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Advanced and Specialist Nursing Practice

Trainees are expected to build up a portfolio of evidence throughout their 2-year training. We currently use the Turas Professional Portfolio available from NHS Education for Scotland. These are free to nurses working within Scotland.

Go to https://turasnmportfolio.nes.nhs.scot/ and follow links to register for an account.

Trainees will begin to build this early in their training and continually contribute evidence to the Portfolio as they progress through training. For example, evidence of achieving competencies related to prescribing and therapeutics can be added whilst undertaking the prescribing component of your pathway. 

Further to the information below, our own guide to working with the Turas Professional Portfolio can be found by clicking here.  

Portfolio Content

Trainees are expected to record the following in their Portfolio:

  • Personal details including NMC PIN Number.
  • Learning Plan – the ‘Professional Journal Plan’ in the Portfolio can be used for this purpose.
  • Record of Learning – All learning activities (these can be grouped into themes e.g. modules completed, eLearning, supervised practice etc)
  • All supervision sessions
  • An anonymised list of patients seen (gender, approx age, presenting complaint, diagnosis, management/referral and any key learning points). Trainees may wish to keep this as a spreadsheet or word file and upload into their portfolio periodically. A blank template can be found on the trainee ANP moodle site. 

Remember – no patient identifiable information should be kept in your portfolio.

  • Competencies
    • Trainees are expected to work through the appropriate competency document and upload a scanned copy to their Portfolio prior to any supervision meetings (relevant competency documents will be given to trainees during the training). The trainee should self-assess and then the Practice Assessor should go through with the trainee. Competencies should be signed as complete when the assessor has seen satisfactory evidence, within the Portfolio, that the competency has been met. Items listed below can contribute towards evidence of competence achievement and should be cross referenced within the Portfolio. 
  • Reflection
    • Trainees are encouraged to regularly write up anonymised reflective accounts relating to patients they have seen or from appropriate learning situations.  
  • Feedback
    • Supervisor in Practice Reports. Practice Supervisors are expected to feedback at various points throughout a trainees training using the Generic Feedback form in the Portfolio.
    • Trainees are expected to get feedback from a variety of different people for components 1-3 described below:
      1. Mini-CEX – Trainees should include a number of mini Clinical Examination assessments in their portfolio. A mini-CEX should be used where a Practice Supervisor gives formal formative feedback to a trainee on a consultation. Forms can be found on the Portfolio and ‘a ticket’ can be raised so the supervisor can complete. 
      2. DOPS – Direct Observation of Procedural Skill. Once a trainee has learnt a new procedural skill, the Practice Supervisor should give formal formative feedback using the DOPS form. Forms can be found on the Portfolio and ‘a ticket’ can be raised so the supervisor can complete. 
      3. Case Based Discussion – Trainees will discuss numerous cases with their Practice Supervisors. Trainees are encouraged to keep notes on all their significant discussions and to write up formal case based discussions. The Case Based Discussion template within the Portfolio should be used for this.
      4. Multisource feedback (MSF) – Trainees should request feedback from different clinicians (e.g. ANPs and medical staff) and non-clinicians. The generic feedback form in Portfolio can be used and a ‘ticket’ can be raised for the respondent to complete. 

Ultimately, the Portfolio will become a central part of the final sign-off process and trainees should familiarise themselves with the requirements for this on the Final Sign-Off area on this web page.                                                              

Final Sign Off

Prior to being recorded as an ANP your line manager needs to confirm that you have completed all the required training for the role and have evidence that you meet all the required competencies. This process is termed ‘final sign-off’.

Final sign-off is required when an individual:

  • Completes initial training
  • Changes job (especially if it’s in a new speciality)

For final sign-off the ANP trainee should select out the ePortfolio evidence which best demonstrates their learning and competence. The trainee ANP will submit a ‘Share-Pack’ of this evidence to their line manager when they are ready for ‘final sign-off’.

The Final Sign-Off Process

Final Sign-off involves:

  • The individual’s line manager who will take the lead on the sign-off process
  • The Practice Supervisor or a nominated Practice Assessor
  • The Education Institution – this would usually be through evidence of completion of a programme of education (for example a copy of the Postgraduate Diploma in Advanced Practice and/or academic transcript)

STEP 1

The trainee ANP will develop a share pack of evidence within the ePortfolio which meets the requirements of final sign-off. 

