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Exploring advanced clinical practitioner perspectives on training, role identity and competence: a qualitative study
Abstract:
Background: Advanced Clinical Practitioners (ACPs) are a new role that have been established to address gaps and support the existing medical workforce in an effort to help reduce increasing pressures on NHS services. ACPs have the potential to practice at a similar level to mid-grade medical staff, for example independently undertaking assessments, requesting and interpreting investigations, and diagnosing and discharging patients. These roles have been shown to improve both service outcomes and quality of patient care. However, there is currently no widespread formalised standard of training within the UK resulting in variations in the training experiences and clinical capabilities of ACPs. We sought to explore the training experiences of ACPs as well as their views on role identity and future development of the role.
Methods: Five online focus groups were conducted between March and May 2021 with trainee and qualified advanced clinical practitioners working in a range of healthcare settings, in the North of England. The focus groups aimed to explore the experiences of undertaking ACP training including supervision, gaining competence, role identity and career progression. Thematic analysis of the focus group transcripts was performed, informed by grounded theory principles.
Results: Fourteen advanced clinical practitioners participated. Analysis revealed that training was influenced by internal and external perceptions of the role, often acting as barriers, with structural aspects being significant contributory factors. Key themes identified (1) clinical training lacked structure and support, negatively impacting progress, (2) existing knowledge and experience acted as both an enabler and inhibitor, with implications for confidence, (3) the role and responsibilities are poorly understood by both advanced clinical practitioners and the wider medical profession and (4) advanced clinical practitioners recognised the value and importance of the role but felt changes were necessary, to provide security and sustainability.
Conclusions: Appropriate structure and support are crucial throughout the training process to enable staff to have a smooth transition to advanced level, ensuring they obtain the necessary confidence and competence. Structural changes and knowledge brokering are essential, particularly in relation to role clarity and its responsibilities, sufficient allocated time to learn and practice, role accreditation and continuous appropriate supervision.
Source: Kuczawski M. BMC Nursing, 2024; 23(1): 185
Working in primary care: an advanced clinical practitioner's perspective
Abstract: Primary care has often been negatively represented in the media, potentially adding to the notion that this is not an interesting or attractive place to work. I would like to give an honest opinion from my own experience of working within the primary care sector as a nurse and an advanced clinical practitioner (ACP).
Source: Coaten Josey M. British Journal of Nursing, 2024; 33(2): 90
A qualitative study exploring the experiences of advanced clinical practitioner training in emergency care in the South West of England, United Kingdom
Abstract:
Background: Attempting to improve emergency care (EC) advanced clinical practitioner (ACP) training, Health Education England (HEE) South West (SW) implemented a pilot, whereby emergency departments (ED) were provided with enhanced funding and support to help ED consultants deliver teaching and supervision to EC ACPs to ensure more timely completion of EC ACP training compared with previous cohorts training in the region.
We explored the experiences of trainee EC ACPs and consultant EC ACP leads working in EDs, which had implemented the new regional pilot.
Methods: We used a qualitative design to conduct semi-structured interviews with trainee EC ACPs and consultant EC ACP leads across five EDs that had implemented the HEE SW pilot. Interview data were analysed thematically.
Results: Twenty-five people were interviewed. We identified four themes: (1) the master’s in advanced practice could be better aligned with the Royal College of Emergency Medicine credentialling e-portfolio; (2) EC ACP training needs some flexibility to reflect the individual—‘one size does not fit all’; (3) supervision and teaching were recognised as important but requires significant staff capacity that is impacted by external pressures and (4) unclear role expectations and responsibilities hinder role transition and impact role identity.
It was notable that EC ACPs primarily spoke about the development of their clinical skills both academically and within the workplace, despite there being other skills mentioned in the multiprofessional framework for advanced practice (leadership and management, education and research).
Conclusion: A clear supervision structure with protected time allocated for teaching and assessment of clinical skills within the ED is essential to facilitate trainee EC ACP progression. However, increasing demands on EDs make this a challenging goal to achieve. Role identity issues continue to persist despite the introduction of new guidance designed to provide more clarity around the ACP role.
