Funding for ANP training is different this year (2020/2021) as NES funding is coming to an end.
NES Funded Trainee ANPs – i.e. Continuing trainee ANPs (i.e. those who started their ANP training during the 2019-20 academic year).
If the trainee ANP is directly employed by NHSGGC then they should complete an SL2 form for the modules being undertaken this year. This should be locally approved and sent to kulvinder.atwal@ggc.scot.nhs.uk as soon as possible (September 2020). This allows purchase orders to be raised. Following this the trainee ANP should receive an email regarding this. If the trainee ANP is employed within General Practice then their practice should have already applied to NES for their funding for this year.
Service Funded Trainee ANPs – i.e. trainee ANPs who are starting their ANP training now (post August 2020).
If the trainee ANP is directly employed by NHSGGC they should speak to their line manager regarding applying for funding. The trainee ANP will be expected to complete an SL2 and submit via their line manager to approval and funding. If the trainee ANP is employed within general practice they should speak to their local practice manager.
Trainees should apply directly to the University for a place on the appropriate ANP programme. If uncertain about which programme a trainee should go on they should contact advancedpractice@ggc.scot.nhs.uk for advice and to obtain a copy of their education plan.
Please note that funding can only be applied for one year at a time, so a further SL2 form will be needed for the second year of any programme.
It is the trainee’s responsibility to:
Ensure they know which programme and modules they are to undertake – all trainees should have an education plan which can be obtained from advancedpractice@ggc.scot.nhs.uk
Complete and submit an SL2 for funding (see above)
Apply to the university for the appropriate programme (and modules)
Send a copy of their ‘award letter’ with the relevant Purchase Order details to the university when they receive it.
Important information relating to Non-Medical Prescribing
For the Non-Medical Prescribing module apply via the Pharmacy & Prescribing Support Unit. Email Mandy Logan (mandy.logan@ggc.scot.nhs.uk), Non-Medical Prescribing Co-ordinator for an application pack including your contact details.
ANP trainees should undertake Non-Medical Prescribing at Masters Level (unless already held) at the institution the ANP programme is being undertaken. Please make it clear when applying to the Pharmacy & Prescribing Support Unit which institution the ANP trainee will be studying at.
“Clinical Supervision…provides nurses with a space to reflect on and discuss aspects of their role that are motivating and inspiring them, and also those elements that are frustrating or concerning them. Nurses and their supervisors can then jointly work through how the former can be promoted and the latter addressed.” (Scottish Government 2017)1 .
West of Scotland Advanced Practice Academy guidance and the CNO’s Transforming Roles work expects regular Clinical Supervision for all ANPs. Over the course of the next few months we’re looking to expand Clinical Supervision across all ANP teams.
What does Clinical Supervision involve?
Clinical Supervision can be undertaken individually or in small groups. A trained facilitator (the Clinical Supervisor) will facilitate a discussion which will reflect on practice and to think about what could be developed. “The facilitator does not make choices for people but creates the opportunity for them to choose”. 2
Who can be an ANP Clinical Supervisor?
ANP Clinical Supervisors should be experienced ANPs with facilitation skills and an interest in Clinical Supervision. Potential Clinical Supervisors should be nominated by their line manager. Nominations should be sent to the Consultant Nurse – Advanced Practice.
How do you train to be an ANP Clinical Supervisor?
The training for the role involves an online course currently taught by NHS Education for Scotland facilitators. Once the training is completed, new Supervisors may begin to undertake supervision sessions with their supervisees. Additional support can be provided by experienced supervisors.
What is expected from Supervisees?
Every ANP will eventually be offered a minimum of 4 Clinical Supervision sessions a year and will be expected to attend. Supervisees will be expected to do some preparation for the meeting and to reflect on what they’ve got out of the session afterwards. This could be written up as a short reflective piece in the TURAS Professional Portfolio and be used for annual appraisal and revalidation.
How will Clinical Supervision Supervisors be allocated?