STEP 2

The tANPs manager sets a date for the tANP to submit the ‘Share Pack’ and shares this with the Practice Assessor. Both would be expected to review the portfolio and confirm it meets the criteria for final sign-off. As a minimum the following is expected:

  • Record of their learning including clinical experience as a trainee.
    • A minimum of 400 hours of supervised practice[1] over a minimum of 1 year
    • Evidence of learning[2] covering the following areas:
      • Clinical assessment
      • Clinical reasoning, judgement and diagnostic decision making
      • Anatomy and physiology
      • Non-medical prescribing
      • Leading, delivering and evaluating care
      • Worked based learning
    • Completion of all academic requirements (record of all modules undertake, including copies of transcripts to evidence results and a copy of their final exit award certificate).
      • Copy of a masters level qualification in advanced practice (or evidence of equivalence [this would normally be 120 credits with a minimum of 50% at masters level).
      • Evidence of being recorded with the NMC as a Nurse Independent Prescriber
      • Evidence of being recorded with Health Board as a Prescriber
    • Completed competencies – The competency framework should be completed and mapped to evidence within the ePortfolio.
    • A range of Work Based Practical Assessments[3] demonstrating competence is managing the broad range of patients seen within the role. This is likely to include:
      • Mini-CEX (min 6)
      • DOPS (min 2)
      • Case Based Discussions (min 10)
    • Reflective Accounts (min 10)
    • Evidence that a broad range of patients has been seen (e.g. an anonymised patient log)
    • Feedback from others (min 4 different people)
    • Satisfactory Practice Assessor reports which confirm the trainee has completed training and has been assessed as competent performing as an ANP

STEP 3

The Practice Assessor and Line Manager will together determine whether the trainee has:

  • Passed – Satisfactorily passed all academic requirements and evidence of competence to practice in ANP role contained within ePortfolio.
  • Provisional pass – satisfactorily passed all academic requirements, but some minor gaps in evidence of competence.
  • Fail – either has still to pass all academic requirements or has major gaps in evidence of competence or both.

STEP 4

If the trainee has passed, the line manager would complete the final sign off form. The trainee will upload and add this to the share pack and forward the  completed share  pack to advancedpractice@ggc.scot.nhs.uk for internal moderation.

If the internal moderator agrees that the portfolio meets all of the requirements then the trainee, employed as Band 7 Annex 21 or Band 6, would be expected to move to a Band 7 at this stage. 

If a provisional pass by either line manager or internal moderator, the line manager would set a period of time (no less than 1 month and usually no-more than 6 months) for the individual to obtain the required evidence.

Trainees employed as Band 7 Annex 21 or band 6 would not normally move until competence has been achieved.

If a fail, the line manager, in consultation with others (which may include the clinical supervisor, education supervisor and Human Resources) the most appropriate course of action for the individual. This may include re-doing part of the training or termination of the traineeship.

If the Practice Assessor and Line Manager cannot agree on a grade the view of the internal moderator should be sought.

STEP 5

As part of quality assurance, it is current practice in NHSGGC for all share packs submitted for final sign-off to be internally moderated by an Advanced Practice Lecturer Practitioner.

STEP 6

A sample of portfolios will be externally moderated each year via the Advanced Practice Academy. This mechanism will involve a suitable expert from another Board reviewing ePortfolios and providing feedback to the line manager, the Board Advanced Practice Lead and the Board Nurse Director.

External Experts will be recorded within their employing Board as an ANP or NMAHP Consultant and either have teaching and assessing qualification or be recognised by the Academy as an ‘External Expert’.

The Academy’s recommendations will be advisory only. Ultimately it will be for the employer to determine whether an individual has met all the requirements to practice.

[1] Supervised practice may involve direct supervision where the supervisor is physically present with the trainee or indirect where supervision is provided at a distance or delegated to another clinician

[2] This may include formal academic modules/courses, clinical courses, eLearning, reflection

[3] Individual specialist areas may require higher numbers that specified here

Final Sign off documentation

Click here to see the ‘Final Sign-off’ documentation that the line manager and supervisor in practice will use to assess the ePortfolio.

Example of an ePortfolio share pack

Please click on the link below to see a dummy ePortfolio for a trainee ANP. In this portfolio you’ll see evidence being gathered to meet the requirements for final sign-off.

Please note the numbering system and ordering being used to make it easier for a reviewer to find the evidence.

Abbreviations used:

MCEX                    mini-CEX

DOPS                     Direct Observation of Procedural Skill (DOPS)

CBD                        Case Based Discussion (CbD)

REF                         Reflective Account

FFO                        Feedback from Others

SPR                        Supervisor in Practice Report

Professional Portfolio – View Share Pack (nhs.scot)

Please note this is ePortfolio is provided as a sample and do not scrutinise the evidence provided, it is indicative of whats required. 

