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In the US, the role of the nurse practitioner is long established. In the UK, the role is not as well developed and there is neither a separate registry nor a recordable qualification to recognise NPs on the Nursing and Midwifery Council register. This has hindered the development of NPs as there is no specified level of training or scope of practice that applies to all nurses in posts labelled "nurse practitioner". This article examines the differences in NP training, licensing and practice between the US and the UK; recommendations are made for using the lessons learnt in the US to help promote the development of NPs in the UK.

Debates in nursing focus on the provision of good nursing care and its relation to academic status. For example, are nurses "too posh to wash" if they believe entry to the profession should require a degree, or is this a case of them having pretensions "above their station"? This article discusses the nature of oppression and its relationship to hierarchy, and concludes that nurses are oppressed through gender and socioeconomic class. It also examines the profession's social position, arguing thatthe majority of nurses identify with the most oppressed social class.

Nurse led clinics have been shown to provide more efficient outpatient care and reduce waiting times. A hospital urology department set up two clinics to improve the patient care pathway, one of which is led by advanced nurse practitioners. This article describes the training and development audit results and plans.

To understand where assistant practitioners fit in the workforce and examine the roles they are asked to undertake, by comparing their job descriptions with the policy vision.A total of 27 job descriptions from three acute trusts were analysed to highlight similarities and differences between the documents. The analysis focused on how clinical tasks related to the level of responsibility APs were expected to assume as part of their role.The analysis revealed the following categories for APs' job descriptions: fully assistive (one description); supportive/assistive (nine); supportive/substitutive (nine); substitutive/autonomous (seven); and fully autonomous (one). This revealed a number of inconsistencies in the form of different organisational expectations about the AP role.This study highlights that it is still not clear what managers and workforce planners want from the AP role as it does not have a clearly defined position in the clinical hierarchy, despite being located at level four on the Skills for Health (2006) framework.

The Clinical Resource and Audit Group (2002) guidelines emphasise that local policies should make the procedure for deciding and maintaining patient observation levels clear.To investigate the views of nurses, doctors and other members of the multidisciplinary team on patient observation.A postal survey of all acute adultinpatient facilities and intensive patient care units in Scotland was carried out, followed by 38 interviews, 37 with staff members and one with a service user.We found a lack of multidisciplinary team involvement, limited pre agreed plans for nurses to reduce levels of observation and limited use of validated risk assessment tools.There is a need to ensure that local practice follows national policy recommendations more closely.

This article outlines an initiative to develop an ophthalmic nurse practitioner's role to carry out YAG laser peripheral iridotomy. It details the training and competency assessment needed to extend this role, and the results of an initial audit. Advice for trusts planning similar projects is also given.

This article follows an In-depth piece published in last week's issue, which explored issues around pain management in older people following fractured neck of femur. It also discussed using femoral nerve block for pain relief in this group of patients. This Changing Practice article outlines the establishment of a nurse-led service to improve pre-operative pain management using femoral nerve block.

This article outlines 10 key steps for practitioners to consider when setting up and running a nurse-led clinic. It lays emphasis on careful planning, professional development and the need to audit and evaluate the service to ensure the clinic is measurably effective.

Kathy Davis and Vari Drennan summarise the results of an investigation into the prescribing behaviours of community-based nurses and GPs, using prescribing in constipation as a case study (Davis and Drennan, 2007).

The aim was to study the factors associated with use of Section 5(4) of the Mental Health Act 1983 and the medical response.A retrospective study was carried out over a year in all psychiatric inpatient units in Leicestershire Partnership NHS Trust. This trust caters to the mental health needs of the Leicestershire and Rutland population.Various factors have been identified with use of Section 5(4) and the medical response. Nurses are in the forefront for psychiatric emergencies at inpatient units and they have used this power to detain patients even in regular working hours.The doctor's opinion concurs with the nurse's decision closely. It is vital that this power is retained in future mental health acts.

To identify some of the factors influencing effective independent nurse prescribing within a surgical high-dependency unit.An audit methodology was used to record the personal prescribing practice of a critical care nurse following the completion of a course in independent and supplementary prescribing.The main factors influencing effective independent nurse prescribing were identified as limitations of the Nurse Prescribers' Formulary; lack of depth and breadth of experience in clinical and diagnostic reasoning; insufficient opportunities to enable reflection in practice and case-based learning; and variation in prescribing practice among individual clinicians.In the acute setting, the limitations imposed by the Nurse Prescribers' Formulory reduced the number of medicines that would otherwise have been prescribed, amended or discontinued. The recommendation from the Committee on Safety of Medicines that suitably qualified and trained nurses should be able to prescribe any medicine from the BNF is therefore wholly welcomed.

City Hospitals Sunderland developed a 'pen portrait' initiative as part of their nursing strategy to ensure patients are the centre of services. This article outlines the development of pen portraits and evaluates the impact they have had on patient care.

Nurses in cancer care have been at the forefront of developing advanced nursing practice, however there has not been national agreement in relation to the education and clinical skills required for this practice. Work is under way by the NMC to develop a regulated framework for the standard for post-registration nursing.

This small-scale study explores the self-perceived differences between the contributions of community psychiatric nurses (CPNs) and other members of a multidisciplinary community mental health team for older people.Four CPNs and five other professionals completed questionnaires consisting of a series of open-ended questions (initially designed for a semistructured interview) in order to collect qualitative responses. The questionnaires were analysed on a thematic basis.CPNs' skills seemed to be recognised and valued by their multidisciplinary colleagues. However, the CPNs did not always appear to appreciate this, while the attributes identified by CPNs were not always the same as those identified by their colleagues. There did not appear to be any consensus among the CPNs yet their colleagues seemed to feel the CPN role was reasonably clear.This study suggests the CPN role involves taking a relationship-based, person-centred approach in which adaptability and flexibility are key characteristics. The results are largely consistent with other findings and demonstrate the need to nurture the contributions made by CPNs as autonomous practitioners in multidisciplinary settings providing care for older people with dementia.

Recent legislative changes have enabled nurse supplementary prescribers to prescribe controlled drugs. This article explores the scope of supplementary prescribing for substance misuse clients within a primary care setting and shares practical experiences of incorporating this new development into clinical practice.

The role of nurse consultant aims to strengthen leadership and to help retain experienced and expert nurses in clinical practice. This article suggests that the consultant role is an example of how a redesigned nursing role can benefit patient care and service provision.