Supervisor-Supervisee pairings will be determined locally by individual ANP line managers. Supervisors don’t need to work in the same service as their Supervisee, but should have a good understanding of the supervisee’s role. It is envisaged that supervisor-supervisee pairings will be within the following groups: adult acute care, acute paediatrics, acute neonates, community and primary care and mental health. Each supervisor will have 3-5 supervisee’s each.
Where will I find time for Clinical Supervision?
All ANPs should have time for Supporting Professional Activities and CPD built into their Job Plan. Some of this time should be used for Clinical Supervision. How this time is allocated will be up to individual line managers and will depend on the demands of service.
Do Supervision Sessions have to be face-to-face?
Supervision sessions can be face-to-face, however they can also be held over MS Teams. At the present time with the high incidence of Covid the use of Teams is to be encouraged.
How will supervision sessions be recorded?
Supervisors are expected to record basic details on the supervision session via Webropol. The information recorded will be the names of those involved in the supervision session, the date supervision took place, whether it was a face-to-face meeting or via teams and the topics discussed (high level only – no details as supervision sessions should be confidential). The webropol link is available on the ANP CPD moodle site.
Where can I find out more about Clinical Supervision?
Unit 1 provides general information for Supervisees and managers on Clinical Supervision. Units 2-4 are aimed at Clinical Supervisors.
Further information will be added to the ‘Clinical Supervision’ section on the ANP Continuing Professional Development GGCMoodle site over time as it develops for ANPs.
Dr Mark Cooper, Consultant Nurse – Advanced Practice,
[1] Scottish Government (2017) Nursing 2030 Vision: Promoting confidence, competent and collaborative nursing for Scotland’s future. Available at: http://www.gov.scot/Publications/2017/07/4277 Last accessed 29.10.19
[2] Joint Improvement Team
Practice assessors
Practice assessors will assess and confirm the student’s achievement of practice learning for a placement or a series of placements.
This does not mean that practice assessors must make an assessment of each individual environment or placement. Practice assessors do not need to be physically based or employed in each or any of the environments in which the student is placed. The practice assessor assesses the students overall performance for their practice learning, taking account of whether or not the relevant proficiencies and programmes outcomes have been met, and if they display the required values of their profession. They must have sufficient opportunities to observe the student across environments in order to inform their decisions.
A nominated practice assessor will also work with the nominated academic assessor to make a recommendation for student progression. However not all practice assessors will be required to perform this aspect of the role.[1]
Practice supervisors
This role is to support and supervise nursing and midwifery students in the practice learning environment. All students must be supervised while learning in practice environments.
Practice supervisors can provide supervision in different ways. These depend on different things – it’s the approved education institution’s (AEI’s) responsibility to decide what supervision is appropriate, with its practice learning partners.
Factors that AEIs and their practice learning partners should take into account when considering the way in which supervision may be delivered include:
public protection student learning needs – both the level of learning required (student competence) and the student’s programme outcomes student and practice supervisor equality and diversity needs the availability of practice supervisors and their skills and knowledge.
Practice supervisors should also be able to judge what kind of supervision and support they are able to provide.[2]
Prescribing Modules
Additional specific advice for supervising prescribing students is available on page 12 of Realising professionalism: Standards for education and training Part 3: Standards for prescribing programmes.[3] Higher Education Institutions should also forward tailored information relating to their own module directly to nominated assessors. For advice on NHSGGC trainees undertaking prescribing modules please look here: NHSGGC NMP Policy
Documenting Supervision
Each of the Higher Education Institutions have their own documentation that students are required to have supervisors read / sign off for different modules. All trainee ANP / ACNS now require to have evidence of supervised practice within their Turas Professional Portfolio, and we have our own guidance document.[4]
Trainees can ‘raise a ticket’, i.e. email you an official request for feedback, either formative or summative, that is sent directly back to, and is stored within their portfolio. This can take a variety of formats which are explained within the advance practice toolkit. [5]
Further support is available from the NES document A National Framework for Practice Supervisors, Practice Assessors and Academic Assessors in Scotland. [6]
There is also a series of learning modules on Turas Learn Practice Supervisors and Practice Assessors’ Learning Resource.[7]
Most Clinical Nurse Specialists (CNSs) work at an Advanced Practitioner level of practice (Level 7). Advanced Clinical Nurse Specialists have a wider scope of practice than CNSs at level 6 and will manage greater complexity (CNOD 2021).
