Competencies for Advanced Nursing Practice PDF

PREFACE

The road towards the recognition of an advanced level of practice on the UK's register of nurses, midwives and health visitors has been long and tortuous - and is still not over. The latest proposal, at the time of going to press, awaits the outcome of a major consultation on a new nursing careers framework (DH, 2006) and decisions regarding the future regulation of advanced practice arising from the Department of Health's White Paper on the future regulation of health professionals (DH, 2007), before final ratification can be achieved.

The quest for full professional recognition began back in the early 1980s when the development of the first nurse practitioner role by Barbara Stilwell (distinguished author of the Foreword to this book) led to calls for the recognition and regulation of a branch of nurses beginning to extend their practice way beyond traditional roles. Since then its gestation has seen the publication of three different sets of competencies, has absorbed the Knowledge and Skills Framework set out in Agenda for Change (DH 2004) and the introduction of the nurse consultant role and it has emerged into a post-Shipman era determined (rightly) that public protection must be paramount.

In the absence of a recognized and distinct place on the register, however, and the enabling legislation to create one, nursing practice has burgeoned and few now could imagine a UK health service without the existence of nurse practitioners. As nursing practice itself has developed, driven by an impatience to prove that nursing values can successfully and beneficially complement the knowledge and skills traditionally located within a medical model of care, so the pressures of the modern health service have conspired to create conditions in which the development of the advanced nurse practitioner role is not just desirable but inevitable. The working time directive which limited the hours junior hospital doctors were allowed to work, the new General Medical Services contract and the development of nurse prescribing have all made it economically, as well as professionally, desirable that whole swathes of care – for those requiring anticoagulant therapy, those with Parkinson's disease or dementia, those receiving intravenous or oxygen therapy at home, and many others in both primary and secondary care settings – should be not just delivered but directed and managed by nurses operating at an advanced level of practice.

The first set of RCN-accredited nurse practitioner programmes started running in UK universities in 2002, based on competencies anglicized from those developed in the US by the National Organization of Nurse Practitioner Faculties (NONPF). Many nurses have completed these RCN-accredited courses, or sought alternative routes to advanced practice and are practising at that level today. These competencies formed the basis of the current RCN framework for nurse practitioners which was subsequently adopted by the NMC and received Council's approval in December 2005. They are reproduced in full in the Appendix to this book.

Although yet to be formally ratified, such is their currency and importance that the decision was taken not to delay publication further and these competencies or domains therefore form the backbone to this book. It describes each of the domains in turn but begins and ends with chapters which seek to explain the nature and history of advanced practice, its legal base and the academic and accreditation process required to achieve it.

Heather Griffith's chapter charts in some detail the journey towards advanced practice and offers profiles of nurses working at that level. Caroline Pennels then sets out the legal implications of advanced practice – looking at what it means in law to be called an advanced practitioner, the different standards expected in comparison with those required of the ‘ordinary' practitioner, and how this relates to the professional backdrop. Subsequent chapters take each individual domain in turn, detailing its theoretical base but explaining what that means in practice. Each one is liberally illustrated with stories, profiles and practical examples of how the theory is put into practice. Finally, Sue Hinchliff examines the accreditation process required of the nurse seeking to be recognized as an advanced practitioner – the evidence and profiling he or she is expected to maintain and the different ways in which an advanced level can be proved.

The book is aimed largely at those nurses seeking to become advanced practitioners – but we hope it will also be used by those already practising at that level as well as by lecturers and by those who manage or work with advanced nurse practitioners (ANPs). It is the first of its kind and is meant to support both their studies and their practice. Similarly, as advanced practice is not a concept that is confined to nursing but also increasingly evident in the practice and education of allied health professionals, this book should also prove a valuable resource in that arena.

In an ideal world the publication of this book would have been timed to coincide with – indeed to celebrate - the final definite creation of a separate place on the register for advanced nurse practitioners. But just as ANPs themselves have decided that the needs and demands of their patients, their health service and their own professional development could not wait, and have developed their practice and their standards accordingly, so we feel that neither could a publication to support that practice be further delayed. By the time of publication we hope the decision is finally ratified – and look forward to a second edition reflecting that fact!