortcuts and career ladders

In addition, there is little in the way of a career framework for ACPs, which will limit the effectiveness of the role at some point.

Where does the experienced ACP go? There is no shortcut to other disciplines and there is no career ladder once an ACP has exhausted the incremental values at bands 6, 7 or 8a.

The voracious and increasing appetite of service demands never seems to be satisfied and often drives innovation in practice more than anything else.

However, I sincerely believe that a period of reflection and forward planning would help in nurturing the aspirations of the next generation of emergency care clinicians rather than stifling them with what is merely expedient.

James Bethel is senior lecturer and advanced nurse practitioner, University of Wolverhampton, and a member of the Emergency Nurse advisory board




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