Across NHSGGC there are over 300 nurses working at this level of practice in ACNS roles. They work in a wide variety of areas including:
“The Advanced Clinical Nurse Specialist (ACNS) is an experienced and highly educated registered nurse working within a specific field of practice. They manage, deliver, advise on and support the care for people within a specialist area. Educated to at least Postgraduate Diploma level in an appropriate subject, they are assessed as clinically competent in their defined specialty. They have a wider scope of practice than the clinical nurse specialist at Level 6 and will manage greater complexity.
As a clinical leader they have the autonomy to act and accept responsibility and accountability for their actions, acting as an expert advisor or resource for others. This includes specialist assessment and treatment using a holistic approach to managing complex, multidimensional situations. This may require management of care over a prolonged period of time. They have the authority to refer, admit and discharge within appropriate clinical areas. Their practice is characterised by a high level of clinical decision making based on in-depth, expert knowledge in their specialism of care delivery.
Working as part of the multidisciplinary team, they can work in or across all settings, including non-clinical areas, dependent on their area of expertise.” (CNOD 2021).
Training
ACNSs train in post for the role. Trainee ACNSs are usually CNSs before they embark on deepening and broadening their knowledge for an ACNS role. Trainee ACNSs are increasingly being formally employed in training posts (using Annex 21 from Agenda for Change) while they learn. Trainee ACNSs are supervised whilst they learn additional skills and will also undertake appropriate post-registration education at postgraduate level at university to support their learning. Trainee ACNSs will build a portfolio of evidence to demonstrate they are competent to practice which is formally assessed at the end of their training.
Transforming Roles Paper 8 sets out the core competencies for any ACNS. To these additional specialist competencies are added. The competency framework needs to be completed before a new ACNS can be regarded as appropriately prepared.
Agenda for Change
ACNS are paid at a minimum of Band 7
Advanced Nurse Practitioners (ANPs) are experienced and highly educated Registered Nurses who manage the complete clinical care of their patients, not focusing on any sole condition (Chief Nursing Officer Directorate, Transforming Nursing Roles Paper 2, 2017). ANPs are generalists and are trained to work within one of five broad areas (Chief Nursing Officer Directorate, Transforming Nursing Roles Paper 7, 2021)
· Neonatal acute care
· Paediatric acute care
· Adult acute care
· Primary/community care
· Mental Health
Some ANPs have undertaken additional specialist training to work in specific specialist areas e.g. Intensive Care, Emergency Care etc. Within NHSGGC there are over 100 ANPs working across a wide variety of areas from primary care through to intensive care.
NHSGGC has been training and employing ANPs for many years and works closely with Glasgow Caledonian University, University of the West of Scotland, University of Stirling and Napier & Queen Margaret Universities in Edinburgh to prepare ANPs.
Training
Advanced Practice is a level of practice, rather than a specific role or title (Transforming Nursing Roles Paper 2 CNOD 2017)and has four pillars of practice, which the ANP must have as part of their core role and function. These are:-
• Clinical practice
• Leadership
• Facilitation of learning
• Evidence research and development
Definition
” An Advanced Nurse Practitioner (ANP) is an experienced and highly educated Registered Nurse who manages the complete clinical care for their patient, not solely any specific condition. Advanced practice is a level of practice, rather than a type of speciality of practice.
ANPs are educated at Masters Level in advanced practice and are assessed as competent in this level of practice. As a clinical leader they have the freedom and authority to act and accept the responsibility and accountability for those actions. This level of practice is characterised by high level autonomous decision-making, including assessment, diagnosis, treatment including prescribing, of patients with complex multi-dimensional problems. Decisions are made using high level expert, knowledge and skills. This includes the authority to refer, admit and discharge within appropriate clinical areas.
Working as part of the multidisciplinary team ANPs can work in or across all clinical settings, dependent on their area of expertise.”
