The Advancement Of The Nursing Roles Within The Primary Care Arena
The media, in particular television loves medical drama and our screens are populated with the heroics of the uniformly attractive staff of Holby City and Casualty, the even more glamorous ER and the humorous Scrubs.
However, after watching a recent episode of Call the Midwife I began to reflect on the dramatic advances in primary care nursing throughout the past sixty years. The nurses and midwives commanded huge respect from their patients and the community in general but, nurses’ roles have significantly changed as a consequence of the ever increasing pressure on NHS services. The current practice of a primary care nurse would be unrecognisable to a clinician from the age the television programme that I mention.
When talking of Practice Nurses (PN) I refer to the wide range of nurses within General Practice from Health Care Assistants to Advanced Nurse Practitioners (ANP): all of whom have seen enormous changes in their scope of practice. Moreover, the expectation of further role advancement remains great. The catalyst for further rapid role change/adaption is the integration of health and social care services and the developing interface between primary and secondary care.
The demand on primary care services has seen the development of the practice of ANPs who see and treat patients independently and offer services that were previously delivered by GP colleagues. Practice Nurses are specialists and often manage patients with chronic diseases and run their own clinics such as family planning, anticoagulation and travel health. Health Care Assistants have become skilled in treatment room duties and have been shown to have great value in promoting and supporting the general health of patients.
The pace of change has been significant and arguably challenging. It is imperative that during this on-going revolution we embrace the numerous challenges but keep our practice safe and patient focused. The moot point is how we best achieve these aims and objectives.
Arguably, education (of the clinicians and service users) is paramount. Again, the nurses referred to from a bygone era would be shocked and surprised to see the level of academic achievement attained by contemporary nursing practitioners.
Due to their independent, autonomous status ANPs are often found to be independent prescribers and highly qualified both clinically and academically.
In my role as an expert nursing witness I am often asked to comment on the care that has been afforded to patients within primary care settings. As a consequence, I believe that education alone will not equip nurses to rise to current challenges. The value of mentorship along with the development of a robust appraisal system will assist nurses to develop and maintain the necessary skills.
In my opinion there also needs to be some kind of protection regarding the use of the title of ANP: at the present time it appears permissible for anyone to call themselves an ANP and I suggest that there needs to possibly be a separate part of the register for ANPs who have met minimum prescribed standards.
As autonomous practitioners, we need to ensure that we work together and that our future role, as it develops is shaped from within inside the profession rather than having changes forced upon it.
Sixty years ago the nurse was the doctor’s handmaiden and was praised for prompt and efficient following of orders. Thankfully, times have changed and a nurse is an independent practitioner who can offer their patients outstanding care. However, arguably, this development in nurses autonomy has not occurred because of recognition of nurses potential but is driven by a need to manage an ever increasing need on already over stretched services.
The second pitfall is the continued cutting down of tall poppies and the fear that nursing colleagues are above themselves.
The nursing profession needs to be careful that it does not allow itself to be merely dumped on by service managers. One wonders if the same opportunities would be offered to the nursing profession if primary care services were not so over stretched.
I’m sure if those nurses and midwives of a bygone era were to look at the current state of the nursing and medical profession they would agree, that the NHS has developed and grown beyond everyone’s imagination. Despite radical political interference and reform it continues to be the most admired health care system in the world. The reason for the success of the NHS has been the dedication of the many doctors and nurses who have dedicated their lives to help others often in great need and dire circumstances. Importantly, it has never been more important for both the medical and nursing profession to stand and work together ensuring that patient need is always the first and overriding priority.