Analysis and evaluation of the NMBI State of the Register 2024: ANP Division
By Theresa Lowry Lehnen, IAANMP Committee Officer
The Nursing and Midwifery Board of Ireland (NMBI) 2024 report provides key insights into the advanced nurse practitioner (ANP) workforce in Ireland. The report highlights growth in registration, practice, geographical distribution, and demographic trends.
Total ANPs (as of June 1, 2024)
- There are 968 ANPs registered in Ireland.
- 701 ANPs are currently practising, while 177 are not.
- 669 ANPs are working in patient-facing roles.
- 90 newly registered or restored ANPs have not provided information on their practice or workplace.
The data demonstrate consistent growth, with a 20 per cent increase in ANP registrations in 2024.
Newly registered ANPs (2013-2023)
The number of newly registered ANPs has steadily increased over the past decade:
- 2013: 14 new ANPs;
- 2015: 36 new ANPs;
- 2019: 119 new ANPs;
- 2023: 171 new ANPs (highest recorded).
While growth was slower in earlier years, there has been a rapid acceleration since 2019.
Gender distribution
- 617 female ANPs (approximately 88 per cent).
- 84 male ANPs (approximately 12 per cent).
Age distribution
- The largest concentration of ANPs falls within the 40-54 age group.
- The highest proportion of practising ANPs is in the 50-54 age group (84 per cent).
- There are very few ANPs under 30, highlighting the seniority of the ANP workforce.
Geographical distribution
Dublin, with 294, has the highest number of practising ANPs. Other counties with significant ANP numbers include:
- Galway (63);
- Limerick (30);
- Cork (50);
- Louth (34);
- Waterford (25);
- Donegal (22).
Counties with little to no growth include Carlow, Longford, Monaghan, Kildare, and Leitrim. One ANP is practising abroad.
| Category | 2022 | 2023 | 2024 | % Change (2023-2024) |
|---|---|---|---|---|
| Registered ANPs | 657 | 809 | 968 | +20& |
| Practising ANPs | 517 | 605 | 701 | +16% |
| Patient-facing ANPs | 489 | 573 | 669 | +17% |
| New registrants | 98 | 157 | 165 | +5% |
TABLE 1: Yearly growth trends (2022-2024)
| Age Group |
Registered ANPs | Practising ANPs (%) | Patient-facing ANPs (%) |
|---|---|---|---|
| 25-29 | 3 | 67% | 67% |
| 30-34 | 49 | 55% | 47% |
| 40-44 | 176 | 68% | 68% |
| 50-54 | 211 | 84% | 78% |
| 60-64 | 55 | 75% | 71% |
| 65+ | 6 | 67% | 50% |
TABLE 2: Age distribution
| County | Practising 2023 | Practising 2024 | Net change | % Change |
|---|---|---|---|---|
| Dublin | 257 | 294 | +37 | 14% |
| Limerick | 23 | 30 | +7 | 30% |
| Louth | 26 | 34 | +8 | 31% |
| Waterford | 19 | 25 | +6 | 32% |
| Cavan | 6 | 10 | +4 | 67% |
| Wexford | 8 | 11 | +3 | 38% |
| Wicklow | 6 | 9 | +3 | 50% |
TABLE 3: Geographical distribution
Key takeaway points:
- The ANP workforce is expanding rapidly – 20 per cent increase in registrations in 2023-2024.
- Most ANPs are senior clinicians – 40-54 age range holds the majority of practising ANPs.
- Dublin is the ANP hub with nearly 300 practising ANPs.
- Smaller counties show growth – Limerick, Louth, Waterford, and Cavan all had notable percentage increases in ANPs.
- Steady increase in new ANPs – numbers have grown significantly since 2013, reaching 171 new ANPs in 2023.
The ANP workforce continues to strengthen, supporting Ireland’s healthcare system with highly skilled, expert nursing professionals. The consistent rise in new ANP registrations indicates a promising future for advanced nursing roles in Ireland. The significant growth in ANP numbers reflects the increasing reliance on their specialist skills in diagnosis, treatment, and autonomous decision-making.
As highly trained expert clinicians, ANPs are bridging gaps in patient care, enhancing service delivery, and alleviating pressures on the healthcare system. Their ability to work independently, prescribe medications, and lead complex clinical interventions makes them invaluable in both acute and community settings.
With their expertise, leadership, and patient-centred approach, ANPs are transforming the future of healthcare in Ireland.
Reference
Nursing and Midwifery Board of Ireland. State of the Register 2024. Available from: www.nmbi.ie/Registration/NMBI-state-of-the-Register.
