This narrative review was undertaken between January 2020 and May 2020 to explore the global development of advanced practice roles in healthcare, reflecting on international differences in role definition, expectations, scope and level of practice (Sandars, 2017). This review forms the first part of a two-part study aimed at exploring the global development of advanced clinical practice (part 1) and the learner experience of training, preparation and role transition (part 2).
Method
The SPIDER (sample, phenomenon of interest, design, evaluation and research type) was used to develop eligibility criteria, develop a search strategy and facilitate rigour in the research (Cooke et al, 2012). The SPIDER framework has a mixed-methods focus so is considered more suitable than other frameworks, such as PICO (population, intervention, comparison and outcomes) (Cooke et al, 2012).
The CINAHL and PubMed databases were searched. Citation lists of articles that appeared most relevant were searched, as well as articles mentioned in discussions in those studies. Inclusion criteria included peer-reviewed literature in the field of advanced practice, and non-peer reviewed literature was excluded.
Exploration of literature illustrated was classified under seven subheadings:
- History and global development of advanced nursing/clinical practice
- Leading developments in health care and advanced practice
- Defining advanced practice
- Global definition, education preparation, regulation and accreditation of the advanced nursing practitioner/advanced clinical practitioner (ANP/ACP) role
- Education preparation and assessment for advanced practice
- Mentorship and multidisciplinary learning
- ANP/ACP role preparation and transition.
History and global development of advanced nursing/clinical practice
Advanced nursing/clinical practice has emerged worldwide in response to the demands of changing complex healthcare needs and ageing populations, and the need to improve services and outcomes, decrease waiting times and reduce overall healthcare cost (Goldsberry, 2018).
Fundamental to role implementation were the global reduction in medical staff and the introduction of the European Working Time Directive, which reduced working hours for doctors across Europe (Royal College of Nursing (RCN), 2018). This reduction and stress on healthcare systems have made it necessary for non-medical practitioners to develop medical skills, including clinical examination, diagnostics, critical analysis, synthesis and complex problem solving-skills across multiple healthcare disciplines to deliver and sustain high-quality and safe health care (Gray, 2016).
King et al (2017) identified further influencing factors, including the need to improve access to services and care for specific patient population groups plus the implementation of government policies. Furthermore, King et al (2017) highlighted the continuous and growing needs for interprofessional collaboration and improvements in nurse education, as well as evidence of the benefits to patient care, overall healthcare outcomes and cost-efficiency from ANP/ACP implementation.
Since advanced clinical practice was introduced in the 1960s, its scope and level have evolved, and the ANP/ACP role is now recognised as a highly valued and integral part of healthcare systems (Hu and Forgeron, 2018). ANP roles were first recognised and introduced in the USA in the 1960s (Furlong and Smith, 2005).
Following this, the ANP role began to evolve globally, emerging in Canada in the 1960s, in the UK in the mid-1980s, New Zealand and Australia in the 1990s, and Hong Kong and China in 2002 (King et al, 2017; Parker and Hill, 2017). By 2008, 70% of hospitals worldwide had some form of advanced practice and well-established advanced nursing practice programmes (Sheer and Wong, 2008). This led to a growing emergence of ACP roles among other professional disciplines, such as pharmacy, physiotherapy and paramedic practice (Health Education England (HEE), 2017).
Loretta Ford and Henry Silver introduced paediatric and neonatal advanced ANP/ACP roles in 1965, following the development of training programmes to increase health services to poor children living in rural and urban areas. This training was considered to be the birth of the nurse practitioner movement and subsequently led to the introduction of the first certificated education programme for paediatric advanced nursing and the development of the paediatric nurse practitioner role (Aruda et al, 2016).