January 2022 module is now full and closed to further applications

This highly desirable and reputable module is predominantly aimed at Trainee Advanced Nurse Practitioners (tANPs) and ANPs working in acute care settings who manage acutely unwell patients. Priority for places is given to tANPs. This is a double module accredited by Glasgow Caledonian University and forms part of the MSc Nursing: Advancing Professional Practice. The module can also be undertaken as a stand-alone CPD module.  

Overview

 The aim of the module is to equip practitioner’s with the knowledge and skills, to assess, diagnose and clinically manage acutely unwell and deteriorating patients. Contemporary teaching and learning strategies are employed, including problem based learning scenarios, additional tutorials and clinical simulation which contribute to a modern blended approach which is led by clinical experts.

Assessment

Formal assessment is by:

  • Academic written examination
  • Assessment in simulated clinical scenarios
  • OSCEs
  • Completion of Competencies

Academic Level

The module is offered at  SCQF level 11 (masters) – MMB721734BC

Students who successfully complete this module will gain 30 credits at masters  level (SCQF level 11).

Timetable

The module runs over a 5-month period, on a day release basis and requires approximately 11 days of study (including 2 day Impact and 2 days at Simulator ) which are spread between January -May. Teaching usually takes place one afternoon per week at Glasgow Royal Infirmary

Requirements

Essential prerequisites for students to be considered for a place on this module include the following;

  • Normally 6 years post registration qualification
  • Advanced Life Support (ALS) qualification
  • Clinical assessment skills (e.g. cardiovascular, neurological and respiratory assessment skills). Applicants should ensure evidence of these skills within their application and CV
  • Venepuncture & cannulation
  • Independent Prescribing (not essential but preferable)
  • An undergraduate degree (usually at honours level for masters)

Course Medical Director

Dr Drew Smith, Consultant Anaesthetist, Glasgow Royal Infirmary.

Module Co-ordinator

Dr Mark Cooper, Consultant Nurse – Advanced Practice, NHSGGC

Module fee

The cost of the module for 2023 is TBC

Application form complete and email toAdvancedPractice@ggc.scot.nhs.uk

NHSGGC Specific

Applicants from NHSGGC will also need to complete a Study Leave 2 form and submit this through their line manager. 

Please note that training for Advanced Practice should be signed and authorised by the appropriate Chief Nurse for your sector/directorate. ANP trainees should ensure completed SL2s are forwarded to AdvancedPractice@ggc.scot.nhs.uk 

Advanced Nurse Practitioner

The professional development of an ANP requires significant educational commitment and investment to underpin the provision of high quality safe and effective practice. Key to this is a Masters level qualification in Advanced Practice, with core educational focus on the development of competence:-

• Clinical assessment;

• Clinical reasoning, judgement and diagnostic decision making;

• Anatomy and pathophysiology;

• Non medical prescribing- V300;

• Leading, delivering and evaluating care;

• Practice learning/transferable work based learning. For further information on the ANP role in Scotland please see the Transforming Nursing Roles Phase 1 paper (link in the introduction).

ANP Education Programmes

Local ANP education providers include the University of the West of Scotland (for neonatal, paediatric and adult ANP education) and Glasgow Caledonian University (for adult ANP education).Napier University provides role specific training for ANPs in Critical Care.

Information on the ANP Education Pathways currently being used in NHSGGC can be found here

Information on the new UWS programme and the programme provided at GCU can be found below, together with contact details for the Programme Leaders for more information.

Please discuss your education requirements with the Consultant Nurse for Advanced Practice before enrolling trainees.

(AdvancedPractice@ggc.scot.nhs.uk)

Financial support for education is available, but must be discussed and agreed prior to enrolment. 

University of the West of Scotland, MSc Advanced Clinical Practitioner Programme

http://www.uws.ac.uk/postgraduate/advanced_clinical_practitioner_%28neonatal-child-adult%29/

University of the West of Scotland, MSc Advanced Clinical Practitioner Flyer

Please note that this programme is only for trainee ANPs and has pathways for training neonatal, paediatric or adult ANPs.

Glasgow Caledonian University, MSc Advancing Professional Practice Programme

https://www.gcu.ac.uk/study/courses/details/index.php/P02886/Nursing_Advancing_Professional_Practice?utm_medium=web&utm_campaign=courselisting

Please note that this programme contains many modules. Please discuss the appropriateness of specific modules for a trainee ANP with the Consultant Nurse for Advanced Practice and the Programme Leader.

