Modernising Nursing CareersAdvanced and Specialist Practice

Mike Sabin,

SEHD

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UK Initiative

The Modernising Nursing Careers (MNC) initiative was launched by the four UK Chief Nursing Officers in 2005/6 as part of the overarching Modernising Healthcare Careers strategy.

The UK-wide nurse leaders group subsequently produced the report ‘Modernising Nursing Careers: Setting the Direction’ (DoH 2006).

The report identified four priority actions:1. Develop a competent and flexible nursing workforce2. Update career pathways and career choices3. Prepare nurses to lead in a changed healthcare system4. Modernise the image of nursing and nursing careers

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Programme of work

• The programme is a UK wide initiative. However the context in each country will drive different approaches where required.

• Each country is responsible for communication, dissemination and stakeholder management; to that end, each country may establish its own national structures or projects.

• Synergy between this and the Modernising Medical Careers (MMC) and similar work with AHPs and the non-clinical workforce will take place via the wider Modernising Healthcare Careers (MHC) programme.

• The programme and related projects where appropriate will consider nursing at all levels (including assistant/associates) and in all sectors.

• Midwifery issues will be managed separately but will engage at all levels.

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Workstreams

• Pre-registration Education• Careers Framework• Competency Passport• Specialist and Advanced Practice*• Community Nursing• Clinical Academic Roles• Career Navigation Tools• Independent sector• Leading and coordinating care• Fast-track Scheme for Nurse Leaders• Image

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Code Workstream Lead

Ai Pre-registration Education NMC

Aii Careers Framework All

Aiii Competency Passport Skills for Health

Aiv Specialist and Advanced Practice& Early Clinical Career Fellowships

Scotland

Bi Community Nursing All

Bii Clinical Academic Roles/ Clinical Education Careers

England

Scotland

Biii Career Navigation Tools SfH/England

Biv Independent sector England

Ci Leading and coordinating care N. Ireland

Cii Fast-track Scheme for Nurse Leaders Wales

D Image NHS Employers/All

Communications and engagement All

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Scottish MNC Group (Chaired by Margaret Smith)

• Provides a forum for dissemination of UK-wide developments and for generating data and focus for implementation or adaptation within the Scottish context.

• Provides stakeholder perspectives on each element to support SEHD decision-making, including option appraisal and risk analysis.• Feed back to the MNC consortium to inform UK wide work.• Provide support on the specific Scottish–led topic of Advanced/ Specialist Practice.

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Advanced/Specialist level practice – Scottish Lead • Designated lead country for this MNC workstream, • Opportunity to use MNC to support greater consistency in titles, roles and reward.• Consultation event and HDL with outline framework for the development of this role within the Scottish context.• New Roles Framework• Cancer, OoH, Workload and Workforce, Educational models

• Crucially – an opportunity to build on existing work • Initial invitation and subsequent work groups

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Advanced and

Specialist Practice

Overview and ideas

MORE SENIOR STAFF - LEVEL 9More senior staff with ultimate responsibility for clinical caseload decision-making and full on-call accountability.

CONSULTANT PRACTITIONERS - LEVEL 8Staff working at very high level of clinical expertise and/or have responsibility for planning services.

ADVANCED PRACTITIONERS - LEVEL 7Experienced clinical practitioners with high level of skill and theoretical knowledge. Will make high level clinical decisions and manage own workload

SENIOR PRACTITIONER/SPECIALIST PRACTITIONER LEVEL 6A higher degree of autonomy and responsibility than level 5 or managing one or more services in a clinical environment.

PRACTITIONERS - LEVEL 5Registered practitioners consolidating pre-registration experience and getting ready for a higher level of functioning

ASSISTANT / ASSOCIATE PRACTITIONER – LEVEL 4Studying for HND/ DipHE some work involving protocol based care under the supervision of a registered practitioner.

SENIOR HEALTHCARE ASSISTANT/TECHNICIAN – LEVEL 3Higher level of responsibility than support worker and studying for or attained S/NVQ 3/4 or NHC / Cert HE.

SUPPORT WORKERS – LEVEL 2Frequently entitled ‘Healthcare or Care Assistant’, probably studying for or attained a vocational qualification (S/NVQ) at level 2.

SUPPORT WORKERS – LEVEL 1e.g. domestic/support staff or those in roles that require very little formal education.

LEARNING&DEVELOPMENT

1

SKILLS

&

COMPETENCIES

2

3

4

5

6

7

8

9MORE SENIOR STAFF - LEVEL 9More senior staff with ultimate responsibility for clinical caseload decision-making and full on-call accountability.

CONSULTANT PRACTITIONERS - LEVEL 8Staff working at very high level of clinical expertise and/or have responsibility for planning services.

