Achieving consensus
The Advanced Practice Toolkit aims to use the emerging consensus around advanced practice to pull together educational, operational and organisational streams to support clarity and consistency. We want to establish a developmental pathway through which existing and new practitioners can work with their managers and service leads to:
- benchmark their competence
- identify developmental needs
- demonstrate the accepted and recognised attributes of advanced practitioners.
Advanced practice themes and definitions
Parallels of definitions
We see clear parallels between the NES principles and themes and the NMC/RCN/AANPE competencies and the nationally agreed elements of Advanced Practice, Department of Health 2010.
. We believe they describe the same 'level' of practitioner. NES has been using these to structure their capability frameworks (see 'Resources' in this section), providing a strong link to support practitioner development.
We see the Skills for Health definition, from the Career Framework for Health, as providing clear articulation of high levels of decision-making, skills and knowledge. It recognises the cross-professional nature of advanced practice and acknowledges the non-clinical advanced practitioner role.
The International Council of Nurses (ICN) definition of the advanced nursing role has application beyond the purely clinical domain and places nursing role development within an international context. It recognises the contextual nature of the skills that might be exhibited by an advanced practitioner, although the level of practice would be consistent in relation to autonomous practice, critical thinking, decision-making and problem-solving and the other underpinning principles.
The Nursing and Midwifery Council (NMC) definition articulates the clinical 'advanced nurse practitioner' role within the UK context. We recommend the adoption of a minor change to the NMC definition, to amend the phrase 'carry out physical examinations' to read 'carry out in-depth clinical assessments'. We believe that this better reflects the role across different clinical contexts.
Advanced practice themes and definitions
This links to the NES advanced practice themes, which describe advanced practice across the four domains. More detailed definitions can then be created for each of the other domains to demonstrate the advanced practice level within that domain.
Relationship between advanced practice themes and definitions
For example, the review of the senior charge nurse/midwife role in Scotland, Leading Better Care (Scottish Government, 2008), has provided a structured role framework for the clinical leadership/ management role that will map against this model. Emerging work around clinical education careers (practice education) and clinical academic careers (research) provide the appropriate background for the development of the other articulations.
This allows each clinical context to develop the applied characteristics of advanced practice skills and knowledge without diluting the core benchmarked elements of the level. It also provides greater opportunities for either movement across this level - between a clinical practice role and a clinical education or clinical management role - or recognition of the 'equal status' of such roles across contexts.
Our proposal...
We therefore propose the following:
- advanced practice is a 'level of practice' rather than a role or title
- the Career Framework for Health articulates 'Advanced Practitioners' across professional boundaries
- advanced practice in nursing can be broadly defined by the International Council of Nurses' definition
- the NMC definition articulates the clinical 'advanced nurse practitioner' role within the UK context
- advanced practice is shown across four key themes:
- advanced clinical/professional practice
- facilitating learning
- leadership/management
- research
- these themes are underpinned by autonomous practice, critical thinking, high levels of decision-making and problem-solving, values-based care and improving practice
- the skills and knowledge base for advanced practice are influenced by the context in which individuals practice.
