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ANPs - much more than a 'mini-doctor'

Many roles traditionally carried out by junior doctors can be performed by advanced nurse practitioners who are supported to broaden their skills
Jude Campbell

Many roles traditionally carried out by junior doctors can be performed by advanced nurse practitioners who are supported to broaden their skills

A controversial report by the Nuffield Trust claimed nurses who retrained as physician associates could do the work of junior doctors.

Advanced nurse practitioners, such as Jude Campbell, can act as 'maxi-nurses'. Picture: Neil O'Connor

The report , published in May, said advanced practice roles offer opportunities to improve clinical continuity and fill in medical workforce gaps.

Coming as it did in the middle of the junior doctors dispute, the idea soon had critics pouring cold water on it.

The Patients Association said the proposal should not be seen as way of replacing highly qualified staff with a cheap alternative. Some junior doctors expressed

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Many roles traditionally carried out by junior doctors can be performed by advanced nurse practitioners who are supported to broaden their skills

A controversial report by the Nuffield Trust claimed nurses who retrained as ‘physician associates’ could do the work of junior doctors. 

Jude Campbell
Advanced nurse practitioners, such as Jude Campbell, can act as 'maxi-nurses'. Picture: Neil O'Connor

The report, published in May, said ‘advanced practice roles offer opportunities to improve clinical continuity… and fill in medical workforce gaps’.

Coming as it did in the middle of the junior doctors’ dispute, the idea soon had critics pouring cold water on it.

The Patients Association said the proposal should not be seen as way of replacing highly qualified staff with a cheap alternative. Some junior doctors expressed concern that patients’ lives may be put at risk. 

RCN chief executive and general secretary Janet Davies commented positively, ‘Flexibility and expanded nursing roles will be vital to the NHS’s future.' Davies called for training and funding to support ‘nursing’s future contribution’.

Minding the gaps

Advanced clinical practitioners (ACPs) have been filling gaps in junior doctors’ rotas at Sheffield Teaching Hospitals NHS Foundation Trust since 2006. There are currently about 80 ACPs working across a range of services at the trust.

At Norfolk and Norwich University Hospital NHS Foundation Trust, advanced nurse practitioners team with junior doctors in the trauma and orthopaedic department. Matron for orthopaedics and orthotics Danny Brewster believes many doctors' roles can be performed by nurses supported in broadening their skills. 

‘The idea began developing about five years ago,’ he says. ‘Our junior doctors had a heavy workload, and our orthopaedic consultant suggested that experienced advanced nurse practitioners could play a key role. We started with four orthopaedic nurse practitioners who focused on pre-operative assessment and educating patients undergoing elective surgery,’ he adds.

Added dimensions

‘As the role developed,' continues Mr Brewster, 'the nurses began to review elective patients while developing their skills in gaining patient consent. They also marked patients for surgery and clinical assessment.’

As the team grew in size, trauma patients were added to the workload. With guidance from orthopaedic consultants and registrars, the team now manages patient care from admission to discharge. Over four years, the team has grown to include 11 experienced nurses from a variety of backgrounds. These include orthopaedics, emergency department, critical care, thoracic surgery, respiratory medicine and community nursing. 

‘Each nurse brings their own experience which adds to the combined knowledge of the team,’ says Mr Brewster. ‘Every team member is extremely dedicated to their role, and absolutely determined to make sure the service continues to develop to provide the best care for our patients.’

Higher education

The role involves clinically assessing trauma and elective patients, then taking a lead on delivering patient care. Prospective team members must have a degree-level nursing qualification and are expected to do a master's degree to become an advanced practitioner. The required modules are in clinical assessment, advanced clinical decision making and non-medical prescribing.

‘The challenges of undertaking master's-level study while working full-time should not be underestimated,’ says Mr Brewster. ‘But it's a fantastic opportunity for a variety of extended roles within the multidisciplinary team to be valued.’

He says this model puts the patient at the centre of care. ‘We have a consistent team of experienced nurses who don’t rotate away from the department every three months. Patients see the nurse practitioners in pre-operative assessment and again post-operatively.’ 

Expansion

The growing number of patients and the demand to meet targets means the functionality of the service is constantly being tested. ‘We had to work hard to explain our role to get buy-in from other departments,’ says Mr Brewster. ‘Doctors in other specialties – X-ray, for example – were not used to receiving referrals from nurses, so this was new to them.

‘There was initial trepidation, but the way the team has continued to develop has proved we're providing an excellent service,’ he adds. ‘We have just recruited two additional nurse practitioners in general surgery to make a team of four. There are also nurse practitioners in the special care baby unit in a slightly different role. We also have two more advanced practitioners in paediatric orthopaedics.’

RCN Eastern region director Karen Webb is fully supportive of these extended roles. ‘Throughout our history, nurses have always operated as gate keepers and lynchpins for co-ordinated care planning,’ she says. ‘This innovation offers an opportunity to showcase the seamless nature of holistic nursing practice.’ 

Mr Brewster adds: ‘These are maxi-nurses rather than mini-doctors who are in an ideal position to become more holistic practitioners and support our medical colleagues. That is the beauty of the role.’

 

Top tips for becoming an advanced nurse practitoner

  • Take on a variety of roles to broaden your experience.
  • Get support and buy-in from your colleagues.
  • Understand the wider context of your role in the hospital.
  • Sell the benefits of the role to patients and the trust.
  • Be a role model to junior staff.
  • Acknowledge the role played by other members of the multidisciplinary team.
  • Identify the trust’s targets and link your contribution to them.
  • Be a team player – communicate well and draw on everyone’s strengths.
  • Be prepared for the commitment required by combining further education with a demanding role.

 

Author

Alison Whyte is a freelance journalist 

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