Transforming Nursing, Midwifery And Health Profession (NMaHP) roles: review of Clinical Nurse Specialist and Nurse Practitioner roles within Scotland

Annex E Outcomes from Review: Governance

3.1 Governance: Level 6

Clinical Nurse Specialist

Nursing Governance Structures

• Clinical Nurse Specialists are embedded in nursing governance structures, with clear lines of responsibility and accountability leading through the professional nursing line. Working across traditional organisational boundaries may be required to facilitate this.

Clinical Competence

• Clinical Nurse Specialists must demonstrate competence in a specialist area of practice and across all four pillars of practice.

Career Framework

• Clinical Nurse Specialists posts are aligned to Level 6 of the NES NMaHP Development Framework^[24] and reviewed at a minimum against AfC Band 6.

Qualifications

• Minimum of a graduate certificate (honours degree level) qualification specific to the area of practice with a core educational focus on development of clinical competence. A Postgraduate Certificate is recommended.

Portfolio

• All Clinical Nurse Specialists must have a NES TURAS Professional Portfolio containing evidence of their qualifications, clinical competence and continued professional development.^[25]

Clinical Supervision

• Clinical Nurse Specialists must have effective Clinical Supervision and support through competence frameworks and supervision models (such as the NES Clinical Supervision model).^[26]

Competence, Capability and Continuing Professional Development

• Established Clinical Nurse Specialists should be mapped against current recommendations and local arrangements to meet any gaps in competence and capability. Continuing Professional Development (CPD) for Specialist Practitioners must be evidenced within the NES TURAS Professional Portfolio. Specialist Practitioner requirements should be reviewed during periods of service change or development, using an accepted service needs analysis tool. For example, the NES ANP tool.^[27]

Evaluation of Impact

• Clinical Nurse Specialist teams should use a range of outcome measures to evaluate the impact of their practice on safety, effectiveness and person-centred care. Where possible, existing data/data already being collected should be used.^[28]

Service-Level Impact/Quality Improvement

• Collect baseline data prior to implementing a new model of care or initial test phase, with follow-up and review post-service change.

Quality Assurance

• Ensure quality of care is evaluated as part of the supervision model, using patient record review and direct supervision to evaluate the competence and effectiveness of each Clinical Nurse Specialist.^[29]

Review and Recording of Existing Workforce

• Review the existing nursing workforce at AfC Band 6 and above against the definition, competences and requirements of the Specialist Practitioner role: those matching directly should be logged as Specialist Practitioners on the NHS Electronic Employee Support System (eESS) or Scottish Workforce Information Standard System (SWISS).

Final Sign-off

• Boards should introduce a robust final sign-off process, that involves the review of a Clinical Nurse Specialist's portfolio of evidence to ensure that nurses who meet the definition, competencies and requirements of the CNS role are recognised and logged on eESS/SWISS.

Expert Specialist Resource

• Provides specialist advice and support for patients throughout the care pathway
• Acts as an expert clinical advisor for colleagues across a range of settings
• Acts as a resource or educator to others
• Is a key member of the wider MDT, contributing to case management presentations and clinical management decisions.

3.2 Governance: Level 7

The following recognises that there are two versions of the CNS roles at Band 7 that are sometimes combined:

• an Advanced CNS role, operating at a higher clinical level to Level 6 CNSs;
• a lead CNS role, operating at a higher level in the Clinical leadership/management pillar to CNSs at Level 6, or alternatively, operating at the same clinical level.

Advanced Clinical Nurse Specialist

Nursing Governance Structures

• ACNSs are embedded in nursing governance structures, with clear lines of responsibility and accountability leading through the professional nursing line: working across traditional organisational boundaries may be required to facilitate this where no suitable professional nursing governance structure is in place.

Clinical Competence

• ACNSs can demonstrate competence across all four pillars of advanced practice.

Qualifications

• ACNSs have a minimum of a postgraduate diploma and preferably a master's degree which incorporates clinical work-based learning and has a core educational focus on the development of competence within their field of practice.

Portfolio

• ACNSs have a portfolio containing evidence of their qualifications and clinical competence. The NES TURAS Professional Portfolio is recommended.

Final Sign-Off (before recording as an Advanced CNS)

• Boards should introduce a robust final sign-off process, that involves the review of an ACNS's portfolio of evidence, to ensure that nurses who meet the definition, competencies and requirements of the ACNS role are recognised and logged on eESS/SWISS as ACNSs.

Job Planning

• Ensure all ACNSs have a job plan that includes some time for Supporting Professional Activities (SPA) and Continuing Professional Development (CPD).

Supervision

• Ensure ACNSs have effective supervision (clinical and professional) and support through competence frameworks and supervision models.

Appraisal

• All ACNSs should have a regular appraisal where performance is reviewed against agreed objectives.

Competence, Capability and Continuous Professional Development

Ensure:

• established practitioners are mapped against current recommendations and local arrangements are agreed to meet any gaps in competence and capability
• ongoing continuous professional development for ACNSs is demonstrable and evidenced
• identification of requirements for ACNSs is carried out during periods of service change or development, using an accepted service needs-analysis tool

Evaluation of Impact

• ACNS teams should use a basket of measures to evaluate the impact of their practice on safety, effectiveness and person-centeredness. Where possible, existing data/data already being collected should be used.

Service-Level Impact

• Collect baseline data prior to implementing a new model or initial test phase, with follow-up and review post-service change.

Quality Assurance

• Ensure quality of care is evaluated as part of the appraisal and supervision model, with patient-record review, feedback from others and direct supervision being used to evaluate the competence and effectiveness of each ACNS prior to thematic review across the service.

Review and Recording of Existing Workforce

• Review the existing nursing workforce at AfC Band 7 and above against the definition, competences and requirements of the ACNS role; those matching directly should be logged as ACNSs on the NHS Electronic (eESS) or Scottish Workforce Information Standard System (SWISS) or equivalent.

Job Description

• Use the points within this paper to populate the job description, specifically the definition, education and supervision requirements, core clinical competences and the four pillars; any local variance should be in the form of addenda/person specification to these points matched to AfC; each NHS Board should then have a core job description for ACNSs within the Board.