Policy to Practice:

Implementing a strategy for advanced practice in Wales

DR JEAN WHITE

Welsh Assembly Government

To provide:

• Context to the work in Wales

• Overview of the challenges and issues

• Summary of approach and progress to date

Purpose of this presentation

Context

Modernising Nursing Careers: Setting the Direction (2006)

“Review careers paths & educational preparation for specialist & advanced roles”

MNC - Toolkit work

• Since 2007 Scotland has led for the UK the development of the Advanced Practice Toolkit and continues to develop this resource

• This has UK CNO acceptance – reconfirmed at the last Coalition meeting in December 2009

• Website recently updated:

http://www.advancedpractice.scot.nhs.uk/home.aspx

1. Consensus definition of advanced nursing practice 2. Competency map for advanced practice 3. National AfC job profile for advanced practice, and

exemplar/template KSF outlines and job descriptions/role profiles

4. Activity analysis tools 5. Skills analysis/educational needs analysis tools 6. Portfolio development support 7. Educational framework to support advanced

practice role development 8. Links to Qualification frameworks and the Career

Framework 9. Regulatory guidance

Sections of the Toolkit

Dept of Health Project 09/10

Dept of Health funded project being conducted by Abi Masterson Consulting Ltd to support the development of a UK wide professional advanced practice standard.

The work involves sourcing existing standards and competence development work on advanced practice in nursing and synthesising all the relevant content from these into one draft standard.  

Final standard is to be produced by the end of April 2010

Nursing and Midwifery Council position

2005 NMC agreed to seek permission to regulate advanced practice – put on hold due to the White Paper

Issue being considered as part of revalidation work

CHRE report on extending regulation 2009

New CE Dickon Weir Hughes reported to be revisiting the debate. Has said

'There is a commitment to making sure that the public is protected and that ANPs are competently and consistently trained.’

Pre-registration degree level preparation

5

6

7

8

9+

Level

WIDE ENTRY GATE

Consolidation of practice

Careers in: generalist/ specialist clinical posts, academic and teaching posts.

Continued education in 4 ‘pillars’:• Clinical/Professional Practice • Leadership and Management • Facilitated Learning & Development• Research

Registration

Careers in consultant, senior and strategic level roles, senior clinical academic and academic/research posts.

Continued education in 4 ‘pillars’ plus (where appropriate)• Strategic service development• Corporate skills/responsibilities

Overview of the career framework

Graduate and post graduate

level study

Post graduate to doctorate level study

Advanced Practice

Careers in advanced generalist/ specialist roles, ward manager posts, management, education and research posts.

Continued education in the 4 ‘pillars’

Career Advice

Specialisation & Level of Practice

• Inherited relationship of specialisation to advanced level of practice, eg UKCC 1994 SPQ standards use confusing language.

• Use of language in Skills for Health Careers Framework for Health – level 6 referred to as “Specialist Practitioners”

• Trends

- increased status of specialists over generalists, often associated with pay and promotion

- Plethora of confusing job titles and roles

Key Facets of Framework

Recognition of specialist and generalist practice up to advanced level. Education and training to prepare practitioners for roles – emphasis on knowledge and skills preparation that can be transferred.

Clinical Nurse Specialists to have a degree in a relevant subject and be able to demonstrate competencies in field.

Advanced level practitioners – accepted principles set out in Advanced Practice Toolkit. Academic level set at master’s level.

Advanced Practice Actions

28.a. Employer organisations ensure that job descriptions for new level 7 Advanced Nurse Practitioner (ANP) posts reflect the description and role competencies of advanced practice.

28.b. ANP post holders hold an appropriate master’s level award and can demonstrate advanced levels of knowledge and skills commensurate with the role, and high levels of decision making, problem solving and critical thinking.

28.c. Service employers have in place transition arrangements to support current ANP post holders who do not possess an appropriate master’s degree. AP(E)L arrangements are considered.

Making it happen

NLIAH established a steering group in Nov 2009 to review Toolkit and advise on implementation in Wales. Due to report June 2010

Approach is multi- professional and includes AHPs, some healthcare scientists, and paramedics.

Service Activity

Following restructuring of the NHS in 2009, new Nurse Directors are taking stock of roles and skill mix within their nursing workforce.

One LHB example: staff in existing specialist, nurse practitioner and senior/advanced positions have been asked to complete an algorithm styled assessment. Outcome – staff/management have clearer sense of match to expected standards and what development staff need – role title adjustments are being considered.

Challenge going forward

• Concerns of staff over grading as roles are reviewed

• Supporting staff to undertake further development and CPD – release, funding, motivation, etc

• Governance issues – employers must ensure staff are fit for purpose

• Devolution - commitment to support UK wide work on standards