The Framework – Level 7 – Advanced Clinical Nurse Specialist

Level 7 – Advanced Clinical Nurse Specialist

Role and responsibility

Qualifications and experience

Core Competency 1: Specialist Knowledge

Core Competency 2: History Taking, Clinical Assessment and Investigation

Core Competency 3: Analysing Data in the Diagnosis Process

Core Competency 4: Treatment and Care

Core Competency 5: Co-ordination of Care

Core Competency 6: Expert Specialist Resource

Core Competency 7: Facilitation of Learning

Core Competency 8: Leadership

Core Competency 9: Evidence, Research and Development

The framework has a section for each level of practice on level 5, level 6 and level 7. The role and responsibility of staff at each level is described along with relevant qualifications and experience. The knowledge, skills, and behaviours (KSBs) are then described for the clinical pillar of practice.

For core KSBs for each pillar of practice, please refer to the NMAHP Development Framework

Level 7 Advanced Clinical Nurse Specialist
Role and responsibility
People at level 7 of the career framework have a critical awareness of knowledge issues in the field and at the interface between different fields. They are innovative and have a responsibility for developing and changing practice and/or services in a complex and unpredictable environment. Title: Advanced Clinical Nurse Specialist The level outline is informed by the Advanced Practice Transforming Roles Papers 8
Qualifications and experience expected for practitioners at this level of career framework
Registered as a Nurse or Midwife with the Nursing and Midwifery Council or registered with the Health and Care Professions Council Post-registration qualification Advanced CNS 120 credits SCQF 11 (Postgraduate Diploma) Evidence of operating/thinking at Master’s level Evidence of working towards relevant Master’s level award

Core Competency 1: Specialist Knowledge
Is able to educate HCPs on the aetiology and classification of the condition
Displays expert knowledge on the relevant anatomy, physiology, pathophysiology by the education of experienced health professionals
Is able to educate experienced HCPs on the disease presentation, symptoms and management options
Briefs HCPs on red flag symptoms which may be suggestive of alternative diagnoses
Can interpret scales and investigation results and collaborate with MDT management planning
Uses expert knowledge to develop specific pathways, risk management approaches, and local and national resources for specific neurological condition
Is able to advise other experienced HCPs on the implications of genetic influences of specific neurological conditions
Works with the local drug and therapeutics committees to develop protocols and shared care guidelines
Advises and supports health professionals in medicine management of pwNC
Develops and applies treatment pathways that make use of evidence based practice, using local and national guidelines
Uses innovative leadership style to develop the skills of the nursing team, to enable the delivery of safe, patient centred care and the development of autonomy among the nursing team
Educates and disseminates best practice in relation to code of professional conduct

Core Competency 2: History Taking, Clinical Assessment and Investigation
Undertakes appropriate specialist assessment relevant to specific neurological condition
Expertly interprets all of the information available
Assists other HCPs in interpreting findings from assessments
Coordinates and formulates assessment and investigation pathways within the MDT that prioritises person-centred care
Works nationally or internationally in partnership to develop and validate clinical rating scales that improve clinical assessment
Educates HCPs to develop examination skills for comprehensive assessment of pwNC
Uses expertise to assess pwNC with the inclusion of necessary investigations
Liaises with MDT to plan care management utilising information gathered from appropriate investigations
Collaborates locally and nationally to devise protocols/guidelines for use of appropriate tests/investigations in care of pwNC
Collaborates locally and nationally to develop timely assessment-treatment pathways

Core Competency 3: Analysing Data in the Diagnosis Process
Uses expertise to collaborate with MDT during the diagnostic process of the pwNC
Collaborates with local MDT to produce protocols and guidelines for timely diagnosis of specific conditions related to recognised national and international criteria
Educates HPCs on the diagnostic processes of specific neurological conditions, in relation to signs and symptoms and investigation findings
Educate HPCs on red flags and differential diagnoses