(Scottish Government 2017)
Competency Framework
“The Advanced Nurse Practitioner role has a specific focus on the clinical pillar, but must demonstrate competence within all four pillars of advanced practice. With regard to the clinical pillar all ANPs must be able to demonstrate competence in:
a) Comprehensive history-taking b) Clinical assessment c) Differential diagnosis d) Investigations e) Treatment f) Admission, discharge and referral.” (Chief Nursing Officer Directorate, Transforming Nursing Roles Paper 2, 2017)
ANPs are paid at a minimum of Band 7, and within NHSGGC the generic ANP Job Description should be used for any new Band 7 ANP roles.
Advanced Nurse Practitioners in General Practice
Advanced Nurse Practitioners who work within General Practice and are not directly employed by NHSGGC but work within the Board area, are encouraged to join the Board held list of ANPs in General Practice. The benefits of joining this list are:
On-going access to specific ANP education and information
The process to join is exactly the same as for those who are Board employed, but with the following grandfathering arrangements for those employed before 2010 or between 2011 and 2017.
meet all the appropriate competencies for their area of practice,
can evidence the formal learning undertaken relevant to the role which may have been below master’s level (commonly degree level modules)
provide evidence of recent workplace based assessments (within last 5 years)
provide satisfactory feedback from others (minimum of 4 within the last year)
provide a satisfactory supervision report
provide evidence of reflection and a broad range of patients seen
evidence continuing professional development
Employed as an ANP between 2011 and 2017
In addition to the above, ANPs employed between these years should demonstrate master’s level learning. This could be done, for example, through having completed a module at master’s level.
Employed as an ANP after 2018
Expected to demonstrate that they meet all the appropriate competencies for their area of practice, a master’s level qualification in advanced practice, workplace based assessments, reflection, feedback from others, and a satisfactory final supervisors report (see Final Sign-off).
Recording General Practice ANPs
There are two stages to the process.
Stage 1: Involves the Post being recognised as an ANP post (please note that posts which utilise the Board’s generic ANP job description automatically meet this requirement)
A completed ‘Final Sign-off’ form and the poster-holder’s Job description should be submitted to the Consultant Nurse for Advanced Practice (AdvancedPractice@ggc.scot.nhs.uk) . Following the moderation process the following will occur.
The individuals name, NMC number, NHS email address and place of work will be recorded on the Board held list of GP ANPs
The individual will receive written confirmation that their name has been recorded (a copy will be sent to their line manager and practice supervisor)
Access will be given to the NHSGGC ANP Continuing Professional Development Moodle site so that ANPs can be kept up-to-date with news and resources relevant to ANPs including West of Scotland Advanced Practice Academy CPD days
Annually the ANP will receive an email asking them for confirmation that they remain in their ANP post (a nil response will be taken to mean that the individual has left the post and their name will be removed from the list).
Annually, ANPs will be requested to submit an updated ‘share pack’ from their ePortfolio evidencing continuing professional development and reflection on practice to their line manager.
[1] Set out in Chief Nursing Officer’s Directorate (2017) Transforming Nursing, Midwifery and Health Professions’ (NMaHP) Roles: Paper 2 Advanced nursing practice. Edinburgh: Scottish Government
Transitioning ANPs
An ANP who moves from one broad area to another, for example from acute care to primary care, is still regarded as an ANP while they transition. In this example, the ANP can be viewed as an Acute Care ANP practising within Primary/Community Care until they have met all the Primary/Community Care competencies.
Transitioning ANPs will need a Practice Supervisor and Practice Assessor to help them meet any learning needs and assess that they’ve met all appropriate competencies for their new role.
Transitioning ANPs may choose to undertake additional courses to help with transition.
Evidence of meeting additional competencies will need to be uploaded into the ANP’s Professional portfolio, a transitioning ANP sign-off form, should be completed by the Practice Assessor and line manager and emailed to advancedpractice@ggc.scot.nhs.uk along with the portfolio sharepack link. A sample of transitioning portfolios will be moderated
The ANP will then be recorded on the Board’s Advanced Practice database under the new broad area as well as their previous area.
