The Irish Association of Advanced Nurse/Midwife Practitioners (IAANMP) represents a cohort of highly skilled and dedicated practitioners who have delivered quality value for money care to thousands of patients over the past sixteen years within the Irish healthcare system (NCNM, 2010). The Advanced Nurse/Midwife Practitioner (ANP/AMP) provides a service across a wide variety of specialties and although health care is a dynamic entity and is constantly changing to meet the needs of the public, the delivery of safe and effective care is a constant. The Nursing and Midwifery Board of Ireland (NMBI) develop criteria to ensure that requirements are met to guarantee that standards of excellence are maintained. The driver for health care initiatives is patient need, this need however is fluid and responds to fluctuations in population numbers and disease patterns. The role of nursing and midwifery is integral in the solution of delivering safe and effective health care (Dept. of Health, 2011).
The IAANMP was established in 2004 to:
- Provide support to nurses and midwives practicing at an advanced level in Ireland.
- To enable practitioners to debate issues and concerns pertinent to their area of practice.
- To facilitate education and promotion of professional development among ANPs and AMPs.
- To promote advanced practice in Ireland.
- To establish relationships with advanced nursing/midwifery practice organisations in other countries.
In this paper the IAANMP state the position of the organisation in relation to:
- Education requirements & standards; continuing competence for the ANP/AMP group.
- Promotion of advanced practice.
- International networking and collaboration.
- Vision for the future.
ADVANCED PRACTICE THE IRISH PERSPECTIVE
The emergence of advanced practice in Ireland occurred on foot of the Report on the Commission of Nursing (1998) which proposed a clinical career pathway for nurses into specialist and advanced practice roles. The first accredited advanced practice role was in emergency nursing in St James’s Hospital in 2001. Since then advanced practice roles in nursing and midwifery have flourished in a myriad of specialties. To date, there are two hundred and forty Advanced Nurse Midwife Practitioners registered in Ireland .The specialties include mental health, women’s health, stroke, diabetes, hematology, cardiology, colorectal, breast care, heart failure, neonatology, occupational health, ophthalmology, oncology, palliative care, primary care, care of the older person, midwifery care and gastroenterology (NMBI, 2014).
1.1 EDUCATION/ REQUIREMENTS AND STANDARDS
The National Council for the Professional Development of Nursing and Midwifery in Ireland (NCNM, 2001) introduced the educational requirements for the advanced practice roles through a framework based on four core competencies of advanced nurse and midwifery practice:
- Autonomy in Clinical Practice
- Expert Practice
- Professional and Clinical Leadership
In 2011, the Nurses and Midwives Act was signed into legislation. Subsequently, the NCNM was dissolved and the function of the council as it pertained to the regulation and promotion of the advanced practice role was taken over by the NMBI. Heretofore the standards and requirements for ANPs/AMPs was concise and transparent (NCNM, 2001). Currently, the NMBI has established a working advanced practice group (WAGP) to develop the standards and requirements for the advanced practice role to inform future criteria and an Interim Report of the WAGP was disseminated, the results of which represent the views of the advanced nurse and midwife practitioners (NMBI, 2014).
In 2017 the NMBI published the Advanced Practice (Nursing) Standards and requirements (NMBI, 2017). These set out a further 2 domains of competence for practice.
1.2 STANDARDS AND REQUIREMENT FOR ADVANCED PRACTICE ROLES,
IT IS THE POSITION OF THE IAANMP THAT:
- The nurse/midwife be on the live register of the NMBI
- Be educated to Master’s Degree Level or higher.
- Have a clinical educational component that pertains to the area of specialisation.
- Have a minimum of seven years post registration experience, with five years in the area of specialisation.
- Have substantive hours at advanced practice level.
- Demonstrate competence to exercise critical thinking and decision making skills in the clinical area that is superior to that expected of the registered nurse or midwife.
- Demonstrate competencies in the clinical area of practice
- Provide evidence of continuous professional development (NCNM, 2001).
- Adhere to NMBI regarding Standard and requirements and continued competence,
2.1 PROMOTION OF ADVANCED PRACTICE.
The promotion of advanced practice occurs in a myriad of ways, professionally clinically and politically. Clinically, advanced nurse practitioners are perceived as role models by junior staff through their implementation of evidence based practice (Gerrish et al 2011). Elliot et al (2012) identify clinical and professional leadership and acknowledge the dearth of empirical evidence as to the utilisation of professional leadership at national and international levels. Elliot et al (2013) identifies four core leadership outcome categories:
- Capacity and capability building of the multidisciplinary team · Measures of esteem
- New initiatives for clinical practice and health care delivery · Clinical practice based on evidence
These indicators capture the complex nature of leadership in advanced practice settings. They invite others to test the efficacy of these outcomes and evaluate leadership roles in a variety of practice areas.
Antrobus and Kitson (1999) explored the social and political factors that influenced nursing leadership and suggest that the foundation for any nursing leader is cemented in clinical practice and nursing knowledge. It is from this base that the academic and political agenda can be pursued. Their research found that political strength comes from a strong unified voice to inform political issues with regard to nursing and health policy.
2.2 Promotion of Advanced Practice,
It is the position of the IAANMP that:
- All sources of media including written, verbal and the use of social media be utilised in the promotion of advanced practice. (www.iaanmp.com, Facebook, Twitter etc.)
- A web based newsletter will be available through the www.iaanmp.com website.
