The Role Of An Advanced Nurse Practitioner

“The role is rigorous, and you will encounter complex situations which require a clear head and good clinical judgement. If you enjoy a challenge, this role might be the one for you!”

Looking to move forward in your nursing career? If you enjoy a challenge and have Level 7 qualifications on top of your degree, it could be for you. Jess explains the role and a day in the life of an ANP.

Perhaps you have come across the title ‘Advanced Nurse Practitioner’, and wondered what exactly it involves? As of yet, there is no officially registered role of the ‘Advanced Nurse Practitioner’ on the Nursing and Midwifery Council register (CQC).

Generally speaking, an Advanced Nurse Practitioner is a nurse who operates at a higher level of clinical practice.

There is now an agreed framework for advanced practitioners, created by Health Education England, which sets out a standard of practice. This article will mainly focus on the role covered by this framework, which is the Advanced Nurse Practitioner (ANP).

What Is An Advanced Nurse Practitioner?

As people live longer, with increasingly complex long-term health conditions, the scope of practice for nursing has adapted to the health needs of the UK population. In primary care, the role of the ANP was developed to work in tandem with GPs. In part, it was designed to relieve some of the pressure on GP practices by giving experienced nurses more autonomy to treat and diagnose their own patients.

ANPs can undertake a full history and physical examination of their patients. They can also independently prescribe medication. They need to have completed a Masters, and they use their wealth of clinical experience to diagnose and treat people, whilst working closely with the rest of the multidisciplinary team.

How Does It Differ From A Doctor?

ANP’s aren’t doctors. Although the activities of ANPs and GPs certainly overlap, the clue is in the name!

At the end of the day, their job title is ‘nurse’, and they practice according to the NMC code. This means working within the limitations of their nursing scope of practice. The boundaries of their role should be agreed with their employer, to ensure there is clarity about what they can and can’t do.

What Does It Involve?

So, what can you expect if you decide to pursue this career?

Firstly, you will need to complete a comprehensive clinical assessment of patients, including history-taking and a full physical examination. You can independently request different diagnostic tests to help you form a differential diagnosis for your patient. And you will use your clinical knowledge to interpret clinical assessments and test results. ANPs develop personalised treatment plans for their patients and consider preventative health strategies alongside giving health education.

By keeping up to date with the latest evidence-based practice, and sometimes taking part in research, their contribution to healthcare is multi-faceted. The role is rigorous, and you will encounter complex situations which require a clear head and good clinical judgement. If you enjoy a challenge, this role might be the one for you!

What Qualifications Do You Need To Become An ANP?

Advanced Nurse Practitioners are mainly found in community settings, such as GP surgeries and hospital avoidance teams.

To become an ANP in a GP surgery, you need to meet the Advanced Clinical Practitioner Framework for Primary Care by Health Education England. This requires you to complete a Level 7 Masters programme in Advanced Assessment and Diagnosis, and an Independent Prescribers qualification.

The course allows you to prescribe any medication within your medical competency, including controlled drugs, as part of your patients’ management plan. You will need to demonstrate your competency for the role through a detailed portfolio of evidence, showing your ability to accurately assess, diagnose, treat, manage, and care for patients.

The role is rigorous, and you will encounter complex situations which require a clear head and good clinical judgement. If you enjoy a challenge, this role might be the one for you!

A Day In The Life

To give you more of an idea, here’s an example of some of the activities an advanced nurse practitioner in a hospital avoidance team might undertake:

• Mr A is an 86-year-old gentleman, referred to the team with new-onset confusion and a recent fall one day ago. The ANP goes out to assess him at the nursing home where he lives.

• They take a full history, including presenting complaint, history of presenting complaint, past medical history, any recent investigations or treatments, a medication overview and infection status.

• The nursing home staff report the patient fell yesterday after an episode of light-headedness. He has had reduced appetite and oral intake for a couple of days. He has been more confused than normal. He has Type 2 diabetes, and his blood sugars have been elevated for the last few days.

• The ANP performs vital signs and a full physical examination for Mr A, which includes chest auscultation, an abdominal examination and listening to his heart sounds. They discover the patient has an elevated respiratory rate and reduced blood pressure. Chest is clear on auscultation, but he is very dehydrated.

• The nurse performs venepuncture and requests a full blood count, urea and electrolytes and C-reactive protein. They also perform urinalysis. Mr A’s urine is high in nitrates and leukocytes. There are no ketones. They send the samples off for urgent analysis.

• Mr A’s blood results come back and confirm signs of a urine infection. The ANP prescribes a course of antibiotics and subcutaneous fluids to rehydrate Mr A. They ask the care home to monitor his blood sugars. In conjunction with the care home, the team can manage Mr A at his residence and create a management plan to treat him safely at home. This includes ensuring he is regularly prompted to drink, and that the care staff avoid giving him sugary drinks or snacks.

• It is discovered that Mr A has not been drinking adequately for several weeks, which has led to him developing a urine infection. The ANP works with the care manager to encourage more training for staff, and to implement better hydration practices for all care home residents.

What Skills Do ANPs Need?

As you can see, Advanced Nurse Practitioners need to use their clinical reasoning to assess people with a variety of symptoms who have not been previously seen by another healthcare professional.

The clinical picture is often more complex than the scenario above, so they must use critical thinking and analysis to form a clearer understanding of the underlying causes for their patient’s presentation. They are often the first point of contact and can encounter challenging situations which require problem-solving skills, and the ability to communicate clearly with different professionals.

To be an Advanced Nurse Practitioner, you will need to have gained a significant amount of clinical experience. Here’s a list of some of the skills and attributes you will need:

• Complex reasoning skills.

• Knowledge and expertise in your specified area of practice.

• The ability to be self-reflective, so that you can continually improve your practice.

• Excellent communication skills, and the ability to take the lead in your clinical setting.

• Active involvement in leadership, management, and education in your service area.

Salary

To find out more about an advanced nurse practitioner’s salary please read more here.

How Do I Become An Advanced Nurse Practitioner?

This is a conversation you will need to have with your employer. Since the ANP role mostly applies to nurses working in GP surgeries and the community settings, you will need the support of your place of work, and someone who can provide clinical supervision if you want to undertake further training and education.

If this sounds like the career path for you, speak to your employer to explore this career further.

You can view our Advanced Nurse Practitioner jobs here.