Core Competency 4: Treatment and Care
Influences policy at local, organisational, and national level in response to some of the legal, moral, and ethical issues
Uses in-depth knowledge of legislation, professional regulation and codes of practice to lead development, implementation and evaluation of protocols, guidelines, and policies at local operational levels
Provides leadership and expertise in the implementation of relevant guidelines, treatments and services through education of HCPs and colleagues
Informs the strategic direction and leads on change to service delivery
Independent prescriber qualification where neurological condition requires routine medication titrations. Ability to prescribe any licenced medicine within their area of competence
Collaborates with GP, local pharmacists to advise on medication requirements for pwNC
Collaborates with MDT to incorporate pharmacological and non-pharmacological approach to optimise treatment plan.
Educates other HCPs on formulating a treatment plan and assists with any potential ethical issues
Collaborates with services to develop and streamline pathways to ensure access to treatment/care is available at the point of need
Advises, supervises and coordinates peer group and senior staff on the ethical issues of informed consent.
Uses expert knowledge of neurological condition to enhance counselling and support strategies to promote self-management and informed decision making
Leads services and collaborates with stakeholders with the aim of reducing barriers to care and to a healthier lifestyle
Designs and leads educational programmes to assist pwNC/carer and HCP Employs expert communication skills to maintain the therapeutic relationship
Advocates for the pwNC at a local (across the MDT), organisational, and national level and throughout their care pathway
Leads in the recognition, triaging, and assessment of clinical problems and symptoms and provides guidance to HCPs
Uses innovation to develop nursing services to ensure that the service is adaptable and flexible to meet patient’s needs

Core Competency 5: Co-ordination of Care
Leads and directs an integrated, responsive service for the pwNC/carer
Develops specialist services for the pwNC to limit organisational barriers and ensure evidence-based care is implemented
Works as an independent practitioner within the MDT and acts as an expert link between the patient and the MDT, ensuring full engagement from the pwNC/carer in shared decision making

Core Competency 6: Expert Specialist Resource
Maintenance of advanced professional development through frequent reviews of the literature, use of self-directed study, networking and regular reflection
Develops leadership skills of others through training and mentorship
Expertly shares complex information to ensure patient safety and continuity of care
Is able to support other HCPs in the development of their own communication skills
Offers a critical appraisal of information available to the pwNC and is able to provide further educational materials through liaison with community organisations and third sector organisations
Acts as an expert clinical advisor and resource to educate and inform colleagues, HCPs, and other members of the MDT to ensure that care remains evidence-based
Teaches and advises colleagues and members of the MDT and external professions on the best method to educate patient groups
Role model exemplary facilitation, leadership, communication and teaching skills and develop those skills in others

Core Competency 7: Facilitation of Learning
Develops educational pathways and materials for carers and family members
Lead on strategies that enable effective reflective practice
Demonstrates and understands the key theories of adult learning and apply a wide range of facilitation, teaching, and assessment skills to practice
Review data collected from educational audits and sources of other feedback to plan and lead at a local level to enable a positive learning environment
Apply advanced knowledge of andragogy appropriate to specific role
Leads on the development and delivery of regional higher education institutions and ensures appropriate training and curriculum development in undergraduate programmes
Leads the development of local and regional education initiatives for pwNC, healthcare workers and members of the MDT to promote high level practice

Core Competency 8: Leadership
Provides strong and effective leadership across professional and organisational teams/boundaries
Demonstrates how feedback is used by the organisation to positively improve services
Applies advanced leadership skills and behaviours appropriate to specific role
Demonstrate and support others to manage people effectively using organisational policies and exemplary leadership qualities
Develops leadership skills of others through training and mentorship
Aims to actively contribute to a variety of organisational (and international if available) professional networks to share best practice
Role model highly developed verbal, nonverbal and written communication skills
Use creative and innovative solutions to address complex problems, leading innovation and quality improvement and promoting the involvement of others
Promotes a culture of empowerment to enable concerns to be raised, addressed and /or appropriately
Advocates for the pwNC at a local (across the MDT), organisational, and national level and throughout their care pathway
Build and lead teams, engage stakeholders and work in collaboration with others
Demonstrate effective financial and workforce planning, delivery and reporting, progressing workforce development plans aligned to organisational qualities
Manages and develops an MDT appropriate to service need and availability

Core Competency 9: Evidence, Research and Development
Share good practice and the lessons learned from audit, research and quality improvement activity locally and nationally through professional and peer reviewed processes to improve local practice
Acts as a role model for the wider team by promoting a positive research culture
Applies the critical analysis of the literature to help with service development, using specialist knowledge to contribute to the development of evidence-based policies and procedures
Contributes to and leads the design of local and national/multi-centre audits, and then subsequently reviews and implements the findings of the audits
Utilises appropriate policies to ensure support for clinical research activity and adherence to research governance, including GCP, ethics, data protection and confidentiality
Applies advanced knowledge of research and development appropriate to role, and leads in the development, managing, analysis and dissemination of research projects
Identifies research questions relevant to daily practice (which can include the identification of gaps in service or areas for improvement) and with supervision may design, implement and report on research projects
May engage in other research projects that can relate to the care and management of the pwNC
Engages with knowledge dissemination at regional, national, and international levels that may involve speaking at conferences and writing for publication