Advanced nursing practice in cancer

The Royal Marsden has taken another step in the development of courses specific to cancer — one which should be welcomed by nurses and patients. The 2–3-year Postgraduate Diploma/MSc Nurse Practitioner: Cancer Care, is accredited by the Royal College of Nursing (RCN) and in a press release the course is described as one that ‘develops clinical practice skills, supports practitioners in their personal development and career planning and organization in the development of their cancer services’. It is hoped that this MSc will contribute to agreed educational benchmarks for cancer care at an advanced nursing practice level. This is important for good quality patient care, safety of patients and clear role definitions for nurses. At present, advanced nursing practice in any specialist field is developing in an unregulated and confusing way. Roles such as consultant nurses, clinical nurse specialists, nurse practitioners and advanced nurse practitioners (ANPs) often refer to being involved in advanced practice. The lack of a generally agreed definition does not help. The Nursing and Midwifery Council’s (NMC) consultation in 2005 on defining and introducing legislation to open a further sub-part of the nurses’ part of the register for advanced nurse practice is not yet complete. In the meantime, in cancer care at least, this initiative may become the prototype for advanced practice in cancer care. To ensure the safety of patients and the effectiveness and efficiency of nursing practice it is essential that nationally agreed benchmarks for advanced practice in specialisms, such as cancer care, are agreed. These, in turn, can be the basis of standardized education programmes, with theoretical and practice-related learning outcomes for advanced practitioners. Will the MSc, however, be able to show cancer practice that is ‘advanced’ compared with what is expected on a BSc course? The evidence base for practice can, in academic and theoretical considerations, be appropriately placed at a MSc level, but what is the difference going to be in the practice-based elements of the course? Drawing such distinctions is often a problem for educational institutions, that are able to distinguish the academic levels of the theoretical content of courses, but are not as easily able to distinguish academic levels for practice-based skills and competencies. The NMC considers ANPs being able to diagnose and treat or refer as appropriate. This MSc, I expect, will have practice-based learning outcomes that meet the NMC requirements for ANPs to be able to: n Take a comprehensive patient history and carry out physical examinations