Workforce issues
Regulation of advanced practice in nursing
Kate Woodhead RGN DMS discusses advanced nursing practice and the possibilities around future regulation, in light of proposals by the NMC.
Did you know that advanced nursing practice is not regulated? I was very surprised by my own ignorance, recently, to discover this fact. However, there is a move by the Nursing and Midwifery Council (NMC) to consider this over the next year. It is not without complication. A recent report by the Nuffield Trust will feed its findings into the regulatory process – it makes for interesting consideration. The impact of the report is to consider advanced practice roles for a range of different healthcare professionals, although nursing and midwifery are the main protagonists. The concept of what is advanced practice is
not only dynamic but also based on the ‘normal’ scope of practice of a nurse or midwife. The scope of practice is essentially a definition of all the activities carried out within a role and provides expectations of behaviours, responsibilities and duties. An advanced role is expected to practise the scope but still within acceptable boundaries. The interesting element here is that the responsibility for maintaining expertise in practice within the boundaries is largely down to the individual, their role and oversight by their employer. Governance is self-determined and very specific to the role the individual plays in the team and according to their job description. The report cites international comparisons that the UK is behind the curve in terms of regulation with only Finland sharing the position of self-regulation. Countries such as Australia, New Zealand, US, Canada and Ireland all have regulatory systems set up for advanced practice roles.
Examples of skills and competencies which
are used regularly by Advanced Nursing Practitioners (ANPs) are said to be, but not limited to: l Undertaking of comprehensive and sophisticated physical and/or mental health assessments of patients with complex
multiple healthcare needs and/or in crisis.
l Interpretation of the results of multiple different assessments and investigations, in order to make a diagnosis, and plan and deliver care.
l Confidently and competently making ethical, evidence-based decisions and interventions when faced with complexity and assessing and managing the risk associated with these decisions.
l Utilising therapies, such as cognitive behavioural therapy, when working with patients with mental health conditions, either in isolation or associated with a physical long-term condition.
l Prescribing and working with individuals to manage their medicines.
l Working independently but also as part of a multi-disciplinary team and exercising values-based leadership.
l Planning and providing skilled and competent care to meet a patient’s health and social care needs, involving or referring on to other members of the healthcare team as appropriate.1
There is very little that ANPs are not allowed to do according to the law. They can assess a patient, make a diagnosis and provide treatment, just like a doctor. However, they do this within a clearly defined scope of practice
that is agreed with their employer, and the level of medical complexity that they deal with is usually less than that of a doctor. Preparation for the role is recognised globally as master’s level academic study, as well as time in practice to develop advanced clinical skills. This is where the risk for patient safety lies, although the report2
suggests that there is very
little risk identified by the literature. However, in the view of the author, as patient care becomes more complex with multi-morbidities to consider, the risk of not being regulated provides little protection for the patient or the individual practitioner. Providing public confidence and protection of the public is the main purpose of regulation in healthcare.
The merits of advanced practice Practitioners within an advanced practice role are able to make decisions on the assessment, diagnosis and treatment of people who present themselves. They have the ability to deal with complexity, uncertainty and varying levels of risk and are professionally accountable for their clinical decision making. Notions of autonomy and or independence of the practitioner are also considered important, although how these terms are defined is often nebulous.3
The merits
of advanced practice are not in doubt. There is substantial literature that demonstrates that it can support better delivery of services
August 2023 I
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