ANP role improves patient care with more flexible services, improving patient outcomes and enhancing career progression

At NHS Greater Glasgow and Clyde, we supported the development of a new Advanced Nurse Practitioner (ANP) role to help enable more flexible ways of delivering services and improve patient outcomes, whilst also supporting nurses to progress along the career framework.

NHS Rehabilitation and Assessment Services are facing increasing demand as the number of elderly patients increases and the proportion of these with long-term conditions grows. The implications of reduced junior doctor cover, a result of compliance with the European Working Time Directive (EWTD), mean that there needs to be a clear plan on how to deliver medical care using different skills and mix of staff.

This led to the need to explore opportunities for nursing staff to develop into areas of Advanced Practice. Implemented correctly, a more flexible workforce including Advanced Nurse Practitioners could release professional capacity to make services more streamlined. The result would be improved health and well-being, greater clinical effectiveness, and better outcomes for patients.

“The project has given solid evidence of the benefits this type of role has to offer – improved patient care, more flexible ways of delivering services, and greater opportunities for nurses to progress along the career framework.

The Advanced Nurse Practitioner role provides an ideal way for nurses to retain a balance of hands-on practice and combine it with skills in prescribing, leadership, and education.”

Elaine Burt Head of Nursing Rehabilitation & Assessment Directorate,
NHS Greater Glasgow and Clyde

Benefits

• Clinical care was provided more quickly – 80% of interventions were carried out by Advanced Nurse Practitioners
• Improved continuity of care with patients seen more quickly in a rehabilitation ward
• Role enables staff to work at the top of their level, improving productivity
• Demonstrated Advanced Nurse Practitioner role working at Level 7 on the Career Framework
• Greater opportunities for nurses to progress along career framework and raises the profile of rehabilitation nursing
• Provides evidence to support multi-disciplinary ways of working
• National Occupational Standards-based role ensures nationally recognised and transferable skills, and maps into the Knowledge and Skills Framework

NHS Greater Glasgow and Clyde decided to test the Scottish Government’s Advanced Practice Toolkit and to link this with the Career Framework for Health. The Advanced Nurse Practitioner role was piloted in care of the elderly, on a busy rehabilitation ward where the medical cover was usually provided on a rotation basis without a permanent ward-based junior doctor.

The health board worked with a range of stakeholders including Skills for Health and higher education institutions. They identified three levels of practitioner encompassing progression from Level 5 to Level 7 of the Career Framework (CF). This project scoped the skill requirements of an expert practitioner working autonomously at CF Level 7.

Using Skills for Health’s Career Framework and Competences assessment tools, the service selected competencies and produced a job description. Feedback indicates that the Skills for Health interactive tool was useful and user-friendly in developing competence-based roles within Rehabilitation and Assessment.

For this pilot, the Advanced Nurse Practitioner role had a clinical focus, although it is sufficiently flexible to allow greater emphasis in other areas such as educator, research, or practice development – as appropriate to the service need. The post holder completed a Higher Education clinical assessment module as part of his work-based learning, to upskill for the role.

Once in post, the Advanced Nurse Practitioner was able to address a wide range of areas. Medication prescribing, admission protocols and documentation, speed of patient assessment and review, rehabilitation and discharge were all judged to have improved. An audit of interventions over one month (June 2009) showed that around 80% were carried out by the Advanced Nurse Practitioner.

The learning from the pilot will be taken forward into nursing and multi-disciplinary team working by NHS Greater Glasgow and Clyde. It is currently reviewing how Advanced Nurse Practitioner along with other roles can help to alleviate workforce gaps.

As is the Sector Skills Council for all health sector employers we support the NHS, independent, and third sector. Since 2002 we’ve been working with employers to get the right people, with the right skills, in the right place at the right time. We are the authoritative voice on skills issues for the health sector and offer proven workforce solutions and tools – with the expertise and experience to use them effectively.