Why Do You Need Nursing Advanced Practice In Our Fieldof Practice

The aim of the assignment is to look why advanced practice is needed in the author's field of practice. The assignment will look at the author's role working as a Community Matron (CM) within a large inner City Primary Care Trust (PCT); in relation to national developments and perspectives in both the United Kingdom (UK) and on an international level.

The CM role was originally launched in 2005 in response to the NHS Improvement Plan (Department of Health, 2004). The aim of the role was to enable patients to stay at home, prevent hospital admissions and to have more choice about their care (Queens Nursing Institute, 2005). For this to be achieved the Department of Health (DH) proposed that by 2007, 3000 CMs to be in post across the UK (DH, 2005).

There is limited research on the role of the CM at present, however there are two theoretical models that have been successful in the United States, Kaiser and Evercare model (Murphy, 2004). The author highlights that not all models and ideas are transferable and success in America may not necessarily be repeated in the UK as healthcare systems are very different.

The DH identified educational and professional competencies for the role of a CM in a document, Case Management Competencies Framework for Care of People with Long Term Conditions (DH, 2005). Within the document it highlighted that a CM should be educated at master's level and the curriculum consisted of essential components such as, advanced nursing practice, medication management, disease pathology and physical examination (DH, 2006). The author highlights that her job description is also based on these competencies by stating that 'the practitioner should have an expert knowledge base of physical, psychosocial, clinical and pharmacology and will provide a holistic generalist overview and care co-ordination for patients with long-term conditions' (Name Withheld, 2007)). The DH also agrees with the statement by saying that a CM will be making complex clinical decisions using expert clinical judgment (DH, 2005).

The Nursing and Midwifery Council (NMC) advised that a CM should be developed in-line with standards set out for that of an ANP (NMC, 2006). However Wiseman, 2007 is concerned that 124 competencies for ANP's pose a challenge but the competencies identified for CMs are a more formidable task. Lyndon, 2006 also agrees that an ANP master's programme does not address all the competencies set out in the CM framework, such as nurse prescribing, mental health needs or supporting people with long-term conditions. The author disagrees with Lyndon by advising that a large proportion of CMs are already independent prescribers. Board, 2007 supports this statement by highlighting a third of CMs have already undertaken an extended qualification in medicine management. The author also highlights that there is an optional prescribing module which can be taken on the ANP programme to address individual students learning needs.

The author highlights information set out by the NMC is conflicting advising that an ANP should be trained at master's level, however CMs wouldn't need to undertake a full master's programme (DH, 2006 & NMC, 2006). The author highlights there is currently numerous definitions defining the role of an ANP and that of a CM with very little variation. The author goes on to say that the review of literature can be confusing and contradicting at times. Following a review of the literature there is no clear rational why a CM doesn't need to undertake a full master's programme, although they are advised to develop in-line with ANP competencies.

The author highlights the course will broaden and enhance her existing skills and at the same time giving her the opportunity to network with peers in particular from the same field and interests. A study by Girot & Rickaby identified CMs undertaking the ANP course believed that the programme gave them improved confidence and encouraged self-awareness and reflection on their own practice. CMs also expressed that the programme had allowed them to validate their existing skills and identify new areas of development (Girot & Rickaby, 2008). However the study did conclude that other CMs struggled with the mode of delivery and questioned if it met individual needs (Girot & Rickaby, 2008).

In conclusion following a review of the literature it is clear that advanced practice is required in the author's field. The role of a CM is relatively new and further research is needed within the UK. The government and NMC have now clearly agreed on definitions for that of a CM and ANP; however it will be difficult to re-enforce these definitions due to the previous lack of clarity around role definitions. The evidence is unclear around the training needs of a CM, it questions if they require a full or part master qualification for their role. However the DH and NMC are encouraging CMs to be working within standards set out for ANP's. It is clear further research is needed to evaluate the role of a CM in particular focusing on their particular learning and development needs in relation to attaining a full master's qualification. In view of the current NHS climate, no current job security and the constant redevelopment of nursing roles on the individual needs of the author, it's apparent that attaining her full master's qualification in advanced practice will further enhance her skills and knowledge which in turn will ultimately benefit her patients.

REFERENCES

AGENDA FOR CHANGE PROJECT TEAM (2004). The NHS Knowledge and Skills Framework and the Development Review. Department of Health: London.

DEPARTMENT OF HEALTH. (2004). NHS Improvement Plan. The Stationary Office: London.

DEPARTMENT OF HEALTH. (2005). Case Management Competencies Framework for the Care of Patients with Long-Term Conditions. The Stationary Office: London.

DEPARTMENT OF HEALTH. (2006). Caring for People with Long-Term Conditions: an Education Framework for Community Matron and Case Managers. The Stationary Office: London.

GIROT, E. RICKABY, E. (2008) Education for New Development: the Community Matron in England. Journal of Advanced Nursing. 64(1), pp.38-48.

LYNDON, H. (2006) Developing the Role of the Community Matron. The Cornwall Experience. Primary Health Care. 16(3), pp.14-17.

MURPHY, E. (2004)