Finding my place: defining advanced clinical practice in learning disability nursing

When I first heard the term “Advanced Clinical Practitioner,” I honestly wasn’t sure what it meant for someone like me. Learning disability nursing is a unique and highly specialised profession. Career pathways can often feel limited, and advanced practice was never something I imagined would be part of my future.

I often found myself asking, “What would an advanced practitioner in learning disability nursing actually do?” Where would I fit?

Those questions began to be answered when I was given the opportunity to complete the Advanced Clinical Practice Master’s programme at Sheffield through the learning disability pathway. It wasn’t simply an opportunity to gain another qualification; it became an opportunity to redefine what advanced practice could look like within learning disability services.

Like many people undertaking advanced practice, I experienced imposter syndrome. Sitting alongside colleagues specialising in cardiology, emergency medicine and acute care, I questioned whether I belonged. They seemed so clinically experienced, while I wondered whether learning disability nursing really had a place within advanced clinical practice.

Over time, I realised my perspective had been wrong.

Enormous potential for Advanced Clinical Practitioners in learning disability services

As my portfolio developed, so did my understanding of the enormous potential for Advanced Clinical Practitioners within learning disability services. Advanced practice isn’t about trying to become another specialty; it’s about bringing advanced clinical thinking, leadership, education and innovation into the specialty we already know so well.

I’ve always had ideas. What the ACP programme gave me was the confidence, knowledge and framework to turn those ideas into meaningful change.

One of the first areas I wanted to transform was physical healthcare for people with learning disabilities within inpatient services. Annual health checks had become routine conversations, important, but often superficial. We redesigned the process into a comprehensive head-to-toe assessment, producing co-produced Health Action Plans that are reviewed every three months.

Rather than becoming another document, these plans now remain active throughout the admission process, with actions followed up and patients involved at every stage of decision-making.

Constipation, epilepsy and learning disability

Another area that demanded attention was constipation. Despite being one of the leading causes of avoidable morbidity and mortality for people with learning disabilities, conversations about bowel health were inconsistent, recording was poor, and embarrassment often prevented meaningful discussion. We developed standardised bowel assessment tools for both staff and patients, with patient involvement central to the design. Alongside this, we introduced audit processes and developed a training package through our first PDSA cycle, allowing us to identify areas requiring support and build sustainable improvements in practice.

Epilepsy presented another significant challenge. Around half of the people supported within our directorate have epilepsy, yet an initial audit demonstrated considerable variation in assessment, management and staff confidence. This led to the development of an Epilepsy Specialist Nurse role, alongside a service improvement programme.

We are redesigning epilepsy education to make it more accessible, strengthen links with neurology services, improve post-emergency department follow-up, review SUDEP risk discussions, develop meaningful co-produced management plans, and increase staff confidence in administering rescue medication.

Clinical leadership has also extended into emergency care. Our inpatient units were repeatedly struggling during Immediate Life Support simulations, highlighting that staff often lacked confidence rather than knowledge. Working alongside our Practice Educator, we introduced weekly ward-based simulation training built around psychological safety.

Staff are encouraged to make mistakes, reflect openly and learn together through structured debriefing. Feedback has been overwhelmingly positive, with growing confidence and engagement across the nursing workforce.

Financial waste improvements

Advanced practice has also enabled me to recognise opportunities beyond direct clinical care. Like many NHS services, we faced significant financial waste due to expired stock, duplicate orders, and inefficient processes. By introducing a centralised clinical stock system, currently being piloted across two inpatient units, we aim to reduce waste, improve patient safety, save staff time and deliver financial efficiencies. The project has already received recognition through nomination for a national sustainability award.

Alongside these quality improvement initiatives, I have continued to develop my own advanced clinical practice through prescribing, asthma review clinics, comprehensive respiratory assessments, the development of clinical pathways with our aligned GP service, the delivery of education programmes, workforce development, and the strengthening of collaborative relationships between nursing and medical colleagues.

Looking back, I often think about the person who questioned whether there was a place for Advanced Clinical Practitioners within learning disability nursing.

Now I ask a different question.

How can we afford not to have them?

Opportunities for learning disability nurses

At a time when the learning disability nursing workforce continues to decline and career progression has been identified as essential to attracting and retaining nurses in the profession, advanced clinical practice represents more than a new role. It represents opportunity. It demonstrates that learning disability nurses can lead clinically, innovate, influence systems and improve outcomes for some of the most underserved people in healthcare.

We need to stop questioning whether learning disability nurses belong in advanced clinical practice. Instead, we need to showcase what we are already achieving.

When learning disability nurses are given the opportunity to practise at an advanced level, they not only develop themselves; they transform services.

And perhaps that is exactly what advanced clinical practice in learning disability nursing should look like.

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Claire Stickels RNLD- Trainee Advanced Clinical Practitioner/ Specialist

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