Source: Ablard S. Emergency Medicine Journal, 2024; 0: 1-7
Research strategies for trainee and qualified advanced clinical practitioners that enhance evidence-based practice
Abstract: Advanced clinical practitioners (ACPs) are integral to modern healthcare, providing high-quality, evidence-based care to patients. While ACPs show some development in clinical practice, leadership, and education, challenges persist in the research pillar. Trainee and qualified ACPs often have difficulties initiating their research journey and may feel uncertain about where to start. Existing studies have explored and emphasised the importance of ACPs developing and maintaining their research skills, yet there remains a gap in understanding how they can effectively demonstrate their research capabilities. Therefore, this article aims to help trainees and qualified ACPs on how to evidence their research pillar capabilities.
Source: Alsararatee Hasan H. British Journal of Nursing, 2024; 33(14): 663-665
What is nursing in advanced nursing practice? Applying theories and models to advanced nursing practice-A discursive review
Abstract:
Aim: This article appraises models and theories related to advanced nursing practice. It argues that while the role of the advanced nurse practitioner builds on and extends beyond traditional nursing, it remains firmly grounded in 'caring'.
Background: The stereotype that nurses 'care' and doctors 'cure' is fading. Increasingly, nurses have crossed boundaries and conducted independent assessment, diagnosis, prescribing and consultation, which used to be the doctor's role. Confusion and argument have arisen due to the higher-level practice of the advanced nurse practitioner, as many questions where these 'doctor nurses' stand.
Design: A literature review.
Data sources: Databases, including CINAHL, Medline and Google Scholar, were searched.
Method: Databases were searched, and relevant studies and review articles from 1970 to 2023 were identified using the following keywords: 'advanced nurse practitioner', 'nurse practitioner', 'advanced nursing', 'advance practice', 'nurse practitioner', 'nursing theory' and 'nursing model'.
Results: Although advanced nurse practitioners identify themselves as nurses, there is limited use of nursing theory to conceptualize this new level of practice and to define their contribution to the multi-disciplinary team. It is noted that a holistic approach to personalized patient care, based on therapeutic relationships and effective communication, may help us identify the unique contribution of the advanced nurse practitioner.
Conclusions: The development of advanced nursing theory needs to capture this holistic approach and its caring element to recognize the value and strengthen the identity allegiance of this hybrid role.
Implications for the profession and/or patient care: Holistic approach and patient-centred care, effective communication and the therapeutic relationship are strong characteristics relating to ANP practice, the latter of which is yet to be clearly defined and captured in nursing theories. Conceptualizing ANP practice and capturing their valuable nursing care will enable better understanding and clarity for the role to realize its full potential.
Source: Zhang Y. Journal of Advanced Nursing, 2024; Online ahead of print
Validation of the newly developed Advanced Practice Nurse Task Questionnaire: A national survey
Abstract:
Aim: To describe psychometric validation of the newly developed Advanced Practice Nurse Task Questionnaire.
Design: Cross-sectional quantitative study.
Methods: The development of the questionnaire followed an adapted version of the seven steps described in the guide by the Association for Medical Education in Europe. A nationwide online survey tested the construct and structural validity and internal consistency using an exploratory factor analysis, Cronbach's alpha coefficient and a Kruskal-Wallis test to compare the hypotheses.
Results: We received 222 questionnaires between January and September 2020. The factor analysis produced a seven-factor solution as suggested in Hamric's model. However, not all item loadings aligned with the framework's competencies. Cronbach's alpha of factors ranged between .795 and .879. The analysis confirmed the construct validity of the Advanced Practice Nurse Task Questionnaire. The tool was able to discriminate the competencies of guidance and coaching, direct clinical practice and leadership across the three advanced practice nurse roles clinical nurse specialist, nurse practitioner or blended role.
Conclusion: A precise assessment of advanced practice nurse tasks is crucial in clinical practice and in research as it may be a basis for further refinement, implementation and evaluation of roles.
Impact: The Advanced Practice Nurse Task Questionnaire is the first valid tool to assess tasks according to Hamric's model of competencies independently of the role or the setting. Additionally, it distinguishes the most common advanced practice nurse roles according to the degree of tasks in direct clinical practice and leadership. The tool may be applied in various countries, independent of the degree of implementation and understanding of advanced nursing practice.
Reporting method: The STARD 2015 guideline was used to report the study.
Patient or public contribution: No patient or public contribution.
Source: Beckmann S. Journal of Advanced Nursing, 2023; 79(12): 4791-4803
Factors Influencing the impact of nurse practitioners’ clinical autonomy: a self determining perspective
Abstract:
Aim: To explore factors that influence the impact of nurse practitioners' clinical autonomy with a self-determining perspective.