In the UK, the advanced neonatal nurse practitioner (ANNP) role was first developed in the 1980s, primarily to provide care for critically ill infants in intensive care settings. With the introduction of the ANNP master's programme in 1992, by 2012 it was estimated that there were more than 250 practising ANNPs in the UK. As the ANNP and advanced paediatric nurse practitioner roles evolved across the critical care setting, further advanced practice roles emerged across multiple neonatal and paediatric healthcare settings (HEE, 2017).
Leading developments in health care and advanced clinical practice
Early policy drivers for the ANP role in the UK included The NHS Plan: a Plan for Investment, a Plan for Reform (Department of Health (DH), 2000). This plan aimed to modernise and redesign healthcare services to provide flexible services and break down fixed boundaries between medical and other health professionals. The plan was an important step in establishing closer relationships between the private sector and the NHS, with particular focus on collaborative working to ensure the quality and safety of services.
In the USA in 2008, the Robert Wood Johnson Foundation and the Institute of Medicine (IOM) launched a 2-year initiative to assess and transform the nursing profession. Following this, in 2010 the IOM report, The Future of Nursing: Leading Change, Advancing Health, published recommendations for an action-oriented blueprint for the future of nursing. This landmark report led the way for advancements in nursing roles and education, with global recognition of a time for change in healthcare leadership.
This brought significant changes in relation to leadership in the NHS, with a strong emphasis placed on inspiring a shared vision and collaborative learning (NHS Leadership Academy, 2011; Storey and Holti, 2013). The introduction of this leadership framework (NHS Leadership Academy, 2011) and the healthcare leadership model (Storey and Holti, 2013) 2 years later placed leadership and collaborative working at the forefront of the NHS vision and values (Storey and Holti, 2013).
This approach, as highlighted by Giltinane (2013), involved leading and influencing the development of shared values, vision and expectations to enhance organisational goals and overall effectiveness. Furthermore, it was identified that for the entire healthcare system to function effectively and efficiently, the entire workforce must function simultaneously, sharing leadership agendas, qualities and skills (Brockbank et al, 2011). This strategic vision and leadership in health care was deemed paramount to the management of increasingly complex healthcare organisations, generating much-needed change and innovation in healthcare practice (Martin et al, 2014).
The healthcare leadership model (Storey and Holti, 2013) was introduced after the Mid Staffordshire NHS Foundation Trust scandal. Concerns regarding the adequacy of leadership in the NHS and the quality, delivery and safety of care in some healthcare settings were highlighted. These serious failings were identified in the landmark Francis report (Francis, 2013); this prompted a review of leadership in the NHS, which found a great need for improvement, which in turn led to the crucial restructuring of delivery of efficient and safe healthcare services across the NHS (Muls et al, 2015). Vast improvements in healthcare services, care quality, reporting systems and patient safety collaboratives were deemed paramount.
The Francis report highlighted that it is essential for everyone involved in health care—staff, clinicians, patients, leaders, commissioners and regulators—to work collaboratively to assess and improve safety, build capability and focus on actions that could make the biggest difference to patients (Francis, 2013). This extensive review arising from the public inquiry identified critical attributes the NHS should have and subsequently made 290 recommendations, including openness, transparency and candour throughout the healthcare system, fundamental standards for healthcare providers, improved support for compassionate caring and committed care and stronger healthcare leadership (Francis, 2013). This prompted the proposal of this new leadership model.
Following this, the NHS England (2014)Five Year Forward View and the Next Steps on the Five Year Forward View (NHS England, 2017) set out challenges experienced by the NHS, its possible future and choices made (HEE, 2017).
As the demand for services intensifies and issues related to gaps in the current workforce emerge, against a background of low staff retention and recruitment rates and continuing growing financial constraints, the growth of multiprofessional advanced clinical practice has become integral to improving healthcare services and outcomes, with its ongoing emergence supported in the NHS Long Term Plan (NHS England/NHS Improvement, 2019). The plan highlights how advanced clinical practice is central to transforming service delivery and identifies it as a key component of contemporary workforce planning in the NHS. It illustrates how advanced clinical practice effectively meets health needs by providing enhanced capacity, capability, productivity and efficiency within multiprofessional teams.
