Neuroscience nursing

UK Career Framework for Stroke Nurses

In the United Kingdom, more than 100,000 people have a stroke each year, with almost 75% of stroke survivors living with a disability. It is expected that not only the incidence of first time strokes will rise significantly but also the number of stroke survivors living with a disability. These challenges require a robust nursing workforce equipped with knowledge and skills including stroke prevention; acute management and rehabilitation; leadership and innovation; research; and evidence-based care.

With the range of career pathways within nursing and stroke nursing specifically, it is not only important that the stroke nursing workforce is aware of these but also that employers and organisations have pathways in place that actively promote and gives access to these routes.

The UK Career Framework for Stroke Nurses was produced by the Royal College of Nursing (RCN) project group with nursing representatives from across the United Kingdom. The framework will help inform the Northern Ireland Nursing stroke pathway and certain elements do not apply to Northern Ireland at this stage. 

This resource outlines the range of career pathways within stroke nursing and minimum recommended education requirements, in addition to knowledge and skills. It provides a guide for stroke services and employers to develop local career development frameworks for the nursing workforce.

Registered nurses working in stroke care can map their career development, as well as assess their skills and knowledge based on this resource and linked resources.

Career Framework wheel

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Elements of Professional Practice diagram

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We would like to acknowledge the contribution of other RCN Career Frameworks such as the RCN Career Framework for Emergency Nursing in the development of this framework.

UK Career Framework for Stroke Nurses

The UK Career Framework for Stroke Nurses showcases the range of career pathways within stroke nursing. This framework is intended to guide the development of the stroke nursing workforce of the future. Discrepancies between this framework and current practices are expected across the UK. Despite this, we recognize that individual and organizational efforts should focus on channelling resources and creating the necessary structures to move beyond these differences, for the benefits it brings to patient care.

The UK Career Framework for Stroke Nurses does not intend to be linear or prescriptive but to demonstrate the range of opportunities that registered nurses working within stroke care can consider in their career development. Transition between pathways is possible and, therefore, practitioners can consider exit points in a different pathway. In addition, employers may also opt to combine roles to answer the specific needs of patients and services in their local areas. For instance, the role of a Senior Staff Nurse/Deputy Charge Nurse (in the Clinical Practice pathway) may be combined with a Practice Assessor role (in the Practice Education pathway); a Clinical Nurse Specialist / Advanced Practitioner – Stroke (in the Clinical Practice Pathway) may also be a Clinical Academic Training Fellow (in the Clinical Academic Research Pathway). In such cases, it is fundamental that educational requirements for both roles are taken into consideration.

The role titles in this Framework are an attempt to consolidate existent variations within the stroke nursing and the wider nursing profession. However, it is essential that priority is given to the description of each role, the level (according to the Skills for Health Career Framework) and the recommended education requirements, as these define best the scope, knowledge and skills of the practitioner. Education requirements are recommended as an entry point or completion in each post.

We recommend that stroke nursing workforce career development plans and strategies in each stroke service are aligned with this framework.

Elements of Professional Practice

Professional Practice is underpinned by the Nursing and Midwifery Code. For each role of the UK Career Framework for Stroke Nurses, the knowledge, skills and capabilities required should be mapped against the Elements of Professional Practice (based on the 4 pillars of advanced clinical practice - clinical practice, research, education, leadership and management) and the Elements of stroke care (based on the elements of stroke care in the Stroke-Specific Education Framework). Pillars of advanced clinical practice will vary in strength depending on the pathway and level of practice.

To view the elements of professional practice diagram, please click here.

In addition to the scope within this pillar provided by HEE's Multi-professional framework for advanced clinical practice in England, the project group identified sub-themes that may be useful to support professional development:

  • Clear vision
    The NHS Leadership Academy state that clear vision is communicating a compelling and credible vision of the future in a way that makes it feel achievable and exciting. This requires a process of developing a shared vision with an emphasis on co-design.

  • People management
  • Understanding and managing the working relationships of a team to ensure individual performances are augmented and the vision and desired outcomes are achieved.

  • Team working -  inter team working
  • The cooperation and collaboration of each team member in working together to achieve a common aim.

  • Compassion in Leadership
  • The ability to inspire and empower others by understanding, empathy and kindness.

