Enhancing public protection through the effective regulation of advanced practice

1. Enhancing public protection through the effective regulation of advanced practice Dickon Weir-HughesChief Executive and Registrar

2. 23 Portland Place 61 Aldwych, 1st floor oo

3. Our chosen definition • ‘An 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 country and/or context in which she/he is credentialed to practice. A master’s degree is recommended for entry level.’ • International Council of Nurses 2002 oo

4. NMC’s role • The NMC safeguards the health and wellbeing of people who use or need the services of nurses and midwives • Nursing and Midwifery Order 2001 oo

5. Some historical background • 2004/2005 NMC consultation on ‘advanced nurse practice’ • 2005 NMC Council decision to seek regulation of ANPs • 2007 White Paper, Trust Assurance and Safety expresses support for advanced practice • 2008 CHRE report highlights risk to public, the role of employers and the need to develop an evidence base • 2011 Command Paper ‘Enabling Excellence’

6. PM’s Commission (2010) The Commission stated: ‘ The Nursing and Midwifery Council must regulate advanced nursing practice, ensuring that advanced practitioners are recorded as such on the register and have the required competencies. Stakeholders must also consider how to reduce and standardise the proliferation of roles and job titles in nursing.’

7. The Council are enthusiastic to resolve the matter of advanced practice • covers a range of specialist roles, including midwifery • great interest to the profession • very confusing for the public, evidenced by feedback provided to the PM’s Commission

8. So what’s changed?

9. ‘Enabling Excellence’ • In February 2011, the White Paper states: ‘the Government will not support the health professions regulators in taking on any new responsibilities or roles which add to the costs to their existing registrants without providing robust evidence of significant additional protection or benefits to the public.’

10. ‘Enabling Excellence’ • the White Paper also states: ‘the health professions regulators will need to demonstrate that … advanced practice registers, which has some professional support but where a compelling case for further regulatory action has yet to be made, are an appropriate and proportionate use of registrants’ fees.’

11. Interdependence with other workstreams • specialist practice qualification • specialist community public health nursing • midwives rules and the question of whether midwifery is ‘in’ or ‘out’ of advanced practice • nurse prescribing • all graduate RN programmes – concept of graduates in nursing • education QA framework

12. Challenges for the NMC moving forward advanced practice • developing the evidence base • focus on patient safety and not career progression • measurement of patient satisfaction and clinical outcomes • link to revalidation • fitness to practice issues • protection of title • using the stakeholder experience and lessons from around the world • devolved country ‘buy in’ • governmental ‘buy in’

13. Questions and answers Professor Dickon Weir-Hughesdickon.weir-hughes@nmc-uk.org020 7333 6528