Education and competence
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Last reviewed: 07/05/2025
Education and competence
Education and competence
Ophthalmic nurse education is essential to provide high quality and focused evidence-based care. Bespoke education will better enable nurses to articulate concerns, as well as having informed discussions about practice, when speaking to colleagues from the wider multidisciplinary team.
Nurse education is lifelong and practice learning should always be underpinned by reflection. Before embarking on competencies and training in the workplace, nurses should have opportunities for practice in the ophthalmic care environment. This is reflected in the RCN Workforce standards (RCN, 2021) where continuing professional education and practice development is linked to safe staffing and patient care.
For further information on developing as an advanced nurse practitioner in Ophthalmology, see: NHS England's What is advanced clinical practice? along with the RCN's Professional Development Framework - Advanced Level Nursing. The RCN Ophthalmic Nursing forum are currently developing standards for Advanced practice in Ophthalmic Nursing, which will be published later in 2025.
The development of the multidisciplinary workforce is recognised as an imperative due to the increasing need for ophthalmic care (RCOph, 2021), and this recognises that ophthalmic nurses are essential and valuable members of the team. The Ophthalmic Practitioner Training (OPT) Programme provides education for a range of healthcare professionals, including postgraduate orthoptists, optometrists, ophthalmic nurses in secondary care to develop their skills in eye care.
The RCN Ophthalmic Nursing Forum worked collaboratively with the Royal College of Ophthalmologists, College of Optometrists, the British and Irish Orthoptists Society and Health Education England, to develop this curriculum.
Before embarking on the OPT, nurses are recommended to undertake a nursing ophthalmic course (such as a PG Cert Clinical Ophthalmic practice or a university ophthalmic degree at Level 6 or at Level 7 or equivalent) RCOph, 2016), to ensure nurses have the necessary prerequisites to successfully complete the OPT and work within their scope of nursing practice. Level 3 of the OPT is for advanced nurse practitioner roles and the competencies should be aligned to a master’s level degree programme, which covers the pillars of advanced clinical practice (NHS, 2017).
The Ophthalmic Nurse Career Pathway
Any registered nurse may develop an interest in ophthalmic nursing and have opportunities to work in the area. This can lead to enhanced levels of practice, in specialist ophthalmic areas and on to advanced levels of practice.
The RCN Ophthalmic Nursing Forum advocates that ophthalmic nurse education should be embedded in validated/accredited ophthalmic courses where students’ knowledge is formally assessed.
Undergraduate nursing degrees leading to initial NMC registration offer limited exposure to ophthalmic theory or practice, and so post qualifying courses are essential and should be aligned to higher education institutions. There are a number of HEIs offering ophthalmic courses, including some online access. The RCN Ophthalmic Nursing Forum webpages provide links to some of these courses.
The RCN professional framework expands on the concepts of levels of practice, and is due to be launched at the end of 2023.
Advanced Clinical Practice (ACP)
Advanced practice is a level of practice, rather than a type of practice, as is enhanced practice. It should be noted here that the terms Advanced Clinical Practice/Practitioner, and Advanced Nurse Practice/Practitioner are used interchangeably across practice areas and across the UK. This can be subject to service provision required, commission of services and/or local service requirements.
In 2025, the Ophthalmic Nursing Forum published Advanced Level Practice for Ophthalmic Nursing.
Advanced nurse practitioners are educated at master’s level and have been assessed as competent in practice using their expert clinical knowledge and skills. For further information, see: RCN Advanced practice standards, and NHS England's What is advanced clinical practice?
Continued professional development, supervision and audit of own practice is required to attain advanced clinical practice, as well as awareness of limitations and capabilities. They have the freedom and authority to act, making autonomous decisions in the assessment, diagnosis and treatment of patients.
The Nursing and Midwifery Council (2021), Royal College of Nursing (2018) and Health Education England (2021) are unanimous in their support that all advanced clinical practitioners should:
- have an active nursing and midwifery registration
- practice within the four pillars (education, clinical practice, management and leadership and research)
- have a job plan that demonstrates advanced clinical practicethat is equitable with other professional groups
- be educated to master’s level
- be an independent prescriber and
- meet NMC revalidation requirements.
The career pathway to advanced practice will vary in its achievement, but the above standards are recommended as a minimum for nurses to identify as advanced clinical practitioners. The RCN's Advanced Practice Standards (2021) provide further details about the expected standards for those nurses pursuing their career to advanced level practice.
Therefore, advanced practice brings the additional value of critical thinking and understanding, enhanced responsibility and autonomy and extended competency in their scope of practice when working with complexity, risk, uncertainty, and incomplete information.
Nurses working in these roles bring enhanced professional judgement with regard to when to seek help and collaborate with other agencies. They also work in partnership with individuals, families and carers using a range of assessment methods (for example history taking; clinical assessment such as blood pressure, blood sugar monitoring, intravenous administration of medication, urinalysis; identifying risk factors; mental health, safeguarding, cognitive impairment or learning disability concerns) to positively impact individual patients' health. An example of how one nurse is working at advanced practice level can be found here: Advanced ophthalmic emergency nurse practitioner: What I do at work.
