Abstract
Advanced nursing practice is a complex term that has been explored over the last 10 years within nursing as nurses have changed the boundaries of their clinical care to try and meet the needs of their patients in a rapidly changing healthcare setting. These roles are attractive to nurses as they can remain primarily clinically based as they progress within their careers. However there is currently no standardization in relation to job titles, educational provisions or regulations. The Department of Health issued guidance in 2010, but there is nothing mandatory to date. This short article will look at the issues involved in advanced practice in menopause nursing.
Keywords
Introduction
The term Advanced Nursing Practice (ANP) has been around in nursing for the last 10 years or more, both within the UK and the USA. There are many different definitions and the Nursing and Midwifery Council (NMC) undertook a consultation on advanced nurse practice in 2004/2005. Although some position papers have been published, no recommendations on standardization have been forthcoming.
This has led to a situation within nursing where there are nurses working in advanced practice roles in all areas of practice with many different job descriptions and titles and are currently unregulated. This makes it difficult to compare roles and to re-assure nurses, managers, patients and other medical staff of the level of practice being undertaken. This article will look at advanced practice and its relationship to menopause nursing.
Definitions
Definitions for advanced practice have been produced from the International Council of Nurses in 2001, NMC 2004 and Skills for Health 2006. These all recognize the components of advanced practice as including:
Expert knowledge base Complex decision making Advanced assessment skills Leadership skills.
It is recognized that advanced practice can be in one total role or it can be in one aspect of a role and can be fluid within different aspects as needed. Included within the debate on advanced practice is specialist practice, which again has no strict criteria and guidance. The Knowledge and Skills Framework (KSF) defines advanced practice as moving from novice to expert on a vertical access and generalist to specialist practice on a horizontal access, which practitioners move through in their careers.
In order to provide some clarity, in 2010 the Department of Health (DOH) issued a benchmark for advanced practice in a position statement 1 that was generic for all clinical nurses at advanced level. There were 28 elements under four themes:
Clinical/direct care practice, which covers areas such as assessment, health promotion, evidenced-based therapy, using professional judgement, knowing boundaries. Leadership and collaborative practice, which covers consultancy, engagement of stakeholders, work across professional and organization boundaries, identification of need for change and re-design of services to meet the needs of the patients. Improving quality and developing practice, which includes development of strategies that monitor quality, striving to improve practice and services, audit, appraisal and application of research. Developing self and others, which includes peer review of own practice, enabling clients to learn, development of governance systems, work in collaboration with others, contribution to culture that supports learning, high-level communication skills.
The expectation is that nurses will achieve these elements after having gained extensive clinical experience and following completion of Masters level education.
In assessing an advanced practice nurse, using a title is not enough, nurses need to support this with a portfolio that contains evidence of clinical practice, education, management and leadership and research. Examples of this can be:
Structured reflection 360 feedback Learning event log Record of competency Records of consultation activity and external activity.
The advanced practice debate also leads to further issues and questions such as who can teach and assess ANP and who can give and regulate the title, none of which have been fully answered.
From a small audit undertaken by the UK Menopause Nurse Group in 2009 only nine out of the 74 menopause nurses met the then MNC guidance for advanced practice. 2 The areas in which nurses did not fulfill for the criteria were research and audit with only 50% having undertaken these, presenting at meeting/teaching others, and prescribing. In order to help nurses, who wish to advance their practice in menopause care the Royal College of Nursing (RCN) document Competencies in Menopause Nursing, was published. 3 This is modelled on the KSF framework and has menopause nursing roles by grade with the band 7-8 descriptions meeting the outline from the DOH for advanced practice.
The definition of advanced nursing practice for menopause nurses differs considerably from the advanced certificate in menopause care from the Faculty of Reproductive and Sexual Health Care (FRSHC). The criteria are set out in the advanced certificate in menopause. Many nurses who work in menopause do meet the criteria for the advanced certificate but currently are unable to complete this. However within nursing practice the definition of advanced practice is more complex and further work is needed to define what constitutes an advanced nurse practitioner within menopause care.
Recommendations
Advanced practice regulation and education is here to stay. Nurses working in all areas who wish to peruse this title need to be aware of the required elements and how they can be achieved. In particular, menopause education for nurses should be tailored to meet these elements. Nurses themselves need to undertake more active roles in research, audit, teaching, presenting their work and should undertake non-medical prescribing roles.