  • Coaching
  • Coaching is about “learning on the job” and designed to enable people to develop their own skills and competence in a focused, structured, measurable and supported way. This is also supported by mentorship and supervision

  • Questioning
  • Good questioning skills can assist leaders to gain different perspectives on a situation which can then inform and develop a solution.

  • Providing Feedback
  • Successful feedback describes actions or behaviours that the individual can do something about.

  • Influencing
  • The ability to influence is to have an impact on the behaviours, attitudes, opinions and motivation of others to affect positive performance.

  • Service change/redesign
  • The process in the development and improvement of services. Practitioners should understand local, regional and national future agendas, horizon scanning, data intelligence, risk and opportunities, and innovation to be better equipped to redesign services.

  • Managing services
  • The ability to administer and coordinate consistent provision of high quality and effective services.

  • Authenticity
  • The ability of the leader to build honest relationships and trust which then leads to engagement and improved individual and team performance.

  • Openness
  • Openness and honesty when things go wrong: the professional duty of candour.

  • Quality improvements
  • Quality improvement (QI) is a systematic, formal approach to the analysis of practice performance and efforts to improve performance.

  • Listening
  • Active listening builds trust and inspire teams. When people feel like their feelings and concerns are understood they are able to participate in solving problems, be engaged and committed to their work

  • Staff engagement 
  • Staff engagement occurs when the goals of the organisation are aligned with staff goals and how they spend their time.

  • Collective leadership
    Collective leadership entails distributing and allocating leadership power to wherever expertise, capability and motivation sit within organisations.

Further information about these subthemes is available here.

In addition to the scope within this pillar provided by HEE's Multi-professional framework for advanced clinical practice in England, the project group identified sub-themes that may be useful to support professional development:

  • Personal and professional development
    Practising safely and effectively within the boundaries of professional practice. The nurse champions their own continuous learning to develop skills and knowledge and is encouraged by the employer to do so.

  • Patient Education
  • The primary role for the nurse with the intent to foster healthy lifestyle behaviours in people who have experienced a stroke or Transient Ischaemic Attack.

  • Teaching
  • Helping learners acquired knowledge and skills in a variety of settings, applying theories, models and methodologies of learning.

  • Course design
  • Design or re-design of a course that the teacher/instructor is (or will be) teaching.

  • Positive Learning Environment
  • A welcomed and friendly environment, led by principles of effective communication and mutual respect for diversity, that motivates learners is learner-centred.

  • Providing Feedback
  • Successful feedback describes actions or behaviours that the learner can do something about.

  • Receiving feedback
  • Feedback received by the teacher/instructor from the learners, describing their learning process with the teacher/instructor teaching

  • Facilitate Learning
  • Helping learners develop the intellectual tools to form connections between concepts and obtain knowledge.

  • Self-directed learning
  • The learner identifies their own learning needs and learning objectives, implementing the actions required to achieve the learning outcomes and improve knowledge

  • Academic assessment
  • A form of feedback that allows the learner to understand if learning is occurring. Academic assessment can be formative or summative.

  • Workforce development
  • Practitioners may be involved in developing stroke educational programs and workforce development plans and strategies.

Further information about these subthemes is available here.

In addition to the scope within this pillar provided by HEE's Multi-professional framework for advanced clinical practice in England, the project group identified sub-themes that may be useful to support professional development:

  • Searching the literature
  • Critical appraisal
  • Systematic Review & evidence synthesis
  • Developing research questions
  • Writing protocols
  • Quantitative design & analysis
  • Qualitative design & analysis
  • Mixed methods design & analysis
  • Grant writing
  • Recruiting participants
  • Data collection
  • Project management (including managing budgets)
  • Writing for publication (including report writing and dissemination)
  • Public speaking
  • Research ethics
  • Leading research teams
  • Research governance
  • Knowledge translation
  • Patient & Public Involvement
  • Audit and service evaluation

In addition to the scope within this pillar provided by HEE's Multi-professional framework for advanced clinical practice in England, the project group identified sub-themes that may be useful to support professional development:

  • Professional Standards of Practice

  • Influence policy and practice standards
    The nurse is able to identify and interpret wide policy documents that guide professional practice

  • Legal and Ethical dilemmas and decision-making
    The nurse is able to understand the legal and ethical frameworks related to consent, confidentiality, the principles of the Equality Act (or equivalent in country of practice), Mental Health Act (in country of practice), bioethical principles, and the implications for clinical practice. Reflection on ethical and legal dilemmas within practice is required.