Clinical Nurse Specialists (CNSs) and Nurse Practitioners (NPs) are registered nurses with relevant experience and post-registration education for working within a specific area of practice. They assess, manage, deliver care, advise on, and support the care for people within a specialist area (Chief Nursing Officer Directorate, Transforming Roles Paper 8, 2021)
Across NHSGGC there are over 200 Clinical Nurse Specialists and Nurse Practitioners practising in a wide variety of different areas including:
Oncology, Cardiology, Dermatology, Diabetes, Minor Injuries, Gastroenterology, Nutrition, Gerontology, Orthopaedics, General Surgery, Pain, Palliative Care, Respiratory, Rheumatology, Sexual Health, Vascular, Urology, HIV, Diabetes, Osteoporosis, Parkinson’s disease, and Stoma Care The recently published CNO’s Transforming Roles Paper 8 provides an updated definition.
Definition
“A registered nurse with relevant experience and post-registration education for working within a specific area of practice. Educated in an appropriate subject to the level of graduate certificate (honours degree) at a minimum, although a postgraduate certificate is recommended, they are assessed as clinically competent in their defined area of practice. They assess, manage, deliver care, advise on, and support the care for people within a specialist area.
As a Level 6 Senior Practitioner they work under guidance in a peer relationship with other members of the multidisciplinary team. They have the autonomy to act and accept responsibility and accountability for their actions, acting as a skilled advisor or resource for others. This includes specialist assessment, informed decision making, and treatment using a personalised approach to care for patients’ multidimensional presentations. This may require supporting specialist care over a prolonged period of time. They have the authority to refer patients, and may admit or discharge within appropriate clinical areas of practice. This is characterised by a level of decision making based on detailed knowledge and understanding of their area of practice.
As part of the multidisciplinary team they can work in or across many settings, including non-clinical, depending on their area of expertise and scope of practice.” (CNOD 2021)
Training
CNSs and NPs train in post for the role. Increasingly, CNSs and NPs are being formally employed in training posts (using Annex 21 from Agenda for Change) while they learn. Trainee CNSs and NPs are supervised whilst they learn and will also undertake appropriate post-registration education at university to support their learning. Trainees will build a portfolio of evidence to demonstrate they are competent to practice which is formally assessed at the end of their training.
Competency Framework
Transforming Roles Paper 8 sets out the core competencies for any CNS or NP. To these additional specialist competencies are added. The competency framework needs to be completed before a new CNS or NP can be regarded as appropriately prepared.
Agenda for Change
CNSs/NPs are paid at a minimum of Band 6
A warm welcome from the Advanced Practice Team at NHS Greater Glasgow & Clyde. We are here to support the Nurse Practitioners, Advanced Nurse Practitioners, Clinical Nurse Specialists & Advanced Clinical Nurse Specialists of NHSGGC. We have a variety of resources including important information about these roles, links to key documents, information on education and CPD, and support with the ANP / ACNS sign off procedure.
Staff can access all of these resources by visiting the NHSGGC Staffnet site, selecting ‘Nursing & Midwifery’ from the top menu, and selecting ‘Advanced Practice’.
Contact details
The key Advanced Practice contacts for NHSGGC are:
Dr Mark Cooper – Consultant Nurse, Advanced Practice
Victoria Campbell – Lecturer Practitioner, Advanced Practice
Edward Pool – Lecturer Practitioner, Specialist Practice
But when these pressures or demands become excessive, and you can’t cope with them, then you can become stressed. For many people, stress is a significant problem that seriously affects their daily lives and the lives of those around them.
Stress is the most common mental health problem faced by people throughout the world. Two in five of us will experience stress at some stage in our lives and seven out of 10 of us know someone who has it.
So what is stress?
For most people, it involves anxiety or depression, or a combination of both. It becomes a problem when you can’t get rid of it, even though you try. You feel you are losing control of your life. You feel that you can’t cope with things that others can deal with.
The range of signs and symptoms of stress include:
The good news is that there’s a lot that can be done to support people struggling with stress.
