UK criticised over lack of Advanced Practice Nurse regulation

AROUND the world, Advanced Practice Nurses (APN) – trained to take on a wide range of responsibilities, including diagnosis and treatment – are increasingly crucial in the expansion and provision of health care. 

Study Nursing and Midwifery at Huddersfield

In the UK, the commonest roles are that of the Advanced Nurse Practitioner and Clinical Nurse Specialist.

A new book examines APN leadership globally, and a University Teaching Fellow at the University of Huddersfield, which offers Master’s degrees in the discipline, has provided a chapter on the development of the role in the UK and she spotlights some of the problems that must still be surmounted. 

These include a failure so far to provide regulation and formal protection for the title Advanced Practice Nurse.

Dr Melanie Rogers has been an APN for more than 20 years and in her contribution to the book she states: “Being an advanced nurse practitioner is the most rewarding, challenging and stimulating role I have ever had.  Being able to provide patients with holistic care, which brings together the best of nursing and the best of medicine, is a privilege”. 

Dr Rogers has been an influential figure in the development of the APN role globally and in the UK.  In her contribution to the newly-published Advanced Practice Nursing Leadership: A Global Perspective, she tells how she was involved in early discussions with the UK’s Nursing and Midwifery Council (NMC) about nurse practitioner regulation and for 12 years she has worked with the International Council of Nurses, Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/AP) to lobby for regulatory changes and support advanced practice developments globally. 

She has chaired the ICN NP/AP Network for almost four years, and in the book she writes that she been fortunate to support many countries developing AP roles.

But Dr Rogers states she has been saddened and has struggled with the UK being one of only two countries globally with established nurse practitioner roles not to provide regulation.

“I have worked to support advanced practice globally through health policy, education, research and leadership.  I have also consistently spoken about the need for the UK to address this problem.”

Dr Rogers adds that “in order for nurses not to become overlooked as advanced practitioners, it is vital that they stand up and identify the value that advanced practice brings to patients and the healthcare system”. 

Advanced Practice Nurse Development in the United Kingdom

The chapter titled Advanced Practice Nurse Development in the United Kingdom was co-written by Dr Rogers with Annabella Gloster, a Senior Lecturer at the University of Salford.  The authors provide an account of how the APN role developed in the UK and analyse the differences between England, Wales, Scotland and Northern Ireland.

Their detailed data includes a lengthy list of the attainments that the Royal College of Nursing requires from APNs.  These include the ability to make professionally-autonomous decisions and receive patients with undiagnosed problems and make an assessment of their health care needs, based on highly-developed nursing knowledge and skills, including physical examination. 

The New book Advanced Practice Nursing Leadership: A Global Perspective is edited by the USA’s Susan B. Hassmiller and Joyce Pulcini and has contributions by more than 40 authors from countries around the world.

Advanced nurse practitioners should also be able to screen patients for disease risk factors and early signs of illness and makes differential diagnoses.  APNs also need to be able to develop with the patient a care plan for health, with an emphasis on preventative measures.

In their introduction, the editors state that “this is an incredibly exciting time to be an APN, with an unprecedented opportunity to take on roles that expand access to care and more systematically address the root causes of poor health”.