IAANMP: Meet the members

Christina O’Rourke, ANP Dermatology, St James’s Hospital

Staff nurse to ANP: My journey in dermatology
My path to advanced nurse practitioner (ANP) status began at St James’s Hospital 10 years ago, when I left behind the night duty and ‘on-call’ of the theatre department for a more family-friendly roster in skin cancer surgery. As a staff nurse in dermatology, I quickly became drawn to the specialty’s blend of chronic disease management, acute intervention, and the profound psychological impact that skin conditions have on patients’ lives. That early curiosity became the foundation for everything that followed: A deliberate, years-long progression from staff nurse to clinical nurse specialist (CNS), and ultimately to registered ANP, underpinned by a Master’s Degree in Advanced Practice Nursing and the gradual development of experience and competence.

As a CNS, I joined an experienced medical dermatology team and began to focus on where nursing could add the most value to patients who were falling through gaps in traditional consultant-led pathways. This led myself and my job-sharing partner, RANP Deirdre Kennedy, to delivering a nurse-led Roaccutane (isotretinoin) clinic, giving patients with severe acne structured, closely monitored access to a treatment that demands rigorous safety oversight.

I also joined my colleague Deirdre to expand the nurse-led biologic clinic for patients with psoriasis requiring ongoing biologic therapy management. Both services were built around patient safety: Robust pre-treatment screening, monitoring protocols, and continuity of care that reduces consultant wait lists, while improving the patient experience. These innovations reflected a wider truth I have carried throughout my career; advanced practice nursing is not about replacing medical care, it is about designing better systems around the patient.

Leadership, education, and autonomy
Progressing to ANP level meant taking on clinical autonomy, including prescribing authority, but it also opened a leadership dimension I had not fully anticipated. Within St James’s Hospital, Deirdre and I recognised a gap in structured, accessible education for nurses working in dermatology, so, together we established the annual dermatology study day, now a recurring fixture that brings nurses and doctors together for focused, practical learning.

We felt it was important to ensure that skill development is not confined to a small group of specialists, but distributed across the wider nursing and primary care teams. Building on that, we are now working on additional nurse education courses designed to raise the baseline standard of dermatology nursing knowledge across national services. 

This conviction – that education and structured pathways are essential to the evolution and maturity of the profession – has also informed my work outside the hospital in my role as Chairperson of DANAI (Dermatology and Aesthetic Nurses Association of Ireland). Representing over 200 nurses nationally, I continue to advocate for clear training and education pathways for aesthetic and dermatology nurses up to Level 9 postgraduate standard, including ongoing discussions with third level institutions to develop a structured MSc-aligned pathway.

My motivation has been consistency – every nurse working in dermatology, regardless of where they trained or which employer they work for, should have equal access to professional development that is recognised, regulated, and aligned with the Nursing and Midwifery Board of Ireland (NMBI) competencies.

Patient safety is the primary motivation of my voluntary work in this area. In 2023, I led a team to establish a dedicated Dermatology Aesthetic Section within the Irish Nurses and Midwives Organisation (INMO) – a step taken because both nurses and patients were being exposed to inconsistent standards. As Secretary of the INMO section, I have supported Chairperson Cora Murphy at the Annual Delegate Conferences over the last two years, with successful motions passed at each event. It has been a great endorsement for our dermatology aesthetic nurses to secure the support of our peers and colleagues. We now have sustained engagement with our regulator NMBI and continue moving towards the goal of safer practice for patients receiving aesthetic and dermatological treatments from nurses. 

Representing aesthetic and dermatology nurses at the national level, whether in direct engagement with NMBI on scope of practice guidance, in ongoing dialogue with the INMO, or in national media interviews addressing misinformation about nurse-led aesthetic care, has demanded a particular kind of leadership. It requires evidence-based clarity under scrutiny, the composure to correct public misconceptions without becoming defensive, and the persistence to keep pushing even when progress is incremental.

It also requires genuine collaboration and teamwork. It is enjoyable to work with nurses, professional bodies, and educational institutions who share the same conviction that safe, well-educated, appropriately regulated nursing practice benefits everyone, patients and the profession alike. That, ultimately, is what my journey to advanced practice has been about; not a single promotion, but a continuous effort to raise the standard of care and the standing of the nurses who deliver it.