Clinical Practice Pathway

Clinical practice pathway

The Clinical Practice Pathway is based on the Four Pillars of Advanced Clinical Practice of England, Scotland, Wales and Northern Ireland. We acknowledge the various titles and roles in the UK that may not align with the titles used in this framework. Thus, it is paramount that priority is given to the description of each role, the level (according to the Skills for Health Career Framework) and the recommended education requirements, as these define best the scope, knowledge and skills of the practitioner.

Skills for Health Career Framework: Level 5

Recommended education requirements at entry point or for achievement during post: Diploma or Degree; and Nursing and Midwifery Council registration

Working in an acute or community setting, providing care to people who have had a stroke. This Practitioner is part of a multidisciplinary team. They have specialised, factual and theoretical knowledge in stroke care to assess and use decision-making skills to deliver care. They contribute to service development and personal development. They may delegate, supervise staff or provide training to healthcare professionals in levels 4 or below in the career framework level.  

Skills for Health Career Framework: Level 6

Recommended education requirements at entry point or for achievement during post: Stroke-specific course; level 5 knowledge and skills achieved

This practitioner works in the same setting as the Registered nurse – Stroke. They have a critical understanding of theoretical and practical knowledge within stroke care, usually through a stroke-specific course. In addition to the previous skills at level 5, they have added responsibilities such as delegating, supervising or providing training to a team of nurses. 

Skills for Health Career Framework: Level 7

Recommended education requirements at entry point or for achievement during post: Stroke-specific course; Master’s degree (e.g. advanced practice or healthcare education); level 6 knowledge and skills achieved

This practitioner provides care at an advanced level, adhering to the scope of practice and the 4 pillars of Advanced clinical/nursing practice. They have the critical knowledge in stroke care, constantly seeking evidence-base to support their practice. They show innovation and are strongly involved in service improvement and service change. This practitioner may lead or co-lead specific education and training programme. They have strong links with research teams and are the interface between different fields. Their curriculum may have been achieved using Entrusted Professional Activities (EPAs).

Skills for Health Career Framework: Level 8

Recommended education requirements at entry point or for achievement during post: Stroke-specific course, Professional Doctorate/Doctor of Philosophy, accredited leadership training; level 7 knowledge and skills achieved

The consultant role practices at the highest level of advanced clinical practice. These roles blend direct care, education, research and leadership and management. These practitioners are at the forefront of services. They are leaders in stroke nursing. 

Skills for Health Career Framework: Level 9

Recommended education requirements at entry point or for achievement during post: Stroke-specific course, Doctor of Philosophy, accredited leadership training; level 8 knowledge and skills achieved

This practitioner is at the highest level of advanced clinical practice. They provide consultancy in clinical settings but may also merge this role with university, leading research and commissioning roles. Such roles include but are not limited to, Clinical Lead/Director for Stroke Services.

Practice Education Pathway

Practice education pathway The Practice Education Pathway has a strong link between clinical practice and academia. In this pathway, practitioners are teaching, precepting or mentoring students in academic organizations or clinical practice settings.

Skills for Health Career Framework: Level 5

Recommended education requirements at entry point or for achievement during post: Diploma or Degree; and registration with the Nursing and Midwifery Council

Working in an acute or community setting, providing care to people who have had a stroke. This Practitioner is part of a multidisciplinary team. They have specialised, factual and theoretical knowledge in stroke care to assess and use decision-making skills to deliver care. They contribute to service development and personal development. They may delegate, supervise staff or provide training to healthcare professionals in levels 4 or below in the career framework level.

Skills for Health Career Framework: Level 6

Recommended education requirements at entry point or for achievement during post: Stroke-specific course, practice assessor preparation; level 6 knowledge and skills achieved

This practitioner has a critical understanding of theoretical and practical knowledge within stroke care, usually through a stroke-specific course. The practice assessor teaches and/or supports the learning of other nurses in practice, assessing their achievements against pre-specified outcomes. They have achieved an understanding of principles of teaching and learning.

