It is no exaggeration to say that the last year has stretched health services globally. Nurses, together with their colleagues, have valiantly faced demands while continuing to contribute to innovation in care. For many, advanced clinical practice remains a critical priority. In the context of nursing, this is not a novel concept; origins may be traced back to the post-war era of the 1940s with the rise of specialisms, followed laer by the pioneering work of the likes of Henry Silver, Loretta Ford, and Barbara Stillwell (Fulton, 2014; Evans et al, 2020). In the UK, the advanced clinical practitioner (ACP) role is recognised as crucial for transformation of the NHS workforce (Scottish Government, 2017; NHS England and NHS Improvement, 2019). Whereas once the concept may have faced criticism and doubt, now there is renewed support and a drive for consistency with improved definitions and guidance (Health Education England, 2017; Scottish Government, 2017). Policy defines advanced practice as a ‘level of practice’, featuring a high component of complex autonomy and decision making, synonymously underpinned by a master's qualification, encompassing the four pillars of Clinical Practice, Leadership and Management, Education and Research, (Health Education England, 2017; Scottish Government, 2017).
This consensus may have served to quash some anxieties surrounding roles, titles, and inconsistencies. Yet, recent evaluation of the implementation of ACP frameworks worryingly suggested nurses report that ACP roles have the potential to monopolise options for clinical career progression (Lawler et al, 2020). Similarly, it seems the goal of progress in our own profession has been overshadowed by reliance on adopting a medically driven model (Lawler et al, 2020). Although these findings will present little surprise to many, it is remiss if we do not strive to find ways to improve, champion and identify the place of ACPs in nursing.
Nursing has been shrouded in questions related to identity and progression for decades, and it is beyond the scope of this commentary to delve deeply into that debate. Nevertheless, we should acknowledge the logic of nursing rests within a complex competing system of economics, policy, politics and changing epidemiology, thereby shaping an evolution of health and care. Consistently, nurses have been at the forefront of innovation strengthened by legislative change, creating an empowered and enhanced workforce. However, we may fall a victim of our own success if we fail to create an evidence base that explains the uniqueness of how, why and in what circumstances, change such as advanced clinical practice makes a difference.
Peate (2021) argued that regulatory frameworks are needed to define advanced practice, striving for clarity for the wider workforce and service user alike. This is true, although the UK has made significant strides in establishing boundaries by which organisations may benchmark ACP roles. Still, this falls arguably short of the professional recognition and regulation many of us have called on for years. We must attempt to cut through the noise by making connections to the outcomes achieved by ACPs. In doing so, perhaps we should consider advanced clinical practice as a ‘philosophy of care’ that nurses (and other professions) enact for their patients—a programme or intervention. If we accept it as such, we may begin to better appreciate the nuances. Similarly, we may push back the over-medicalisation of advanced practice, which has attracted such controversy. ACP roles do not need to monopolise career prospects but advanced practice may in fact energise them when applied in its many different facets.
Nonetheless, to pinpoint the value, build regulatory frameworks and offer public confidence, we must untangle the confusion surrounding advanced practice. Research going forward needs to change; we must aim for transparency, offering explanations that help make connections with the context and resources offered, justifying, and matching these to the outcomes achieved. Advanced clinical practice is messy and complex but an attractive solution for many organisations. If we can accept it as a core fundamental philosophy of nursing, not a medically driven alternative, attained through experience, and demonstrated learning, we may create an evidence base that offers a true insight into the recipe for ‘triggering’ success in any given setting.