All participants were IPs practising within oncology at the study site at the time of the interviews. Participants were three nurse NMPs, three pharmacist NMPs and three radiographer NMPs.
Analysis using a thematic approach of the data identified four main themes: experience relating to training, competency, support and training methods. Sub-themes were also identified (see Table 1).
NMP experience relating to training requirements
Table 2 displays study participant demographics and their number of years’ experience. The post-qualifying NMP training participants had received is also within Table 2 grouped for each professional group. Similarities between the current NMP training experienced by participants are displayed within Table 2. Table 3 shows when the study participants believe the NMP training topics (within Table 2) should be completed by the oncology NMP, categorised by the NMP’s level of experience.
Other future training suggested by study participants
Participants from all professional groups recommended that structured in-house training for all NMPs is needed. Table 4 shows a list of future training topic ideas per professional NMP group.
NMP competency
Respondents discussed several areas relating to competency, NMP appraisal, objective structured clinical examinations (OSCEs), scope of practice and peer review. Exemplar quotes are provided in Box 2.
NMP appraisal
Nurse-1, Pharmacist-2 and Radiographer-1 described varying opinions on the use of annual revalidation appraisals as a method of ensuring competency governance at the study site. Nurse-1 discussed undertaking a combined appraisal method which involved NMPs proactively collecting a competency ‘portfolio of evidence’ which was reviewed by their nursing line manager and signed off by the consultant oncologist.
OSCEs
An OSCE is a direct observation evaluation tool used to assess clinical staff [18]. Nurse-1 described previously using OSCEs as a revalidation tool for their NMP practice. Nurse-1 believed that assessing NMPs’ clinical reasoning and judgement were more important than completing regular OSCEs for more experienced NMPs.
Scope of practice
Nurse-1 suggested that each NMP’s scope is not clearly defined at the same level of detail across all oncology specialities, which may be due to variable expectations of consultant mentors.
Peer review
Pharmacist-1 and Pharmacist-3 believed that peer review could be used to assess competency. Nurse-1 recommended developing an oncology ‘independent prescribing advanced practice framework’ which could be used to peer review NMPs by reviewing their portfolios of evidence.
Nurse-2 described how they audited themselves as a method of assessing competency, which could have been undertaken due to lack of peer review available at the study site. Collecting and recording NMP prescribing data is not current practice at the study site.
Support for NMPs
All participants agreed that training support from all stakeholders is fundamental to the NMP role. Exemplar quotes are provided in Box 3.
Consultant support
Most participants stated that they did receive training support from their consultant oncologist, although they also described a need for more leadership and support with their NMP development. Pharmacist-3 explained that they used their own initiative to direct their own learning and training needs.
Line manager support
Pharmacist-1 and Pharmacist-2 described a lack of support for attending NMP training from their line manager, due to their line manager not being an NMP themselves, but there was support from the NMP lead. Radiographer-1, Radiographer-2, Radiographer-3 and Nurse-2 described feeling supported by their line managers regarding NMP training. This may be due to their line manager also practising as an NMP. The consultant non-medical professional role was not discussed by pharmacists and nurses due to this role not being implemented within their departments at the study site. Radiographer-3 did describe their consultant radiographer currently providing NMP leadership within the radiotherapy department at the study site.
NMP peer support within the organisation
All participants described how future in-house NMP training sessions are planned within the study site NMP meeting forum on an ‘ad hoc’ basis. Pharmacist-3 suggested that these meetings could be improved upon, especially regarding their frequency and efficacy. Nurse-2 suggested utilising the NMP meeting forum to facilitate peer support, i.e., more experienced NMPs sharing experiences with early career NMPs.
Organisational support
Nurse-1 and Nurse-2 commented on organisational support. Nurse-1 described the need for support when NMPs make an error, making decisions and for regulation protection regarding their clinical judgement. Nurse-2 believed that regular study leave should be provided by the organisation for NMPs’ training mirroring the current medical prescribers’ training at the study site.
Professional group support
Regarding professional support internal to the organisation, Radiographer-1 and Radiographer-2 described having internal radiographer department support sessions for case discussion and in-house NMP competencies led by the lead radiographer NMP (Consultant Radiographer) and believed these to be beneficial. Pharmacist-1, Pharmacist-2, Pharmacist-3 and Nurse-1, Nurse-2 and Nurse-3 did not describe any internal professional training support across the study site, although Nurse-2 described attending useful regular CPD sessions within their CNS role.
Regarding professional support external to the organisation, Pharmacist-1 described utilising British Oncology Pharmacy Association (BOPA) events to keep up to date and network with external colleagues. Radiographer-1 described a radiographer national online forum for NMPs. Both Pharmacist-1 and Radiographer-1 found these beneficial to their practice.
Methods of providing training
Main training methods described by participants are detailed below with exemplar quotes in Box 4.
Learning from others
All participants commented on various aspects of ‘learning from others’. Nurse-1 discussed how their practice benefitted by communicating with other nurses fulfilling the same role, both within and outside of their organisation. Learning from other NMP professional groups was described as beneficial by Nurse-3.
In-house training
Nurse-2 explained how they had not completed any formal training after qualifying as an NMP. Nurse-3 believed that in-house training should be available on a regular basis and Radiographer-3 was in favour of regular in-house training, but topics should be beneficial to all. Pharmacist-3 described how NMPs should be allocated time to attend established in-house junior medical training within the organisation. Participants made suggestions for the development of a structured in-house organisation-wide NMP training programme.
Self-directed Learning
Seven NMP participants described using their own initiative to undertake relevant training to develop their own NMP role. Nurse-2 had experienced a lack of guidance when extending their scope of practice and believed that more guidance should be available from the organisation.