[sharrie]

Originally Posted by wembley1

I agree, PA's have to prescribe under physician supervision, whereas NP's can prescribe independently. As has been shown in the USA, most jobs advertise for either a PA or NP. What irritates me about the UK is that they are advertising the PA course in nursing magazines and St Georges University is the latest to join in and will be offering a PA course. I think NP's need to be careful, protect their ground, but what I find interesting is as others mentioned, NP's only on bad 6, most would be band 7, 33-43k in London or similar, yet in Somerset, they are offering PA's with 2 years experience 40k plus benefits. I think the problem is the NP course, every few do an actual masters and a lot are termed a Bsc in nurse practitioner, I myself already have a bachelors so why would I do another? The education and protection of NP's needs to be looked at. In Australia, all NP course are at least PgD but most are masters level and the content is similar to the USA, fair amount of anatomy, pharmacology, diagnostic tests etc, whereas a lot of courses in the UK provide very basic levels of training. I think NP's as a group need to look at education and protection of their job roles, so PA's don't steal their ground. But I am still perplexed/confused, why use PA's in the UK why not just increase the scope of NP's. seems some NHS managers out their will always view nurses as just hand maidens, just good for basics. I hope NP's and nurses in general stand up....

Before the NP's in the UK are able to stand thier ground and fight for improved pay there has to be clear definitions and regulation of the role of the NP which althought there are moves towards this it still hasn't happened.

I manage a team of NP's as part of my role and there is great diversity in qualification and ability. As a manager I have insisted that they all be BSc level and as a department we have now working towards the true definition of a NP but we are not there yet.

WIthin my trust again there is great variation, there are still many NP's that do not examine patients, without clear role definitions we are not going to be able to demonstrate that all NP's work to a level beyond standard practice so why would be warrant a pay of £40,000

DOn't get me wrong, I agree that those that are practicing at that level should have equal pay to the PA's but there is still no regulation for NP's and without that we are fighting a losing battle.

[wembley1]

I agree that NP's need to be regulated. I suggest the UK has a good look at Australia, NP's are gradually being introduced, despite reluctance of doctors, and minimun standards are a postgraduate diploma or masters of nurse practitioner. The course content is similar to the USA, advanced pathophysiology, pharmacology, diagnostics etc. As you mentioned a lot of NP's hold variable qualifications and roles in the UK. I think minimum qualification should be postgraduate diploma or masters, the UK needs to do away with the Bsc nurse practitioner, as this really suggests it is an undergraduate qualification not a postgraduate. I already hold a Bsc in nursing, an undergraduate degree. I guess it stems from the diploma/degree option for nursing in the UK. What is a concern is that these PA's can be health science graduates, have no previous exposure to patients, come and do this 2 year course and then be ordering nurses around and getting paid 40k plus. What is funny is that they are advertising in nursing magazines for nurses to undertake the course, to become a PA, kind of an insult to NP's. The truly qualified NP's are a great asset and it is a shame to see a new group of health professionals coming into the NHS, I think they are not needed, why not just advance nurses or increase the roles of NP's. I hope NP's sit up and take notice, but, I doubt they will do so, problem with UK is that nurses have no voice, are weak and fail to complain.. Be interesting to see what happens with the PA movement, a short-term ploy or long-term?

[sharrie]

Wembely I completely agree with you, I think that there is a drive to make the NP programs out there MSc level, I know all of the universities in my area now only offer it at masters. The problem is that doing an advanced practice degree is not compulsory, although I think this may well change. Those that don't have the qualification will have to demonstrate advanced level practice to gain entry to the ANP bit of the register. This is how it should be.

We are quite a way off and you are right with roles such as Physicians Assistants being offered at such a huge salary there is no incentive for these NP's to push advanced practice, there needs to be parity across the roles.

Again my suspicion for the level of pay they recieve is that they are paid out of doctors money and under the control of the medics rather than falling into the agenda for change payscales. We need to get our doctors fighting for thier nurse practitioners as well.

It will be interesting to see how these new roles get around the prescribing laws, it has taken such a long time to get independent nurse prescribers will it be a case of just allowing them access to the prescribing course or will they never be able to prescribe, in which case are you not better off employing a prescribing NP who can fulfil the role required.

[karenG]

this is an interesting one...

I have been an NP long enough to remember the introduction of the first contact programme (and I wont tell you how hard we fought against that) and I remember the first PA's being introduced and trust me, the NP committee fought that too.

The NP committee at the RCN have been lobbying hard for years to get the role regulated. there is an agreed standard for education and JD etc on the NP website, which has been agreed with the RCN. NP education should be at masters level in the future. The NMC are ready to open a register for advanced level nurse practitioners- admission to the register will be controlled and you will have to be practicing at masters level and be able to demonstrate masters level education to gain admittance. this is currently sitting with the Privy council waiting for approval. once approved, the register will become active and you will only be able to use the title if you are on the register. This has been a long hard fight- I have been involved in this for 8 yrs now and finally we have light at the end of the tunnel!

the pay issue.. yes- NP's should get paid on at least an 8. but if you read the AfC stuff, we, as NP's lose out because most of us are primary care based (out of my training group only 1 was secondary care based) and dont manage teams. AfC is big on the higher grades having managerial responsiblilty. so until that changes, then the pay will be lower. There is no recognition in Afc for the fact that NP's (particulary in primary care) work alone, carry a case load and act independantly. I work withinn a team of docs but I see patients with an undiagnosed condition, take a history, make a diagnosis and treat or refer as appropriate. there is no recognstion of this in AfC.

as NP's we are still, as Bev Malone said, the lunatic fringe of nursing!