Position Statement
Introduction
Advanced nursing and midwifery practice was first introduced into Ireland following the report on the Commission of Nursing in 1998. “Advanced practice nursing is defined as a career pathway for registered nurses, committed to continuing professional development and clinical supervision, to practice at a higher level of capability as independent, autonomous, and expert practitioners” (NMBI 2017). Advanced Nurse Practitioners (ANP) and Advanced Midwife Practitioners (AMP) have met the Board’s Criteria for Registration to enter the Advanced Practice Division of the Register (NMBI 2017).
‘Advanced Practice Nursing is defined as a career pathway for registered nurses, committed to continuing professional development and clinical supervision, to practice at a higher level of capability as independent, autonomous, and expert practitioners,’ (NMBI, 2017, p15). ‘Registered Advanced Midwife Practitioner (RAMP) promotes wellness, offers healthcare interventions and advocates healthy lifestyle choices for women, their families and the community in a wide variety of settings in collaboration with other healthcare professionals,’ (NMBI, 2018, p14).
The first ANP registered in 2002 with the first AMP registering in 2011. In June 2023, there were 809 ANPs and 30 AMPs providing care across a wide variety of specialities throughout Ireland (NMBI 2024). The Department of Health is committed to increasing the numbers of ANPs/AMPs to maximise the nursing and midwifery response to current and emerging health services challenges. Care provided by ANPs/AMPs is rated favourably by the patient/service user and has been shown to reduce hospital admissions, facilitate early discharge, increase and improve access to services. The patient is central to the advanced practice care model. (Department of Health 2019).
The Association
The Irish Association of Advanced Nurse/Midwife Practitioners (IAANMP) represents a cohort of highly skilled and dedicated practitioners who have delivered quality value for money care to thousands of patients over the past twenty years within the Irish healthcare system.
The IAANMP was established in 2004 to:
Provide support to nurses and midwives practicing at an advanced level in Ireland
To enable practitioners to debate issues and concerns pertinent to their area of practice
To facilitate education and promotion of professional development among ANPs and AMPs
To promote advanced practice in Ireland
To establish relationships with advanced nursing/midwifery practice organisations in other countries
Our Story
In 2004 a small group of visionaries convened to address the growing need for Advanced Nurse Midwife Practitioners of all specialties to have a unified voice – today we represent over 400 Registered Advanced Nurse Midwife Practitioners from over 30 specialist areas.
1.0 Education/Requirements and Standards
ANP/AMP Registration Pathways
There are now two pathways to register as an Advanced Nurse Practitioner (ANP) or Advanced Midwife Practitioner (AMP) as follows:
Pathway One:
All applicants who successfully complete the NMBI approved Master of Science in Nursing (Advanced Practice Nursing) programme may apply for registration as an ANP, in the same way as a nurse who has obtained any other registerable post-graduate qualification.
The current approved courses for Master in Advanced Practice Nursing are:
University of Galway (UG)
Trinity College Dublin (TCD)
University College Cork (UCC)
University College Dublin (UCD)
University of Limerick (UL)
Athlone Institute of Technology (AIT)
Dundalk Institute of Technology (DKIT)
Galway-Mayo Institute of Technology (GMIT)
Institute of Technology Tralee (ITT)
Letterkenny Institute of Technology (LYIT)
Waterford Institute of Technology (WIT)
Royal College of Surgeons in Ireland University of Medicine and Sciences
The current approved courses for Master in Advanced Practice Midwifery are:
University College Dublin (UCD)
University of Limerick (UL)
Trinity College Dublin (TCD)
University of Galway (UG)
University College Cork (UCC)
Pathway Two:
Nurses and midwives who are applying for ANP or AMP registration through a developmental pathway. This means that they have completed a collection of courses when combined meet the Advanced Practice (Nursing) Standards and Requirements. Pathway two applications will be assessed to ensure that the standards and requirements are met. If you are not already a registered prescriber you should apply for registration in the Nurse Prescribers division first and followed by an application in the Advanced Practitioners division.
The following criteria apply for registration as an ANP/AMP with NMBI. You must:
Be a registered nurse or midwife with NMBI.
Be registered in the Prescribers division.
Hold a Master’s degree (or higher) in nursing/midwifery or a Master’s degree which is relevant, or applicable, to the advanced field of practice. The Master’s programme must be at Level 9 on the National Framework of Qualifications (Quality & Qualifications Ireland), or equivalent. Educational preparation must include at least three modular components pertaining to the relevant area of advanced practice, in addition to clinical practicum.
In recognition of services that span several patient/client groups and/or division(s) of the Register, provide evidence of validated competencies relevant to the context of practice.
What are ANPs/AMPs?
ANPs/AMPS are expert practitioners, educated to master’s degree level and have the competencies to be senior decision makers that undertake a comprehensive advanced physical and/or mental health assessment of patients with complex multiple healthcare needs. ANPs/AMPs manage a specific caseload of patients’/service users/women and their babies, from admission to discharge, completing an episode of care at an advanced level. They use advanced clinical knowledge and critical thinking skills to provide optimum care and improved clinical outcomes through higher levels of critical analysis, problem solving and senior clinical decision making. They can interpret the results of multiple different assessments and investigations to make a diagnosis, and plan and deliver care. They continuously extend and evolve practice in line with the needs of the patient (Department of Health, 2019).
As team leaders they can confidently and competently make ethical, evidence-based decisions and interventions and use appropriate therapies when faced with complexity and assess and manage the risk associated with these decisions. The ANPs /AMPs can prescribe and work with individuals to manage their medicines.
Typically, they work independently but also as part of an interdisciplinary/multidisciplinary team where they plan and provide skilled and competent care to meet a patient’s health and social care needs. Involving or referring on to other members of the healthcare team as appropriate they can safely discharge a patient within their scope of practice.
