In a system and profession where things rarely stand still and change and reform are phrases never far from the lips of leaders, sometimes something really significant does come along.
This week was one of those. The Nursing and Midwifery Council announced on Wednesday that it would, in future, be regulating advanced practice nursing across the UK.
“Lack of regulation has been a problem in a number of ways”
The move follows a review of advanced practice by the regulator, which has been underway since 2022 and found huge variation in how professionals enter and undertake advanced practice roles.
To no one’s surprise, the review also highlighted that there was currently no single definition of what an advanced practice nurse is, what education they should have and what skills they need.
Speaking at the NMC’s latest council meeting on Wednesday, Kay Fawcett, chair of its advance practice steering group, stated that regulation was a “defining moment for nursing and midwifery”.
She is not wrong. The regulation of advanced practice has been needed for a long time and has been a long time coming; too long, I think it’s fair to say. It feels like we’ve been talking about it forever.
Lack of regulation has been a problem in a number of ways. For example, for practitioners themselves and their careers, it has been hard to compare roles and posts in different places.
In addition, there has been a lack of an approved way to maintain their knowledge and skills through professional development.
But there is also an important patient safety and communication element to all of this. Back in 2017, educators said lack of regulation of advanced nursing was a “major concern for public protection”.
The Association of Advanced Practice Educators, a network of universities offering training, warned that formal regulation was needed to tackle poor governance among employers.
It claimed that some nurses who were dismissed from university courses for failing to meet standards continued to call themselves advanced nurses and remained in their jobs.
The association itself was responding at the time to a major study into advanced nurses by nursing workforce expert Professor Alison Leary from London South Bank University.
Her research found almost 600 separate job titles were being used by nurses working in advanced practice roles, with no clear link between their education level, competence or experience.
The study also revealed how hundreds of unregistered care staff were being given job titles describing them as “advanced nurses”.
Different parts of the profession and related organisations have previously attempted to make things better, particularly in the wake of Professor Leary’s research.
For example, in the absence of formal regulation, the Royal College of Nursing launched its own voluntary register for advanced nurses.
In addition, the former government arm’s-length body, Health Education England, worked on an advanced clinical practice framework.
Separately, apprenticeship training standards were developed for advanced clinical practitioners by another government-funded body Skills for Health.
All were welcome attempts to fix the problem, but I think most would agree with me that the only solution to all this is formal regulation by the NMC.
It is also not a problem confined to the UK. In 2023, a meeting of the International Council of Nurses discussed the variation in the entry requirements and design of advanced practice courses.
The leaders concluded that collaboration was “essential” to developing consistent approaches to advanced practice and to reduce the variation across the world. Again, they are not wrong.
The NMC will now move to the next phase of its advanced practice review, which will involve coming up with further details on timelines and milestones for regulation. An update is expected in May.
The NMC’s executive nurse director of professional practice, Sam Foster, told the council on Wednesday that this next phase would be “complex”. Again, I suspect she is not wrong.
However, this is a start. Admittedly, it’s the start of a complicated process that is attempting to solve a very knotty problem, but it is still a start and one that I very much welcome.