Clinical practice education, leadership and management, and research
Clinical Practice
Advanced practice roles have been developed in the following subspecialties. It is important to remember that these roles are dependent on the service needs of individual NHS Trusts as well as local service agreements. All nurses practicing at advanced level practice for all subspecialties should be prescribers and this should be reflected in the skills, they are competent and enabled to perform. There may be a cross-over of the remit of various roles and the skills can be used interchangeably between the subspecialties.
| Accident and emergency | Accident and Emergency care nurses advanced skills include diagnostic assessment and management, including independent prescribing, of a range of ophthalmic conditions. This is a holistic role which can encompass aspects of all other sub specialities. The scope of the role will depend on local service requirements including whether the service is provided in Eye Clinics/Eye hospital or general emergency departments. Uveitis advanced nursing skills include advanced slit lamp skills, fundoscopy administering intravitreal implants or orbital floor injections for inflammatory conditions and cystoid macula oedema. The role also includes liaison with other medical specialities (for example rheumatology) to manage any systemic causes of their ocular condition. |
| Oculoplastic / Adnexal | Oculoplastic/Adnexal advanced nursing practice include minor surgery (Dunlop, 2010). Manage, prescribe, and administer injection botulinum toxin for rare diseases example blepharospasm, inflammatory eyelid and orbital disease with oral and intravenous steroid and biologics. Diagnosing and managing lacrimal disorders (Dunlop et al., 2020). In some setting temporal artery biopsies to diagnose giant cell arthritis are undertaken. The ACP diagnose eyelid lesions, prescribe, and arrange surgery via telemedicine consultation to reduce bottlenecks, improve service capacity and increase patient satisfaction (Kang et al., 2021) |
| Vitreo-retinal | Vitreo-retinal advanced nursing skills include undertaking fundoscopy and Yag laser. Their role includes managing new and long-term patients. |
| Uveitis | Uveitis advanced nursing skills include administering intravitreal implants or orbital floor injections for inflammatory conditions and cystoid macula. The role also includes liaison with other medical specialities (for example rheumatology) to manage any systemic causes of their ocular condition. |
| Corneal/external disease | Corneal/external disease nurses advanced practice scope includes collagen crosslinking for the treatment of keratoconus and undertaking confocal microscopy. Diagnosis of infectious organisms example fungus or acanthamoeba is undertaken using corneal scrape and staining techniques. |
| Medical retina | Medical retina nurses within this subspeciality administer intravitreal injections. (DaCosta, Hamilton, Nago et al., 2014; Mapani et al., 2021). In addition, fundoscopy, reading and interpretation of optical coherence tomography (OCT), fluorescein angiogram, indocyanine investigations to monitor patients. Diabetic eye screening is a previously documented role (Kirkwood; 2006). |
| Glaucoma | Glaucoma nurses provide diagnostic assessment and long-term management for patients Provide patient education, promoting concordance with treatment and selfcare (Gray, 2005). Clinical skills within this role may include gonioscopy, there is scope for developing skills in laser procedure, such as selective laser trabeculoplasty (SLT) (at the time of writing, ophthalmic nurses are considered appropriate non-medical professionals to deliver SLT, who may require different education needs and as a second stage approach. Visual Field (VF) and Optical coherence tomography (OCT) interpretation of results, fundoscopy, and examination of surgical patients are skills many glaucoma nurses practice |
| Cataract | Cataract advance role includes fundoscopy, skills in dense cataracts measurements - Accutome, Immersion or others OCT interpretation, Biometry, consenting and prescribing medication following the assessment and management of post-operative patients. Stanford and Ewing (2020) have voiced the role has potential to increase capacity and access to cataract surgery. The ACP should apply professional conduct within the scope of extended practice and be responsible and accountable for acts and omission at this level of practice (NMC, 2018). |
Education
Ophthalmic advanced nurse practitioners use critical thinking, complex decision making, and enhanced autonomy, underpinned by a master’s level qualification. In addition, ACP nurses are also registered non-medical prescribers who often teach and mentor learners, see: NMC's Standards for prescribers.
The OPT programme (Ophthalmic Practitioner Training (2019) is work-based and underpinned by a common clinical competency framework) providing a structured approach to clinical skills acquisition.
MSc Advanced Clinical Practice modules are available in in Glaucoma, Medical Retina, Ophthalmic Emergencies and Cataract are available at some universities, see: RCN Ophthalmic Nursing Forum webpage for further details.
Leadership and management
Leadership and management are a key dimension of the role of the advanced nurse practitioners. In addition, using advanced skills in evidence-based practice will improve patient outcomes, be cost effective and meet patient needs and can shape healthcare reform (Wood, 2021). When developing leadership skills, the ophthalmic nurse should enhance their creative and critical thinking skills, which will in turn improve practice and benefit to patient care. The RCN affirms the importance of leadership within healthcare, linking it to patient mortality, quality of patient care and patient satisfaction, and better staff wellbeing and morale. See: RCN Leadership Skills for further information on developing leadership skills.
Research
As a profession based on evidence, research affects every area of nursing practice, and is a cornerstone to enhancing practice. This may begin with audit of own practice, auditing specialist areas of practice and can include qualitative and quantitative research, which will enhance nursing care. Ophthalmic nurses should also be aware of ‘research findings’ in other fields of nursing and use relevant aspects of those findings when working with ophthalmic patients.
All practitioners are also required to conduct regular audits to ensure that their own practice and the service they provide is always contemporary and evidence based. The ophthalmic nurse should be an inspiration and source of knowledge for others, reflect on their own practice and use audit tools to assess effectiveness of their own practice Some of the areas that ophthalmic nursing research could contribute to, include improvements in health promotion and illness prevention programmes, infection prevention, symptom management, communication and the planning and organisation of care delivered by nurses are a testament to the power of research led by nurses. See: Making research matter: Chief Nursing Officer for England’s strategic plan for research.
Competency Frameworks relevant to ophthalmic nurses
A competency framework for Ophthalmic Nurses is due to be published in 2023.