- The IAANMP will promote advanced nursing and midwifery practice through the dissemination of an information booklet,
- RANPs /RAMPs will promote advanced practice with nursing and medical colleagues and allied health professionals through role modelling and exhibiting the utmost interpersonal and leadership skills and through evidence based practice (Gerrish et al, 2012).
- The Association will promote the establishment of a ‘nursing policy unit’ drawing on the expertise of members of the Association to inform and ensure the Association maintains a voice in relation to social and political healthcare policies.
- Research will play an integral part in the promotion of advanced practice. The Association will foster collaboration between the academic institutions and advanced practice clinicians to achieve this goal.
- The Association will encourage interdisciplinary collaboration both within the clinical area and in third level institutions.
3.1 INTERNATIONAL NETWORK AND INTER-PROFESSIONAL COLLABORATION
Jaarsma (2014) in an editorial acknowledges the variety of simple ways that collaboration is initiated, through, for example, the exchange of business cards or networking at meetings and conferences. The world is a small place and international collaboration is made easier through the use of technology, the internet and print journals. Indeed past constraints of distance are now a non-issue and the opportunities are boundless for international collaboration, research and dissemination of information.
Collaboration between clinicians and academics is vital to advance nursing knowledge and enhance patient care and it is imperative that this relationship once established is nurtured (Tubbs –Cooley et al, 2013). Interdisciplinary collaboration is also of great importance as the patient is a complex entity and many disciplines are involved in the care process (O Connor, 2004).
3.2 INTERNATIONAL NETWORK AND INTER-PROFESSIONAL COLLABORATION,
IT IS THE POSITION OF THE IAANMP THAT:
- The Association will forge links with international colleagues in advanced practice to promote advanced practice in Ireland and internationally.
- The Association will network with international colleagues to enhance the dissemination of information, to enhance patient care and professional development
- The Association will foster links with medical colleagues and allied health professionals to promote advanced practice, provide and receive information and education that will enhance patient care and professional development.
- The Association will facilitate national and international research through collaboration with university networks.
4.1 VISION FOR THE FUTURE
Continued clinical professional development is required by the ANP/AMP cohort. This professional development is necessary to equip the advanced practitioner with the skills and knowledge to address complex health issues. This includes enhancing leadership qualities, and gaining an understanding of the political issues in order to influence strategic planning and policy implementation (Antrobus and Kitson, 1999). The role of the ANP/AMP provided a career pathway that gave the opportunity for senior nurses to remain in the clinical area while advancing along the career pathway (NCNM, 2001, NMBI 2017, DoH 2017). The educational and clinical requirements ensured that nurses combined clinical experience with academic knowledge which forms the cornerstone of advanced practice. Both of these prerequisites continue to inform advanced practice during the career of the advanced practitioner. Currently there are three career options for the practitioner; a PhD, Clinical Doctorate or full time clinical practitioner. It is the view of the Association that a full utilisation and recognition of the third option is not currently occurring. Ironically it would seem that the limited career pathway for the senior nurse that led to the ANP/AMP and indeed clinical nurse specialist roles is recurring in that not all ANP/AMPS can pursue a PhD or a Clinical Doctorate for numerous reasons. Option three therefore is underutilised and has the potential to be undervalued. The Association proposes full utilisation of the clinicians’ role by encouraging and rewarding academically the pursuit of research in collaboration with the universities, the evolution of evidence based practice, change management, service expansion and policy development.
4.2 VISION FOR THE FUTURE,
IT THE POSITION OF THE ASSOCIATION THAT:
- The ANP/AMP group will continue to meet patient/client needs by delivering a quality service through the continued development of the numerous specialties within advanced practice and by persisting in pushing the boundaries of advanced practice beyond the hospital setting into the community.
- The role of the advanced nurse and midwife practitioner will continue to evolve with a firm foot hold in evidence based practice and research.
- The ANP/AMP will be an integral part in the evolution of the health service and inform policies at a national level. The ANP/AMP group will be instrumental in ensuring seamless care through the development of policies procedures and guidelines at regional and national level (NMBI, 2017).
- The advanced practice framework will be an example internationally to inform and guide the development of advanced practice in other countries by ensuring clarity with regard to the advanced practice role and title.
- The Association will engage in talks with the universities and all interested stakeholders to research the feasibility of creating a third recognised pathway that ensures the senior ANP/AMP can remain in the clinical area while continuing to advance the role and service provision through leadership, research, politics, management, teaching and collaboration and in so doing create an intrinsic link between clinical practice and academia. This will ensure that the practitioner can advance the core concepts of the role; autonomy in practice, clinical leadership, expert practitioner, while remaining in the clinical area, and be valued as a leader of advanced practice. This can only be achieved through collaboration with the universities and the development of a tailored learning programme model.
The Irish Association of Advanced Nurse and Midwife Practitioners (IAANMP) accept no responsibility for errors, omissions or views expressed herein. © 2017 IAANMP. All rights reserved. No part of this publication maybe reproduced, stored in a retrieval system or transmitted in any form or by any means without prior permission of the IAANMP.
Antrobus, S,.Kitson, A. (1999) Nursing leadership: influencing and shaping health policy and nursing practice. Journal of Advanced Nursing Mar; 29 (3):746-53.
Elliott, N., Higgins, A., Begley, C., Lalor, J., Sheerin, F., Coyne, I., Murphy K. (2013) The identification of clinical and professional leadership activities of advanced practitioners: findings from the Specialist Clinical and Advanced Practitioner Evaluation Journal of Advanced Nursing Volume 69, Issue 5, pages 1037–1050.
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