Further information on both programmes can be downloaded here

Advanced Clinical Nurse Specialist

Transforming roles paper 8 sets the educational requirement to be an Advanced Clinical Nurse Specialist as a minimum of Post Graduate Diploma. 

As this is a recent publication, NHSGGC and the Higher Education Institutions are collaborating to create pathways for ACNS that meet both the academic requirements and the bespoke in-depth clinical learning required of an ACNS. 

It is envisaged that many of the generalist components of ANP education will also be essential for the ACNS:

• Clinical assessment;

• Clinical reasoning, judgement and diagnostic decision making;

• Anatomy and pathophysiology;

• Non medical prescribing;

• Leading, delivering and evaluating care;

As the number of advanced specialists in each field will be relatively small, it is expected that specialist component of ACNS education may come from practice learning/transferable work based learning. Under this model, the HEI works with NHSGGC and the specialist clinical teams to devise learning contracts, and deliver bespoke learning and assessment, to highly specialist trainee ACNS.

For other specialists, there may be ‘off the shelf’ existing specialist education, such as the long running endoscopy module at Glasgow Caledonian University (Module details | Glasgow Caledonian University | Scotland, UK (gcu.ac.uk)) while other specialist modules are likely to be created when the number of trainees requiring a specialist skill warrants a specialist programme, such as the new Glasgow Caledonian University / NHS Education for Scotland Post Graduate Diploma in Non- Medical Cystoscopy

Module details | Glasgow Caledonian University | Scotland, UK (gcu.ac.uk)

Non-medical cystoscopy | Turas | Learn (nhs.scot)

We will update this page over the coming months as things develop. 

Information for Managers
NES ANP Service and Education Needs Analysis ToolUseful questions to help with deciding whether ANP post is needed and to help build any business caseClick Here for Service & Education Needs Analysis
ANP Service SOP templateClick Here for ANP Service SOP
Generic ANP Job Description (Adult) (with associated AfC Job Match Report for reference)Click Here for GGC Generic ANP Job Description (Adult)
 Click Here for Job Match Report
Generic ANP Job Description (PaediatricClick Here for Paediatric Job Description
Agenda for Change – Annex 21To convert a post into a trainee postClick Here for Agenda for Change Annex 21
SOP for new ANP rolesClick Here for SOP for new ANP Roles
Education ProgrammesSee  ANP education and programmes page
WoS Advanced Practice Academy Clinical Supervision guidanceClick Here for Clinical Supervision Guidance 
GGC MoodleVirtual Learning Environment with resources for trainee ANPs and qualified ANPswww.ggcmoodle.scot.nhs.uk
NHS Education for Scotland Nursing and Midwifery TURAS ePortfoliohttps://turasnmportfolio.nes.nhs.scot/
Final Sign-off (DRAFT DOCUMENT)Click Here for Final Sign-off (Draft)
Metrics (Transforming Roles Advanced Practice Group)Click Here for Metrics (Transforming Roles Advanced Practice Group)
2017-18 ANP Service Annual Report formClick Here for Annual Report Form
Annual PDP Review for ANPs Click Here for Annual Review
Job Planning GuidanceClick Here for RCGP ANP Competencies
Trainee ANP & ACNS Funding

Funding for ANP training is different this year (2020/2021) as NES funding is coming to an end.

NES Funded Trainee ANPs – i.e. Continuing trainee ANPs (i.e. those who started their ANP training during the 2019-20 academic year).

If the trainee ANP is directly employed by NHSGGC then they should complete an SL2 form for the modules being undertaken this year. This should be locally approved and sent to kulvinder.atwal@ggc.scot.nhs.uk as soon as possible (September 2020). This allows purchase orders to be raised. Following this the trainee ANP should receive an email regarding this. If the trainee ANP is employed within General Practice then their practice should have already applied to NES for their funding for this year.

Service Funded Trainee ANPs – i.e. trainee ANPs who are starting their ANP training now (post August 2020).

If the trainee ANP is directly employed by NHSGGC they should speak to their line manager regarding applying for funding. The trainee ANP will be expected to complete an SL2 and submit via their line manager to approval and funding. If the trainee ANP is employed within general practice they should speak to their local practice manager.

A tANP SL2 form (with modules listed) can be downloaded here

Trainees should apply directly to the University for a place on the appropriate ANP programme. If uncertain about which programme a trainee should go on they should contact advancedpractice@ggc.scot.nhs.uk for advice and to obtain a copy of their education plan.

Please note that funding can only be applied for one year at a time, so a further SL2 form will be needed for the second year of any programme.

