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A recent pilot study published in the January edition of the BJGP examined nurse practitioner management of acute in-hours home-visit or assessment requests.1 The very positive conclusions from this study will not be surprising for anyone working with a nurse practitioner. What is surprising is that the study did not define what is meant by the term ‘nurse practitioner’. In the present situation, this is essential. There is no protected or regulated title of nurse practitioner — indeed anyone (not even registered nurses) may call themselves a nurse practitioner.
Most would assume that a nurse practitioner is a nurse who has undergone further training in order to enable her to be able to assess, diagnose, and treat patients. However, it is impossible to say exactly how much or what type of extra training the nurse practitioner has done. As there is no regulated title, there is no specific training. Training courses do of course exist, but they are not mandatory. These courses range from Masters or BSc level (as in the case of the author of this study) to a few days on physical examination carried out by private companies.
It seems ludicrous at a time when GPs in particular are being asked to provide more and more evidence of their fitness to work as GPs in the form of extended training, changes to examinations, and re-accreditation, that there is a group of nurses working in the NHS doing very similar work, with similar outcomes, and patient satisfaction,2 with nothing more mandatory than a registered nurse qualification.
Patients are confused and their safety is put at risk by this situation where there is potentially a huge disparity between nurses practising as nurse practitioners. Employers may equally be confused and unclear as to what to expect from the nurses. Nurse practitioners themselves are frustrated at constantly needing to explain who they are and what they do to patients and colleagues, and are distressed at the potential for damage and harm in this situation.
The Nurse Practitioner Association of the Royal College of Nursing have been working to rectify this situation over the past decade. The Nursing and Midwifery Council have agreed competencies and educational levels for nurse practitioners but are unable to enforce this until the government agrees the legislation. In most other countries where nurse practitioners practice there is a regulated title that allows a recognised level of education and training and would allow re-accreditation.
This situation affects research as well as practice in terms of transferability of studies as there is nothing standardised about either the title or the training of nurse practitioners. Other practices could not therefore, assume that their nurse practitioner was equally qualified or prepared to do the same work.