The Royal College of Nursing (RCN) suggests that, for nurses to be able to work (this is the RCN's word ‘work’ as opposed to practise) at an advanced level, nurses need to meet a number of standards. The standards referred to are the RCN's standards (RCN, 2018), they are not mandatory. It requires universities that are collaborating with the RCN to demonstrate that programmes of study for advanced nursing practice have met these standards in order to receive RCN accreditation. There is, of course, a fee for accreditation.
It is acknowledged that anything to do with advanced practice is complex—and so it should be, as patient safety is at stake. Advanced practice is a rapidly moving policy space (Council of Deans of Health, 2018). The Council of Deans is working with Health Education England on advanced clinical practice across various health professions. It should also be noted that, across the four nations of the UK, advanced practice policy differs. The Council of Deans refers to ‘advanced clinical practice’, as a level of practice, as opposed to ‘advanced clinical practitioner’, as a role. The UK Central Council for Nursing, Midwifery and Health Visiting (UKCC) (now the Nursing and Midwifery Council (NMC)) defined specialist practice more than 18 years ago as the exercising of higher levels of judgement, discretion and decision-making in clinical care (UKCC, 2001).
There is talk of establishing a national advanced clinical practitioners' academy, with the intention of bringing together existing quality assurance and accreditation functions for health professionals and those courses offered by universities (Council of Deans, 2018). For this to happen, there has to be national collaboration as well as local and regional collaboration between universities. At a time of intense competition between universities, this will require much work, a guarantee that the universities will make an investment and that they have the capacity and capability to develop advanced practice programmes. Above all, there has to be trust among the competing universities, as each will, for sure, want its share of the cake if it is to make the investments in human and material resources that will be required.
In nursing, there is too much confusion, misunderstanding and chaos associated with the advanced practice role, not only for those within the profession, but also for those who are the recipients of care. This has been the case for at least two decades.
The Department of Health and Social Care (DHSC) must enter the debate. It has recently announced the regulation of physician associates and physicians' assistants in anaesthesia. The lack of regulation of advanced clinical practitioner roles could be a key factor that has resulted in no consistent approach to the role; however, a consistent approach also has the potential to take away a flexible approach to practitioner preparation. Protection of the title ‘advanced clinical practitioner' would necessitate regulation and this may bring with it consistency and standard expectations for those undertaking the role.
There are many stakeholders involved in advanced practice and none more so than those who are recipients of advanced practice care. There has to be a commitment from all parties to work together to enhance outcomes for those who receive services, ensuring that the clinical and educational requirements of advanced practitioners continue to evolve in order to meet the needs of the population. However, this commitment must be based solely on ensuring that the needs of the patient come first. Where organisations put their interests first, for example, a keen interest in providing education (universities), an interest in credentialing (the RCN) and an interest in adding a practitioner's name on a professional register for a charge (the NMC) then this must be treated with much caution. The aim has to be, first and foremost, safe and effective patient care and not income generation.