I want to start this latest blog post with an apology for the hiatus. As many of us have got used to hearing over the last few months a little thing called Covid got in the way a bit! I ended my last post with the question ACP-where next? So I thought it would be helpful to say what I’ve been up to since the last post and where I think this leads us to next.
Back at the end of March the opportunity for me to return to clinical practice as a Critical Care Nurse presented itself in the form of the ‘Covid crisis’. Whilst this meant that I was somewhat distracted from my plans for this blog it did afford me a unique insight to witness first hand ACPs in action. For me, this provided perfect illustration of what I’ve been reading, learning and thinking about ACP.
After 18 years away from the ‘front-line’ of clinical practice I found myself working one day with a critical care nurse, (I’ll call her ‘Amy’), that had been in the midst of her ACP training when C-19 hit. What I witnessed was a true epitome of the 4 pillars of ACP in action (clinical practice, education, leadership and research).
She became an excellent educator to the (obviously nervous) redeployed staff; something she would never have thought she would need to do so extensively. Staff frequently looked to her to provide leadership in unfamiliar, unprecedented, and scary times. She expertly provided this with clear and supportive instructions and decisions. In coffee room debates of ‘what’s new about Covid-19’ she often was able to refer to an evidence base to support what she was saying, to dispel myths, and propose areas that were uncertain and would likely feature in future research or evidence to come out of this time.
However she also talked to me about her worry that her training had been suspended and that she was trying to think of different ways to meet the (highly demanding) list of clinical competency assessments required. Being in critical care she is in one of the few groups where a set of credentials have been set down to be able to be recognised and practice as an ACP in this field (FICM).
What struck me was that she was so focussed on the clinical competencies and so nervous about getting these right, and was worried about missing opportunities to practice and be assessed in them, that she was perhaps ignoring how she was brilliantly demonstrating what it means to be the true embodiment of an ACP!
I just wanted to say don’t worry, those clinical tasks will come, there will be opportunity for that, and over time new ones will be needed and other ones assigned to the discard pile. What you are doing now is astounding development as an ACP with knowledge, skills and experience that will last you a life time.
We also talked about the potential barriers the future holds for her to utilise the full range of her ACP role. During this time I have also been completing a scoping review of the evidence of the benefits of ACP education, and unfortunately this is a fear that has got significant foundation to it. Clinical practice tends to dominate ACP work and factors such as the way in which ACP roles are organised and developed, and the willingness of colleagues to relinquish tasks and offer autonomy to ACPs can restrict their practice.
This experience and my findings from the scoping review are leading me to think more than ever ‘what’s next for ACP?’
What is clear is that we do not need to repeat the multitude of studies that defines or sets out the potential scope of ACP. The barriers and facilitators to effective development and implementation of ACP are well known. The positive impact that ACPs can have on clinical effectiveness outcomes, including patient satisfaction and measures such as reduced waiting times has been evidenced. The impact on costs depends on whether ACPs are being used to substitute for others (usually Doctors) or provide a supplementary service and ‘add value’, which has often not been measured over long enough to really evaluate the impact. (The OECD working paper on Nursing in Advanced Roles provides a useful summary and exploration of these themes).
What is less clear is where people like the ACP trainee I worked with are heading next. Will they be able to realise the various benefits that I talked about in my first blog post, such as remedying staff shortages, or providing a satisfying career development route for our most skilled, experienced and advanced practitioners in health care?
The recent on-line HEE Advanced Practice workshop held to gather experiences of ACP in this pandemic may help to signal what we can expect from ACPs in such times or in the ‘new normal’ we are all adapting to.
Now the first peak of C-19 appears to have subsided in my part of the world, I am turning my attention back to my research and work as an educator in ACP.
I am still not sure what is next for ACPs, but believe from my research, work, and experiences so far that attention needs to be paid to evidencing the purported benefits of ACPs for those that are interested in/ being encouraged to follow this career route. If people like Amy are to fully realise her potential and the health service is to benefit fully from people like her we need to assure her that she is following the right path. So this questions… is ACP the way to go?…I’ll leave that question to explored in a future blog.