Background: Worldwide, there is a significant demand for healthcare professionals such as the nurse practitioner in meeting some healthcare needs across patients' lifespans. Factors influencing nurse practitioners clinical autonomy can impact the full utilisation of the role in practice.
Introduction: Limited evidence exists that describes or researches nurse practitioner clinical autonomy. Instead, there is a focus in the literature on strategic debates, role confusion and nurse practitioners reporting the straddling between nursing, allied heath professionals and medicine in the provision of healthcare services.
Design: A cross-sectional study design was used in a purposive sample in a national sample of nurse practitioners in Ireland across a full range of healthcare settings. Additionally, the survey included open comments sections to capture qualitative comments by the nurse practitioners themselves.
Methods: Self-determination theory is rooted in an organismic dialectical stance. This study used a convenience sample of n = 148 from a total sample of n = 448 (33%) of the population. The Dempster Practice Behavioural Scale and an initially validated advanced nursing practice clinical autonomy scale were used. Open comments were analysed by thematic analysis. STROBE Standards guidelines for cross-sectional studies were followed, and COREQ guidelines were followed for writing qualitative research.
Results: The study findings demonstrated that the more clinical experience the nurse practitioner had, the higher their levels of clinical autonomy. The previous length of nursing experience did not impact nurse practitioner clinical autonomy levels. However, average experience of nurse practitioner' in this study was 3-10 years. No significant differences existed between the reported gender, nurse practitioners' clinical autonomy and decision-making. 1:40 female and 1:9 male nurse practitioners undertook a doctorate or PhD-level education. No advanced nurse practitioner identified as non-binary. Gender and organisational culture considerations can influence nurse practitioners clinical autonomy.
Implications for nursing and health policy: This study highlights intrinsic motivators that support nurse practitioners in providing innovative healthcare: competence, relatedness and clinical autonomy. Countries credentialing, regulations professional standards and healthcare policy positively influence nurse practitioner clinical autonomy. Nurse practitioners' clinical autonomy is championed when health policy and organisational stakeholders intrinsically collaborate. A disconnect between health policy organisational culture extrinsically influences lower levels of nurse practitioners' clinical autonomy.
Conclusion: The findings underline the positive impact of nurse practitioner clinical autonomy. A recommendation of this study is to continue to measure impact of clinical autonomy and develop nurse practitioners' self-determination strategies around the role and integrity of their levels of intrinsic clinical autonomy.
Source: Lockwood Emily B. International Nursing Review, 2024; 71(2): 375-395
Supporting Advanced Practice Nursing Clinical Instructors with a Multimedia Guidebook
Abstract: Clinical instructors (CIs) in advanced practice nursing need to be competent clinicians and educators and understand the academic programs and clinical processes. CIs were asked to interact with an evidence-based multimedia guidebook and complete a survey to measure their acquisition of knowledge after the interaction. Response to the survey was 41.6%. Most CIs scored ≥83% on the knowledge acquisition survey. The findings support the use of a multimedia guidebook to support CI knowledge in the educator role and highlight the need for continued CI training and mentorship.
Source: Montejo L. The Journal of Nurse Practitioners, 2024; 20(5): 104969
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Continuing education for advanced practice nurses: A scoping review
Abstract:
Aim: The aim of the study was to identify the nature and extent of scientific research addressing continuing education for advanced practice nurses.
Design: A scoping review.
Review methods: The Joanna Briggs Institute's methodology for scoping reviews.
Data sources: Electronic search was conducted on 17 September 2023 via CINAHL, PsycINFO, PubMed, Scopus, Web of Science, Cochrane Library and the Joanna Briggs Institute's Evidence-Based Practice Database for research articles published between 2012 and 2023.
Results: Nineteen papers were included in this review. Scientific research on continuing education for advanced practice nursing roles (i.e. nurse practitioner, clinical nurse specialist) has primarily been conducted in the United States and mostly addresses online-delivered continuing education interventions for clinical care competency. Most of the interventions targeted nurse practitioners.
Conclusion: Continuing education has a pivotal role in supporting advanced practice nursing competency development. In addition to clinical care, future continuing education research should focus on other advanced practice nursing competencies, such as education, leadership, supporting organizational strategies, research and evidence implementation.
