Defining advanced practice
In this section of the toolkit, we have drawn together the key elements of definitions from work by organisations. These are:
- International Council of Nurses (ICN)
- Skills for Health
- Royal College of Nursing (RCN)
- Association of Advanced Nursing Practice Educators (AANPE)
- Nursing and Midwifery Council (NMC)
These have been used to propose a consensus definition of advanced-level practice in the 'Achieving Consensus' sub-section.
Three of the definitions produced by the organisations listed above are further explored below:
- International Council of Nurse definition
- Skills for Health Career Framework for Health definition
- Nursing and Midwifery Council definition
This definition is 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 Nurse Practitioner/Advanced Practice Nurse is 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.' (ICN) http://international.aanp.org/Practice/APNRoles
The ICN have published the Scope of Practice, Standards and Competencies of the Advanced Practice Nurse and this was revised in May 2008 and is available for purchase here.
The Career Framework for Health (click to download document) 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 a roles directory which provides information describing roles arranged by titles and Career Framework levels.
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 revised their definition of advanced nurse practice in February 2006 so that it could be accessible to patients and the public.
"Advanced nurse practitioners are highly experienced and educated members of the care team who are able to diagnose and treat your health care needs or refer you to an appropriate specialist if needed."
They also expand this definition to provide patients, their carers and other health care professionals with more detailed information about what they can expect of an advanced nurse practitioner, have and have provided this information on the NMC website.
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'.