In relation to health services for children and young people, the Kennedy report, Getting it Right for Children and Young People, highlighted a lack of priority given to children, young people and families within the NHS (Kennedy, 2010). Following this, the DH (2012) Report of the Children and Young People's Health Outcomes Forum, built on the Kennedy report (2010), identifying the fundamental review of child health services, setting out priorities for political and professional action and supporting the principle of constructing holistic child health services centred around the child and family and the ‘patient journey’ (RCN, 2018).
In 2017, HEE published the Multi-professional Framework for Advanced Clinical Practice in England, focusing on ‘four pillars of advanced practice: clinical practice, leadership and management, education and research’. The framework aims to define and standardise advanced practice in England, and similar frameworks were produced in Scotland, Wales and Northern Ireland (HEE, 2017). In addition, Barnes et al (2019) developed the Cheshire and Merseyside Governance Framework for Advanced Clinical Practice: Paediatrics and Neonates as part of the Vanguard New Models of Care Programme (Barnes et al, 2019). These frameworks were introduced to provide academic and clinical guidance on advanced clinical practice.
Defining advanced practice
Integration of advanced practice roles is complicated by the lack of a universal definition of what constitutes advanced practice (Casey et al, 2017). With such global variation, a lack of clarity regarding boundaries, levels of practice, autonomy and practitioner preparation is evident, suggesting international inconsistency (Bryant-Lukosius and DiCenso, 2004; Stasa et al, 2014; Casey et al, 2017).
Evident in the literature, however, is that globally ‘advanced practice’ is arguably based on either ‘scope of practice’ or ‘level of practice’, with these determinants dependent on in which country and or region the ANP/ACP is practising (International Council of Nurses (ICN), 2008). Internationally, the consensus definition of the ANP role is ‘registered nurses who have 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’ (ICN, 2008:7). This international consensus indicates differences around the world in ANP/ACP role, expectations, responsibilities and title protection. Moreover, levels of education required to enter the role, advanced practice training and qualification, regulation, licensing and accreditation vary across the globe (Parker and Hill, 2017). Arguably, these global differences define the ANP/ACP role worldwide.
ANP/ACP: global definition, education, regulation and accreditation
In the USA, the advanced practice registered nurse (APRN) is an umbrella term that covers four types of advanced nursing practice roles and is associated with practitioner scope of practice. These practitioners are clinical nurse specialists, nurse practitioners, nurse midwives and nurse anaesthetists (Parker and Hill, 2017).
Scope of practice concerns the process, procedures and actions that licensed practitioners are permitted to carry out. It is limited by licensing bodies and regulations and determined by education, training and competency (Wilhite, 2012). All role titles under the APRN umbrella are legislatively protected, regulated and certified positions (Parker and Hill, 2017). The APRNs are experienced registered nurses with an extended scope of practice. They must undertake an accredited, graduate-level course, pass a national certification exam and obtain a licence to practice (Stasa et al, 2014). Unlike in the UK, the ANP role in the USA has required doctorate-level qualification since 2015 (Morgan et al, 2012; Parker and Hill, 2017).
Similarly to the USA, in New Zealand, ‘advanced nursing practice’ differs from expert practice and extended roles and is connected with ‘scope of practice’ (New Zealand Nurses Organisation, 2020). nurse practitioners (NPs) are registered to practise within a speciality area and must have a minimum of 4 years' experience. An approved master's qualification is required and the NP title is protected.
In contrast, in Canada, Australia and the UK, advanced nursing practice refers to a ‘level of practice’. In Canada, advanced nursing practice covers two advanced nursing practice roles, the clinical nurse specialist (CNS) and the NP. The CNS provides expert care for particular population groups, while the NP has a much larger and regulated scope of practice, providing direct care with authority to diagnose, order diagnostic tests and prescribe medication (Parker and Hill, 2017). Graduate-level education is recommended for entry, with master's-level education completed for NP level and with only the NP role regulated and having title protection (Parker and Hill, 2017).
