The Nursing and Midwifery Council (NMC) has acknowledged a growing debate concerning whether advanced practice requires regulation. There are various approaches to advanced practice across the four countries of the UK, and all are at odds with each other. The NMC 2020-2025 strategy (NMC, 2020) noted a plan to undertake a comprehensive review of advanced nurse practice, including consideration of whether regulation is needed.
As the ways in which health care is delivered change, there is an opportunity to restructure healthcare roles to meet future needs. The increasing number of people with long-term or complex multiple conditions, for example, would benefit from receiving services from an advanced clinical practitioner (ACP). Advanced clinical practice over the years has expanded beyond nurses and now advanced-level practitioners come from a range of professional backgrounds including nursing, pharmacy, paramedics, occupational therapy, healthcare science and midwifery. Leary and MacLaine (2019) noted that, although this does much to highlight the importance of recognising advanced practice as a level of care that comes with common core characteristics across professions, it has also added to the complexity. In 2017 Health Education England (HEE) produced a multidisciplinary framework for advanced clinical practice. The framework aims to ensure that there is uniformity across England as well as enhance understanding of the ACP role. Advanced clinical practice requires practitioners (and those who aspire to the role) to understand how to communicate effectively, working with patients and carers as they aim to enhance patient outcomes and improve patient satisfaction, generate an ability to self-manage healthcare needs and to collaborate with care planning. Those health and care professionals working at the level of advanced clinical practice are required to have developed their skills and knowledge aligned to the standards outlined in the HEE framework and the four pillars that underpin it: clinical practice, leadership and management, education, and research.
If the growth of the ACP is to become a reality this will also require organisational change, to facilitate role expansion in an environment that is supportive of the possibilities for positive patient outcomes and the practitioner's professional development. Advanced practice roles require a regulatory framework in order to define advanced practice and the education this requires. If this approach is adopted across the UK (and the regulators coming together could achieve this) it could lead to less confusion as to what advanced nursing practice comprises, as well as the implications for patient safety. ACPs must be supported in their role by their employers as well as everyone working around them. This will encourage innovative ways of working in contemporary care environments.
It is important that the level of advanced clinical practice is widely explained and understood by the rest of the workforce, as well as by service users. Much of this task falls to the ACP, who must disseminate widely the role and function and the benefits for enhancing patient outcomes. Twenty years ago BJN reported that it was possible to recognise nurses who were working at a higher level of clinical practice, emphasising the level of responsibility, functioning and competence that determine how practitioners are recognised, as opposed to the title that they use. What was accepted then was the need to accept and adopt levels of clinical practice, including higher-level practice, acknowledging the levels would provide a much clearer clinical career framework or structure (Castledine, 2001). In this issue, BJN starts a new series on the role of the ACP and advanced clinical skills. Articles will cover topics such as critical thinking and diagnostic reasoning, as well as prescribing practice, consultation and clinical assessment.