EVOLVING SENIOR NURSE ROLES IN ACUTE STROKE SERVICES: AN EXPLORATION OF PAST PRESENT AND FUTURE IN ENGLISH HOSPITALS (SEVERN REGION) 
L. Vincent1, L. Shaw1
1Royal United Hospitals Bath NHS Foundation Trust, Stroke Medicine, Bath, United Kingdom 
Background
United Kingdom stroke services have improved since creation of a stroke sub-speciality in 1999, but audits show there is vast regional variation1. Twenty years ago, “stroke coordinators” signposted patients to rehabilitation services, supported service development and comprised a regional network which shared knowledge/expertise2. These roles either disappeared as specialist services became established or evolved into advanced practitioner roles as thrombolysis/thrombectomy became the focus3. Unlike their emergency department counterparts, these posts don’t have standardised competency frameworks4. Prior to introducing stroke nurse competencies, we explored the contemporary issues encountered by local hospitals and their evolution over time. 
Method
Qualitative telephone survey of advanced stroke nursing roles in six hospitals comprising one UK region 
Findings
Each site had evolved different types of advanced nursing roles which lacked role definition, competencies, standardised validated training, or mentorship. Shifts towards acute stroke services
had afforded less time for service development and had been instrumental in dissolution of the stroke coordinators’ network. Overall individuals were feeling isolated and overwhelmed, limiting their ability to focus on service development and innovation. 
Conclusion
We have identified a clear need for standardisation of advanced acute stroke nursing roles. We recommend that further work should include a national role definition, scope of practice and competency framework. This would support development from junior nurse right up to fully trained nurse practitioners adept at leadership/service development. Support is required from structured mentorship and a nationally/ professionally validated MSc programme. The rejuvenation of a local nurse practitioner network would improve education, service development and morale. 
References
1. Rogers H. Strategy 2017-2010: British Association of Stroke Physicians; November 2016.
2. McDonald PS. Mayer P. and Dunn L. National service framework for older people: Stroke coordinators. British Journal of Nursing. 2002; 11(19), 1259.
3. Sanders C. Ashman G. The impact of an Advanced Nurse Practitioner training programme in an acute stroke service. British Journal of Neuroscience Nursing. 2018; 14(3), 130-134.
4. The Royal College of Emergency Medicine. Emergency Care Advanced Clinical Practitioner curriculum and assessment. 2015; Version 1.0.[Accessed 20.11.2018] Available from: http://rcem.ac.uk.