Skills for Health Career Framework: Level 7

Recommended education requirements at entry point or for achievement during post: Master’s degree (e.g. advanced practice or healthcare education) or Master’s Clinical Research with clinical education postgraduate certification; or Master’s Clinical Education; level 6 knowledge and skills achieved

This practitioner provides care at an advanced level, adhering to the scope of practice and the 4 pillars of Advanced clinical practice. They show innovation and are strongly involved in service improvement and service change within the area of education. This practitioner leads and/or has developed specific education and training programme. They have full understanding of how to embed research into teaching practice.

Skills for Health Career Framework: Level 7

Recommended education requirements at entry point or for achievement during post: Master’s degree/Professional Doctorate/Doctor of Philosophy; level 6 knowledge and skills achieved

This practitioner provides care at an advanced level, adhering to the scope of practice and the 4 pillars of Advanced clinical practice. They show innovation and lead service improvement and service change both within clinical practice and within the area of education. This practitioner leads and/or has developed specific education and training programmes within higher education institutions and will be jointly appointed between clinical practice and a university. They have full understanding of how to embed research into teaching practice.

Skills for Health Career Framework: Level 8

Recommended education requirements at entry point or for achievement during post: Professional Doctorate/Doctor of Philosophy

This practitioner provides care at an advanced level, adhering to the scope of practice and the 4 pillars of Advanced clinical practice. They show innovation and lead service improvement and service change both within clinical practice and within the area of education. This practitioner leads and/or has developed specific education and training programmes within higher education institutions and will be jointly appointed between clinical practice and a university. They will lead or provide mentorship to more junior members of staff and will have a developing national profile, actively engaging with research within stroke care clinical education.

Skills for Health Career Framework: Level 8

Recommended education requirements at entry point or for achievement during post: Professional Doctorate/Doctor of Philosophy

This practitioner provides care at an advanced level, adhering to the scope of practice and the 4 pillars of Advanced clinical practice. They show innovation and lead service improvement and service change both within clinical practice and within the area of education. This practitioner leads and/or has developed specific education programmes within higher education institutions and will be jointly appointed between clinical practice and a university. They will lead or provide mentorship to more junior members of staff and will have an established national profile and developing international profile, leading programmes of research and disseminating best practice and pedagogy within stroke care clinical education.

Traditional Academic Pathway

Traditional academic pathway The Traditional Academic Pathway is based on the UK Professional Standards Framework for Teaching and supporting learning in higher education. Consultation of the full document is recommended. We acknowledge that titles between academic institutions may differ.

Skills for Health Career Framework: Level 5

Recommended education requirements at entry point or for achievement during post: Diploma or Degree; and registration

Working in an acute or community setting, providing care to people who have had a stroke. This Practitioner is part of a multidisciplinary team. They have specialised, factual and theoretical knowledge in stroke care to assess and use decision-making skills to deliver care. They contribute to service development and personal development. They may delegate, supervise staff or provide training to healthcare professionals in levels 4 or below in the career framework level.

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Clinical Academic Research Pathway

Clinical academic research pathway The Clinical Academic Research Pathway reflects the established Clinical Academic Research Career Framework for Nursing, Midwifery and Allied Health Professions. Below we summarise the main points in this framework. Practitioners at any level of the Skills for Health Career Framework (i.e. levels 5 to 9) can pursue this pathway.

Early Clinical Academic Research Career; Pre-Doctoral Clinical Academic Fellowship

Recommended education requirements at entry point or for achievement during post: Master’s degree or Master’s Clinical Research or Master’s degree (advanced practice)

This practitioner has consolidated skills and expertise in stroke care and is an agent for change, developing and implementing local and national policies and/or guidelines. They are able to translate research findings and implement evidence-based practice as well as support research projects in their clinical areas. In addition, in this role, they have developed their research knowledge and skills and take a lead in an activity within research (e.g. Data collection) within their local services.

Middle Clinical Academic Research Career; Clinical Doctoral Research Fellowship

Recommended education requirements at entry point or for achievement during post: Doctor of Philosophy 

This practitioner develops specialist knowledge and skills in stroke care, acting as a clinical resource to staff and students in stroke nursing. Within research, they may be a Co-Investigator, contributing to research development in their field. They deliver and facilitate academic education, including mentoring and supervising doctoral students.