Mental Health ANPs of Ireland
By Joanne Flood, FFNMRCSI, Advanced Nurse Practitioner Liaison Psychiatry, Mental Health Services for Older People, North Dublin
On 27 May, 2022, a small group of mental health advanced nurse practitioners (MHANPs) met in Tullamore to address the need for ANPs in MH to have a unified voice. It was agreed that an association which represents the specific needs of the MHANP should be established at that time. A working group was formed and together we developed the foundations of Mental Health Advanced Nurse Practitioners of Ireland (MHANPI).
An AGM was held in September, 2023, and a committee was elected. We aimed to include a representative from each health region in the country on the committee for equity. Following the committee formation, and with membership support, the launch of MHANPI began.
During 2023, ANP’s from the intellectual disability (ID) service approached MHANPI and requested to join as they felt our organisation could be of value to them. The membership agreed and our first ID ANP members joined in 2024, with a representative being co-opted onto the committee to represent them. MHANPI membership continues to grow, reflecting the increasing numbers of ANPs and candidate ANPs in MH and ID.
MHANPI launch 2024
Further to our ever-expanding vision for MHANPI, and after months of hard work by the committee, the official MHANPI launch day was successfully celebrated on 7 June, 2024, in the Ashling Hotel, Dublin.
Joanne Flood opened the event with Anne Caprani and Sinead Frain, who detailed the origins of MHANPI over the previous two years. MHANPI had the pleasure of Anne Brennan, Director of Nursing Midwifery Planning and Development Unit (NMPDU) North Dublin, and Sheila Cahalane, Office of the Nursing and Midwifery Services Director National Lead for Advanced Practice, present at the conference, particularly highlighting how advanced practice in MH and ID services has grown rapidly over recent years.
The MHANPI co-produced logo was unveiled during the launch. The MHANPI logo was created by Cathy Doyle, Recovery Education Facilitator, Mental Health Ireland, and the result was a thoughtful piece of art that reflects the advanced practice work we are all striving towards. The day continued with a number of clinical snap shots from ANP’s around the country.
Ongoing progress
MHANPI went on to host its second AGM online on 22 November, 2024, with a good turnout from members. The event featured updates on key initiatives and provided a platform for members to engage in a webinar event with speakers including Aisling Culhane, Research and Development Advisor Psychiatric Nurses’ Association Ireland, and Board Member of Horatio, who focused on the development of the ANP role in MH and how to protect it in the future.
She highlighted the importance of protecting the specific pathway for MH nurse training moving forward. Aisling provided guidance and support to members who submitted questions relating to their ANP practice.
Catherine Marsh, HSE SPARK Innovation programme and ANP, was next up with an inspiring presentation. Catherine spoke passionately about nurses using innovation to enhance processes and outcomes in healthcare practice.
She highlighted ways for multidisciplinary teams to drive forward pioneering solutions in the healthcare sector. There was a positive response to Catherine’s presentation and the possibilities for advanced practice she described.
Building and strengthening networks
MHANPI has a growing membership database from all over the country in many different specialist services within both MH and ID. Once a member, you have access to our WhatsApp group, are placed on the MHANPI emailing list, and receive newsletters and updates automatically via email.
The committee are now in the process of completing their third quarterly newsletter, which is available for all members of MHANPI. MHANPI works closely with the IAANMP, who elected one of our committee members onto their committee as the MH representative last year, contributing to a growing collaboration within advanced nursing practice in Ireland.
Looking ahead, MHANPI at every opportunity will aim to strengthen its advocacy efforts, enhance professional development opportunities for its members, and continue pushing for greater recognition of the role of ANP in MH care. The focus of 2025 will be on organising a second annual conference, quarterly newsletter development, website construction, and a spring webinar series development.
The ANP role in general practice
By Dara Maguire Bagina, Registered Advanced Nurse Practitioner in General Practice, Ardee, Co Louth
This feature outlines the role of a registered advanced nurse practitioner (RANP) in designing and mplementing a new service in the general practice setting. It also identifies the impact the service has had on the patient population, and explores how RANPs can contribute to a positive trajectory for general practice in the future.
My current role as RANP in general practice was established in March 2023 on a part-time basis. I had a background in the acute hospital setting on a busy emergency department (ED), where the RANP service was a highly functioning one that boasted remarkable and statistically significant impacts on patient episodes, experiences, and the quality of care provided. That service is now established in EDs nationwide, and was slightly remodelled to develop a similar RANP-led service in general practice.
Patients attending the service present with a range of issues including abdominal pain; flank pain; urinary symptoms; sore throat; ear pain; respiratory illness; and chest pain. Patients are managed autonomously by the RANP, from initial assessment, to diagnosis, and implementation of treatment plans for the management of the illness.