Implications for the profession and/or patient care: Continuing education programmes for advanced practice nurses should be rigorously developed, implemented and evaluated to support the quality and effectiveness of patient care.
Impact: Continuing education for advanced practice nursing roles is an understudied phenomenon. This review highlights future research priorities and may inform the development of continuing education programmes.
Reporting method: PRISMA-ScR.
Source: Wright Mea Mirella Marjatta. Journal of Advanced Nursing, 2024; 80(8): 3037-3058
History taking for advanced clinical practitioners: what should you ask?
Abstract: Good history taking is a vital component of patient assessment and high-quality care. This second article in our assessment and interpretation series for advanced nurse or midwife practitioners shows how a systematic approach to taking a history, combined with asking patients about their ideas, concerns and expectations, gives a thorough understanding of patients’ complaints and priorities.
Source: Butler S. Nursing Times, 2024; 120(3): 1-4
Senior Nurse Manager Perceptions of Nurse Practitioner Integration: A Quantitative Study
Abstract:
Supporting Advanced Practice Nursing Clinical Instructors with a Multimedia Guidebook
Abstract: Clinical instructors (CIs) in advanced practice nursing need to be competent clinicians and educators and understand the academic programs and clinical processes. CIs were asked to interact with an evidence-based multimedia guidebook and complete a survey to measure their acquisition of knowledge after the interaction. Response to the survey was 41.6%. Most CIs scored ≥83% on the knowledge acquisition survey. The findings support the use of a multimedia guidebook to support CI knowledge in the educator role and highlight the need for continued CI training and mentorship.
Source: Montejo L. The Journal of Nurse Practitioners, 2024; 20(5): 104969
Contact the library for a copy of this article
Continuing education for advanced practice nurses: A scoping review
Abstract:
Aim: The aim of the study was to identify the nature and extent of scientific research addressing continuing education for advanced practice nurses.
Design: A scoping review.
Review methods: The Joanna Briggs Institute's methodology for scoping reviews.
Data sources: Electronic search was conducted on 17 September 2023 via CINAHL, PsycINFO, PubMed, Scopus, Web of Science, Cochrane Library and the Joanna Briggs Institute's Evidence-Based Practice Database for research articles published between 2012 and 2023.
Results: Nineteen papers were included in this review. Scientific research on continuing education for advanced practice nursing roles (i.e. nurse practitioner, clinical nurse specialist) has primarily been conducted in the United States and mostly addresses online-delivered continuing education interventions for clinical care competency. Most of the interventions targeted nurse practitioners.
Conclusion: Continuing education has a pivotal role in supporting advanced practice nursing competency development. In addition to clinical care, future continuing education research should focus on other advanced practice nursing competencies, such as education, leadership, supporting organizational strategies, research and evidence implementation.
Implications for the profession and/or patient care: Continuing education programmes for advanced practice nurses should be rigorously developed, implemented and evaluated to support the quality and effectiveness of patient care.
Impact: Continuing education for advanced practice nursing roles is an understudied phenomenon. This review highlights future research priorities and may inform the development of continuing education programmes.
Reporting method: PRISMA-ScR.
Source: Wright Mea Mirella Marjatta. Journal of Advanced Nursing, 2024; 80(8): 3037-3058
History taking for advanced clinical practitioners: what should you ask?
Abstract: Good history taking is a vital component of patient assessment and high-quality care. This second article in our assessment and interpretation series for advanced nurse or midwife practitioners shows how a systematic approach to taking a history, combined with asking patients about their ideas, concerns and expectations, gives a thorough understanding of patients’ complaints and priorities.