Middle Clinical Academic Research Career; Clinical and Senior Clinical Lectureships

Recommended education requirements at entry point or for achievement during post: Doctor of Philosophy and/or Post-doctoral experience

This practitioner has developed highly specialist knowledge, skills and expertise in stroke nursing. Within research, they may be a Chief Investigator on grant applications, advancing delivery of evidence-based practice. The advanced practitioner builds stroke clinical and research network, develops own practice, whole services and teams.

Late Clinical Academic Research Career

Recommended education requirements at entry point or for achievement during post: Doctor of Philosophy and post-graduate certificate in research supervision; accredited leadership training

This practitioner has developed advanced theoretical and practical knowledge, allowing them to provide expertise and leadership in their clinical practice. They have a national and international reputation. The Consultant Practitioner works on the development across services and/or the wider organisation. 

Late Clinical Academic Research Career

Recommended education requirements at entry point or for achievement during post: Doctor of Philosophy and post-graduate certificate in research supervision; accredited leadership training 

The Clinical Professor leads service transformation in the whole organisation and/or across healthcare systems. They provide clinical and professional leadership nationally, lead research programs national and internationally, manage and supervise research teams. They have a sustained an international reputation in research.

Leadership and Management Pathway

Management pathway

The Leadership and Management pathway stems from the need to value, recognise and consider the management and leadership skills and knowledge of registered nurses with stroke expertise in organizations and teams, at local, regional and/or national level. The role of the practitioner in this pathway has a stronger emphasis on management and leadership in comparison with the other pillars of advanced clinical practice.

Skills for Health Career Framework: Level 6

Recommended education requirements at entry point or for achievement during post: Stroke-specific education; level 5 knowledge and skills achieved

This practitioner works in the same setting as the Registered nurse – Stroke. They have a critical understanding of theoretical and practical knowledge within stroke care, usually through an accredited postgraduation training. In addition to the previous skills at level 5, they have added responsibilities such as delegating, supervising or providing training to a team of nurses.

Skills for Health Career Framework: Level 7

Recommended education requirements at entry point or for achievement during post: Accredited leadership training at postgraduate level; level 6 knowledge and skills achieved.

This practitioner is responsible for managing an area, teams and resources. They show innovation and are strongly involved in service improvement and service change. 

Skills for Health Career Framework: Level 8

Recommended education requirements at entry point or for achievement during post: Master’s degree (eg.  advanced practice or healthcare education or Business Administration); accredited leadership training at postgraduate level; level 7 knowledge and skills achieved

The lead nurse – Stroke provides leadership to a service, ensuring it delivers high-quality care. They monitor the quality of care delivered to patients and have responsibility and accountability for staff satisfaction. 

Skills for Health Career Framework: Level 9

Recommended education requirements at entry point or for achievement during post: Master’s degree (eg. advanced practice or healthcare education or Business Administration); accredited leadership training at postgraduate level; level 8 knowledge and skills achieved

This practitioner leads an organisation and team, setting its strategic goals. Such roles include but are not limited to, Clinical Lead/Director for Stroke Services.

Demonstrating Evidence

For each role above, the knowledge, skills and capabilities required should be mapped against the Elements of Professional Practice (based on the 4 pillars of advanced clinical practice - clinical practice, research, education, leadership and management) and the Elements of stroke care (based on the Stroke-Specific Education Framework). Pillars of advanced clinical practice will vary in strength depending on the pathway and level of practice.

Evidence to demonstrate knowledge, skills and capabilities may include:

  • Supervision 
  • Capabilities assessments 
  • Simulation
  • Reflective accounts and discussions
  • Quality improvement projects
  • Feedback from patients, carers, their families; and colleagues within the wider multi-disciplinary team
  • Accredited courses and/or work-based learning options 
  • Examinations and certifications (e.g. NIH Stroke Scale Certificate of training; Good Clinical Practice)
  • Entrusted Professional Activities assessments 
  • Appraisals
  • Professional Development Reviews
  • Revalidation 
  • Serious Incidents reports
  • Case studies 
  • Job plans
  • Stroke competencies workbooks

Acknowledgements

Ismalia de Sousa, Project Lead UK Career Framework for Stroke Nurses; Doctoral Student at the University of British Columbia (Canada); Clinical Nurse Specialist in Stroke at Imperial College Healthcare NHS Trust (until July 2019); Intercollegiate Stroke Working Party (until December 2019); RCN Neuroscience Forum Steering Committee