It is the trainee’s responsibility to:

· Ensure they know which programme and modules they are to undertake – all trainees should have an education plan which can be obtained from advancedpractice@ggc.scot.nhs.uk

· Complete and submit an SL2 for funding (see above)

· Apply to the university for the appropriate programme (and modules)

· Send a copy of their ‘award letter’ with the relevant Purchase Order details to the university when they receive it.

IMPORTANT INFORMATION RELATING TO NON-MEDICAL PRESCRIBING

For the Non-medical prescribing module apply via the Pharmacy & Prescribing Support Unit – email Mandy Logan, Non-Medical Prescribing Co-ordinator for an application pack including your contact details. (mandy.logan@ggc.scot.nhs.uk). ANP trainees should undertake Non-medical Prescribing at Masters Level (unless already held) at the institution the ANP programme is being undertaken. Please make it clear when applying to the Pharmacy & Prescribing Support Unit which institution the ANP trainee will be studying at.

“Clinical Supervision…provides nurses with a space to reflect on and discuss aspects of their role that are motivating and inspiring them, and also those elements that are frustrating or concerning them. Nurses and their supervisors can then jointly work through how the former can be promoted and the latter addressed.” (Scottish Government 2017)1 .


West of Scotland Advanced Practice Academy guidance and the CNO’s Transforming Roles work expects regular Clinical Supervision for all ANPs. Over the course of the next few months we’re looking to expand Clinical Supervision across all ANP teams.

What does Clinical Supervision involve?

Clinical Supervision can be undertaken individually or in small groups. A trained facilitator (the Clinical Supervisor) will facilitate a discussion which will reflect on practice and to think about what could be developed. “The facilitator does not make choices for people but creates the opportunity for them to choose”. 2


Who can be an ANP Clinical Supervisor?

ANP Clinical Supervisors should be experienced ANPs with facilitation skills and an interest in Clinical Supervision. Potential Clinical Supervisors should be nominated by their line manager. Nominations should be sent to the Consultant Nurse – Advanced Practice.

 
How do you train to be an ANP Clinical Supervisor?

The training for the role involves an online course currently taught by NHS Education for Scotland facilitators. Once the training is completed, new Supervisors may begin to undertake supervision sessions with their supervisees. Additional support can be provided by experienced supervisors.

What is expected from Supervisees?

Every ANP will eventually be offered a minimum of 4 Clinical Supervision sessions a year and will be expected to attend.
Supervisees will be expected to do some preparation for the meeting and to reflect on what they’ve got out of the session afterwards. This could be written up as a short reflective piece in the TURAS Professional Portfolio and be used for annual appraisal and revalidation.


How will Clinical Supervision Supervisors be allocated?

Supervisor-Supervisee pairings will be determined locally by individual ANP line managers.
Supervisors don’t need to work in the same service as their Supervisee, but should have a good understanding of the supervisee’s role. It is envisaged that supervisor-supervisee pairings will be within the following groups: adult acute care, acute paediatrics, acute neonates, community and primary care and mental health. Each supervisor will have 3-5 supervisee’s each.


Where will I find time for Clinical Supervision?

All ANPs should have time for Supporting Professional Activities and CPD built into their Job Plan. Some of this time should be used for Clinical Supervision. How this time is allocated will be up to individual line managers and will depend on the demands of service.


Do Supervision Sessions have to be face-to-face?

Supervision sessions can be face-to-face, however they can also be held over MS Teams. At the present time with the high incidence of Covid the use of Teams is to be encouraged.


How will supervision sessions be recorded?

Supervisors are expected to record basic details on the supervision session via Webropol. The information recorded will be the names of those involved in the supervision session, the date supervision took place, whether it was a face-to-face meeting or via teams and the topics discussed (high level only – no details as supervision sessions should be confidential). The webropol link is available on the ANP CPD moodle site.

Where can I find out more about Clinical Supervision?

NES have some really good resources at: https://learn.nes.nhs.scot/3580/clinical-supervision.

Unit 1 provides general information for Supervisees and managers on Clinical Supervision. Units 2-4 are aimed at Clinical Supervisors.


Further information will be added to the ‘Clinical Supervision’ section on the ANP Continuing Professional Development GGCMoodle site over time as it develops for ANPs.


Dr Mark Cooper, Consultant Nurse – Advanced Practice,

[1] Scottish Government (2017) Nursing 2030 Vision: Promoting confidence, competent and collaborative nursing for Scotland’s future. Available at: http://www.gov.scot/Publications/2017/07/4277 Last accessed 29.10.19

[2] Joint Improvement Team

Practice assessors

Practice assessors will assess and confirm the student’s achievement of practice learning for a placement or a series of placements.

