The Royal College of Nursing (RCN) Ophthalmic Nursing Forum (ONF) is committed to clinical excellence through advancing ophthalmic nursing practice and supporting career development. With the increasing demand for ophthalmic services, advanced and specialist practice roles are vital to increase capacity and enhance patient experience [1].
However, inconsistencies in advanced level practice (ALP), career progression routes, role titles and role ambiguity currently exist [2,3]. From an ophthalmic context, this is compounded by the lack of recognition and regulation of ophthalmic nursing by a professional body. To ameliorate some of these challenges, the ONF developed guidance for ‘Advanced Level Practice for Ophthalmic Nursing’, which was published in September 2025 [4]. The guidance outlines the various stages of role progression as well as the knowledge and skills required at the different levels of practice. It takes into account the core principles of ophthalmic nursing as framed in the definition of an ophthalmic nurse:
“An ophthalmic nurse is a nurse who has the education and expertise to provide holistic nursing care for people with a visual impairment or related conditions, temporary or permanent, wherever they may be” [4].
Nurses working at ALP should have a master’s degree qualification [5–7]. The ALP guidance covers the four pillars of practice – namely clinical, research, education and leadership – across the most common subspecialties. Additionally, it provides clarity on the differentiation between role title and level of practice. Advanced practice is a level of practice where a healthcare practitioner exercises autonomous decision-making in a context of complexity, uncertainty and varying levels of risk, holding accountability for decisions made [8]. This is supported by the Nursing & Midwifery Council (NMC) who define a nurse working at advance level as:
“An expert professional with additional post-graduate education and experience. They use their evidence informed knowledge, skills and capability to influence, shape, deliver and lead safe and effective care, while managing risk, uncertainty and complexity” [7].
The ALP guidance has been developed building on from previous initiatives and educational frameworks to support career development pathways. Such examples include the Health Education England and National Health Service England Multiprofessional Frameworks [9,8] – more specific to ophthalmic practice, the Ophthalmic Common Clinical Competency Framework was developed into the Ophthalmic Practitioner Training Programme. The International Council for Nurses’ guidance on advanced practice nursing [10], RCN’s Professional Development Framework [5], RCN’s Workforce Standards [11], and the recently published NMC Principles for Advanced Practice [7] have all helped to inform the ALP guidance.
The ONF’s new guidance is a vital resource in the prevailing healthcare landscape with evolving nursing roles, emerging new patient pathways, and the implementation of the NHS 10-year plan [12]. It is envisaged that the guidance will reduce disparities by providing clarity on the education requirements and competencies that are aligned with each level of practice across different subspecialties.
To conclude, the RCN ALP publication is a comprehensive and practical guide for nurses on their career trajectory from novice to expert. It is a vital step towards the much-needed standardisation of practices. It promotes expert knowledge, skills, and enhanced patient care by contextualising the four pillars of practice to the different level of practice.
As a body of ophthalmic nurses, the future of ophthalmic nursing is incumbent on us. Collaboration and engagement are key. The ONF and Annual Ophthalmic Nursing Conference provide platforms to discuss contemporary issues in practice, address challenges, and collectively seek out solutions by sharing and adopting best practice. For further information about the RCN ONF, please follow the link: https://www.rcn.org.uk/Get-Involved/Forums/Ophthalmic-Nursing-Forum
The sought-after Annual Ophthalmic Nursing Conference will be held on the 14 March 2026. Please register early to avoid disappointment.
References
1. www.rcophth.ac.uk/news-views/
rcophth-census-2022-report
2. www.nuffieldtrust.org.uk/sites/
default/files/2023-05/ Advanced%20practice
%20report%20FINAL%5B69%5D.pdf
3. Devereux E. Support for regulation of advanced practice nurses. Nursing Times 2023:
www.nursingtimes.net/news/professional-regulation/
support-for-regulation-ofadvanced-practice-nurses-12-05-2023
4. www.rcn.org.uk/Professional-Development/
publications/rcn-advanced-level-practice-for
-ophthalmic-nursing-uk-pub-012-161
5. www.rcn.org.uk/Professional-Development/
publications/ rcn-professional-development-framework
-advanced-level-nursing-uk-pub-011-127
6. https://icn.ch/system/files/documents/2020-04/
ICN_APN%20Report_EN_WEB.pdf
7. www.nmc.org.uk/globalassets/
sitedocuments/advanced-practice-review/
principles-for-advanced-practice-english.pdf
8. https://advanced-practice.hee.nhs.uk/
wp-content/uploads/sites/28/2025/05/Multi
-professional-framework-for-advanced-practice
-in-England-%E2%80%93-Edition-2025.pdf
9. www.hee.nhs.uk/sites/default/files/
documents/ multi-professionalframework
foradvancedclinicalpracticeinengland.pdf
10. www.icn.ch/system/files/documents/2020-04/
ICN_APN%20Report_EN_WEB.pdf
11. www.rcn.org.uk/-/media/Royal-College-Of-Nursing/
Documents/Publications/2025/May/011-930.pdf
12. www.england.nhs.uk/long-term-plan
[All links last accessed November 2025]
Declaration of competing interests: None declared.
