Date Published: 8 September 2006

Highly qualified, highly respected but an uncertain future for nurse practitioners (UK)

Nurse practitioners are highly qualified, well respected and feel positive about their roles despite concerns for the future, according to a new Royal College of Nursing (RCN) report.

Nurse practitioners work in advanced roles and take on full patient examinations, make diagnosis and referrals, advise on and provide care packages.

A survey of over a thousand nurse practitioners (NPs) suggests that the financial crisis in the NHS is beginning to affect NPs. Almost half (47%) report that they are increasingly having to absorb other people's workload and in spite of this one in four are uncertain about whether the future funding for their post is secure. One in five (21%) reported that NP jobs in their workplaces are under threat, and are worried they may be made redundant. Around 40% of respondents did not feel confident, or felt uncertain about the future of nurse practitioners in the UK.

The survey also highlights a lack of understanding of the role of nurse practitioner, and what they can offer a problem which many believe is reflected in referral refusals. Around 44% of nurse practitioners have had an X-ray request refused. A further 44% have had referrals to other clinicians refused on the grounds that they were a nurse.

There is also evidence that the growth in NP posts has been curtailed; the number of respondents taking up current post gradually increased between 1990 and 2004, but fewer respondents have taken up their current post in 2005 -2006 than in any of the preceding years. Around 30% felt the new roles of 'Physician Assistant' or 'Medical Care Practitioner' may threaten the work of NPs.

However, the majority of nurse practitioners felt positive about their jobs and that their work was valued (85%). Respondents also consider that their professional judgement is respected by nursing colleagues (95%) and the doctors they work with (91%).

The results of the survey also found:

  • 95% of respondents felt that the NP role had given them the opportunity to advance their career whilst remaining clinically focused
  • Two-thirds of NPs work in primary care settings whilst a quarter work in hospitals and 5% in NHS walk-in centres
  • NPs are typically highly-qualified three quarters hold a degree and a further 10% are currently studying for one, and in 35% of cases this is at Master's level
  • The majority of patients (60%) referred to NPs have not had a medical diagnosis made for their presenting condition
  • Almost all respondents report that nursing skills are important to their job
  • A quarter felt that the NP role was not used to its full potential.

Alison Kitson, Executive Director of the RCN said:

Nurse practitioners have a vital role to play in patient care. They have been championed by government and are highly-respected and valued by colleagues and patients alike - research tells us that many patients actually prefer to be seen by a nurse.

_ Yet many nurse practitioners feel their role is not being used to its full potential this is a real waste of skill and experience. Nurse practitioners are an extremely valuable resource, and employers need to provide the support and resources that NPs need to provide the best possible patient care.

_ It is also deeply worrying to see concerns about the future creep into the nurse practitioner workforce, the Government must ensure the future for nurse practitioners is secure to fail to do would be an enormous loss for both the NHS and its patients.

Benny Hartson, chair of the RCN Nurse Practitioners Association said:

The results of this survey show clearly that nurse practitioners make an enormous contribution to patient care. However, a lack of understanding and awareness of the NP role, their abilities and responsibilities, has meant many NPs face barriers such as referral refusals which ultimately affect the patient.

_ The government has asked nurse practitioners to share their concerns about professional barriers and these findings make it clear NPs are still facing frustrations on a daily basis. We call on Government to listen to nurse practitioners' concerns, work with them to clear these professional 'blocks' and ensure patients continue to get the best possible care.

Source: Royal College of Nursing (RCN), UK.
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