Ghislaine Young's comment in Independent Nurse described advanced nurse practitioners (ANPs) as an invisible workforce. I can understand why. In a recent statement Jeremy Hunt talked about 'growing the workforce with a new class of medic so that busy doctors have more time to care for patients'. His medic of choice is not the healthcare clinician already in post, not the clinician already in training but a new dependent clinician – the physician associate.
ANPs are not invisible in practice, nor are we invisible to patients accustomed to interacting and consulting with nurses – patients who trust and have developed longitudinal therapeutic relationships with us. We embody a silent revolution across many areas of healthcare, driven by the commitment and courage of nurses.
Initial work, including a national consultation by the NMC, gave us real hope that regulation and indeed recognition would come in 2005/6. Any possibility of regulation was abandoned when the Council for Healthcare Regulatory Excellence published their report Advanced Practice: Report to the four UK Health Departments in 2009, which concluded that:'What is often called "advanced practice" across many of the health professions does not make additional statutory regulation necessary.'
The NMC refocused on Fitness to Practice and caused the desire of ANPs for regulation and registration to falter. We understand and share Ghislaine Young's disappointment. She was part of the RCN ANP steering committee during that devastating period. But as a profession we need to focus on new possibilities and consider what might be achieved through a voluntary registration framework or employer-led models of regulation/governance rather than statutory regulation.
A major concern and one highlighted by the testimony of Ghislaine Young and Kirsty Armstrong is the very definition of an advanced nurse practitioner.
Many of the ANPs in general practice would challenge whether or not compression bandaging and childhood immunisations are actually within the scope of advanced practice. This issue must be addressed. The public and our professional colleagues need to know who we are, what we do and what the advanced nursing role can offer. Physician associates will have no such problem with role clarity, as they will have a unified national qualification and voluntary registration. If we do not do the same, we will be overlooked.
The debate must move forward and we urge the RCN to support us, to explore innovative ways of recognising, owning and accrediting the standards of advanced nursing practice. We need to clarify and inform to demonstrate why ANPs are best placed to add value to health services across the NHS.