Transforming the Advanced Practice landscape in Scotland Eddie Docherty, Mark Cooper, Ellen Hudson, Joanne Corlett and Margot McCulloch on behalf of the Scottish Government Chief Nursing Officer s Transforming Roles Advanced Practice Group
Disclosure presenter
Political Landscape of Scotland One of the four countries that make up the UK Own Government Publically funded Health care service
Mental Health in Scotland a 10 year vision
Where we need to be Person centred (not condition focused) care Self-management, independence, prevention, rehabilitation Understand complex needs Reduce risk of unnecessary hospital admission Sensitive end of life care More community based services Focus on -mental health, children and young people, older people
ANPs: evolution of the role 1965 USA - 1984 UK - 1994 Scotland Small number of areas to most specialities A few individuals to larger teams Limited scope of practice to wide scope In house training to Masters degrees
ANP programme of work Undertaken by Scotland s Chief Nursing Officer through Transforming Roles To provide: Strategic oversight Direction Governance To ensure: Nationally consistent, sustainable and progressive nursing roles and career pathways. Undertaken in two Phases: 1 & 2
ICN Definition The Advanced Practice Nurse is: A registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A Master's degree is recommended for entry level. (ICN 2002)
Phase I: Complete Agreed by Chief Nursing Officer Department and Scottish Executive Nurse Director (SEND) group Definition Competence Job description and pay Accountability and responsibility Advanced and specialist practice National data Education & CPD Evaluation
National Definition of ANPs in Scotland An Advanced Nurse Practitioner (ANP) is an experienced and highly educated Registered Nurse who manages the complete clinical care for their patient, not solely any specific condition. Advanced practice is a level of practice, rather than a type or speciality of practice. ANPs are educated at Masters Level in advanced practice and are assessed as competent in this level of practice. As a clinical leader they have the freedom and authority to act and accept the responsibility and accountability for those actions. This level of practice is characterised by high level autonomous decision making, including assessment, diagnosis, treatment including prescribing, of patients with complex multi-dimensional problems. Decisions are made using high level expert, knowledge and skills. This includes the authority to refer, admit and discharge within appropriate clinical areas.
Competencies Comprehensive History Taking Clinical assessment Differential Diagnosis Investigation Treatment Admission, Discharge and Referral
Accountability and responsibility It should be noted in relation to competence that advanced practice is not a recordable title by the NMC however responsibility for competence remains embedded within the NMC code. ANPs must be embedded into nursing governance structures, with clear lines of responsibility and accountability leading through the professional nursing line, up to the Executive Nurse Director. The clinical supervision structure must include a competent senior clinician (medical/nursing) to give sign off and regular review of competence.
Advanced and Specialist Advanced and specialist practice should not be seen as a directly hierarchical relationship, i.e. that advanced is more senior than specialist or the reverse. Both practitioners may be functioning at an extremely high level of practice, but with a different clinical focus.
National Data Scottish Government CNO directorate in collaboration with Workforce Directorate and ISD Data from July 2017
Service Needs Analysis/Education Purpose Needs Analysis Support health and social care teams to plan, implement and evaluate ANP roles systematically Enable teams to prepare strong, evidencebased business cases for new ANP roles and the education required to support these
Triangle of capability Academic Preparation Clinical Competence ADVANCED PRACTICE Effective Supervision
Educational Core Completion of triangle of capability will vary Based on training needs analysis In principle 2 3 years to complete Mandatory Elements: Practice-based Assessment Clinical Supervision Sign-off
Proposed Structure Masters level qualification Core to focus on competence in: Clinical assessment Clinical reasoning, judgement and diagnostic decision-making Anatomy and patho-physiology Non medical prescribing Leading, delivering and evaluating care Practice learning/transferable work based learning processes Recognition of prior learning
Phase 2: Completing High level competencies Adult Acute Care Primary & Community Care Paediatrics Neonatal Mental Health Metrics Mentorship and supervision Non-clinical time Academy model
Legacy - the Academies Collaboration between NHS Boards and Universities Continuing Professional Development Programme of regional CPD events (3 per year) Governance Moderation of final sign-off Establishment of regional standards Three Academy s are being established: West, North and East Academy's will be multi-disciplinary nursing and the allied health professionals
Summary ANPs are essential to help meet the current and future needs of Scotland s health and care system There is now greater clarity around the ANP role in Scotland with reducing variation Regional academies will ensure that the national work continues to be taken forward