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.
Recent Scottish Government work through Transforming Nursing Roles has added greater clarity around the role including an updated 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)
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
• Facilitation of learning
• Evidence research and development
"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 – the ANP:
• carries out comprehensive clinical examination of patients in their entirety, including physical examination of all systems and mental health assessment.
c) Differential diagnosis – the ANP:
• applies high-level decision-making and assessment skills to formulate appropriate differential diagnoses based on synthesis of clinical findings;this takes account of managing clinical risk in dealing with undifferentiated client groups across the age spectrum.
d) Investigations – the ANP:
• has the freedom and authority to request, where indicated and using judgement and clinical reasoning, appropriate diagnostic tests/investigations based on differential diagnoses
• interprets and analyses previously ordered results of tests/investigations and works collaboratively with other healthcare professionals when needed
• acts on the results to confirm diagnosis and thereby optimise treatment and management outcomes.
e) Treatment – the ANP:
• formulates an action plan for the treatment of the patient, synthesising clinical information based on the patient’s presentation, history, clinical assessment and findings from relevant investigations, using appropriate evidence-based practice
• is an Independent Prescriber
• implements non-pharmacological interventions/therapies, dependent on the situation and technical requirements of care.
f) Admission, discharge and referral – the ANP:
• has the freedom and authority to admit and discharge from identified clinical areas, dependent on patient need at the time of review: this includes the freedom and authority to refer to all appropriate healthcare professional groups and agencies, working collaboratively with them." (Chief Nursing Officer Directorate, Transforming Nursing Roles Paper 2, 2017)
Banding 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.