My ACCP Journey
David is an ACCP based in the North Midlands
Where it started
I started my career in critical care nursing in 2007 only a few months after graduating as a registered nurse. I knew early on in my nurse training that I wanted to work in ICU. The technology and the attention to detail appealed to me and my personality. While working as a nursing assistant years before I had been sent to the ICU to retrieve some equipment, I had immediately been mesmerised by the apparent serenity of the unit with the calming rhythm of the ventilators and the organised, methodical layout with one nurse to one patient providing such detailed, expert care to the sickest patients.
I was lucky enough to have a placement as a student nurse in the ICU during my final year and it confirmed everything I had thought it to be. The nurses were calm, caring and supportive but with expert knowledge and skills honed through years of nursing the most critically unwell patients. Unlike some of my previous placements where understaffing, operational pressures and underinvestment in education had created a disenfranchised team, the ICU team were positive and encouraging. This cemented my desire to make this my career even more.
As a junior staff nurse in ICU the concept of nurses or other AHPs taking on extended skills and working as part the medical team was beyond comprehension. Nurses were nurses, doctors were doctors and there was nothing in between. The nurses were highly skilled and knowledgeable but there remained a clear role boundary. One of my former colleagues recalls a time when during a job interview for a promotion to senior staff nurse, he asked an ICU consultant if he could ever see a time when nurses might be trained to take on extended skills such as the insertion of central venous catheters – the considered response was “not until hell freezes over”. Ironically, this particular consultant is now one of the ACCPs most ardent supporters and sees no end to our ability to progress.
Becoming an ACCP
I became an ACCP in 2014 after progressing to Charge Nurse. The role had just been introduced on our unit a few months before and I felt at a crossroads in my career with the choice between progression managerially or clinically. Although I enjoyed the people management side of being a charge nurse and encouraging/developing the team I knew that further progression managerially would take me away from the clinical environment I loved and so I chose to take the leap and go for ACCP.
Eight years in and I would say I am now fully settled as an ACCP and it was definitely the best decision I ever made professionally. Our team is highly established and embedded in the workforce and for many people working in critical care we have always been there, and they know nothing else. Despite being settled and established the transition from ICU nurse to ACCP was not without its challenges.
Rising to the challenge
One of the main challenges was acquiring the depth and breadth of knowledge to be an effective ACCP. We immediately went from working as part of the nursing team to part of the medical team and the differences between nurse and doctor education quickly became very clear. Doctors spend years at university learning the fundamental underpinning science behind the human body and medicine while steadily transitioning to practising clinicians who put this knowledge into practice. Nurses, to some extent, do things the opposite way round. Particularly in ICU, we learn to do the job, practically, and develop the knowledge we need to support this either concurrently or by reading and studying topics after seeing them in practice. So, it soon became clear that although I was an experienced, competent ICU nurse, there were many things that happened in the ICU for which I lacked detailed underpinning knowledge. The ICU consultants and senior registrars were invaluable in this. They helped outline the topics we needed to focus on and gave excellent bedside teaching. It was tough going but with their encouragement and tutoring the knowledge developed and became more embedded in our day-to-day practice.
Being one of the first cohort of ACCPs introduced, I was worried about whether the wider team would understand and welcome the new role. We are very lucky on our unit that the entire consultant group were committed and supportive of our introduction. There have been instances where this has not always been the case for every ACCP.
Although we felt no animosity towards us, there was a significant period in which it was unclear, both to us as novice ACCPs, and to the wider team where our boundaries lay, and what degree of autonomy was expected of us. The introduction of the FICM curriculum in 2015 helped massively with this and around the same time we were given new clinical lead consultant who was instrumental in giving our team and role some structure and clarity. Over time the medical, nursing and AHP teams have become much more familiar with our role, as have we as ACCPs. Allocation of tasks and referral pathways are much clearer and has demonstrated the benefit of ACCPs to the multidisciplinary team even further
Resolving conflict and the importance of communication
One concern over the introduction of ACCPs, as with ACPs in other specialities, is the impact it may have on the training of junior doctors. This is often talked about and how it can create disharmony between advanced practitioners and trainee medics who ought to be working together for the same end goal of patient care. On our unit we have only experienced this as a problem on a very small number of occasions. During our initial training we did need exposure to many of the skills, procedures and patient encounters that were required to complete our transition to qualified, competent ACCPs. At that time we had a strong group of senior ICM trainees on the unit who, along with the consultant team, recognised the benefit our role would have to patient care and took time to seek us out for training opportunities and support our education. It was a year or two after our introduction that an issue was raised by a group of colleagues on rotation through ICU. They felt that their training was being negatively impacted by the presence of ACCPs, that consultants favoured the ACCPs during teaching ward rounds leading to a lack of opportunities to learn skills and procedures as we were often the ones carrying them out.
However, as with many issues, it came down to inadequate communication and misunderstanding of each other. Some discussions were had and both teams came to better realisation of how we can support and complement each other. The ACCPs had much that they could learn from the trainee doctors, and the trainees began to appreciate how our wealth of experience over years of ICU as nurses/AHPs and now as ACCPs could support and enhance their training rather than diminish it. I’m pleased to say the issues were resolved and some of the those that had complained are still with us and are highly supportive of our role within the ICU workforce.
A worthwhile journey
My experiences both as trainee and now as an experienced ACCP have been varied and with many challenges along the way. However, I would say it has been a unanimously positive journey and I have never regretted my decision to take on the role. By far the most important key to success is a supportive, committed and encouraging consultant team along with a strong understanding by the wider ICU team of the role and how it fits into the multidisciplinary team. There will inevitably be some struggles and challenges along the way but with commitment they can be successfully overcome.