ANPs and AMPs work within an agreed scope of practice and meet established criteria set by Nursing and Midwifery Board of Ireland (NMBI) to register as either an ANP or an AMP.
The competence of ANPs and AMPs are clearly aligned with the Code of Professional Conduct and Ethics for Registered Nurses and Midwives (NMBI 2021) and are underpinned by the three core values of Compassion, Care and Commitment and the philosophy and values of midwifery (NMBI).
The five practice standards that guide care for all nurses and midwives and ANPs and AMPs are:
Standard 1: Respect for dignity of the person
Standard 2: Professional Responsibility and Accountability
Standard 3: Quality of Practice
Standard 4: Trust and Confidentiality
Standard 5: Collaboration with Others
Competences for Advanced Practice build on the competences achieved/acquired to register as a nurse or a midwife with the NMBI.
There are six domains that govern and frame advanced practice.
Domain 1: Professional Values and Conduct Competencies
Domain 2: Clinical-Decision Making Competencies
Domain 3: Knowledge/Cognitive Competencies
Domain 4: Communication/Interpersonal Competencies
Domain 5: Management/Team Competencies
Domain 6: Leadership/Professional Scholarship Competencies
2.0 Promotion of Advanced Practice
It is the position of the IAANMP that:
Sources of media including written, verbal and the use of social media be utilised in the promotion of advanced practice (www.iaanmp.com, X, Linkedin etc.).
A newsletter or Chairperson membership updates will be available through the www.iaanmp.com website and will be sent by email to the membership.
The IAANMP will promote advanced nursing and midwifery practice through the dissemination of an information booklet, ANPs /AMPs will promote advanced practice with nursing and medical colleagues and allied health professionals through role modelling and exhibiting the utmost interpersonal and leadership skills and through evidence-based practice (NMBI 2019).
The Association will promote the establishment of a ‘nursing policy unit’ drawing on the expertise of members of the Association to inform and ensure the Association maintains a voice in relation to social and political healthcare policies.
Research will play an integral part in the promotion of advanced practice. The Association will foster collaboration between the academic institutions and advanced practice clinicians to achieve this goal.
The Association will encourage interdisciplinary collaboration both within the clinical area and in third level institutions.
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3.0 International Network and Inter-Professional Collaboration
It is the position of the IAANMP that:
The Association will forge links with international colleagues in advanced practice to promote advanced practice in Ireland and internationally.
The Association will network with international colleagues to enhance the dissemination of information, to enhance patient care and professional development.
The Association will foster links with medical colleagues and allied health professionals to promote advanced practice, provide and receive information and education that will enhance patient care and professional development.
The Association will facilitate national and international research through collaboration with university networks.
4.0 Vision for the Future
Continued clinical professional development is required by the ANP/AMP cohort. This professional development is necessary to equip the advanced practitioner with the skills and knowledge to address complex health issues. The role of the ANP/AMP provides a career pathway that gave the opportunity for senior nurses to remain in the clinical area. Currently there are three career options: a PhD, Clinical Doctorate, or full-time clinical practitioner.
It is the position of the IAANMP that:
The ANP/AMP group will continue to meet patient/client needs by delivering a quality service through the continued development of the numerous specialities within advanced practice and by persisting in pushing the boundaries of advanced practice beyond the hospital setting into the community.
The role of the advanced nurse and midwife practitioner will continue to evolve with a firm foothold in evidence-based practice and research.
The ANP/AMP will be an integral part in the evolution of the health service and inform policies at a national level. The ANP/AMP group will be instrumental in ensuring seamless care through the development of policies, procedures and guidelines at regional and national level (NMBI, 2017).
The advanced practice framework will be an example internationally to inform and guide the development of advanced practice in other countries by ensuring clarity with regard to the advanced practice role and title.
The Association through collaboration with the universities and all interested stakeholders ensures the ANP/AMP can remain in the clinical area while continuing to advance the role and service provision through leadership, research, politics, management, teaching and collaboration and in so doing create an intrinsic link between clinical practice and academia. This will ensure that the practitioner can advance the core concepts of the role and be valued as a leader of advanced practice.
The IAANMP will act as a national link between ANP/AMP subcommittee’s and encourage collaboration. between all advanced practitioners.
The IAANMP will link with key stakeholders in policy and health care to act as a voice and advocate for advanced practitioners in Ireland.
The IAANMP aim to work positively with other groups and organisations that it deems to be suitably equipped to provide information on shared educational programmes or courses for the enhancement of Advanced Practice.
The IAANMP will facilitate learning and development.
The Irish Association of Advanced Nurse and Midwife Practitioners (IAANMP) accepts no responsibility for errors, omissions or views expressed herein. © 2024 IAANMP. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without prior permission of the IAANMP.
5.0 References
Department of Health (DOH) (2019). A Policy on the Development of Graduate to Advanced Nursing and Midwifery Practice. https://www.gov.ie/en/publication/96ce55-a-policy-on-the-development-of-graduate-to-advanced-nursing-and-midw/
Irish Association of Advanced Nurse and Midwife Practitioners (2013) IAANMP Booklet, Version 1
Nursing Midwifery Board of Ireland (2017) Advanced Practice (Nursing) Standards and Requirements, NMBI, Dublin
Nursing Midwifery Board of Ireland (2018) Advanced Practice (Midwifery) Standards and Requirements, NMBI, Dublin
Nursing and Midwifery Board of Ireland (NMBI) (2019) Philosophy and values of midwifery https://www.nmbi.ie/Standards-Guidance/Midwives-Standards/Midwifery-Philosophy-Values
Nursing and Midwifery Board of Ireland (NMBI) (2021). Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives