Supporting Advanced Practitioners - Governance

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Resources and guidance for managers developing advanced nurse practice.

Supporting Advanced Practitioners – Governance

In this section we have put together information, resources and sign posting to aid organisations in understanding the employer responsibility in providing effective governance for advanced practitioners and clinical nurse specialists.  

NHS Boards should ensure that all advanced level roles are embedded into governance structures, with clear lines of responsibility and accountability leading through all professional lines. The Transforming Roles papers 2 and 7 provide an outline of the recommendations.

This is a governance example from the West of Scotland Advanced Practice Academy Leadership Group for advanced nurse practitioners. This approach could be adapted to fit other advanced level practice roles.

West of Scotland Advanced Academy Governance Example

Competence Frameworks

  • Each advanced level practitioner should have a core competence framework underpinned by the four pillars of advanced practice: leadership; clinical practice; evidence, research & development; and facilitation of learning.
  • The competence framework will demonstrate the advanced practitioner’s core competence in comprehensive history taking, clinical assessment, differential diagnosis, investigations and treatment – including independent prescribing and admission/discharge/referral.
  • Each competence framework should demonstrate comprehensive and progressive evidence of practice within the advanced practitioner’s clinical setting.
  • Any area specific competencies should be demonstrated as an addendum to the above.
  • A competence framework should take no longer than 3 years to complete.

Sign off

In line with the triangle of capability principle, competence should be assessed and signed off by a lead clinician in the area of practice, a peer and line manager.

You can find out more here: Support resources | Career Framework (scot.nhs.uk)

Maintaining Competence

  • Annual review of 10 clinical cases by line manager/senior clinician which must include evidence of reflection and learning.  
  • Annually signed peer review form as evidence of maintenance of competence.

Education

Each advanced practitioner should complete a training needs analysis on a yearly basis to ensure that individual training needs are being met.

Academic Education

  • Minimum qualification achieved within 3-5 years of taking up post.  
  • Must achieve, as a minimum, a Post Graduate Diploma in Advanced Clinical Practice
  • Must achieve an independent prescribing qualification from an accredited HEI.
  • Should be working towards an MSc in a subject applicable to advanced practice.

Continuous Professional Development

  • Completion of all local mandatory training programmes
  • Annual attendance at simulation training
  • Immediate life support as a minimum
  • Where applicable, advanced life support for first responders
  • Completion of course in recognition, management and escalation of the deteriorating patient
  • Attendance at local continuous professional development twice per year
  • Attendance at national non-medical prescribing conferences

Supervision

Line Manager Supervision

  • Regular team meetings – attendance at 2 per year with action notes/minutes available to all team members 
  • Annual Performance Development Review (PDR) using the Knowledge and Skills Framework (KSF). Ten case notes with prescribing practice, reflection and learning points at every PDR session
  • Critical companion at least once per year
  • De-brief sessions following difficult/stressful cases
  • Random case note reviews throughout the year
  • Regular direct supervision of clinical work

Peer Supervision/Support

  • Informal/ad-hoc on a shift to shift basis
  • Each advanced practitioner new to post should be given a designated supervisor
  • Potential for linking across localities/Boards to engage in appropriate mentorship

Clinical Supervision

  • Should be provided monthly as a minimum.
  • Every advanced practitioner should be provided with an advanced level practitioner supervisor (fully qualified/competent AP) at the earliest opportunity
  • Supervision should take place by critical companion and/or case based discussion/presentations – at a minimum of four times annually
  • Supervision of prescribing practice during and following academic qualification including reflection on learning from prescribing practice
  • Direct supervision of clinical work – at a minimum of annually

You can find out more about supervision requirements for specific advanced level practice roles here Supervision | Turas | Learn (nhs.scot) and in the Facilitation of Learning pillar.

Record Keeping

It is recommended that all advanced practitioners collate evidence to support their level of practice. It is helpful to have one portfolio that can support with all the different requirements.

Links to access the Turas portfolio for your profession are below and for more information go to the Professional Development section.

Nursing https://www.nes.scot.nhs.uk/our-work/professional-portfolio-nursing-and-midwifery/

AHP Professional Portfolio AHP professional portfolio | NHS Education for Scotland

Pharmacy

To register for E-portfolio follow this link RPS core advanced curriculum overview and select ‘access E-portfolio'. 

For more information on professional portfolios please go to the Professional Portfolios section.

Advanced Practice Data

NHS Boards need to maintain appropriate records of all advanced practitioners, and these should be linked to the Scottish Workforce Information Standard System (SWISS).

A key requirement from TNR paper 7 is the development of benchmarking indicators focused on outcomes that can be applied across all established and new roles.

Metrics

As per Transforming Roles Paper 7 advanced practice metrics should developed that relate to both quality of care and patient outcomes. A number of underpinning principles have been highlighted for consideration:  

Principle 1: Metrics should be both qualitative and quantitative and triangulated to demonstrate effectiveness.

Principle 2: Metrics that measure effectiveness of practice must be based on key result areas/ outcomes and align with service needs.

Principle 3: Where possible, metrics should be based upon existing data sources and systems to support a Once for Scotland approach and minimise additional work required for data collection.

Principle 4: There must be clear methods for displaying outcomes of ANP practice through time (scorecards/dashboards etc.). These should be aligned to the national nursing assurance framework, Excellence in Care.

Service level impact

NHS Boards are expected to collect baseline data before implementing a new advanced practice role, with follow up and review post service change.

Quality assurance

NHS Boards are expected to evaluate the impact and quality of care delivery.