1. Advanced practice requires advanced education: some challenges for the university Gary Rolfe School of Human and Health Sciences Swansea University g.rolfe@swan.ac.uk

2. Advanced Nursing Practice is ‘concerned with adjusting the boundaries for the development of future practice, pioneering and developing new roles responsive to changing needs abd with advancing clinical practice, research and education to enrich professional practice as a whole’. UKCC 1994

3. Advanced Nursing Practice is ‘concerned with adjusting the boundaries for the development of future practice, pioneering and developing new roles responsive to changing needs abd with advancing clinical practice, research and education to enrich professional practice as a whole’. UKCC 1994 Nurse practitioner Specialist practitioner Advanced practitioner

4. Advanced Nursing Practice is ‘concerned with adjusting the boundaries for the development of future practice, pioneering and developing new roles responsive to changing needs abd with advancing clinical practice, research and education to enrich professional practice as a whole’. UKCC 1994 Advanced Nursing Practice ‘is not an additional layer of practice to be superimposed on specialist nursing practice. It is, rather, a description of an important sphere of professional practice which is concerned with the continuing development of the professions in the interest of patients, clients and health services’. UKCC 1994 Nurse practitioner Specialist practitioner Advanced practitioner

5. ‘There was a split regarding understanding of advanced practice. Some participants saw advanced practice as a list of extended tasks and occupational competencies gained through a structured period of study at Masters level and supervised clinical practice. Others understood it as a broader way of looking at and developing nursing gained through a portfolio of experience, structured reflection and individually tailored study’. UKCC 1996

6. ‘There was a split regarding understanding of advanced practice. Some participants saw advanced practice as a list of extended tasks and occupational competencies gained through a structured period of study at Masters level and supervised clinical practice. Others understood it as a broader way of looking at and developing nursing gained through a portfolio of experience, structured reflection and individually tailored study’. UKCC 1996 ‘It was felt that there are neither agreed definitions of advanced practice nor criteria against which standards for advanced practice can be set… For these reasons, it was felt that the UKCC, while fully supporting the notion of advancing practice, should avoid setting explicit standards but should consider how specialist practice could embrace nurse practitioners and clinical nurse specialists’. UKCC 1997

7. ‘Advanced nurse practitioners are highly experienced and educated members of the care team who are able to diagnose and treat your healthcare needs or refer you to an appropriate specialist if needed’. NMC 2006

8. ‘Advanced nurse practitioners are highly experienced and educated members of the care team who are able to diagnose and treat your healthcare needs or refer you to an appropriate specialist if needed’. NMC 2006 Advanced nurse practitioners are highly skilled nurses who can: * take a comprehensive patient history * carry out physical examinations * use their expert knowledge and clinical judgment to identify the potential diagnosis * refer patients for investigations where appropriate * make a final diagnosis * decide on and carry out treatment, including the prescribing of medicines, or refer patients to an appropriate specialist * use their extensive practice experience to plan and provide skilled and competent care to meet patient’s health and social care needs, involving other members of the health care team as appropriate * ensure the provision of continuity of care including follow-up visits * assess and evaluate, with patients, the effectiveness of the treatment and care provided and make changes as needed * work independently, although often as part of a health care team * provide leadership * make sure that each patient’s treatment and care is based on best practice.

9. How can we teach advanced nursing practice if we can’t say what it is? What can we teach if each practitioner has different and unique learning needs? Who is qualified to teach advanced nursing practice? Who is qualified to assess advanced nursing practice? What should be assessed? How should it be assessed? Who should have the authority to bestow the title of Advanced Nurse Practitioner? How should we address the issue of multi/inter/trans disciplinarity? What educational level should advanced nurse practitioner courses be pitched at? Why bother?

10. Eighteen months ago, I was made aware that my trust directorate wished for two staff members to study M.Sc. Nurse Practitioner in order to open and run a paediatric acute assessment unit. I volunteered. On completion of the course, I hope to be an autonomous practitioner, with a broader, deeper knowledge base to equip me for my new role

11. Having not yet achieved the kudos of professional promotion, it would perhaps have been understandable had I resigned my lot to despair and anger, however I came to recognise that advanced clinical practice need not depend totally upon the actuality of being a physical embodiment of a nurse practitioner - with the banding and badge to prove it. Advanced clinical practice can exist within the staff nurse I am, a mindset that has evolved through education at master’s level, and be integrated into experiences at a practical level during every working day.

12. Eighteen months ago, I was made aware that my trust directorate wished for two staff members to study M.Sc. Nurse Practitioner in order to open and run a paediatric acute assessment unit. I volunteered. On completion of the course, I hope to be an autonomous practitioner, with a broader, deeper knowledge base to equip me for my new role Having not yet achieved the kudos of professional promotion, it would perhaps have been understandable had I resigned my lot to despair and anger, however I came to recognise that advanced clinical practice need not depend totally upon the actuality of being a physical embodiment of a nurse practitioner - with the banding and badge to prove it. Advanced clinical practice can exist within the staff nurse I am, a mindset that has evolved through education at master’s level, and be integrated into experiences at a practical level during every working day. I sincerely believe advanced practice is a state of mind (as much as a recognised position of nurse practitioner), which enhances practice as a nurse regardless whether or not this is rewarded through promotion. This will come with time, but for now I content myself with exploration, analysis and interpretation of what and how I have achieved and embody, in preparation to move forward with confidence when opportunities arise.

13. Just thought I would let you know I have secured a nurse practitioner post! You after all endured the philosophical justifying that I am an Advanced Practitioner so I thought it fair to inform you I will soon be doing advanced practice! I think only you will know what I mean. My new role is precisely the "doing" of advanced practice"! I am moving to primary care in a nurse practitioner role. It will provide an opportunity for me to put both RGN and RSCN registrations into practice and also the Advanced Clinical Practice and independent prescribing. In a sense I feel I have "sold out" from what I wrote in the dissertation regarding expert paediatric experience in a familiar clinical environment and moving into a "novice" role yet performing advanced practice skills. But as you say, the money will come in handy!!! The post was formerly held by Beth Griffiths, one of the course lecturers and I saw the advert on the day you gave me the "OK" to submit. Fate... or as you said Zen?