Why Nurses Need to be Politically Active

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Follow Jennifer on Twitter @JJackson_RN

Editor: It is with great pleasure that Injectable Orange welcomes back guest author Jennifer Jackson. In this post Jennifer implores us, as nurses, to take an active interest in politics, as it really does impact right down to our capacity to provide care and treatment. This is a very timely post, as many of our junior doctor colleagues throughout the UK are in the midst of a political struggle around threats to their contractual provisions. In my home state we have seen major threats to senior doctor contracts and significant cuts to nursing jobs. The medical profession are often galvanised in their political missions to preserve the integrity and entitlements of their profession. Unfortunately nursing often seems to rely on unions or figureheads to represent our professional interests and often feel disempowered or disinterested by the politics of healthcare. Jennifer offers a call to action – stand up and be counted as a profession #NursesUnite.

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Why Nurses Need to be Politically Active – Jennifer Jackson

After a thesis-writing hiatus, I’m back for more discussion about professional issues in nursing! First on my list is nursing and politics. We are about to have a federal election here in Canada, which is promising to be one of the most interesting and important elections in a long time. In most countries, there are many opportunities to vote and be part in the political process. This blog post will look at some reasons why nurses need to be politically active, and what political action in nursing can look like.

It is a great thing to be able to participate in a general election. The ability to have women, Indigenous persons, and Persons of Colour vote are fairly recent historical developments. There are fragile democracies around the world, where people are fighting to have political rights. Many people have devoted their lives to the support of these rights, and I think we do them a great disservice if we take our democratic power for granted.

I also believe that voting and political engagement DO make a difference. If we look to the Greek meaning of democracy, demos refers to the people, while –cracy is government, meaning the government of the people. Our political opportunities, such as voting, give each person a voice in what happens in our systems. Whether you are male or female, rich or poor, rural or urban, you have an equal vote in how your country and your municipality are run.

It is great to encourage general political participation, and there are lots of reasons that nurses can benefit from voting and being politically active. Political activity is as old as the nursing profession. Florence Nightingale developed the world’s first graphs, and showed them to the British Parliament, convincing politicians to continue funding her work in Crimea. There is a legacy in health care that is the result of political activity, and nurses can continue these efforts today.

Here are my top 3 reasons why nurses need to be politically active:

  1. Politics can change the work we do.

Political factors can have a substantial impact on what type of work we do as nurses, because of the impacts on society. A prime example? Texting and driving. Laws were enacted in Canada to decrease distracted driving, and there have been fewer car accidents as a result. This means fewer trauma codes, fewer ICU admissions, fewer fatalities. Laws and political decisions impact care we need to provide as nurses. As nurses, we can ask ourselves, who is coming through our doors? What could be done to address preventable illness and injury?

  1. We can represent the interests of the nursing profession.

Most nurses are experiencing, or have experienced a period where there have been health care cutbacks. Wage freezes, working without a contract, decreases to hospital funding, strikes- most of us have been there. Nurses can follow these funding decisions directly to their impact on patient care, because of our role providing patient care. When we vote, we elect people who will make budgeting decisions. We can vote for people who will support our job security, and adequate funding for health care. We can also reinforce the importance of the nursing profession by contacting politicians to share information and let them know that nurses vote. Political activity gives nurses an opportunity to represent and advance our professional values.

  1. We can advocate for our patients.

For me, the most important reason to be politically active is because politics is a means for nurses to advocate for patients. Advocacy is very important for nurses because social justice is a core value of the nursing profession. When we work in clinical settings, we can help one patient at a time, and this work is central to our profession. When we vote, sign a petition, or participate in a political event, we can potentially help thousands of people at a time. Political activity takes the work of nurses from being a discreet event in one setting, and raises it to a societal level.

A lot of the social determinants of health can be impacted through political decisions. Nurses can help to protect health care access for vulnerable populations. An example of this is refugees. In Canada, funding was cut to refugee health care programs. An outcry from multiple professions took the case to the Supreme Court of Canada, where the decision was overturned. This is an example of when political action was effective to advocate for a vulnerable population.

So what can we do?

There are many ways nurses can be politically active.

