The role of advanced nurse practitioner shows how far the profession has come - but there are significant obstacles preventing them doing the best for patients

Peter Carter

Of all the professions working in healthcare, few have changed so much in recent times as nursing. In 2012, nursing is an integral part of an expert, skilled and efficient health machine. In our fast-moving health world, there can be no doubt that nurses are not, as they were so often unfairly labelled, the “hand maidens” of their doctor colleagues.

A good demonstration of just how far nursing has come in the past few decades is the role of the advanced nurse practitioner.

Nurses working at this level are experienced in making an assessment of their patients’ healthcare needs, based on hard earned knowledge and skills. They have the expertise to diagnose, treat and discharge a patient – something that might surprise the lay person, who expected all this do be done by a doctor.

However, despite this expertise, a recent Royal College of Nursing survey revealed significant obstacles that prevent these nurses delivering the very best for patients.

‘There is significant variation in nurses being empowered to actually carry out advanced-level practice, despite being qualified to do so’

Many working at this level reported real and repeated challenges in undertaking their role; one nurse told us that a “traditional medical approach” predominates, in which “nurses need to pass everything by a doctor first regardless of experience or qualifications”. We would never seek to undermine or question the remarkable work of this country’s doctors. However, experienced staff should be empowered to carry out work for which they are qualified – it really is that simple.

Variations in practice

The RCN has learnt that there is significant variation in nurses being empowered to actually carry out advanced-level practice, despite being qualified to do so. This disparity may depend on where they are or the specialism in which they work, not to mention the support of colleagues to allow them to complete whole episodes of care. 

Group of clinical professionals talking

Many nurses who have advanced experience and training are not being enabled to perform clinical functions without the approval or advice of a qualified doctor, causing an obvious and unhelpful delay for patients. The time taken by two healthcare professionals to treat a patient makes for an inefficient process, particularly when just one advanced nurse practitioner is more than competent to do the job.

Routine referrals into secondary care are also being hindered when archaic and unnecessary rules demand that referrals are approved by a GP only. Similar obstacles occur when experienced staff are prevented from ordering x-rays and scans, despite these advance-level nurses being more than competent to do so.At a time when efficiency savings are at the top of the NHS agenda, we should be making the most of the skills and expertise of nursing staff, not resigning ourselves to an ill thought out hierarchy in clinical practice.

On the ground, it is common that an advanced nurse practitioner in primary care will work alongside GPs to manage the patients in that surgery, particularly those living with long term conditions. They are a one-stop shop for patients attending with a wide range of clinical issues that once, some years ago, used to be the territory of the doctor.

One nurse, who is a partner of a practice, explained that her patients like being offered an alternative approach, and having the choice of seeing either a GP or a senior nurse.

Skills and expertise

It is vital that service level agreements (SLAs) are reached to allow fully competent nurses working at an advanced level to deliver the streamlined, high quality patient care they are capable of.

An SLA would specify the best practice for the employment of an advanced nurse practitioner, the education and training they are required to undertake and, just as importantly, the work they will be able to do.

We must empower nursing staff to lead, and give them the tools to do the job. Quite simply, the NHS cannot afford to miss out on their skills and ability to do so. We need to free them to deliver expert care, and we need to do it now.

Peter Carter is chief executive at the Royal College of Nursing