It would be true to say that there has been a near explosion in nurses working in more specialist roles, moving themselves from the generalist basic bedside level, within both primary and secondary care. The word nurse is a protected title, if you aren’t one then you cannot pretend to be one, but if you are already a nurse, then there is nothing to stop you or or employer calling yourself a nurse practitioner and that is in my opinion where the problem lies.
“A Nurse Practitioner is a nurse who is responsible for autonomous clinical decisions, who uses skills not usually exercised by nurses in differential diagnosis, screens patients for disease, develops preventative care management and who may refer or discharge patients.”
The RCN original definition of NP practices defined by the RCN in 1996 is furthered and detailed in its more recent publication (001797) July 2002 (revised 2005).
The RCN or Royal College of Nursing has a vested interest in maintaining (or perhaps the way things are going) restoring the good name of nursing, so suggest that in order to become a nurse practitioner, you follow a specifc programme of study at BSc or MSc level which gives you the appropriate skills. However they can do little more than suggest, as at present the regulating body for nursing the NMC does not actually recognise or record the qualification separately.
So what does the course involve? Well, one I found for the University of Swansea in Wales offers a course comprising as follows:
“The course commences in October runs on a part-time basis of one study day per week over two years, followed by the dissertation year. Please note that this does not include the one year prerequisite pre-clinical year . Some modules may be delivered in a block form, however students will be advised of this in advance.”
Part One – years 1 and 2 (part-time)
90 Credits would be compulsory as outlined below
Clinical Assessment Skills
Clinical Assessment Skills 2
Clinical Portfolio 1a and 1b
Research, Information and Knowledge Development
Students can opt for any combination of approved modules that total a minimum of 30 credits from the School’s module catalogue.
Part Two- year 3
Clinical portfolio dissertation
Students who achieve 60 credits on the course will be awarded a Postgraduate Certificate, those who achieve 120 credits will be awarded a Postgraduate Diploma and those who complete the full programme obtaining 180 credits will receive the full award.
As education manager, I have provided funding for many people to do this kind of course and so far they have mostly been practice nurses who are taking on a more advanced role within GP practices, and more recently we have sent a number of district nurses on a community matron course which is post graduate and is a years duration which will be probably followed by further study in specific areas like COPD or Heart Disease.
Sadly some nurses act under the misapprehension that a short course in developing specific clinical skills makes you in some way a ‘specialist’ or a ‘nurse practitioner’, this is not the case, and even if a nurse takes part in a long course, it is not going to be that which makes her into the competent practitioner. Clinical practice is where you apply new skills, it is where, under supervision, you learn how to actually do it and to recgnise how theory is applied in practice. An employer who does not recognise this, is doing both themselves, their nurses and doctors and indeed their patients a dis-service. This seems to be how we have arrived in a situation where people appear to go on a short course and return with the title ‘nurse practitioner’.
I would like to see some kind of advanced nurse role being registered with the NMC, so that people could tell what gave that specific nurse the right to call themselves Nurse Practitioner or Specialist, but although this has been consulted on by the regulator, so far there has been no concensus or decision and perhaps this is adding to the confusion. The other problem is that nurses appear not to want to actually do basic nursing and that is less about ability and more about the type of people who are being chosen to be nurses by universities, but that is another issue entirely!
You can find the RCN guidance on Nurse Practitioners here, you will need Adobe to so as it is a PDF file.
Let the debate begin!!