28 | Nursing in Practice | Winter 2023
EDUCATION
My journey to advanced nurse
practitioner in primary care
Amid the ongoing discussions about the regulation of advanced practice , Helen E Lewis describes what working as an advanced nurse practitioner in primary care means to her , and how she sees the role developing in the future
The Nursing and Midwifery Council ( NMC ) is currently discussing the regulation of the advanced practice role . If this leads to regulation , it would not only give direction to the role but , in my view , help to protect clinicians and patients in the long term .
The advanced nurse practitioner ( ANP ) is not a new phenomenon , but there is variation in how advanced practice is described and implemented . Education to masters level and practice across four key pillars are elements included in the Royal College of Nursing ’ s Standards for Advanced Level Nursing Practice . 1
From a personal view , the decision to undertake an MSc in Advanced Practice was exciting , as part of a journey filled with new challenges that has developed me from a personal and professional viewpoint .
This article will offer community nurses information that may be useful if they are considering advanced practice in their professional role .
Advanced practice Advanced practice was first introduced in the late 1980s and early 1990s 2 and has continued to develop nationally and internationally .
In the UK , advanced practice was part of the 2019 NHS Long Term Plan , which offered a multiprofessional framework 3 outlining the capabilities expected of advanced practitioners working across the four key pillars of education , research , leadership and management , and clinical practice . I have no doubt that advanced practice has been central to the transformation of service delivery in response to the changing demands of 21st century healthcare .
My own journey to ANP started as far back as 2006 when I first entered primary care . I was fortunate that my first role after qualifying was within the community setting , as I already knew my career was not going to be hospital based .
Advanced practitioners are qualified nurses , paramedics , physiotherapists or occupational therapists who have undertaken post-registration training to complete a masters-level degree , to include prescribing in order to be able assess a patient fully in a single episode of care . Autonomy is a key factor to the advanced practitioner role .
Any new day in practice will bring fresh challenges . Some patients are straightforward but others will test , and ultimately enhance , my knowledge . Patients may raise a plethora of concerns during the episode of care .
We encounter anything from sore throats , cough and abdominal pain , to a change in bowel habit , musculoskeletal complaints and minor injuries . All have to be assessed fully , as do mental health conditions , such as anxiety and depression and post-traumatic stress disorder .
Patients will also attend with long-term health conditions such as COPD or diabetes , for a medication review . A care plan review is often required with dementia or debilitating conditions such as MS or Parkinson ’ s , where the needs of patients and carers will change as the disease progresses .
There are four distinct pillars to advanced clinical practice to which every advanced practitioner must align their practice and subsequent continued professional development : 3
• Clinical practice
• Facilitation of learning
• Leadership and evidence
• Research and development .
Clinical practice is the foundation of any episode of care , and advanced practitioners have a high level of understanding of this aspect of patient care .
Team leadership looks at innovative ways of delivering care to patient groups and is borne out of a multidisciplinary approach based on up-to-date evidence . Education is not exclusively related to the education of the advanced practitioner , but encompasses junior staff , which includes practice nurses aspiring to advanced practice , as well as our patient groups .
As an ANP in primary care , I work in a multidisciplinary team of practice nurses , healthcare assistants , advanced practitioners from nursing but also paramedic physiotherapists , along with GP colleagues and district nursing teams . Successful outcomes for patients , their families and the team depend on a collaborative approach .
The team acknowledges the knowledge and skills of everybody within it , which are always changing . The experience gained and the knowledge shared between team members is essential ; there is a mutual respect that fosters a shared approach to care .
The team also includes members of the admin staff , who are essentially the gatekeepers to accessing care at the surgery . They are the patient ’ s first point of contact to schedule an appointment and are essential to the care journey for the patient population .
Work at an advanced level of practice is developed and enhanced by the team around us . Forward planning is seen as an essential part of patient care and one that allows staff to develop and work towards more senior roles , supported and mentored by the team . This ensures consistency , with patient care continued using the same team ethos and standards , and also that individuals within the team feel supported and valued .
Education The journey to become an ANP is a long one , but it is a role that embodies the years of practice accumulated since initial qualification .
Advanced nurse practitioners are fundamental to a modern healthcare service