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Final Sign-off

Final Sign-off

Please click on link to see Final Sign-off video https://www.youtube.com/watch?v=Y8AJbyn2GMo&rel=0

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)

During the two to three year training period a trainee ANP will have amassed a great deal of evidence to demonstrate their learning and clinical competence. This evidence should be stored in their NHS Education for Scotland TURAS ePortfolio.

For final sign-off the ANP trainee would select out the 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’.

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)

The Line manager would set a date for the trainee ANP to submit a ‘Share Pack’ of their portfolio. The line manager would share this with the Practice Supervisor/Assessor. Both would be expected to review the portfolio and confirm it is completed to a satisfactory standard. 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 results and copy of their final exit award certificate) and recorded as a non-medical prescriber with the Nursing and Midwifery Council.
      • 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 – where appropriate competencies will be mapped to evidence elsewhere in the portfolio (e.g. specific courses or Work Based Practical Assessments)
    • 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)
      • Feedback from others
    • 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 Supervision reports which confirm the trainee has completed training and has been assessed as competent performing as an ANP

The Practice Supervisor/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.

If the trainee has passed, the line manager would inform the Consultant Nurse – Advanced Practice who is responsible for recording ANPs on the Scottish Standard Workforce Information System (SWISS). 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, 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. The trainee would not normally move to a Band 7 until after confirmation that satisfactory evidence has been submitted.

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 Supervisor/Assessor and Line Manager cannot agree on a grade the view of the internal moderator should be sought. If agreement can still not be reached then advice can be sought through the external moderation mechanism system i.e. the Academy.

Moderation

A sample of portfolios will be internally and externally moderated each year. Each Board will put in place a mechanism for internal moderation.

The Advanced Practice Academy will put in place a mechanism for external moderation of a sample of portfolios from each board every year. This mechanism will involve a suitable expert(s) 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