NHSGGC’s stress in the workplace policy has been developed to support staff to deal with issues that contribute to stress at work and in the outside world. It encourages staff wellbeing by giving information on techniques and services which help individuals to cope with pressure and stress and equipping all staff, including managers, with tools to identify the risk of stress and intervene at an early stage.
Staff should be aware of the signs and symptoms of stress as outlined in this article, and know how to receive support if required. The organisation has put in place a range of measures to reduce the risk of staff being affected by stress in the workplace, but staff should be aware that stress can often originate from life outside of work. The organisation will do all it can to support you if you are suffering from stress.
A guide to the policy and the responsibilities it sets for the organisation, managers and individuals in supporting employees at risk of stress.
The organisation
NHS Greater Glasgow and Clyde is committed to:
action to support employees to address issues contributing to stress at work and in their wider lives
action to support staff who have experienced mental or physical health symptoms associated with stress to return to work and ensure their skills are not lost
action to tackle stress and provide support to help staff manage stress.
Directors and senior managers
developing an organisational culture where stress is not seen as a sign of weakness or incompetence and where seeking help in managing stress is seen as a sign of strength and good practice
reducing and managing, as far as possible, factors which lead to stress in the workplace
providing advice and information to managers on their duty of care to staff
encouraging a working environment where staff who feel at risk of experiencing the effects of stress can raise an issue in confidence.
Line managers
encouraging a team culture where mental wellbeing is as important as physical health
carrying out stress risk assessments every two years or before if stress related issues are raised
resolving work-related issues at individual level and team level as appropriate, involving people outside the team if necessary
regularly reviewing excess hours worked by staff
when change is being introduced, provide the necessary support and training to staff
when issues arise, involve staff in seeking solutions.
Individuals
ll staff are responsible for:
talking to your line manager if you have a problem. If this is not possible, then you should talk to our occupational health service or human resources
supporting colleagues experiencing work-related stress and encouraging them to talk to their line manager, occupational health service, human resources or trade union
seeking support, which may include in-house counselling from the Occupational Health Service
speaking to your GP if worried about health issues
recognising that stress is not a weakness
attending stress management course if identified that this would help
discussing with your manager whether it is possible to alter your job if necessary to make it less stressful.
Human resources department
The department is responsible for:
promoting a positive culture within the workforce
assisting the process of return to work for staff
facilitating discussions within areas of conflict
making sure that polices and codes of conduct are adhered to.
Trade unions
Trades unions are responsible for:
encouraging members to speak up
investigating potential hazards and complaints from their members
liaising with managers to carry out risk assessments.
Occupational health service
The service is responsible for:
providing support for staff who may be experiencing stress
advising managers and staff on stress triggers and risk assessment process
delivering training and education programmes on stress risk assessment with the Health and Safety Service
monitoring and reviewing patterns of stress-related sickness absence.
In-house counselling service
The service is available to anyone experiencing problems which affect their ability to function.
Part of Occupational Health, the service is responsible for:
offering help to establish a tailor-made programme of stress management which extends beyond work into home life
offering help to individuals is assessing whether their coping strategies are working
offering an opportunity to talk in confidence about any problem or difficulty, whether work-related or not. The service offers face-to-face and telephone appointments. Please call 0141 201 0600 to make an appointment with one of our counselling team.
Health and safety service
The service is responsible for:
ensuring training is provided to managers to carry out stress risk assessments
advising managers on effective measures for work-related stress
helping monitor work-related stress by assisting with analysis of Datix incident data related to stress.
The mental health and wellbeing of our staff is important to us. Growing research demonstrates the importance of mental health and wellbeing in relation to satisfaction and effectiveness at work.
Stress, depression and anxiety are reported as the most common reasons for staff absence. Poor mental health is associated with an increased risk of diseases such as cardiovascular disease, cancer and diabetes, while good mental health is a known protective factor. Poor physical health also increases the risk of people developing mental health problems.
NHSGGC have in place a range of support for staff and managers in order to prevent and assist with mental health issues in the workplace.