ADVANCED PRACTITIONERS - LEVEL 7Experienced clinical practitioners with high level of skill and theoretical knowledge. Will make high level clinical decisions and manage own workload

SENIOR PRACTITIONER/SPECIALIST PRACTITIONER LEVEL 6A higher degree of autonomy and responsibility than level 5 or managing one or more services in a clinical environment.

PRACTITIONERS - LEVEL 5Registered practitioners consolidating pre-registration experience and getting ready for a higher level of functioning

ASSISTANT / ASSOCIATE PRACTITIONER – LEVEL 4Studying for HND/ DipHE some work involving protocol based care under the supervision of a registered practitioner.

SENIOR HEALTHCARE ASSISTANT/TECHNICIAN – LEVEL 3Higher level of responsibility than support worker and studying for or attained S/NVQ 3/4 or NHC / Cert HE.

SUPPORT WORKERS – LEVEL 2Frequently entitled ‘Healthcare or Care Assistant’, probably studying for or attained a vocational qualification (S/NVQ) at level 2.

SUPPORT WORKERS – LEVEL 1e.g. domestic/support staff or those in roles that require very little formal education.

LEARNING&DEVELOPMENT

1

SKILLS

&

COMPETENCIES

2

3

4

5

6

7

8

9

Expert Practice

Specialist Practice

Generalist Practice

Novice Practice

Clinical

EducationalClinical

Management EducationalClinical

Management EducationalClinical

Research

Management EducationalClinical

ResearchLEVEL 5 Practitioner

LEVEL 5Practitioner

LEVEL 5Practitioner

Clinical

LEVEL 5Practitioner

ClinicalEducational

LEVEL 5Practitioner

ClinicalEducationalManagement

LEVEL 5Practitioner

ClinicalEducationalManagement

Research

LEVEL 5Practitioner

LEVEL 6Senior Practitioner

LEVEL 5Practitioner

LEVEL 6Senior Practitioner

Clinical

LEVEL 5Practitioner

ResearchManagement

LEVEL 5Practitioner

LEVEL 6Senior Practitioner

Clinical

LEVEL 5Practitioner

LEVEL 6Senior Practitioner

LEVEL 7Advanced Practitioner

LEVEL 5Practitioner

LEVEL 6Senior Practitioner

LEVEL 7Advanced Practitioner

LEVEL 8Consultant Practitioner

Advanced Practice – The ‘Toolkit’

• Create a model to explicitly link the regulated title, agreed national competencies, academic preparation and credit, the Career framework, the KSF and Agenda for Change.•Articulation of clinical ‘ladder’ with research, education and management ladders.•Development of ‘Toolkit’ which captures complexity/interaction in user friendly format. •Establishment of Advanced Practice toolkit development group

Stakeholders

Employers/Managers Linking competencies to KSF and AfC

Link to PDPs and learning/development contractSkills Analysis/Needs analysis toolsOutline of roles above and below AP

Practitioners Mapping self to AP Competencies

PDPsNeeds analysisPortfolio development

HEIs Mapping of Programme outcomes to AP competencies

Assessment of competence - theory and practice guidanceLinks to Qualifications frameworks (SCQF/NQF/N.I. NQF/FHEQ)Links to regulatory frameworks (NMC, HPC)

Workload Analysis tool – what the service needs

Workforce Analysis tool – what we already have (skills/compencies)

Training Needs Analysis tool – what development is needed

Recruitment Modelling tool – what skills we can bring in

Workforce model – how this fits with national structures

Governance, Policy and Regulation Guide – Supporting patient safety and staff governance

AfC/KSF interface – what the rewards/expectations are

Educational Framework – SCQF, Theory/Practice, Assessment and QA

•Service•Workforce Planning•Education •Partnership•Regulators•Public

Workload and Workforce Planning ProjectSCN Review and CQIsCancer FrameworkAdvanced/Specialist practice reviewEducational modelsKSF Mapping and Job Profiles

Advanced Practice - Actions

Creation of ideal-type exemplars in key clinical areas: •Cancer•OoH/Unscheduled Care•Critical Care/H@N •Elderly care/ Long-standing Conditions•Mental Health•Public Health/Community

•Midwifery/AHPs

• Appointment of MNC Project Leader for work on Early Clinical Career Fellowship Programme, Advanced Practice Framework and Career Pathways.• ECCF development model to target key areas and populate the framework

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Workload Analysis

Workforce Analysis

Training Needs Analysis

AfC/KSF mapping and outline

Career Framework

Education Framework

Governance, Policy, Regulation

Advanced Practice – Communication Strategy• Engagement with NES and HEIs to support educational and assessment models.• Engagement with service to ensure buy-in and integration in service redesign models. • Engagement with Scottish Partnership forum and key UK partners

• Evaluation framework to explore numbers, core competencies, skills application service models and service impact.

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