Some suggestions include:

  • VOTE! (Especially on October 19 if you are Canadian).
  • Encourage your friends to vote, too!
  • Call or email your elected representatives, and tell them about an issue that matters to you.
  • Engage with a political party or organization on social media, and share information with your followers.
  • Actively participate in your nursing union or association.
  • Join a protest or demonstration.
  • Write a letter to the editor about an issue in your community.
  • Run for a political position or office- can be anything from your local union chapter to a federal seat in parliament.
  • Talk about politics with your coworkers, friends, and neighbors. Encourage them to get involved too, even if they have different views.

Other resources include:

Samara, a non-partisan organization dedicated to improving political participation.

Vote Compass, to help you determine whom you should vote for on election day.

Nursing union and association election resources

United Nations, Department of Political Affairs

 

These are just a few of the ways that nurses can be politically active. I encourage you to use political activity as part of your nursing practice, to advocate for our patients and our profession!

 

Key to The Future: MNHHS Nursing & Midwifery Conference

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                Simulation Education Workshop: Technique, Not Technology: Nursing CPD 2.0

This post is to curate a selection of materials linked to the the Simulation Education Workshop I delivered on May 12th (International Nurses Day) at the inaugural Metro North Hospital and Health Service Nursing and Midwifery Conference.

The central theme of this workshop was scenario based simulation through the progress of a nursing career. There is increasing adoption of simulation as a teaching technique for many technical and team based skills in the health professions. The aim of this workshop was to outline practical tools that can facilitate the utility of simulation at pivotal points in the progress from undergraduate nurse, to new graduate, to team leader, educator, executive and beyond. Nursing has many divergent career pathways, but using the correct framework, I believe scenario based simulation can facilitate a smooth transition, expanding scope of practice, leadership and communication skills and understanding the risks our environments hold.

 

Australian Healthcare Simulation Community

This Health Workforce Australia (HWA) project aims to connect simulation educators and provide standardised resources that can smooth out the bumps and workload involved in introducing a simulation program into your institution.

SimNET

 

Simulation Glossary of Terms

A very useful glossary of the vocabulary of health simulation. Development of a common language is important to take simulation from being an ad hoc event such as the “Mock Arrest” to a more educationally sound and crucially integrated teaching technique. Terminology sets expectation.

HWA Data Dictionary

 

Templates

These documents are pro-formas that may assist with planning and evaluating scenarios.

Scenario template (pdf)

Scenario Template (doc)

Post Scenario Report (pdf)

Post Scenario Report (doc)

 

Podcasts & Blogs

There are some posts in the back catalogue of Injectable Orange that can be found here SIMULATION Posts

Top ten tips for In Situ Sim at St.Emlyns – A great blog and podcast post giving ten solid tips about integrating simulation into your workplace education program.

Injectable Orange Simulation Basics: Back to the Future – A casual walkthrough of the phases of simulation.

Simulating Healthcare Blog  – A brilliant blog by Dr Paul E. Phrampus, a guru in the world of healthcare simulation.

Mobile Medical Simulation – A brilliant website curating a whole host of resources from scenarios, templates and debrief guide.

 

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Thanks again to my awesome co-conspirators Sean Lannan and Thea-Grace Collier.

 

Why “Soft Skills” Matter

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Follow Jennifer on Twitter @JJackson_RN

Injectable Orange Editorial: So the call went out on Twitter for eager bloggers to share their words via injectableorange.com and Jennifer replied… big time. This post is the second in what we are hoping to be a series of regular guest posts focussing on professional communication and the so-called “soft skills” of nursing. Enjoy.Slide1

In this blog, I examine professional development, and other non-clinical aspects of nursing. It is important to illustrate why these skills matter for nursing, and why you should care about these issues. To understand this effectively, it is helpful to talk about the pillars of the nursing profession; this gives us a framework. In this post, I talk about how nursing is structured, and how soft skills fit into this structure, and why it is important for you.

We all love some excitement. Many nurses love the adrenalin rush of participating in a Code Blue or other high-intensity scenario. There are a multitude of psychomotor skills required in these events, and it gets your blood pumping to be in the middle of a critical situation. Today, I am here to advocate for a different type of essential nursing skill: soft skills. I believe that these skills are integral to nursing, and are among the most important abilities that a nurse can have at the bedside.

