Leaping Over the Boundaries: Advanced Practice

19.11.08 Sue First MSc SRCh

Leaping Over the Boundaries:

Advanced Practice

Advanced Practice Role

• Modernising Careers (AHP 2008, Nursing 2006) • Lord Darzi Our NHS Our Future 2008• Developing NHS Workforce 2000• Meeting the Challenge (AHP’s) 2000• The New NHS ;Modern & Dependable 1997

• Towards a framework for Post registration nursing careers (consultation 2007)

What is an Advanced Practitioner?

• Career Framework for Health

• Multi-professional role

• Core characteristics, concordatS

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ADVANCED PRACTITIONERS - LEVEL 7‘Advanced Practitioners’ are experienced clinical professionals who have developed their skills and theoretical knowledge to a very high standard. They are empowered to make high-level clinical decisions and will often have their own caseload. Non-clinical staff at Level 7 will typically be managing a number of service areas

CONSULTANT PRACTITIONERS - LEVEL 8‘Consultant Practitioners’ are staff working at a very high level of clinical expertise and/or have responsibility for planning of services

MORE SENIOR STAFF - LEVEL 9More senior staff with the ultimate responsibility for clinical caseload decision-making and full on-call accountability

ASSISTANT PRACTITIONERS/ASSOCIATE PRACTITIONERS - LEVEL 4‘Assistant Practitioner/Associate Practitioners’ – probably studying for Foundation degree, BTEC higher or HND. Someof their remit will involve them in delivering protocol-based clinical care that had previously been in the remit of registered professionals, under the direction and supervision of a state registered practitioner.

PRACTITIONERS - LEVEL 5‘Practitioners’ – most frequently registered practitioners in their first and second post-registration/professionalqualification job.

SENIOR PRACTITIONERS/SPECIALIST PRACTITIONERS - LEVEL 6‘Senior Practitioners/Specialist Practitioners’ who would have a higher degree of autonomy and responsibility than‘Practitioners’ in the clinical environment, or who would be managing one or more service areas in the non-clinical environment.

INITIAL ENTRY LEVEL JOBS - LEVEL 1Initial entry level jobs such as ‘Domestics’ or ‘Cadets’ requiring very little formal education or previous knowledge,skills or experience in delivering, or supporting the delivery of healthcare.

SUPPORT WORKERS - LEVEL 2 Support Workers – frequently with the job title of ‘Healthcare Assistant’ or ‘Healthcare Technician’ – probably studyingfor or has attained NVQ Level 2.

SENIOR HEALTHCARE ASSISTANTS/TECHNICIANS - LEVEL 3‘Senior Healthcare Assistants/Technicians’ – this is a higher level of responsibility than support worker, probablystudying for or have attained NVQ level 3, or Assessment of Prior Experiential Learning (APEL).

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What’s the difference?

• An Advanced Practitioner is an experienced professional who has developed their generalist advanced level skills to a high level of practice and theoretical knowledge to Masters level. They are empowered to make autonomous high level clinical decisions and will often have their own case load. Level 7

• A specialist / expert is as above but only in a specific field, may only be first degree level. Level 6

Why introduce AdPs?

…….…expected benefits• Patients

– Enhanced experience, continuity of care, better access reduced waiting, admissions, LOS, safety

• Service– Best use of skill mix, productivity & financial balance, helps

to achieve targets• Individual

– Personal growth, career development • Colleagues

– Free up medical staff for more complex work, increased inter-professional working, joint learning

GMSHA

Primary & Secondary Trusts,

Other NHS& Social Care Organisations

2 Local HEI’sBolton & Salford

Collaborative Between:

Advanced Practice Programme

Collaborative link to learning environment (Linklater 1987)

3 Key stakeholders

• Individual

• Academic Institution

• Employer

Advanced Practice Role

Structure of the MSc

Principles of Advanced Practice (20)

Managing Clinical Care (20)

Public Health & Health Promotion (20)

Semester 1 Semester 4 + summer Semester 3Semester 2

Foundations of Advanced Practice (40)

Application of Life Sciences for Advanced Practice (20) Research

Dissertation (60)

Negotiated/ independent learning (20)

Induction

Feb

Feb

Feb

FebSept Summer + Sept

Feb

Core module Options

Summer + Sept

Summer + Sept

Summer + Sept

Critical Evaluation

and Review (20)

Advanced Practice Role

Work Based Learning is a dynamic and unfolding process

Linking learning to the work role 3 inter-related componentsEach of which provides an essential contribution to thelearning process:-structured learning in the workplace- On job learning opportunities- Off job learning opportunities

(Levy 1987)

Advanced Practice Role

• Workplace Learning is dynamic and unfolding• Heart of the overall programme of study• Tackles complex work based, real-life problems

(Gray et al 2004)

• Learn wider skills outside the academic requirements (HMI 1990)

• Requires flexible, student centred approach• Range of teaching environments to personalise

the WBL.

