Advanced practice courses in children's nursing are booming but budget cuts could threaten their future
London South Bank University's RCN-accredited advanced nurse practitioner course has seen numbers nearly double over the past three years and many predict a role for community nurses in light of the lack of child health-trained professionals in general practice. Places could be threatened by imminent funding cuts although a scheme by some NHS trusts to offer advanced clinical practice as an apprenticeship could be the answer.
London South Bank University's RCN-accredited advanced nurse practitioner course is creating new opportunities for children's nurses.
Vicky Nash has been busy. She runs London South Bank University’s children’s advanced nurse practitioner course – the only Royal College of Nursing-accredited MSc dedicated to children in the UK.
Over the past three years the numbers of students taking part has almost doubled from 40 a year to 75. ‘The interest has been phenomenal,’ says Ms Nash. ‘We’ve got people coming from all over. There is one student who flies in from Belfast each week.
‘We get some nurses funding themselves. But NHS trusts are putting in money too – either paying for the full cost of the course or part-funding it with the nurses.
‘NHS trusts see the value in this. They want to develop nurse-led services – especially in emergency departments – and they realise it is good for staff motivation and retention. We are seeing more community nurses too.’
The course, which costs just under £10,000, takes between three and six years to complete, with students normally spending one day a week on the course, splitting the day between study and clinical practice. A range of modules have to be completed and these include applied clinical physiology, managing complex conditions and research. There is also an optional module available in non-medical prescribing.
In the past three years, the number of students doing the ANP course at the university has risen from 40 to 75
Ms Nash says she sees a variety of different nurses applying to take part, from those with just a few years experience through to clinical nurse specialists with many years behind them. The minimum amount of experience they are willing to accept is three years, although Ms Nash advises ‘five is best’.
Rise in demand
But London South Bank University is not the only place to have seen a rise in demand. While the university is the only RCN-accredited centre to have a dedicated children’s course, there are more than 30 universities running general advanced nursing courses that children’s nurses can apply to.
Most have seen the numbers taking part increase, says Association of Advanced Practice Educators chair Katrina MacLaine. ‘There are several things driving this. Patients have increasingly complex conditions – and that is the same for children – so it is recognition that nurses need this skill set.’
But she also says it is beneficial for patients. ‘They get the right care at the right time. If the nurse can assess, diagnose and prescribe it means patients get that care more quickly than if you are waiting for doctors.’
Cost of three to six year ANP course at London South Bank University
Research supports this. A review, led by Sheffield Hallam University and published in the Journal of Advanced Nursing in 2014, found advanced nurse practitioners working in hospitals had a ‘positive impact on experience, outcomes and safety’. In particular it said there was evidence they were more likely to pick up problems with care and patient deterioration and provided better continuity of care.
Ms MacLaine says: ‘It annoys me when people say we are creating mini-doctors. Yes, there are shortages of doctors and expanding the skills of nurses like this is a necessity. But that doesn’t mean it’s not good for the patient.’
So what’s next? Ms MacLaine believes there are ‘real opportunities’ to expand the numbers of advanced children’s nurses working in the community, in particular as part of NHS England’s Five-Year Forward View. ‘Children are one of the biggest users of general practice, but practice nurses do not always have the skills to treat children.’
But she is concerned about money. ‘Some of the rise we’ve seen is down to funding that has been provided by Health Education England for advanced practice. But that will stop in September because of the cuts. Will we see such numbers coming forward? Possibly not – and that would be a shame.’
However, there are moves afoot to combat this. A group of NHS trusts, including London’s Great Ormond Street Hospital, is looking to get advanced clinical practice recognised as an apprenticeship. If that happens it could help unlock funding.
Meanwhile, the RCN is about to launch its credentialing scheme, giving nurses working at an advanced level the opportunity to become accredited for the first time, while Health Education England is developing a multi-professional advanced clinical practice framework.
Fee for RCN accreditation
RCN head of nursing practice Wendy Preston believes this could benefit children’s nurses in particular. ‘We now have tens of thousands of nurses working at an advanced level. But it has happened without any consistency and so we have different practices in different places. ‘For the first time we are establishing the bar for what advanced nursing practice is. It will help establish what their roles and responsibilities should be – that can vary a lot particularly in children’s nursing.’
Credentialing: what’s it all about?
Credentialing is an RCN accreditation scheme for nurses working at an advanced practitioner level. It will formally roll-out from late April after careful piloting over recent months.
The scheme will be open to nurses who have a master's degree in advanced nursing. Transitional arrangements have also been put in place for those who do not have a master's degree, but have other qualifications or who have been working at a master's level already. They will have until 2020 to submit evidence of their roles and gain accreditation.
The fee for credentialing – which will last three years before it has to be carried out again – will be £275.
The RCN believes it will develop a ‘formal recognition of high-quality, advanced-level practice’ and help develop a ‘comprehensive career pathway’ for experienced staff.
Advanced nursing: how nurses in Liverpool are leading the way
Liverpool’s Smithdown NHS walk-in centre for children is entirely nurse-led and treats children with minor injuries and illnesses from asthma attacks to bumps and bruises.
There are four advanced nurse practitioners supported by 11 nurse practitioners.
The team has access to X-ray facilities and can assess, diagnose and treat more than nine in ten patients who come through their doors. If it did not exist, a third of patients report they would have gone to an emergency department instead, while 15% would have gone to a GP.
Hayley Lally, one of the advanced nurse practitioners at the unit, says: ‘Parents value our expertise. They know they will be seen quickly and we have the skills and knowledge to treat their children.’
Ms Lally has worked for Smithdown, which is run by Liverpool Community Health NHS Trust, for the past 12 years, the last four as an advanced nurse practitioner.
She gained a master's degree in advanced nursing practice at Liverpool John Moores University.
She says: ‘I would urge any nurse who gets the opportunity to do it. It is great for career progression and for the service you can provide to patients. Healthcare is changing and nurses have a crucial role to play.’
Nick Evans is a freelance health writer