Soft skills, or non-clinical skills, or non-technical skills, refer to skills that are above and beyond the psychomotor tasks that nurses complete. They have been loosely defined as skills that enhance interpersonal interaction. Examples of soft skills are communication, advocacy, critical thinking, and interpersonal skills. It is important to see these skills as a distinct, and learnable part of nursing. All nurses can work to improve their soft skills, and in turn their nursing practice. In this post, I will cover 3 distinct reasons why soft skills matter: they connect domains of nursing practice, they express different kinds of nursing knowledge, and they make a difference for patients (and employers!). We’ll also explore what do to next.

Connecting Domains of Nursing Practice

It is important to consider how the nursing profession is structured. Nurses have 4 distinct domains of practice: clinical, administrative, educational, and research. Each of these areas is united by the fact that we all use the nursing process. While the bulk of nursing takes place in the clinical domain, each of these domains is essential. They reflect how nurses create professional knowledge (research), learn professional knowledge (educational), apply professional knowledge (clinical), and foster the creation/learning/application of professional knowledge (administrative). Side note: this is why we should refer to nurses by their domain of the profession, such as “clinical nurse” instead of staff nurse, frontline nurse, bedside nurse etc. It ties the role directly back to its pillar of the profession. Each domain is a leg of our table, and is essential to having a robust nursing profession. It is important to know how the profession is structured, so you can map where your role lies, and how you relate to other roles within the profession. This is not a hierarchy- it is an understanding that we are different but that we are all on the same team.

However, each domain is also different. You can discuss backwards regression analyses in research and progression of mobilization in clinical practice. So how do we talk to each other? Soft skills. We use interpersonal and communication skills to connect between domains of practice, and share our insights and our challenges. This is important because clinical nurses may have a great suggestion for new nursing research initiatives. Nurse educators may inform nurse administrators about a need for advocacy around educational funding. Our soft skills can break down barriers and strengthen the integration of our domains of practice, making nursing practice easier for all of us.

Expressing Different Kinds of Nursing Knowledge

In addition to having different domains of nursing practice, we also have different kinds of nursing knowledge. These kinds of knowledge cross all 4 domains of practice, and represent how nurses understand their profession. Carper’s landmark article outlined that nursing knowledge is categorized as art, science, ethics, and experiential knowledge. Chinn and Kramer later added social justice or emancipatory knowing as a fifth type of nursing knowledge.

Domains of Practice Types of Nursing Knowledge
Clinical Art
Administrative Science
Research Ethics
Education Experience
Social Justice

Everything we do is multidimensional, or it would not be nursing. Our unique types of knowing are expressed through soft skills, in everything that we do. Let’s take an IV insertion, which is a bread-and-butter psychomotor skill. While you get your supplies to put in the IV, you grab a hot pack- your experiential knowledge tells you your patient might be a hard poke, and your science knowledge tells you that heat will help this situation. While you prepare your supplies, you comfort the patient and explain the procedure. That’s the art of nursing. This patient may need a PICC line, but could be high risk for IV drug use- the ethics and social justice of nursing. One commonplace procedure; 5 types of nursing knowledge.

So how do we express our different types of nursing knowledge? You guessed it, soft skills. Nursing runs on this complex integration of knowledge; however, a lot of it can happen internally and it is not seen or recognized by others. When we can articulate what we are doing, using our nursing knowledge as a framework, we demonstrate the full range of nursing. This will increase the appreciation and respect for our profession.

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Soft Skills Make a Difference for Patients (and Employers!

No matter where we work, nurses make a difference for patients. When you ask patients what makes the biggest impact to them during a hospital stay, nursing communication ranks consistently as one of the most important factors. In my experience as a clinical nurse, I found that many people placed emphasis on psychomotor skills. I remember the days of being a student and saying, I need an IM and an IV start! However, if we really want to make a difference for patients, we need to have good soft skills too. Research has demonstrated that communication makes a huge impact for patients, and is the most important aspect of being a health care leader. In light of this, we need to consider soft skills as seriously as any other type of nursing skill.

Increasingly, employers care about soft skills. Now that patient experience is a common measuring point in hospitals (whether it should be or not- this is reality), administrative nurses are hiring clinical nurses for personality instead of experience or background. I have heard this stated by many nurse managers- “We will teach them everything they need to know during orientation. What I need is someone to be part of our team.” If you are looking to score your nursing dream job, you need to demonstrate that you have strong soft skills. To see how to write a resume that does this, see this post.

So Now What?

