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Are advanced nurse practitioners invisible?

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The future of nurse practitioners is uncertain The future of nurse practitioners is uncertain

I have been an advanced nurse practitioner for over 20 years. After being in post for a while it dawned on me that the role was invisible. It seemed a profound silent revolution had taken place and that we were taking on increasingly autonomous and responsible roles and no one blinked an eye. In fact the NMC steadfastly refuses to recognise us and the role is to this day, unregulated. In 2005 I wrote a very contentious article in the BMJ1 on advanced nursing and doctors were outraged because a nurse was daring to suggest that research showed that nurses were not only good communicators but safe and effective practitioners in roles previously only undertaken by physicians. Some nurses were outraged because I was forsaking my own profession and pretending to be something that I wasn't. But then nothing: ANPs sunk back into oblivion and no one was interested.

Physician associates are the new kids on the block and suddenly they are causing a clamour of interest, and hospitals and general practices all want to employ them.

Hang on a minute, what about advanced nurse practitioners who have been in the clinical arena for a quarter of a century in the UK? Advanced nurse practitioners are two for the price of one, the alchemy of nursing and medicine bound into a new professional role, all the richer because of the symbiosis of the two parent disciplines.

Physician associates undergo much shorter training in bio-medicine than doctors, cost less to train and employ but cannot prescribe or work autonomously. I was dismayed to see in a recent article in Independent Nurse2 that a physician associates was quoted as saying that whereas advanced nurse practitioners can only do certain things physician associates can see patients with 'almost anything'. The arrogance and ignorance of this comment has left me deeply troubled.

I remain uncertain about the future of advanced nursing. I hope that one fine day the NMC will see the light that is blindingly obvious to all but them, and in the meantime it may be that medical bodies such as the RCGP will have to take a lead in setting standards for advanced nursing and giving our role its mandate and infrastructure of professional development.


1. The Nursing Profession's Coming of Age. Young G. BMJ 2005; 331:1415

2. Physician Assistants Plough the Same Furrow as ANPs. Bhardwa S IN 2015

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The national health service is facing a significant workforce shortage over the coming ten years, many of the appropriately educated and very clinically compenent and experienced ANPs in both community and acute hospitals will be considering retirement. The introduction of new types of healthcare workers such as PAs is not the way forward, NHS Trusts, CCGs and universities need to concentrate on recruiting, retaining and investing in the education of the RN workforce. Those of us in clinical practice and education need to be positive role models and inspire students and post grads to enter speciality ANP practice.The NMC could lead by fully recognising the existence and contribution of ANPs. Innovative working across professional disciplines along with investment in our existing clinicians is required ; not the creation of a new hybrid 'unregulated' clinical assistant.
Posted by: ,
very true and well said, however the cold facts are that there are no suitably trained nurses available just now.
a local GPs has employed 2 PA when they could not recruit nurses.
it is worrying though how see one do one is still in existance.
Posted by: ,
So true!
Posted by: ,
I think Ghislaine makes a really good point. I have to, sadly, agree that nurse practitioners now do seem to be largely invisible. I remember 10 years ago, when I was working in East Lancs, that NP's were really making some waves. Every school of nursing was launching nurse practitioner courses but now it's all gone quiet, very quiet. NP's were ensuring good and speedy patient access - many were same day access. I remain amazed that no one in the mainstream seems to have remembered NP's and thought "hold on, they might be part of the solution in this time of GP shortage and long GP waits" . I particularly like Ghislaine's idea re. working with RCGP regarding standard setting. Unfortunately, the RCGP still thinks that present medical students and foundation doctors can be persuaded to go for GP careers yet failing to acknowledge that even if they did, primary care still can't meet current demands.

What is the future? I don't know but feel that NP's need some friends in high places to "bang the drum for them". I still think they are the future. I'm not sure PA's are the future as I'm just not sure they have enough experience after two years. GP training takes 5 years after medical school so I can't see how 2 years of training can get close, unless PA's have a post graduation preceptorship.

I'd suggest that NP's could try writing to surgeries that struggle filling GP vacancies offering their services and selling the role. It might just work.
Posted by: ,
Great comments thanks ghislaine
Yes I wonder why PAs are getting so much attention as they cannot prescribe-even paramedics may get prescribing before them. Whichever PA said that needs to take a long hard look at what they are doing and what we are doing. I co-led a module for several years on child and family health for PAs so I do have an opnion on their capabilities and bedside manner. Remember this is 2 year post grad diploma and many have done a degree that does not related to the bedside or patients at all.
Anyway yes ANPs are invisible.
My GPs ask me on a daily basis ' how is the bandaging going' or ' you should not be doing medication reviews as you are a nurse'!
ANPs and GPNs are invisible - we need to promote ourselves more to patients, the public, other medical professions and to our own profession too. Therein lies the greatest problem!!
Posted by: ,
Well said!
Posted by: ,

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