Specialist and Advanced Practice

 

 

Specialist Practice

Nurses working with a 'specialist' title continue to contribute in important ways to health care provision in NHS Scotland. Specialist roles do however differ and there is no shared understanding amongst the public, service leads and practitioners of what the 'specialist' role actually entails. This may reduce the impact and effectiveness of such roles.

Considerable debate has focused on whether 'specialist' practice is at a lower level than 'advanced'. In fact, it is increasingly recognised that 'specialist' should be considered as one pole of the 'specialist-generalist' continuum, rather than on the developmental continuum from 'novice' to 'expert'. This approach defines 'specialist' practice as that which is particular to a specific context, be it a client group, a skill set or an organisational context.

Advanced Level Practice

'Advanced' practice, it is argued, is a particular stage on a continuum between 'novice' and 'expert' practice.

The 'advanced' role profile is characterised by high levels of clinical skill, competence and autonomous decision-making and reflects a particular benchmark on the career development ladder, as exemplified in the Career Framework for Health (Skills for Health, 2006) and Scottish Government, 2009.

Junior-level specialist and/or the advanced generalist

While many 'specialist' nurses may function at an 'advanced' level, it is possible to identify roles that might characterise the 'junior-level specialist' and/or the 'advanced generalist' role (Fig. 2.1).

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Fig. 2.1 Relationship between specialist and advanced practice.

Fig. 2.1 recognises that the developmental pathway towards advanced level practice in nursing may be different for individual practitioners, with some following a 'specialist nursing' route through focus on high-level skills and decision-making within a particular client group or clinical context, while others will develop a portfolio that reflects high-level assessment, decision making and autonomous practice across a greater breadth of practice.

'Senior' and 'advanced'

Scottish Government guidance on the Career Framework for Health replaced the term 'Specialist' with 'Senior' practitioner and we would advocate the use of the terms 'senior' and 'advanced' when describing benchmarked developmental levels, The term 'specialist', if required, woudl be used to define specific contextually focused role types.

This is not to devalue 'specialist' knowledge or skills, or the roles of existing Specialist Practitioners, but to recognise that these roles do not necessarily characterise an advanced level of practice.

For example, in the NES Professional Development Framework for Specialist and advanced Cancer Nurses (NES 2008), a 'specialist nurse' is regarded as someone with in-depth knowledge and skills in the speciality who would usually be functioning at Level 6 of the career framework (the level of 'Senior Practitioner').