Soft skills are an essential part of nursing, across all domains of practice and types of nursing knowledge. So what does a nurse do about this? Treat soft skills the same way as you would any other skill. Practice, seek out resources, ask for advice, and participate in continuing education. It is reasonable to ask your colleague, how can I improve at IV insertion? It is also completely reasonable to ask, what are some ways to communicate with a family that is grieving? You wouldn’t put in an IV without learning about it first, and the same logic applies to soft skills too. Consider soft skills an integral part of how you nurse and how you talk about the nursing profession. You will see great benefits for yourself, and also for your patients.

I will continue to explore soft skills and nursing in this blog, so stay tuned! In the meantime, how have soft skills impacted your nursing practice?

 

How to Write Resumes Like a Pro – Professional Communications

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Follow Jennifer on Twitter @JJackson_RN

Injectable Orange Editorial: So the call went out on Twitter for eager bloggers to share there words via injectableorange.com and Jennifer replied… big time. This post is the first in what we are hoping to be a series of regular guest posts focussing on professional communication and the so-called “soft skills” of nursing. Enjoy.

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How to Write Resumes Like a Pro – Professional Communications

There are many challenges in the nursing profession. One of these is to clearly articulate what we do as nurses, and why our work is valuable. There is a great deal of variety in nursing roles, and it can be hard to pinpoint our expert contributions. We give medication, but we are not pharmacists. We mobilize patients, but we are not physiotherapists. The media is also full of negative images of nurses, whether they be hyper-sexualized or diminutive. As a profession, we have an uphill battle when it comes to articulating our worth and value.

Fighting for credibility and recognition is as old as the nursing profession. Florence Nightingale invented modern statistics, and the graph (yes, she made the first visual representations of data EVER) in order to demonstrate the impact of her interventions in Crimea. There are many examples of Florence taking nursing from something regarded as slightly better than prostitution and creating a respectable profession.

In the modern era, we continue to advocate for ourselves as nurses. A perfect example of this is with resumes. Many nurses I meet view resumes as a necessary evil, a summary list of tasks written to get a job. I see resumes differently. What a nurse is really doing when they write a resume is creating a professional document, highlighting their value and potential contributions as a member of a team. Resumes are not just a list for when you prepare to change jobs; they are an active record of what you do as a professional and why it matters. It is essential that nurses are able to speak and write strongly about the profession, and resumes are a great way to start.

Where Do I Start?

I encourage nurses to have 3 key documents: a master list of everything you have ever done, a functional CV, and a resume. To differentiate: a master list includes all of your accomplishments, a CV is 4-5 pages and includes the key highlights across a comprehensive spread of subjects, and a resume is 2 pages max and is specific to a job posting. If you were Johnny Depp, the master list would contain all your movies, a CV would highlight roles under Villians, Romantic Leads, Voiceover Work, and a resume would be Mentally Unstable Protagonists Who Can Do Stunts.

It can be daunting to go back and dig up all of this information, if you haven’t written a resume in a while. Don’t wait for a job application to come along, be ready to go with professional documents. I liken this to shaving your legs for the first time in the spring; the first go round is brutal, but after that, the maintenance is much easier (at least for us Canadians!).

            The next piece is to organize your information by general categories. These can vary widely, but there are three things you must include: work experience, formal education, and continuing education. If you don’t have recent continuing education, get some. This is a professional standard, and is absolutely essential to any resume. Other areas can include presentations, publications, volunteer experience, leadership opportunities, mentorship roles etc. When you are formatting your resume, lead with your strongest suit. If you have lots of work experience, start there. If you are a recent grad, your education goes first.

What Do I Say?

The single biggest mistake nurses make on resumes is to list psychomotor skills they can do, or places they have worked. If you list tasks, a manager will see that you can complete tasks. If you highlight your leadership and advocacy skills, a manager will see that they are going to interview someone who can make a valuable contribution. Drive the discourse towards your potential contributions. As you have limited space, you will want to include lots of “resume ninjas”- phrases that are short and sweet, but pack some major punch.

For Example:

Poor: Worked at a 10 bed inpatient facility in Guysborough. Assessed patients, administered medications, full and accurate charting, and worked with physicians.

All this tells me is that you can do the bare legal minimum required of any nurse.

Much better: Clinical nurse with 10 years of experience providing care for diverse populations at rural transfer centre. Formal leadership role as Charge Nurse, and member of interdisciplinary steering committee.