In Australia, the ANP has a level of practice that uses extended and expanded skills, is educated to postgraduate (master's) level but may work within a speciality or generalist capacity (Parker and Hill, 2017). The Nursing and Midwifery Board of Australia, (2011) endorses the basis of advanced practice as a high degree of knowledge, skill and experience. The role involves legislative authority to prescribe medications, refer clients to specialist medical practitioners and request diagnostic tests.
Advanced practice in the UK is viewed as a level of practice (NHS Wales, 2010; Department of Health, Social services and Public Safety, 2016; HEE, 2017). ANPs are nurses who practise with a higher degree of autonomy and responsibility than registered nurses across the domains of clinical practice, education, research, leadership and management (Stasa et al, 2014). These domains are set out in the HEE's (2017)Multi-professional Framework for Advanced Clinical Practice in England. The framework defines advanced practice as ‘clinical practice delivered by experienced, registered health and care practitioners. It is a level of practice characterised by a high degree of autonomy and complex decision making. This is underpinned by a master's-level award or equivalent that encompasses the four pillars of clinical practice, leadership and management, education and research, with demonstration of core capabilities and area specific clinical competence’ (HEE, 2017:8).
The RCN defines advanced practice as ‘a level of practice, rather than a type of practice. Advanced nurse practitioners are educated at master's level in clinical practice and have been assessed as competent in practice using their expert clinical knowledge and skills. They have the freedom and authority to act, make autonomous decisions in assessment, diagnosis and treatment of patients' (RCN, 2020a: 4).
The role involves working at an ‘advanced level’ of clinical practice, managing the clinical care of patients in partnership with patients, families and carers. It incorporates analysis and synthesis of complex problems, enabling innovative solutions with the aim of enhancing people's experiences and improve outcomes. Health professionals working at this advanced level exercise autonomy and complex decision-making and are held accountable for these (HEE, 2017). Comparable to Canada and Australia, the ANP role in the UK involves clinical examination, diagnostics, referral to specialist practitioners, prescribing of medications and practising as an independent, autonomous practitioner (Barnes et al, 2019).
Regulation is crucial to the development of advanced clinical practice to ensure consistency in credentialing and accreditation of educational preparation (ICN, 2008). However, evident in the literature is that wide global variation still remains in the regulation of advanced practice roles (Illingworth et al, 2013). The UK has yet to establish registration and regulation (Illingworth et al, 2013; Nadaf, 2018).
Current authority of ANP/ACP regulation in the UK is held by the Professional Standards Authority, which highlights that activity by ANP/ACPs must not go beyond the scope of existing regulation (HEE, 2017). It is advised that practitioners working at an advanced level of practice must work within their limitations and recognise their scope of practice (Barnes et al, 2019). Accountability lies with the practitioner's professional regulatory body, with individual trusts carrying responsibility and vicarious liability (Barnes et al, 2019). All ANPs/ACPs must work within their scope and code of professional practice regulated by their professional body (Nursing and Midwifery Council (NMC), 2018). The emergence of advanced practice roles in nursing and other healthcare disciplines has given rise to debate over central regulation and the implementation of the umbrella title of ‘advanced clinical practitioner’ (ACP), which will include all advanced healthcare practitioners from all healthcare disciplines practising at an accredited advanced practice level (HEE, 2017).
The RCN (2018), however, has set out Standards for Advanced Level Nursing Practice. These standards state that nurses working at this advanced level must meet the following standards:
- Have an active registration with the NMC
- Practice within the four pillars
- Have a job plan that demonstrates advanced nursing practice and has equity with peers working at this level
- Be educated to master's level
- Be an independent prescriber
- Meet NMC revalidation requirements
- Demonstrate evidence of working autonomously.