Advanced Practice work based learning is multifaceted

Linking learningto requirements of the job

Learning FOR workLearning AT workLearning THROUGH work

Seagraves et al 1996

Advanced Practice Role

• Build on previous experience• Prime position to link theory / practice• Professional constraints / responsibility / accountability• Employment• Conflicting priorities of work, home & study• Transferable skills eg negotiating, strategic thinking• Ability to prioritise (Brown 1995)• Risk management aware • Self motivated, reliant, directed, aware (Finn et al 1985)

Advanced Practice student / challenges

Require multi layered support (Brennan & Little 1996)

Service Manager Champion/ PCT Link

Advanced Practitioner

Mentor

Assessors

Supervisors

Learning facilitator

HEI Student support

Programme Lead

Module Tutors

Personal Tutors

Student Liaison Officer

APLF Role Summary

Prepare students for placement Effective collaborator Innovator Ensure effective follow up Support the university Reflective practitioner Pastoral guide Guide and teacher

Role of Mentors• Lead mentor + informal mentors• Identify leaning needs & negotiate a programme

of learning via Tripartite Learning Agreement to develop their competencies.

• To assist students to identify relevant clinical assessors/supervisors.

• To ensure students receive 2 facilitated learning days / per week

• To challenge & develop students within the work place setting

• To inform APLF / Programme lead any concerns in progress

Clinical Assessors

• Lead assessor / more than one• Tripartite Learning Agreement – personalised plan for

meeting outcomes for the clinical modules. • Undertakes for the clinical assessments against the

performance criteria.• Provides support & constructive criticism• Complete clinical skills documentation & verify their final

decision • To challenge & develop students within the work place

setting• To inform APLF and or Programme lead any concerns in

their progress

Clinical Supervisors

• To provide practical hands on teaching in real life situations

• To support, challenge, develop & provide constructive feedback to students in the work place setting.

• Tripartite Learning Agreement – personalised plan for meeting outcomes for the clinical modules.

• Guidance, advice & verifying comments for the students portfolio if appropriate

Clinical Skills Component Clinical Skills Component MSc Advanced PracticeMSc Advanced Practice

Learning Outcomes• Systematic understanding and critical

awareness of current problems and /or insights of service context

• Synthesis practice and theory to underpin demonstrably higher levels of discretion & judgement in decision making within service delivery & leadership

Learning outcomes

• Deal with complex issues to make sound judgments in the absence of complete data & to communicate their conclusions clearly.

• To identify, critically evaluate & reformulate:

• Development of their practice• New ways of working within & beyond those

boundaries.

History Taking Consultations Skills Assessment

• 5 Integrated systematic history taking and consultation assessment skills per year :

• 10 Components – A-J, Level 2 / 3 must to be achieved on all components in order to be successful

• Circle the level awarded for each element

• Students must achieve:– level 2 = competent by end of year 1 – level 3/4 = proficient / expert by end of programme.

Physical Examination Body System Assessment

• 5 systems chosen from a choice of 13 / customised

• 5 Integrated systematic physical examinations / body systems per year

• Each clinical skills log is supported by an assessor verification form

• Students must achieve:– level 2 = competent by end of year 1 – level 3/4 = proficient / expert by end of

programme.

Essentials completion of documentation

• Completed, signed & dated by both assessor and students.

• Verifying comments – validate the mark awarded.

• Comments - students’ performance, identify strengths & weakness , improvement of performance .

• Where verifying comments are lacking or appear to contradict the mark, it may be challenged through the marking, moderating and external moderation mechanism within the university.

Advanced Practice : Future

The world is your oyster!

The significant problems we face cannot be solved at the same level of thinking we were at when we created them Albert Einstein

Contact details

• Susan First

01204 903756

mob 07780 542862

sfr1@bolton.ac.uk • Trish Houghton

• 01204 903756 mob 07780 958829

• tah1@bolton.ac.uk

• Ann Winter

• 01204 903788

• a.m.winter@bolton.ac.uk

Advanced Practice Role