Now we’re cooking with gas. This says, you can work in a rural area- thus, you can critically think. The people there trusted you to run the facility. You also cared enough about your workplace to be involved in something.

Resume Ninja: Leader for in-patient education relating to hemodialysis decision-making and family support.

This tells me a) you know about dialysis, both inpatient and at discharge b) you understand the importance of patient teaching c) you know that there are complex ethical issues surrounding hemodialysis, and you know that it is a nursing role to provide support d) you have good communication skills e) you can work with people. Bam!

I always encourage nurses to focus on how they lead, advocate, communicate, plan, negotiate, coordinate, facilitate, implement, spearhead, critically think etc. Write with confidence about what we do and why it matters.

(Caveat: there are exceptions to the skills list rule- if you have advanced psychomotor skills, such as hemodialysis, those merit inclusion. The trick here is to associate the skill with the higher-level competencies, such as critical thinking or troubleshooting).

Also, a general disclaimer for language: NEVER call yourself a staff, frontline, or bedside nurse. Associate what you do with one of the domains of practice: research, administration, clinical practice, or education. If you treat patients, you are a clinical nurse. If you teach, you are a nurse educator. Link your role to its pillar in the profession.flowchart

I’ve Got the Content. Now What?

Before submitting a resume, is important to deciding what content is most important to include (remember, 2 page max!). Here, focus on recent and relevant. Generally, you want to include things from the last 5 years or so, depending on the number of items under each category. However, if you worked in the OR 15 years ago, and you are applying for an OR position, add that piece to demonstrate that you have experience in the area.

Some nurses that I work with are very hesitant to remove items from their resume. Remember, you want to demonstrate the best fit for the position, and the resume is to get   an interview, not a job. You can elaborate about your qualifications during an interview. It is also important to look at the job posting, as colleagues in human resources generally do the first cut of resumes, not nurse managers. Therefore, if the posting says they are looking for someone who can work as part of an interdisciplinary team, your resume needs to demonstrate that you can do team work.

Before you submit a resume, have a friend or family member look it over. Make sure the font is size 12, either Arial or Times New Roman. This is not the place to go out on a limb with new fonts or formatting, especially if you submit electronically. Make sure all the bullets line up, the layout is clear, and it is 100% spelling/grammatical error free. If there are mistakes on a resume, it will go in the garbage.

Dare to Share!

Now that you have a resume ready to go, keep it updated as you complete more continuing education. If you have sections that could benefit from some more points, seek out new opportunities, like conferences. When a new professional opportunity presents itself, you will be ready to share your experiences and land a new job. You will also be a strong advocate for nursing, as you can clearly articulate why nurses matter.

 

Is there a Critical Care (Nurse) Practitioner in the House?

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Editor (Jesse): It is with very humble pleasure that injectableorange.com plays host to a great insight into the strategic, organisational and personal history of critical care nurse practitioner role in the UK. @ccpractitioner himself shares an insight into his world. I have long been a fan of Jonathan’s website. Jonathan is a living example of the ethos of critical care, tirelessly working to better himself and in the process raising the bar and sharing resources for others. Without further ado, over to Jonathan.

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The NHS Plan (2000) identified the need to undertake some experiments regarding skill mix in the National Health Service. This was followed by the Modernisation Agency establishing a New Ways of Working team in 2001. The Changing Workforce Programme subsequently developed into the National Practitioner Programme and consequently a number of new ways of working, streams were established. These covered surgery, medical care, anaesthesia, critical care, endoscopy and assistant roles in theatre.

It is widely accepted that the reduction in junior doctors’ hours (Council Directive, 2000), coupled with career development, namely Modernizing Medical Careers (SEHD, 2005), could result in a reduction in the number of hours junior doctors are available for service provision. These changes may have specific implications for the provision of medical care for critically ill patients.

A major component of this strategy was the development and introduction of the Advanced Practitioner roles. It had been recognised already that there were many healthcare professionals who wanted to use their extended skills in new ways of working. There were consequently four main ways in which roles were redesigned to offer practitioners more potential for development.

The International Council of Nursing defines an advanced nurse practitioner as;

“A registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which she/he is credentialed to practice”

There were several goals for the development of the new roles, which included ensuring the necessary skills and competencies required by care pathways or interventions are present in the workforce, encouraging working across professional boundaries, matching skill mix to service delivery models, reducing workforce cost and attracting a new workforce where shortages exist.

