Experienced nurses can now move up the career ladder without leaving the clinical arena. The ranks of the advanced nurse practitioner are swelling, writes Danielle Barron.
In the past, to climb the career ladder in nursing, you had to move into management or an administrative role. A relatively new development in the field, however, has meant that nurses with extensive experience and added qualifications can become an advanced nurse practitioner, managing their own particular caseload of patients from the time of admittance to discharge.
Valerie Small works in the A&E department at St James's hospital and was the first accredited advanced nurse practitioner (ANP) in Ireland. Small says that the idea of nurses with extra clinical skills and responsibilities first came about 10 years ago in 1996, as part of endeavours to address the problem of prolonged waiting times in casualty for patients with minor injuries such as muscle strains, cuts and abrasions.
"We looked at developments in the US and Britain regarding nurses managing cases that were not urgent or life-threatening," recalls Small.
Having reviewed the available literature, Small and consultant Patrick Plunkett put forward a proposal to the hospital board and Department of Health for Small to be trained as a nurse practitioner.
"The pilot scheme proved to be quite successful and it also proved that a nurse with specialised training could actually manage a proportion of the patients who presented with certain types of injury," says Small.
In 1997 it became a fully approved post in St James's, and was the first of its kind in the country, says Small.
There are now 45 approved posts in diverse areas such as diabetes, breast care, rheumatology and neonatology. "There has been a huge increase of approved posts, especially in the past six months, with the first post in palliative care approved just recently," she says.
Since its inception in 2000, the National Council for Professional Development for Nursing and Midwifery (NCNM) has been responsible for setting the standards for education, qualification and job descriptions of ANPs.
They also monitor the ongoing development of advanced practice across the country, says Kathleen MacLellan, head of professional development with NCNM.
"Advanced practice reflects the changing pace of nursing," she says. "The benefits we see are reduced waiting time in A&E and enhanced continuity of care."
The initial success of the scheme meant that there were formal structures put in place to educate those nurses who wished to follow this career path. "Because of its success we decided that we needed to develop that even further and put in place an education package to train other nurses that would be suitably qualified," says Small.
The training package now takes the form of a module attached to the Master's degree in nursing in Trinity College, which nurses, who have the required years of experience and other qualifications, can study as part of the course. ANPs must be educated to Master's degree level, and have at least seven years' post-registration experience, with at least five years in the chosen area of speciality.
"The value of this is we are seen as academically as well as clinically qualified to carry out the job," says Small.
There is also a stringent accreditation process carried out by the NCNM, with re-accreditation necessary after five years.
Ireland is now regarded as being ahead of the UK in terms of professional development, says Small, adding that the well-developed structures for job descriptions and accreditation employed here have also garnered international attention.
"The government of Western Australia has now taken on board the frameworks that we use," she says.
Becoming an advanced nurse practitioner is seen as an attractive career option for those nurses who wish to move up the career ladder, without entering management or administration, says Small.
"Up until then there wasn't a career pathway for nurses like myself who wished to remain in the clinical area but also having some progression in terms of seniority and recognition of experience," she says.
The development of posts for ANPs has helped stem the outflow of experienced nurses from the profession, adds Small. "It's acknowledging a lot of the hidden work that nurses did in the past and giving us some recognition for expertise acquired over the years," she says.
ANPs in Ireland have been likened to consultant nurses, or the so-called "super-nurses" found in British hospitals. There are inherent differences, however, explains Small.
"What we tried to do was take the best of what they had developed in the UK and the US and adapt it to suit our own healthcare and education systems," she says. The result is that ANPs are very much clinically based here, as opposed to the UK, where their roles are mainly confined to consultancy, says Small. "Our role is at least 65 per cent clinical," she says.
The role of an ANP is very diverse, with a detailed job description, admits Small. "Even though the reason it came about was to manage a particular patient group, it now has lots of other facets," she explains.
ANPs are involved in teaching junior staff of all grades, including nurses and doctors, and they are also expected to carry out and use research, says Small.
Six ANPs are working in emergency medicine at St James's, treating 20-25 patients every day. Patient attitudes are "brilliant", says Small, adding that a surprising proportion of them are already aware of the role of ANPs.
"They understand the principle of it, that an experienced nurse is managing their care," she says. "Over the past 10 years here, the nurse practitioner service has seen 60,000 patients by itself and we have had no complaints. The amount of good feedback we get is quite amazing," says Small.
"We complement the existing roles that are there and show that nurses have a valuable contribution to make to patient care. And in the long run, the reason we are employed is to help the patient," says Small.
"It's all about enhancing the patient journey," concludes MacLellan.