The RANP prescribes appropriate medication for the condition, arranges follow-up, referral to appropriate services or specialities, and referral to the acute services if further investigations are warranted.
A performance audit was conducted after 12 months of service provision, along with a patient satisfaction survey, in order to evaluate the effectiveness and benefits of the RANP service.
Results
Auditing data revealed that the RANP service has resulted in significantly positive outcomes for both the practice and its patient population. From March 2023 to March 2024 a total of 595 complete episodes of care were carried out.
The survey highlighted a highly positive impact on patients’ perceptions of, and satisfaction with, the service in their local community practice. A total of 115 patient responses were received and reviewed to analyse levels of patient satisfaction with the service. The survey was conducted to gather data on patient preferences for RANP appointments, perceptions of service quality, and pricing considerations. The following information gives a synopsis of the outcomes:
- 96.5 per cent of respondents were happy to attend the RANP instead of the GP.
- 97.3 per cent said they were willing to have a follow-up/review RANP appointment.
- 88.6 per cent ranked the care they received from the RANP as equal to that received from their GP.
- 94.4 per cent felt that the RANP service was priced appropriately.
- 76 per cent found access to RANP appointments ‘easy’.
In my current role I have only received positive feedback from colleagues in the practice. Following initial education about the role and the cohort of patients being provided for, it was quickly understood this would be a very beneficial service to the practice and to the patients.
These findings are among many examples illustrating the effectiveness of integrating RANPs into primary care settings; however, major discrepancies exist between these and secondary care settings regarding the number of practitioners. This is of importance as general practice settings, in particular, are in a difficult situation at present, with an ongoing nationwide shortage of GPs and an ever-increasing demand for appointment access. There is also an ageing society and an increasing population with challenging and more complex needs. It is well noted that general practice ANPs are a viable solution in addressing these challenges and enhancing service delivery.
ANPs in general practice
I am one of only 24 RANPs currently working in a general practice setting nationwide, alongside 27 candidate ANPs. The number of RANPs working in general practice accounts for substantially less than 1 per cent of the nursing workforce, which is minute in comparison to the hospital setting, for example, where there are numerous RANPs practising.
The differences in numbers are obvious. As of June 2023, there were 809 RANPs and 30 RAMPs in Ireland, according to Nursing and Midwifery Board of Ireland data. When we compare the number working in general practice to the total number of RANPs/RAMPs, there is a significant difference. This, coupled with the well-documented evidence of the benefits of having a RANP service, brings to light the question of why is there such a difference in numbers?
It is well-documented that primary care ANP services are as safe and effective as those led by doctors. They allow for improved access to care for patients with minor ailments, their services are cost-effective, and they contribute to improving the quality of primary care.
GP ANP Ireland
It must be mentioned that GP ANP Ireland have devised an extremely informative document that was submitted as part of the Strategic Review of Irish General Practice Services 2024. This is a very detailed document highlighting the role and workload of the ANP in the general practice setting. It outlines projections for the potential benefits ANPs can achieve if the workforce increases and develops.
GP ANP Ireland noted an important point in their submission regarding workforce planning. They observed that the most recent general practice contract (2023) supports the new role of a GP practice assistant GPA, with consideration of other professionals such as the community paramedic and physician associate also being explored.
GP ANP Ireland remarked that it would be a missed opportunity for policymakers and planners to ignore the feasibility of also upskilling nurses to advanced practice roles in general practice.
It would seem obvious that a considerable workforce of 2,318 general practice nurses (GPNs), with established competencies and experience, be enabled to work at the top of their scope and licence. This is felt to be a significant point to mention as the benefits of advanced nursing roles in primary care settings have been heavily documented and it can be agreed that failure to invest in the GPN workforce would be a missed opportunity.
Providing the necessary investment in role progression and development of advanced practice services would allow for opportunities to promote the retention of our workforce and have a sustainable service delivery for our patients – in keeping with recommendations from The International Council for Nurses.
Conclusion
From this short review it can be agreed that more research into the potential barriers to, and facilitators of, role development in the general practice setting need to be addressed. It was felt necessary to discuss these points as the work we all do as ANPs across all settings needs to be recognised. It can be agreed we make up a significant proportion of the healthcare workforce, therefore, investing in us now will pave the path for a sustainable healthcare service in the future.
Celebrating 20 years of advanced nursing and midwifery practice in Donegal
By Dr Janice Richmond, RANP Oncology; Ms Deirdre Diver, RANP Gastroenterology; and Ms Liz Breslin, ADON NMDPU
Letterkenny University Hospital (LUH) proudly hosted a significant event on 13 November, 2024, to celebrate 20 years of advanced nurse practitioner (ANP) and advanced midwife practitioner (AMP) positions in Donegal.