This does not mean that practice assessors must make an assessment of each individual environment or placement. Practice assessors do not need to be physically based or employed in each or any of the environments in which the student is placed. The practice assessor assesses the students overall performance for their practice learning, taking account of whether or not the relevant proficiencies and programmes outcomes have been met, and if they display the required values of their profession. They must have sufficient opportunities to observe the student across environments in order to inform their decisions.

A nominated practice assessor will also work with the nominated academic assessor to make a recommendation for student progression. However not all practice assessors will be required to perform this aspect of the role.[1]

Practice supervisors

This role is to support and supervise nursing and midwifery students in the practice learning environment. All students must be supervised while learning in practice environments.

Practice supervisors can provide supervision in different ways. These depend on different things – it’s the approved education institution’s (AEI’s) responsibility to decide what supervision is appropriate, with its practice learning partners.

Factors that AEIs and their practice learning partners should take into account when considering the way in which supervision may be delivered include:

public protection
student learning needs – both the level of learning required (student competence) and the student’s programme outcomes
student and practice supervisor equality and diversity needs
the availability of practice supervisors and their skills and knowledge.


Practice supervisors should also be able to judge what kind of supervision and support they are able to provide.[2]

Prescribing Modules

Additional specific advice for supervising prescribing students is available on page 12 of Realising professionalism: Standards for education and training Part 3: Standards for prescribing programmes.[3] Higher Education Institutions should also forward tailored information relating to their own module directly to nominated assessors. For advice on NHSGGC trainees undertaking prescribing modules please look here: NHSGGC : Post Graduate, Non-medical prescribing and AHPs.

Documenting Supervision

Each of the Higher Education Institutions have their own documentation that students are required to have supervisors read / sign off for different modules. All trainee ANP / ACNS now require to have evidence of supervised practice within their Turas Professional Portfolio, and we have our own guidance document.[4]

Trainees can ‘raise a ticket’, i.e. email you an official request for feedback, either formative or summative, that is sent directly back to, and is stored within their portfolio. This can take a variety of formats which are explained within the advance practice toolkit. [5]

Further support is available from the NES document A National Framework for Practice Supervisors, Practice Assessors and Academic Assessors in Scotland. [6]

There is also a series of learning modules on Turas Learn Practice Supervisors and Practice Assessors’ Learning Resource.[7]

[1] What do practice assessors do? – The Nursing and Midwifery Council (nmc.org.uk)

[2] What do practice supervisors do? – The Nursing and Midwifery Council (nmc.org.uk)

[3] programme-standards-prescribing.pdf (nmc.org.uk)

[4] the TURAS Professional Portfolio In advanced nursing practice (nhsggc.org.uk)

[5] https://www.advancedpractice.scot.nhs.uk/education/turas-professional-portfolio.aspx

[6]https://www.nes.scot.nhs.uk/media/fxdd4d01/scottish_approach_to_student_supervision_and_assessment_interactive.pdf

[7] https://learn.nes.nhs.scot/45749/future-nurse-and-midwife/practice-supervisors-and-practice-assessors-learning-resource

Most Clinical Nurse Specialists (CNSs) work at an Advanced Practitioner level of practice (Level 7). Advanced Clinical Nurse Specialists have a wider scope of practice than CNSs at level 6 and will manage greater complexity (CNOD 2021).

Across NHSGGC there are over 300 nurses working at this level of practice in ACNS roles. They work in a wide variety of areas including:

Breast Care Nursing, Burns, Oncology, Cardiology, Mental health, Urology, Dermatology, Diabetes, ENT, Emergency Medicine, Epilepsy, Gastroenterology, Haematology, Multiple Sclerosis, Neurology, Nutrition, Gerontology, Ophthalmology, Orthopaedics, Pain, Palliative Care, Parkinson’s Disease, Plastic Surgery, Renal, Respiratory, Rheumatology, Sexual Health, Tissue Viability, and Vascular. The recently published CNO’s Transforming Roles Paper 8 provides an updated definition. Transforming Nursing, Midwifery And Health Profession (NMaHP) roles: review of Clinical Nurse Specialist and Nurse Practitioner roles within Scotland – gov.scot (www.gov.scot)

Definition

“The Advanced Clinical Nurse Specialist (ACNS) is an experienced and highly educated registered nurse working within a specific field of practice. They manage, deliver, advise on and support the care for people within a specialist area. Educated to at least Postgraduate Diploma level in an appropriate subject, they are assessed as clinically competent in their defined specialty. They have a wider scope of practice than the clinical nurse specialist at Level 6 and will manage greater complexity.

