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a full assessment of a patient , request and interpret investigations , and prescribe medication .
Primary care is the gatekeeper to secondary care , and having knowledge and understanding of a patient from a holistic point of view informs appropriate referral , or admission into hospital where needed .
ANPs are fundamental to a modern healthcare service so holistic care needs to be introduced at an early stage of our collective training . The knowledge and skills we develop are adjusted and enhanced throughout our career . As far as regulation is concerned , though , the role itself remains in the wilderness .
The NMC acknowledges that public understanding of the role remains unclear , but that experienced nurses and midwives are increasingly taking on complex autonomous and expert roles under the umbrella of advanced practice .
The basis of any advanced practice role is the education and training that has come before it , and for me this included qualification as an RGN followed by qualification as a midwife .
When I started as a practice nurse , I was aware that education and training were going to be key to success within the role . Undertaking courses for ear syringing , cytology and chronic disease management were an essential part of the learning curve . Childhood immunisation , once the domain of health visitor colleagues , also became part of the practice nurse role .
I undertook the community degree with a focus on minor illness nearly 10 years before starting the masters degree for advanced practice .
Autonomous roles The Department of Health and Social Care describes an advanced practitioner as someone who can undertake
References 1 Royal College of Nursing . RCN Standards for Advanced Level Nursing Practice . tinyurl . com / RCN-ANP-standards 2 Leary A et al . The evolution of advanced nursing practice : past , present and future . Nursing Times 2019 ; 115:10:18-19 . tinyurl . com / NT-advanced 3 NHS . Multi-professional framework for advanced clinical practice in England . tinyurl . com / HEE-advanced 4 Palmer W et al . Independent report on the regulation of advanced practice in nursing and midwifery . Nuffield Trust , 2023 . tinyurl . com / Nuffield-advanced 5 Ford M . NMC looking for ‘ sweet spot ’ on advanced practice regulation . Nursing in Practice , 5 October 2023 . tinyurl . com / NIP-advanced 6 Rolewicz L . Past , present and future of NHS nurse numbers . Nuffield Trust , 2023 . tinyurl . com / Nuffield-nurses
Specific regulation needed While the NMC does not specifically regulate advanced nurse practice now , it has committed to considering additional regulation as part of its 2020-25 strategy . It commissioned the Nuffield Trust to look at existing literature on regulation of advanced practice , given the variation in how the role is interpreted across the UK . The study found that the ‘ consensus ’ among stakeholders , which included nursing leaders at the highest levels , was that some form of specific regulation is needed for advanced practice in nursing . 4
And in an update in October , the nursing regulator said it would likely present a ‘ preferred option ’ for regulation by early 2024 . 5 It stressed it wanted to avoid the risk of any future regulation confusing the public or disengaging members of the profession .
The regulation of health and social care professionals is a practical way to protect those using services from harm and to enhance trust in healthcare professionals . Student nurses are made aware of their responsibility to be patient advocates , to understand our limitations and to work within the healthcare regulatory framework .
The same is true for advanced practice . In my view , regulation is essential – to protect the public but also to acknowledge our educational attainment .
My MSc in Advanced Practice was the start of a new journey and each day there is still something new to learn , an understanding to gain , and a patient to support using the knowledge and understanding I have developed . I have often told patients that there is no such thing as a silly question , but we should always ask questions of our own practice too . It is this everquestioning approach that ultimately provide the blocks of knowledge we need as advanced practitioners to adopt a truly holistic approach to our patients .
In the UK , there are 716,100 registered nurses and 40,900 midwives on the NMC Register . 6 Nurses and midwives working at an advanced level enhance the patient experience and we bring a greater understanding of practice developed through experience and educational attainment . This contribution enhances the profession we are all very proud to be associated with .
Nurses and nursing need to use a collective voice , and enhancing our knowledge – working within the four pillars of advanced practice – will allow that voice to be heard more clearly across healthcare and political forums , and also support and encourage the next generation of advanced practitioners .
Helen E Lewis is a Queen ’ s Nurse and an independent nurse practitioner based in South Wales