Currently in the UK, advanced practice includes nurses (adult, mental health, paediatric and neonatal) and allied healthcare practitioners (such as physiotherapists, pharmacists and paramedics) who have completed an accredited master's-level award in advanced practice as well as the non-medical and supplementary prescribing award (Department of Health, Social Services and Public Safety, 2016). The master's-level qualification came into force in 2016. Any ANPs/ACPs practising before 2015 must show evidence of the working within four pillars of advanced practice (RCN, 2018).
In 2017, credentialing was introduced in the UK by the RCN (2018). This, together with the HEE (2017) advanced practice framework, has contributed significantly to the definition and level of advanced practice roles in the UK (HEE, 2017; Nadaf, 2018; Barnes et al, 2019).
The promotion of a collaborative learning approach across multiple disciplines is embedded in today's advanced practice education provision. This helps ensure practitioners are equipped with essential knowledge and skills required for advanced healthcare roles and bridge the gap between practitioners, promoting an improved, streamlined healthcare service (HEE, 2017; Barnes et al, 2019).
UK education preparation and assessment for advanced practice
In the UK, the master's-level advanced practice education is completed over 2–3 years and combines academic and clinical work-based learning. The curriculum encompasses anatomy and physiology, clinical examination and diagnostics, comprehensive history-taking and differential diagnosis, management of acute and chronic illness, emergency management, mental health, research, independent and supplementary prescribing and a dissertation study (HEE, 2017; Barnes et al, 2019).
Following academic achievement, ACPs must provide evidence of ongoing continuing professional development structured around the four pillars of advanced practice to illustrate crucial maintenance of existing skills and competence. This will be used as evidence for credentialing for individual governing and regulatory bodies, ensuring fitness to practice (Barnes et al, 2019). All ANPs/ACPs have to revalidate every 3 years (RCN, 2020b).
Mentorship and multidisciplinary learning
Health professionals' education relies heavily on learning through experience within the clinical environment, mentorship and guided clinical supervision (Morgan et al, 2012; Chen et al, 2016; Monahan et al, 2018). This experiential learning approach as described by educational theorist Kolb (1984) is essential in the learning process as knowledge construction and the clinical skills base need to relate theory and practice to consolidate learning, provide assessment and build practitioner competence and confidence, with the ultimate aim of achieving a practitioner who provides safe care and is independent and autonomous.
Within this guided support method, referred to by educational psychologist Brunner (1985) as a ‘scaffold approach’, support is slowly retracted as the learner develops and accomplishes learning objectives (Maybin and Mercer, 1992). This places an emphasis on collaborative learning with active engagement of both parties and on good mentor–mentee relationships. This learning experience is considered vital in developing crucial interprofessional communication skills, understanding differing healthcare roles and how they link together, and promotes interprofessional education (IPE) and interprofessional collaboration (IPC) across healthcare disciplines (Interprofessional Education Collaborative Panel (IPEC), 2016).
The role of IPC has been widely recognised by leading healthcare organisations, such as the IOM and the World Health Organization (WHO) as a key strategy to improve the value and quality of healthcare (Goldsberry, 2018). The WHO's (2010)Framework for Action on Interprofessional Education and Collaborative Practice gives detailed evidence on the need for interprofessional collaboration that promotes innovative strategies to strengthen the healthcare workforce for future generations. With IPE, this collaboration can positively contribute to global healthcare challenges (WHO, 2010). Moreover, IPE and IPC maximise the strengths and skills of health workers, enabling practitioners to function at their highest capacity. Innovation of this nature is paramount to manage the ongoing challenges and strains placed on healthcare systems worldwide (WHO, 2010). IPC improves access to clinical care and healthcare outcomes, and reduces patient complications and errors (WHO, 2010).