Amanda Cheesley, RCN Professional Lead for Long Term Conditions and End of Life Care (until December 2019)

Dr Sue Woodward, Senior Lecturer at King’s College London; Chair of the RCN Neuroscience Forum (until December 2019)

Sandra Harding, RCN Professional Lead for Prince of Wales Nursing Cadets (until December 2019)

Claire Fullbrook-Scanlon Stroke Nurse and AHP consultant group representative

Ofrah Muflahi, RCN Professional Lead for Nursing Support Workers and Long Term Conditions (since Feb 2020)

Kylie Crook, Stroke Specialist nurse, Welsh Stroke Nurse Forum representative

Linda Campbell, Scottish Stroke Nurses Forum representative

Sandra Aitcheson, Nurse consultant for Older People, Northern Ireland Stroke Nurse Network representative

Professor Dame Caroline Watkins, Professor of Stroke & Older People’s Care, University of Central Lancashire; UK Stroke Forum and host of the Stroke-Specific Education Framework (Chair)

Colette Miller, Research Fellow at the University of Central Lancashire; Stroke-Specific Education Framework

Dr Liz Lightbody, Reader in Health Services Research at the University of Central Lancashire; National Stroke Nursing Forum representative (until August 2020)

Joseph Bailey, Stroke Specialist Nurse at Sheffield Teaching Hospitals; National Stroke Nursing Forum representative (since August 2020)

Carolyn Doyle, RCN Professional Lead for Community and End of Life (January 2020 until February 2020)

Debbie Quinn, Chair of RCN Neuroscience Forum (since January 2020)

Margaret Ojo, RCN Nursing Department Project co-ordinator

The following members provided feedback during the reference group consultation and at different stages of the project:

Prof Alison Leary, Professor of Healthcare and Workforce modelling, London South Bank University

Louise Ward, Interim Clinical Lead for Stroke, East Kent Hospitals University Foundation Trust

Dr Kathryn Jones, Health Education England

Beverley Harden, Health Education England

Gail Harries-Huntley, Health Education and Improvement Wales

Gill Coverdale, RCN Professional Lead for Educational Standards and Professional Development

Elizabeth Stebbings, Lead Clinical Nurse for Stroke, West Suffolk Hospital

Rachael Jones, Senior Advanced Nurse Practitioner for Stroke, Royal Wolverhampton NHS Trust

Louise Vincent, Medical Nurse Practitioner in Acute Stroke, Royal United Hospitals NHS Foundation Trust

Claire Bryant, Clinical Nurse Specialist – Stroke Coordinator, Bronglais Hospital

Dr Deb Lowe, National Clinical Director for Stroke NHS E&I; Joint Clinical Lead for GIRFT (Getting it Right First Time); Consultant Stroke Physician and Geriatrician at Wirral University Teaching Hospital NHS Foundation Trust and Clinical Lead for Stroke within the Strategic Clinical Networks and Senate

Dr David Hargroves, Joint Clinical Lead for GIRFT (Getting it Right First Time); Consultant Physicians and Clinical Lead for Stroke Medicine at East Kent Hospitals University Foundation Trust

Dr Adrian Brooke, Deputy Medical Director Workforce alignment NHS E&I stroke project board

Prof Tom Robinson, President of the British Association of Stroke Physicians

Dr Gill Cluckie, Stroke Nurse Consultant at St George’s University Hospitals; Joint Clinical Lead for Stroke within London; Intercollegiate Stroke Working Party (stroke nurse representative);

Jon Cooper, Consultant Physician with an interest in Stroke, Honorary Clinical Associate Professor, Chair of Stroke Medicine sSAC, Centre for Neuroscience Leads Teaching Hospitals NHS Trust

Northern Ireland Career Pathway Stroke Nursing Steering Group

The following members were consulted during the Wider stakeholder engagement:

RCN Neuroscience Forum members

National Stroke Nursing Forum members

Stroke Nurse and Allied Healthcare Professionals Consultant Group

Intercollegiate Stroke Working Party members 

UKSF Steering group

Welsh Stroke Nurse Forum members

Scottish Stroke Nurses Forum members

Northern Ireland Stroke Nurse Network members

Chest and Heart Scotland

Chest and Heart Northern Ireland

Health Education England

NHS Education for Scotland

Health Education and Improvement Wales