Is advanced nursing practice under attack, and why?
Some nurses told us they are worried to speak out and defend their advanced practice due to fear of retaliation and 'personal online attacks' others have experienced
Recent media coverage claimed that nurses' are being used to cover ‘doctor rota gaps’. In late April, a Guardian article entitled ‘Safety fears as UK hospitals use nurses to cover for doctors due to shortage of medics’ suggested that ‘more than half’ of UK hospitals were deploying nurses in lieu of doctors. The Telegraph followed this story with its own ‘Half of NHS hospitals let nurses cover doctors’ shifts.’ The message in these articles that nurses are being inappropriately used as substitutes for their medical colleagues by cash-strapped NHS trusts, thus creating a patient safety risk.
The stories, you see, are based on data collected by the British Medical Association (BMA), the doctors’ trade union, which says figures from NHS trusts reveal widespread doctor substitution with advanced clinical practitioners (ACPs) - who are often nurses - regularly working beyond their competence. BMA chair Tom Dolphin said ‘enhanced’ healthcare roles ‘must never encroach’ into areas where a doctor’s training and expertise is required. ‘This is a potential disaster for everyone involved.’
Well, yes, if that is indeed what is happening. However, Wendy Preston, RCN UK head of nursing (practice and workforce), questioned some of the responses given by the trusts. Other nurses told Nursing Standard the BMA data being used to support its argument is not robust enough and does not reflect important nuances of settings and specialties.
The RCN has now voted to ‘act against attempts to undermine advanced nursing practice’ and to tackle what it sees as misunderstanding of advanced roles.
‘Remaining silent in the current climate no longer feels neutral. Sustained and poorly contextualised narratives can have a real impact on people delivering care and public confidence.’
Vice-chair of the RCN ANP forum Adele Parsons
What’s no doubt frustrating to nurses is that the narrative being expounded to the public is a simplistic one of ‘doctor and non-doctor’. The problem with that narrative is the obvious devaluing of clinicians who are not medics that is inherent within this binary framing of two ‘sides’.
The debate - sometimes ugly - has spilled online with forum chats in which doctors discuss advanced clinical practitioners and ANPs in a negative light, such as this recent discussion about ANPs in critical care or this one about medical students being taught by advanced practitioners. Perhaps this is why two ANPs would only speak to Nursing Standard on condition of anonymity, because of what they described as ‘personal online attacks’. Another was too fearful to speak to us at all.
The BMA’s focus on advanced practice follows a similar campaign on physician associates and anaesthesia associates, who are often biomedical science graduates. That campaign led to those associate roles becoming regulated by the General Medical Council from December 2024.
The question is what is the union’s end game when it comes to ACPs?
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