Defining advanced practice
We recognise that a considerable amount of work has been undertaken by a number of different organisations over the last few years to define 'advanced practice'. Some definitions are succinct statements while others outline the key elements of the role.
In this section of the toolkit, we have drawn together the key elements of definitions from work by organisations such as the International Council of Nurses (ICN), Skills for Health, the Royal College of Nursing (RCN), the Association of Advanced Nursing Practice Educators (AANPE) and the Nursing and Midwifery Council (NMC) to propose a consensus definition of advanced-level practice in the 'Achieving Consensus' sub-section.
The International Council of Nurses, International Nurse Practitioner/Advanced Practice Nursing Network definition of a Nurse Practitioner/Advanced Practice Nurse aimed to facilitate a common understanding and guide further development of these important roles (ICN 2001). The ICN definition of advanced nursing practice identified the need for the following components:
"A registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A Master's degree is recommended for entry level."
The ICN also outlined its perspective of the characteristics of advanced practice. This work on Scope of Practice, Standards and Competencies of the Advanced Practice Nurse was revised in May 2008.
Skills for Health developed the Career Framework for Health in 2006. (This has been enhanced by the Scottish Government guidance on the Career Framework, 2009). It provides steps on a structured career ladder that can be characterised as level 'benchmarks' to support consistency.
The framework places the 'Advanced Practitioner' at Level 7, defining advanced practitioners as:
"Experienced clinical professionals who have developed their skills and theoretical knowledge to a very high standard. They are empowered to make high-level clinical decisions and will often have their own caseload. Non-clinical staff at Level 7 will typically be managing a number of service areas."
Skills for Health has also provided role-level descriptors for each of the levels of the Career Framework (Skills for Health, 2007). The elements described for 'Advanced Practice' (Level 7) are set out in this document.
Theoretically, all health care roles can be mapped to the Career Framework for Health. The Skills for Health definition for advanced-level practice therefore relates to a wide range of professional roles and can be seen as an over-arching definition of 'advanced practice' which crosses professional groups and practice contexts, such as education and management/leadership.
From a nursing perspective, the definition is clearly consistent with the ICN characteristics of an advanced-level nurse.
The NMC definition of the advanced nurse practitioner (NMC, 2005) is shown in this document.
The NMC definition can be viewed as a contextualisation of the wider international definition of the clinical 'advanced-level practice' nurse. The Royal College of Nursing and Association of Advanced Nursing Practice Educators (2006) subsequently worked with the NMC to map the related competencies to the Knowledge & Skills Framework (KSF).
Many clinical areas of practice are comfortable with this definition for a clinical advanced nurse practitioner role, although there are concerns (particularly from mental health and learning disability practitioners) that the statement 'carry out physical examinations' is too restricted to acute physical health. They feel it may be more accurate to state 'carry out in-depth clinical assessments'.