As a clinical leader they have the autonomy to act and accept responsibility and accountability for their actions, acting as an expert advisor or resource for others. This includes specialist assessment and treatment using a holistic approach to managing complex, multidimensional situations. This may require management of care over a prolonged period of time. They have the authority to refer, admit and discharge within appropriate clinical areas. Their practice is characterised by a high level of clinical decision making based on in-depth, expert knowledge in their specialism of care delivery.

Working as part of the multidisciplinary team, they can work in or across all settings, including non-clinical areas, dependent on their area of expertise.” (CNOD 2021).

Training

ACNSs train in post for the role. Trainee ACNSs are usually CNSs before they embark on deepening and broadening their knowledge for an ACNS role. Trainee ACNSs are increasingly being formally employed in training posts (using Annex 21 from Agenda for Change) while they learn. Trainee ACNSs are supervised whilst they learn additional skills and will also undertake appropriate post-registration education at postgraduate level at university to support their learning. Trainee ACNSs will build a portfolio of evidence to demonstrate they are competent to practice which is formally assessed at the end of their training.

Competency Framework

Transforming Roles Paper 8 sets out the core competencies for any ACNS. To these additional specialist competencies are added. The competency framework needs to be completed before a new ACNS can be regarded as appropriately prepared.

Agenda for Change

ACNS are paid at a minimum of Band 7

ANPs in General Practice

Advanced Nurse Practitioners (ANPs) are experienced and highly educated Registered Nurses who manage the complete clinical care of their patients, not focusing on any sole condition (Chief Nursing Officer Directorate, Transforming Nursing Roles Paper 2, 2017) .

Within NHSGGC there are over 100 ANPs working across a wide variety of areas from primary care through to intensive care.

NHSGGC has been training and employing ANPs for many years and works closely with Glasgow Caledonian University, University of the West of Scotland, University of Stirling and Napier & Queen Margaret Universities in Edinburgh to prepare ANPs.

Definition

” An Advanced Nurse Practitioner (ANP) is an experienced and highly educated Registered Nurse who manages the complete clinical care for their patient, not solely any specific condition. Advanced practice is a level of practice, rather than a type of speciality of practice.

ANPs are educated at Masters Level in advanced practice and are assessed as competent in this level of practice. As a clinical leader they have the freedom and authority to act and accept the responsibility and accountability for those actions. This level of practice is characterised by high level autonomous decision-making, including assessment, diagnosis, treatment including prescribing, of patients with complex multi-dimensional problems. Decisions are made using high level expert, knowledge and skills. This includes the authority to refer, admit and discharge within appropriate clinical areas.

Working as part of the multidisciplinary team ANPs can work in or across all clinical settings, dependent on their area of expertise.”

(Scottish Government 2017)

Training

Advanced Practice is a level of practice, rather than a specific role or title (Transforming Nursing Roles Paper 2 CNOD 2017)and  has four pillars of practice, which the ANP must have as part of their core role and function. These  are:-

• Clinical practice

• Leadership

• Facilitation of learning

• Evidence research and development

Competency Framework

“The Advanced Nurse Practitioner role has a specific focus on the clinical pillar, but must demonstrate competence within all four pillars of advanced practice. With regard to the clinical pillar all ANPs must be able to demonstrate competence in:

a) Comprehensive history-taking
b) Clinical assessment 
c) Differential diagnosis 
d) Investigations 
e) Treatment 
f) Admission, discharge and referral.” (Chief Nursing Officer Directorate, Transforming Nursing Roles Paper 2, 2017)

Transforming roles ANP competency frameworks are available here NHSGGC : Key Documents

Agenda for Change

ANPs are paid at a minimum of Band 7, and within NHSGGC the generic ANP Job Description should be used for any new Band 7 ANP roles.

Advanced Nurse Practitioners in General Practice

Advanced Nurse Practitioners who work within General Practice and are not directly employed by NHSGGC but work within the Board area, are encouraged to join the Board held list of ANPs in General Practice. The benefits of joining this list are:

  • On-going access to specific ANP education and information

The process to join is exactly the same as for those who are Board employed, but with the following grandfathering arrangements for those employed before 2010 or between 2011 and 2017.

Advanced Nurse Practitioners in General Practice Guidance Document

Employed as an ANP prior to 2010

Expected to demonstrate that they:

  • meet all the appropriate competencies for their area of practice,
  • can evidence the formal learning undertaken relevant to the role which may have been below master’s level (commonly degree level modules)
  • provide evidence of recent workplace based assessments (within last 5 years)
  • provide satisfactory feedback from others (minimum of 4 within the last year)
  • provide a satisfactory supervision report
  • provide evidence of reflection and a broad range of patients seen
  • evidence continuing professional development

Employed as an ANP between 2011 and 2017

In addition to the above, ANPs employed between these years should demonstrate master’s level  learning. This could be done, for example, through having completed a module at master’s level.

