Nurse practitioner (NP) roles first emerged in the USA in the 1960s. Nurses practising in these roles were educated to master's level and taught to provide an advanced level of patient care (Phillips, 2018). In the 1980s these roles were imported into the UK – Barbara Stillwell is credited with introducing NP roles to the UK and supporting the development of initial accredited post-registration undergraduate NP programmes (Rogers and Gloster, 2020). The 1986 Cumberlege report (Department of Health and Social Security, 1986) promoted expansion of NP roles in primary care and with ensuing support from Government, it was in the 1990s that NPs became more evident in the UK. However, as there is no regulatory body or Government-led initiative to protect the title, local variances have proliferated (Rogers and Gloster, 2020; Gloster and Leigh, 2021).
The UK has taken a unique multiprofessional approach to the development of advanced practice. Higher education institutes across the UK provide master's-level programmes for advanced practice. Requirements vary with master's level awards mandatory in some countries but not in others. Educators recognise the need to support students to develop both clinically and academically. Preparation for transition to advanced practice has identified challenges with variable levels of support needed for individual students from a variety of professional backgrounds. Anecdotally, for example, it is recognised that mental health nurses undertaking advanced practice programmes struggle more with the required physical clinical assessment.
In 2008, NHS Education for Scotland developed an Advanced Practice toolkit, which identified four pillars of practice (NHS Education for Scotland, 2018). Although this was developed as a Scottish resource, the detail provided at that time within the toolkit regarding educational preparation (master's level education) was relevant and endorsed by the chief nursing officers across the UK (NHS Education for Scotland, 2018). This commentary will focus on the importance of preparation of students for advanced practice. It is recognised that advanced practice titles vary across the UK (Leary et al, 2017) and for clarity the term ‘advanced practitioner’ will be used.
Background
In 2021, a small group of advanced practice educators from higher education institutions across the UK collectively identified the need for trainee advanced practitioner student support. The faculty involved concurred this support should be offered prior to students commencing advanced practice programmes. The main areas of concern were recognised individually and collectively among the faculty as students lacking anatomy and physiology knowledge, context-specific understanding of advanced practice development within the UK and critical writing skills, a core component of MSc-level education. MSc-level preparation is recognised across the UK and internationally as a requirement for advanced practitioners (International Council of Nurses, 2020; National Leadership and Innovation Agency for Healthcare, 2010; Department of Health, Social Services and Public Safety, 2016; Health Education England, 2017; Scottish Government, 2017)
Approach
Faculty from higher education institutions from the four countries of the UK were invited to join the project through the Association of Advanced Practice Educators UK (AAPE UK). This offered a breadth of knowledge and perspectives of student needs, that were similarly aligned across all four countries.
Staff from 15 universities met virtually on four occasions to agree the content of the workbook, including an appreciation and understanding of the history and development of advanced practice within the UK and more widely its inception in the USA. Roles were then assigned to individuals within the project group. The project group consented to develop a pre-course workbook incorporating the key areas identified above, anticipating this would provide a facilitated and proactive approach to student learning. The development of the workbook was achieved through these four meetings and associated email communications. The meetings offered an opportunity to benchmark practice, as well as to develop the content of the workbook.
To encourage knowledge of and engagement with AAPE UK, and thereby offering students an opportunity to engage in the wider advanced practice agenda, the workbook is currently hosted on the AAPE UK website (https://tinyurl.com/yc8rym77). This is important not only to highlight the work of AAPE UK who have spearheaded advanced practice education UK wide but, also to encourage future committee members.
Key learning
This project enabled faculty members to collaborate on the development of a UK wide resource. This method supports robust, proactive and aligned approaches to the development of advanced practice student resources. It was encouraging to have strong agreement across the UK faculty involved, and a collaborative project group ensured the workload was shared. Remote/virtual working supported effective and efficient development of this resource and has resulted in additional networking and collaborative projects.
The development of UK-wide resource enables a consistent national approach to advanced practice student support. Ensuring the workbook is held on the AAPE UK website encourages knowledge of and engagement with the AAPE UK. The project team are hopeful this meets the needs of students, and an evaluation is currently in progress. The outcome will be reported in a future publication.