Comment

We need a national standard for advanced clinical practice

Health Education England is devising a framework to ensure common understanding and consistency of advanced practice.

Health Education England is devising a framework to ensure common understanding and consistency of advanced practice.

Advanced clinical practice is increasingly heralded as one of the solutions to the workforce and financial challenges in healthcare systems. Expectations are high and policy directives explicitly or implicitly call for healthcare professionals to apply advanced-level knowledge and skills to the delivery of timely, individualised, safe and effective care for patients with complex needs.

Yet, 30 years on from the introduction of the nurse practitioner role, England has not set a nationwide standard for advanced clinical practice. This means England lags behind Northern Ireland, Scotland and Wales in the UK, as well as Australia, Canada, Ireland, New Zealand, Spain and the US.

Ensuring safety

This matters because setting

...

Health Education England is devising a framework to ensure common understanding and consistency of advanced practice.


Setting a national standard would clarify the steps needed to work at an advanced level
Picture: Alamy

Advanced clinical practice is increasingly heralded as one of the solutions to the workforce and financial challenges in healthcare systems. Expectations are high and policy directives explicitly or implicitly call for healthcare professionals to apply advanced-level knowledge and skills to the delivery of timely, individualised, safe and effective care for patients with complex needs.

Yet, 30 years on from the introduction of the nurse practitioner role, England has not set a nationwide standard for advanced clinical practice. This means England lags behind Northern Ireland, Scotland and Wales in the UK, as well as Australia, Canada, Ireland, New Zealand, Spain and the US.

Ensuring safety

This matters because setting such a standard is needed to ensure safe and high-quality care. Many healthcare professionals call themselves nurse practitioners, advanced nurse practitioners or advanced clinical practitioners, and work with an expanded scope of practice, yet have undertaken no additional study or undergone no formal assessment to ensure they merit this higher-level designation.

As a result, patients may be cared for by healthcare professionals who are ‘unconsciously incompetent’.

In addition, students and graduates frequently report that they are pushed to work beyond their limitations because there are no agreed standards for advanced clinical practice in their workplace. This situation is of particular concern in areas of clinical practice traditionally viewed as medicine.

Regulation

One solution to this problem is regulation, but attempts by the Nursing and Midwifery Council (NMC) to regulate advanced nurse practitioners have not been supported by the Council for Healthcare Regulatory Excellence, which concluded in 2009 that the current level of registration was sufficient.

The situation is not easy for employers either. In many organisations, a multitude of titles are used across different settings, specialities and professions, all of them underpinned by differing standards of education and competence.

While some professionals have ‘advanced’ in their job titles, others, including some clinical nurse specialists, work at an advanced level without being recognised formally as advanced nurse practitioners in their organisations.

In the absence of a national standard, local frameworks for advanced clinical practice have emerged. These are not always consistent with each other, which reduces their transferability.

Finalisation

Health Education England has therefore launched a project to devise a national standard and framework for advanced clinical practice. A definition of the term has been published and capabilities related to the four pillars of advanced practice – clinical, leadership, education and research – are being finalised, and are illustrated with case studies.

Will this solve the problem? I am sceptical. Without a ‘must do’ mandate, the situation may not improve. Demand for advanced nurse practitioners is high and yet too few healthcare professionals graduate from sufficiently high-quality courses to meet the need.

A quick-fix approach that emphasises clinical skills may be proposed, but may not focus enough on patient safety and care quality, and could diminish the contribution of advanced practice education to the four pillars.

Too much time is spent explaining and justifying advanced clinical practice. Setting a national standard for England may lead to initial disagreements about how titles, roles, responsibilities and educational needs should be re-evaluated under the term 'advanced clinical practice', but this is no reason not to make a change that is long overdue.

  • The RCN is set to lauch its 'credentialing' advanced-nursing accreditiation scheme in April.

Further information


About the author

Katrina Maclaine is associate professor in advanced practice at London South Bank University and chair of the Association of Advanced Practice Educators

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