The WHO initially emphasised the importance of IPE in 1988 in its Learning to Work Together for Health, statement, with this becoming a key driver for further global legislation and policy (Gaskell and Beaton, 2010). They describe IPE as when two or more professionals learn with, from and about each other to improve collaboration and the quality of care (WHO, 2010). Supporting this, the IOM (2010) highlights that team collaboration should be the focus of healthcare systems to deliver accessible, high-quality, patient-centred care.
Following this, the IPEC (2011) revolutionised models of healthcare education, with the goal of increasing collaborative practice and reducing medical errors. Originating in 2009 as a collaborative of six national education associations of schools of health professions, IPEC grew to 16 by 2016 (IPEC, 2016). The IPEC (2016) update further defined the goal to help prepare future health professionals for enhanced team-based care of patients and improve population health outcomes (Figure 1). The IPEC (2020) vision for the future states: ‘Interprofessional collaborative practice drives safe, high-quality, accessible, person-centred care and improved population outcomes.’ Its mission is to collaborate with academic institutions to promote, encourage and support efforts to prepare future health professionals for interprofessional collaborative practice to ensure the health of individuals and populations. Four competencies for interprofessional collaborative practice were created to guide curriculum development across health profession schools.
This notion of IPC and the recognised need for IPE had been acknowledged earlier in the NHS Plan in 2000 and associated polices (DH, 2004). These outlined a commitment to improve multiprofessional team-working, with a requirement for greater multidisciplinary collaboration leading to the development of IPE (Cooper and Spencer-Dawe, 2006).
This view continues to be supported today in the NHS Long Term Plan (NHS England/NHS Improvement, 2019), where a comprehensive workforce implementation plan outlines the promise of an increase in nursing, medical and allied health professionals across the NHS, including an increase in ANP/ACP roles to meet continuing complex healthcare demands.
ANP/ACP role preparation and transition
A further review of literature specifically focusing on the learning experiences of ANP/ACPs after training was undertaken. This review yielded limited research findings.
Hart and Macnee's (2007) cross-sectional descriptive study evaluated perceived preparedness of nurse practitioners following academic completion. Overall, the study concluded adequate preparation was experienced in core areas of advanced practice, including health assessment, differential diagnosis and acute/chronic illness management; however, less preparedness was evident in advanced diagnostics, including radiology imaging, interpretation and practical procedures (Hart and Macnee, 2007). Study participants also reported that the education faculty lacked clinical competence, with faculty having little or outdated practice experience. This suggests a lack of credibility and arguably a negative learning experience.
This was echoed by Illingworth et al (2013), whose qualitative study identified a lack of practice teachers and mentors to support acquisition of advanced practice knowledge and skills, leading to concerns regarding structure and organisation of advanced practice programmes.
One common theme emerging from the literature is the fundamental need for mentorship and guided clinical support during training and thereafter. Hart and Macnee (2007) highlighted the need for more clinical learning hours, and specifically recommended that students would benefit from a lengthy final residency or fellowship during the post-qualification transition period.
Supporting this, Hill and Sawatzky (2011) said mentorship in the transition period was essential for the development of knowledge, skill and competence. They also acknowledged the psychological effects of transition. Internal stressors associated with a perceived need to be fully competent and external stressors, such as workload and their impact on the transition process, were identified. Feelings of isolation and a lack of emotional support were detrimental to transition and led to diminished enthusiasm and negative experiences (Hill and Sawatzky, 2011).
Supporting these findings, Robeano et al (2019) highlighted the transition from experienced nurse to novice ANP/ACP was stressful and challenging, and suggested that support needed to be provided from selection and recruitment and through the learning journey, with heightened focus on wellbeing, effective mentorship and organisation-level support. This supports well-established educational learning theories described by Benner (1984) and Dreyfus (2004), whereby learning is described as a process, progressing through stages from novice to expert.