Employed as an ANP after 2018

Expected to demonstrate that they meet all the appropriate competencies for their area of practice, a master’s level qualification in advanced practice, workplace based assessments, reflection, feedback from others, and a satisfactory final supervisors report (see Final Sign-off).

Recording General Practice ANPs

There are two stages to the process (see Recording ANPs).

                Stage 1: Involves the Post being recognised as an ANP post (please note that posts which utilise the Board’s generic ANP job description automatically meet this requirement)

                Stage 2: Final Sign-off (see Final Sign off)

A completed ‘Final Sign-off’ form and the poster-holder’s Job description should be submitted to the Consultant Nurse for Advanced Practice (AdvancedPractice@ggc.scot.nhs.uk) . Following the moderation process the following will occur.

  • The individuals name, NMC number, NHS email address and place of work will be recorded on the Board held list of GP ANPs
  • The individual will receive written confirmation that their name has been recorded (a copy will be sent to their line manager and practice supervisor)
  • Access will be given to the NHSGGC ANP Continuing Professional Development Moodle site so that ANPs can be kept up-to-date with news and resources relevant to ANPs including West of Scotland Advanced Practice Academy CPD days
  • Annually the ANP will receive an email asking them for confirmation that they remain in their ANP post (a nil response will be taken to mean that the individual has left the post and their name will be removed from the list).
  • Annually, ANPs will be requested to submit an updated ‘share pack’ from their ePortfolio evidencing continuing professional development and reflection on practice to their line manager.

[1] Set out in Chief Nursing Officer’s Directorate (2017) Transforming Nursing, Midwifery and Health Professions’ (NMaHP) Roles: Paper 2 Advanced nursing practice. Edinburgh: Scottish Government

Clinical Nurse Specialists (CNSs) and Nurse Practitioners (NPs) are registered nurses with relevant experience and post-registration education for working within a specific area of practice. They assess, manage, deliver care, advise on, and support the care for people within a specialist area (Chief Nursing Officer Directorate, Transforming Roles Paper 8, 2021)

Across NHSGGC there are over 200 Clinical Nurse Specialists and Nurse Practitioners practising in a wide variety of different areas including:

Oncology, Cardiology, Dermatology, Diabetes, Minor Injuries, Gastroenterology, Nutrition, Gerontology, Orthopaedics, General Surgery, Pain, Palliative Care, Respiratory, Rheumatology, Sexual Health, Vascular, Urology, HIV, Diabetes, Osteoporosis, Parkinson’s disease, and Stoma Care The recently published CNO’s Transforming Roles Paper 8 provides an updated definition.

Definition

“A registered nurse with relevant experience and post-registration education for working within a specific area of practice. Educated in an appropriate subject to the level of graduate certificate (honours degree) at a minimum, although a postgraduate certificate is recommended, they are assessed as clinically competent in their defined area of practice. They assess, manage, deliver care, advise on, and support the care for people within a specialist area.

As a Level 6 Senior Practitioner they work under guidance in a peer relationship with other members of the multidisciplinary team. They have the autonomy to act and accept responsibility and accountability for their actions, acting as a skilled advisor or resource for others. This includes specialist assessment, informed decision making, and treatment using a personalised approach to care for patients’ multidimensional presentations. This may require supporting specialist care over a prolonged period of time. They have the authority to refer patients, and may admit or discharge within appropriate clinical areas of practice. This is characterised by a level of decision making based on detailed knowledge and understanding of their area of practice.

As part of the multidisciplinary team they can work in or across many settings, including non-clinical, depending on their area of expertise and scope of practice.” (CNOD 2021)

Training

CNSs and NPs train in post for the role. Increasingly, CNSs and NPs are being formally employed in training posts (using Annex 21 from Agenda for Change) while they learn. Trainee CNSs and NPs are supervised whilst they learn and will also undertake appropriate post-registration education at university to support their learning. Trainees will build a portfolio of evidence to demonstrate they are competent to practice which is formally assessed at the end of their training.

Competency Framework

Transforming Roles Paper 8 sets out the core competencies for any CNS or NP. To these additional specialist competencies are added. The competency framework needs to be completed before a new CNS or NP can be regarded as appropriately prepared.

Agenda for Change

CNSs/NPs are paid at a minimum of Band 6