Expanded Scope of Practice Policy for Registered Nurses and Midwives
Version / 2Name of responsible (ratifying) committee / Nursing and Midwifery Advisory Committee
Date ratified / 11.10.2012
Document Manager (job title) / Nicky Lucey (Deputy Director of Nursing)
Date issued / 23.05.2011
Review date / October 2015 (unless requirements change)
Electronic location / Corporate Policies
Related Procedural Documents / N/A
Key Words (to aid with searching) / Expanded Practice; Nursing and Midwifery;
Health Visitors
CONTENTS
QUICK REFERENCE GUIDE 3
1. INTRODUCTION 4
2. PURPOSE 4
3. SCOPE 4
4. DEFINITIONS 4
5. DUTIES AND RESPONSIBILITIES 5
6. PROCESS 5
7. TRAINING REQUIREMENTS 6
8. MONITORING COMPLIANCE WITH, AND THE EFFECTIVENESS OF, PROCEDURAL DOCUMENTS 6
Appendix 1: Expanded Practice request submission details 7
QUICK REFERENCE GUIDE
This policy must be followed in full when developing or reviewing and amending Trust procedural documents.
For quick reference the guide below is a summary of actions required. This does not negotiate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.
1. Any Nursing and Midwifery expanded practice for registered Nurses and Midwives should be within the Nursing and Midwifery guidance.
2. The need for expanded practice nursing and midwifery roles should be agreed by the Clinical Service Centre Management Team (CSCMT), ratified at the CSCMT governance forum, before being submitted for review.
3. All requests for expanded N&M Practice should go to the Head of N&M Education for a first line review and approval to proceed.
4. The Head of N&M Education will review the request and reply to the CSCMT within two weeks of receipt.
5. If agreed, the development of the expanded practice education and protocol is the responsibility of the CSC head of Nursing/Midwifery.
6. The protocol and education plan for the expanded practice should be presented by the CSCMT at the Trust Nursing and Midwifery Advisory Committee for ratification.
7. The CSC is responsible for sending the final guideline to the Trust Policy Officer for logging of the new guidance in the Intranet N&M guidelines section.
8. This policy does not apply to non-medical prescribing for Nurses and Midwives, which is covered by an alternative policy.
9. The final ratified protocol should be noted by the Learning and Development Department.
10. The CSCMT must ensure the protocol is reviewed and updated each year in line with the Trust Policy for policies.
1. INTRODUCTION
1.1 The Nursing and Midwifery Council (NMC) scope of practice (2008) and The Code: standards of conduct and performance and ethics for nurses and midwives (2008), sets clear guidance and standards to be upheld by nurses and midwives. It clearly outlines the need for continual development of practice, whilst ensuring the public are protected by the practitioner working within their competency level that they are trained and experience for. This enables the practitioner to maintain patient safety within a dynamic and responsive care service.
1.2 Before developing an expanded practice it is required that a proposal is reviewed and agreed through the governance framework in each Clinical Service Centre, with senior ratification by the Director of Nursing, to ensure the expanded practice meets the professional standards required.
1.3 Expansion of practice must always consider the benefit to the patient and service in terms of quality, safety and cost efficiency and have agreement from the senior clinical lead that the enhanced practice contributes to these areas.
1.4 The education, training, audit and monitoring of the expanded practice must be developed to ensure the role can be conducted competently and safely. This must be reviewed as part of the individual yearly performance review, against linked KSF outlines.
1.5 The expanded practice should reflect the best evidence based practice, where available.
2. PURPOSE
This policy provides the framework for developing a proposal and ratifying process of expanded practice. This will ensure there is a clear documented audit trail on the decision to expand practice, ensures assurances are in place around the need, governance and review of any expanded practice
This policy will ensure the Trust has assurances on the standards of expanded practice and the best use of expertise across the organisation to meet the demands of the modern healthcare system in providing best care as cost efficiently as possible.
3. SCOPE
This policy applies to Registered Nurses, Midwives who may wish to expand their practice. In addition, it applies to all senior CSC Heads of Nursing/Midwifery and Clinical Chiefs who maybe looking at developing services to include the expansion of practice for nurses, midwives or health visitors.
‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’
4. DEFINITIONS
· Registered Nurses and Midwives refer to those practitioners registered with the Nursing and Midwifery Council (NMC) to practice legally in the United Kingdom.
· NMC Scope of Practice was updated in July (2008) it states that: “The NMC expects that all registered nurses will develop their practice in accordance with their knowledge and competence and only undertake practice and accept responsibility for those activities in which they are competent. Registered nurses are also personally accountable for their own practice, regardless of advice or directions from other professionals.”
5. DUTIES AND RESPONSIBILITIES
· Director of Nursing: responsible for expanded practice standards within Portsmouth Hospitals NHS Trust (PHT) and is chair of Nursing and Midwifery Advisory Committee (NMAC) the ratifying committee.
· Head of Nursing and Midwifery Education: responsible for the first line review and approval to proceed in developing a guideline for expanded practice for ratification at NMAC. Responsible to noting the new guideline at the Trust Learning and Development Department meeting.
· Head of Nursing: the responsible professional in the Clinical Services Centre (CSC) for the development, governance, implementation and monitoring of the expanded practice.
· Senior Clinical Lead: responsible to complete and submit the proposal in line with this policy. In addition responsible for ensuring the expanded practice guideline is updated annually.
· Individual Nurse/Midwife undertaking the expanded practice: responsible to work within the agreed expanded practice guidance and N&M scope of practice and code of conduct.