Illingworth et al's (2013) qualitative study used focus groups and semistructured interviews to explore the educational experiences of students preparing for advanced nursing roles in England. The study highlighted a variance and inconsistency of participant perceptions of skill acquisition and knowledge transfer, despite a consensus of ‘overwhelming’ learning. One participant described the educational journey as ‘a roller-coaster’, suggesting intensity in the learning process and in the ability to retain the vast amount of learning required (Illingworth et al, 2013). Supporting Hill and Sawatzky (2011), Illingworth et al (2013) highlighted a continuing concern over disparity and inequality of support for trainee learning and development in practice across organisations, which led to negative feelings of role accomplishment and satisfaction, thus supporting the need for a more structured learning journey incorporating organisational support and effective mentorship, as highlighted by Robeano et al (2019).
Further supporting this, a literature review undertaken by Fitzpatrick and Gripshover (2016) identified a need for more structured education and support for trainee nurse practitioners with a lack of frameworks to support the transition from novice to expert. They identified the critical need for effective transitioning from academia to a ‘real-world’ environment (Fitzpatrick and Gripshover, 2016). They described ‘transition shock’ as a major experience felt by trainees as they moved into advanced practice roles. Transition shock is described as ‘disorienting, confusing and doubt-ridden chaos’ that is often experienced during the transition period (Fitzpatrick and Gripshover, 2016: 419). This creates feelings of stress, anxiety and insecurity as well as doubt in one's ability, which may lead to overall job dissatisfaction.
However, the qualitative nature of individual perceptions and experiences us a limitation of these studies and findings cannot be generalised. Moreover, further elements of advanced practice such as research and leadership have not been explored. Despite these limitations, it is evident that mentorship and support at both practice and organisational levels are key to an effective learning journey and successful role transition. This supported by Morgan et al (2012), who highlighted successful role transition depends on confidence, enthusiasm, clinical support and opportunities to acquire practical skills. For this to transpire, careful development of advanced practice curricula and clinical practice mentorship opportunities are crucial.
Conclusion
Vast global differences in advanced practice definition and roles are evident in the literature. However, advanced practice is recognised as an acquisition of a higher level of clinical skills, knowledge and problem-solving that complements the medical education paradigm and is integral to support the evolving global demands of healthcare systems. With vast evidence supporting the positive impact of IPE and collaboration (Goldsberry, 2018), collaborative learning and working partnerships across healthcare disciplines are central in meeting ongoing needs and leading much-needed change and innovation in health care.
IPC improves healthcare outcomes, access to clinical care and reduces patient complications and errors (WHO, 2010). It brings practitioners from multiple backgrounds together to work and learn in unison and integrate healthcare services in order to provide safe, efficient and effective patient-centred health care.
This educational leadership approach enables healthcare practitioners to provide valued input strengthening healthcare education and curriculum (WHO, 2010).
With advanced clinical practice now firmly embedded within healthcare, advanced practice training must conform to agreed academic requirements and accreditation to ensure fitness for practice (HEE, 2017; Barnes et al, 2019). Evidence of ongoing competence through professional body revalidation processes are crucial, with future regulation required in this field.
With advanced practice roles emerging across multiple disciplines within healthcare services, ongoing evaluation of training is needed.
KEY POINTS
- Advanced clinical practice has emerged worldwide in response to the continuous demands of complex healthcare needs, ageing populations and the need to improve services and outcomes.
- Variations in advanced clinical practitioner role definition and scope of practice exist worldwide.
- Advanced clinical practice promotes unity in the healthcare workforce, encouraging collaborative working partnerships to improve patient care, services provision and outcomes
- Standardisation of advanced clinical practitioner training, with multidisciplinary education and mentorship for advanced clinical practice roles are fundamental to effective practitioner development.
CPD reflective questions
- Does multidisciplinary collaborative learning occur in your clinical practice and how does this affect your learning, knowledge and skill acquisition?
- How does a multidisciplinary learning approach promote future collaborative learning and working partnerships in healthcare?
- What impact have advanced clinical practice roles had in your clinical area on service provision, patient safety and patient experience?