The advanced practitioner role often requires management of own caseloads with high levels of decision-making and diagnostic reasoning. The development of these roles has required substantial investment and as a consequence evidence of added value has been essential when considering developing these roles.

Both the Royal College of Nursing (RCN) and the Department of Health (DoH) have reiterated the need for advanced practitioners to be educated to Masters level and in order to achieve this I first undertook a post graduate diploma in Anaesthetic practice which I then went on to convert to a Masters degree by completing a research dissertation over another year.

The current critical care practitioners within my trust study towards their Masters degree by undertaking several modules. These include Clinical History Taking and Examination, Clinical Diagnostics, Clinical Investigations, Non-Medical Prescribing (which entitles them to prescribe anything a doctor can) and a research module teaching them how to critically analyse and formulate a research plan. These modules are also backed up by achieving a series of clinical competencies related to the intensive care unit, supervised by their consultant mentor.

They are also required to keep a logbook of the procedures they have undertaken, which initially they have to be supervised for. It is only when they are assessed as competent by their consultant mentor in that particular skill that they are able to undertake it independently. These skills include Arterial line placement, central venous catheter insertion, dialysis line placement and intubations. All the practitioners are also Advanced Life Support providers and most are also Advanced Life Support instructors.

Once considered qualified the practitioner works alongside the junior doctors on their rota on both the day and the night shift, providing valuable support to the team.

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It would not be true to say that the advance practitioner role has been taken up across the entire health service. Decisions to develop the advance practitioner role have often been taken at a local level within the health service and often depends upon the championing of extended or advance practitioner roles by one or more key individuals, commonly heads of department or chief executives. It is probably fair to say that the development of the role requires a lot of support because without it there can be resentment among staff and the feeling that the advance practice role has been introduced simply to increase volume rather than the scope of practice.

The path has not always been a smooth one during my experience as a practitioner. Initially I found it very difficult to adjust to my change in role. With my many years experience in the intensive care environment, I initially felt myself going from expert to non-expert quite quickly. Whilst I felt that I already had a lot of relevant knowledge, I very quickly became aware of the steep learning curve. Occasionally some of the junior doctors also seem to have been a little confused about the new role. I think it was hard for them to understand where nursing input stops and our practitioner role began. I do believe, however, that the practitioner now offers more teaching opportunities and learning situations for the junior doctor, rather than less. Certainly, for some of the procedures there is more likely to be support to offer them when they are trying to learn.

I think the greatest benefit to having the critical care practitioner is the continuity that they offer to the medical team. Many of the junior doctors rotate through the intensive care unit fairly quickly. This results in a team of doctors with reduced levels of experience in intensive care every few months. The critical care practitioner is able to bridge this gap and ensure that the care in the intensive care unit is led by current practice and research and carried out in a safe and consistent manner.

One of the issues mentioned with the advance practitioner role is that there are few further routes for career advancement. In the current climate I find this a slightly pointless argument. I was at band seven in my nursing role in critical care and without going into either education or management I was unlikely to achieve a higher grade without a major change. That major change came about when I was offered the opportunity to take up the advance practice training. Once qualified I was then able to achieve a higher band, 8a, which I otherwise was not going to get. In my trust there are now some senior advance practitioners at even higher grades, so I feel that this change in my career pathway has only raised the ceiling for me.

It is difficult to foresee where the advance practice roles will go, but I can only say that it is been a huge developmental step for me personally.

 

Reading List

 

Advanced nursing roles in critical care- a natural or forced evolution? Coombs et al. Journal of Professional Nursing Vol 23, No 2 2007: pp 83- 90.

 

Practitioner role in a hospital setting. Dalton, M. British Journal of Nursing Vol 22, No 1 2013 : pp 48- 53

 

Advanced level nursing- a position statement. Department of Health 2010

 

Exploring advanced nursing practice: past, present and future. Duke, N. British Journal of Nursing Vol 21 No 17 2012 : pp 1026-1031

 

Steering a course to advanced nursing practice. Nursing in Critical Care Vol 16 No 2 2011 : pp67-76

 

Evaluation of advanced practitioner roles. Institute for Employment studies. 2009

 

Advanced nurse practitioners. Royal College of Nursing. 2012.