6. PROCESS
The following processes should be followed:
6.1 The Senior Clinical Lead responsible for the service should submit a proposal of “intention to develop and expanded practice guidance” form (Appendix 1) to the Head of N&M Education, Learning and Development Department. The aim of this is to ensure that the area of expanded practice is appropriate from the professional perspective and prevent duplication of any protocols for expanded practice. The Clinical Service Centre Management Team (CSCMT) must provide evidence of support for the expanded practice, ensuring it fits within the workforce plan and service strategy.
6.2 The responsible person submitting the intention to expand practice will be informed of one of the following decisions by the Learning and Development Department:
· The proposed area of practice is not appropriate for the development of an expanded practice protocol.
· The existence of other protocols or guidance on the same area of practice, which will be forwarded to the submitter.
· Agreement that the guidance can be developed.
6.3 Once approved to proceed the final guidance for expanded practice must be submitted to the local CSC governance meeting for agreement
6.4 If approved the final CSC approved guidance for expanded practice is then submitted to NMAC for ratification. The CSC HoN is responsible to ensure all completed documentation is submitted for NMAC.
6.5 NMAC will either approve or decline to the expanded practice guidance.
6.6 The ratified protocol will be then be noted by the Trust Learning Development Team.
6.7 The CSC management Team is responsible to submit the final approved guidance to the Trust Policy Officer for the Intranet N&M guideline section.
6.8 Annually the Senior Lead must review and update the expanded practice guidance.
The practicing Nurse/Midwife must follow the guidance at all times when undertaking the expanded practice, in line with this policy and their NMC registration.
7. TRAINING REQUIREMENTS
Each expanded practice guidance must specify all training requirements for all relevant levels of staff, how frequently the training should take place (as identified in the Training Matrix), how it is to be delivered, and where appropriate by whom. A cross reference to the Trust’s Training Matrix needs to be made in this section.
A competency must be included in the training to ensure assessment of completion and attainment of the expanded practice, in line with the Trust generic competency framework policy.
Include within this section any processes for following up those who fail to complete the training: this needs to be in line with any learning and development policies and include a cross reference to such policies.
8. MONITORING COMPLIANCE WITH, AND THE EFFECTIVENESS OF, PROCEDURAL DOCUMENTS
Detail how this document will be monitored to ensure it is effective and being complied with.
The effectiveness in practice of all guidance documents should be routinely monitored (audited) to ensure the document objectives are being achieved. The process for how the monitoring will be performed should be included in the guidance document.
The details of the monitoring to be considered include:
· Annual review at the individuals’ yearly appraisal and 6-monhtly review is the responsibility of the registered Nurse/Midwife.
· The Line Manager of the Nurse/Midwife must ensure the individual has completed any relevant training and competency assessment prior to approving the individual undertaking the expended practice.
· The Senior Clinical Lead will review annually the expanded practice guidance to ensure it reflect best evidence based practice and any new NMC guidance or legal acts.
· HoN are responsible to ensure all practicing Nurses and Midwives under their professional leadership have a yearly appraisal and have systems in place to monitor this monthly.
· Director of Nursing will oversee the CSC appraisal performance of compliance for Nurses and Midwives through the CSC performance reviews held monthly.
/ Expanded Practice request submission details /
1. / Expanded Practice protocol title:
2. / Summary of Expanded practice remit:
3. / Background supporting information to expanded practice request (include service strategy and workforce plan information here):
4. / Rationale for expanded practice:
5. / Patient Group and area of practice:
6. / Benefits to patients are:
7. / Impact of wider healthcare team (include who currently undertakes proposed practice/procedure):
8. / Definition of expanded practice procedure:
9. / Consent process (it maybe appropriate to gain patient consent for treatment in the area of practice, if relevant document appropriate information here):
10. / Staff group/ roles qualifications and experience required to undertake expanded practice:
11. / Nurse/Midwife education and training requirements (specific to area of expanded practice, include any specific medical device training required)
12. / Nurse/ Midwife assessment of competence (include measurable outcomes):
13. / Monitoring and audit process (include how and who will be responsible for this):
14. / Supporting references (to demonstrate evidence based procedure):
15. / Submitting CSC support:
Name Senior Clinical Lead:……………………………Signature Senior Clinical Lead:………………………..
Name Head of Nursing:……………………………..Signature: Head of Nursing……………………………….
Date:……………………………………………………………………..
16. / Learning and Development Department Head of N&M Education decision:
□ The proposed area of practice is not appropriate for the development of an expanded practice protocol.
□ The existence of other protocols on the same area of practice, which will be forwarded to the submitter.
□ Agreement that the proposal can be developed.
17. / Head of N&M Education decision comments and recommended actions:
Reviewer name:………………………………………. Reviewer Signature:…………………………………..
Date:…………………………………………………….
18. / If approved for submission to NMAC for ratification complete this section:
Date for NMAC:…………………………………
Responsible person presenting to NMAC name: ………………………………………………………
19. / NMAC ratification:
□ The proposed area of practice expansion is not supported due to the following reasons:
□ The proposed area of practice expansion is supported and ratified.
20. / NMAC Chair decision/recommendations:
Reviewer name:………………………………………. Reviewer Signature:…………………………………..
Date:…………………………………………………….
Expanded Scope of Practice Policy for Registered Nurses and Midwives. Issue 2. 19/04/2013
(Review Date: October 2015) Page 1 of 9