The event was supported through a collaborative process by the Director of Nursing and Director of Midwifery at LUH, the Director of Public Health Nursing in Donegal, and the Nursing and Midwifery Planning and Development Unit, North West.
Dr Anne Drake, Director of Nursing, LUH, welcomed attendees and said: “We celebrate and mark 20 years since the first ANP position was established in LUH. Since then, advanced nursing and midwifery services have enhanced healthcare across Donegal.
“These advanced nurse-led and midwife-led services expand from the hospital to community services. They consistently focus on person-centred, safe, high-quality care to service users and their families.”
This milestone event honoured the journey of advanced nursing and midwifery practice in Donegal, celebrating past achievements and charting a promising path forward. Colleagues shared reflections during the celebrations, expressing what the role meant to them.
Dr Janice Richmond, ANP in Oncology at LUH said: “Working as a registered ANP over the past 20 years is an absolute privilege. Currently there are over 40 ANPs and AMPs in the county, and daily we have the opportunity to assess, plan, implement, and evaluate care for patients and connect with families through advanced clinical expertise, knowledge, and clinical skills.”
ANPs and AMPs are senior clinicians with advanced level clinical expertise, education, and knowledge, and are empowered to autonomously manage service users’ care. Enhancing care delivery and outcomes for service users and their families/carers is a pivotal focus of the role.
“This includes making evidence-based decisions and prescribing treatments for a large population of patients. ANP/AMP roles are the highest level of clinical experts in the nursing profession in Ireland.
Aligned with the HSE Health Regions Integration Plan, the event highlighted Donegal’s nursing and midwifery leadership’s commitment to collaboration, innovation, and supporting the future of healthcare reform.
Attendees had the opportunity to network, share insights, and build connections with ANPs and AMPs across hospital and community services, alongside meeting local, national, and HSE West and North West strategic leaders and partners. This symposium also coincided with the International Celebration Week for Advanced Nursing and Midwifery Practice, adding significance to Donegal’s achievements and future ambitions in healthcare.
The LUH ANP/AMP Council Forum, an integral part of LUH’s Magnet Hospital Initiative, warmly welcomed ANPs, AMPs, nursing and midwifery leaders, and strategic colleagues from HSE West North West and nationally to unite, empower, inspire, and celebrate advanced practice developments in Donegal.
Attendees engaged with speakers who discussed the history, the impact, the latest developments, and the emerging roles of ANPs and AMPs, showcasing the future of advanced nursing and midwifery practice in Donegal.
ANP Miriam Griffin, on behalf of her colleagues, said: “The ANP service in the emergency department (ED) of LUH provides a career pathway for registered nurses in direct clinical care. There are four ANPs in the ED in LUH; our vision for the future is that the ANP service will continue to grow to provide safe, timely, evidence-based care for patients and their families in Donegal.”
Denise Gillespie, ANP Child Health and Parenting, Donegal, said: “I have been in post for 16 years as an ANP in Child Health and Parenting in Public Health Nursing in Donegal. When I reflect on my time in post it has provided me with many opportunities which I have enjoyed immensely. I really enjoy working in partnership with parents to provide support in the areas of sleep and behaviour.”
Pauline Ferry, Registered ANP Diabetes (Pregnancy) also spoke about her experiences. She added:
“I am a Registered Advanced Midwife Practitioner (RAMP) specialising in supporting women with diabetes during pregnancy. Since stepping into this role in 2023, my focus has been on delivering advanced, midwife-led care that is both holistic and person-focused.
“With a deep commitment to pre-pregnancy care for women with type 1 and type 2 diabetes, I am passionate about ensuring each women receives the support and guidance they need for a healthy pregnancy journey. My RAMP role is incredibly fulfilling.”
Carmel Erskine, candidate ANP Disability Services, said: “As the first candidate ANP in HSE disability services in Donegal, I’m proud to be working in this important role in intellectual disability services. I support individuals holistically, focusing on early recognition and assessment of their illness.
“My goal is to enhance health and wellbeing, empowering individuals to take an active role in their care. Equally important, I am committed to upholding the UN Convention on the Rights of Persons with Disabilities, ensuring that each individual’s dignity and quality of life are prioritised.”
Thanking the ANMP workforce, General Manager at LUH Sean Murphy said: “Advanced practitioners strengthen the healthcare workforce and maximise our healthcare potential. We celebrate the dedicated nurses and midwives who have advanced their education and clinical expertise to become nurse/midwife practitioners and we recognise the vital role they play in supporting many patients.
“Your expertise, dedication, and care make a lasting impact on our patients and clinical teams. Thank you for your invaluable contribution to healthcare every day.”
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