Source: Butler S. Nursing Times, 2024; 120(3): 1-4
Senior Nurse Manager Perceptions of Nurse Practitioner Integration: A Quantitative Study
Abstract:
Aim. To determine Senior Nurse Managers’ perceptions of integration of Nurse Practitioner roles in Healthcare Organisations across Ireland and Australia. Background. Introduction of the Nurse Practitioner role in both countries is well established with national policies aimed at developing a critical mass in the health workforce. Current policy requires Senior Nurse Managers to be actively involved in the introduction of and oversight of the integration of Nurse Practitioners across healthcare settings. This is integral in the context of the success and sustainability of the services provided by the Nurse Practitioner. Methods. A quantitative, cross-sectional cloud-based survey of senior nurse managers across Ireland and Australia from April to September 2022. Results. Of 300 responses received, 122 were eligible for analysis. Of these, 77% expressed that there should be a specific role to support the integration of Nurse Practitioner roles at local level, and 61% recommended that this should occur at a national level, whilst 48% reported the absence of a standardised governance structure. Three reporting structures were identified: professional, clinical, and operational. Autonomous clinical decision making and prescribing were two Nurse Practitioner functions most identified. Fifty-five percent reported having performance indicators for Nurse Practitioner roles, with 24% agreeing that performance indicators captured the quality of care provided. Thirty-five percent of senior nurse managers indicated that there were agreed reporting timelines for performance indicators and a requirement for the provision of an annual report. Conclusion. Whilst some participants reported structure to guide and evaluate the work and value of Nurse Practitioners, the approach was inconsistent across organisations and countries. This paper demonstrates that integration is not broadly established across both countries. Implications for the Profession. The main findings were that Nurse Practitioners were misunderstood and the development of a structured framework to support the integration of Nurse Practitioners would provide long-term benefits.
Source: Ryder M. Journal of Nursing Management, 2024
Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence‐based practice into routine care: An interpretative phenomenological analysis
Abstract:
Source: Ryder M. Journal of Nursing Management, 2024
Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence‐based practice into routine care: An interpretative phenomenological analysis
Abstract:
Aim: To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care.
Design: A qualitative interpretative phenomenological analysis.
Methods: A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis.
Results: Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice.
Conclusion: There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care.
Impact and implications: The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients.
Contribution to the wider global clinical community: As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care.
Reporting method: Consolidated criteria for reporting qualitative research (COREQ).
Patient or public contribution: No patient or public contribution.
Source: Clarke V. Journal of Advanced Nursing, 2024; 80(4): 1559-1573
Advanced nurse practitioner well‐being: A 4‐year cohort mixed methods study
Abstract:
Design: A qualitative interpretative phenomenological analysis.
Methods: A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis.
Results: Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice.
Conclusion: There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care.
Impact and implications: The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients.
Contribution to the wider global clinical community: As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care.
Reporting method: Consolidated criteria for reporting qualitative research (COREQ).
Patient or public contribution: No patient or public contribution.
Source: Clarke V. Journal of Advanced Nursing, 2024; 80(4): 1559-1573
Advanced nurse practitioner well‐being: A 4‐year cohort mixed methods study
Abstract:
Aims: To examine changes in advanced nurse practitioner (ANP) well-being, satisfaction and motivation over a four-year period.
Design: Longitudinal Cohort study.
Methods: Surveys were carried out each year from 2019 to 2022 with the same cohort of ANPs in the United Kingdom (UK). The survey consisted of demographics, questions on contemporary issues in advanced practice, National Health Service (NHS) staff survey questions and validated questionnaires. A core set of questions were asked every year with some changes in response to the COVID-19 pandemic.
Results: Response rate ranged from 40% to 59% and appeared to be affected by COVID-19. Staff satisfaction with pay and the well-being score were stable throughout. Other questions on well-being, job satisfaction and motivation saw statistically significant reductions after 4 years. Open-ended questions about ongoing well-being concerns show participants are concerned about exhaustion levels caused by workload, staffing issues, abuse from patients and colleagues' mental health.
Conclusion: The findings highlight a decline in ANP well-being, job satisfaction and motivation post-COVID-19. Reasons for this, explored in the qualitative data, show that ANPs have faced extremely difficult working conditions. Urgent action is required to prevent a workforce retention crisis as many nursing staff are close to retirement and may not be motivated to remain in post.
Impact: This study has followed ANPs through the most challenging years the NHS has ever seen. Job satisfaction, motivation and enjoyment of the job all significantly reduced over time. In many areas, the ANP role has been used to fill medical workforce gaps, and this will become harder to do if ANPs are dissatisfied, disaffected and struggling with stress and burnout. Addressing these issues should be a priority for policymakers and managers.
Patient or public contribution: None as this study focussed on staff. Staff stakeholders involved in the design and conduct of the study.
Source: Wood E. Nursing Open, 2024; 11(7): e2218
Examining advanced clinical practice from the perspective of a trainee advanced clinical practitioner
Abstract: This article discusses advanced clinical practice from the perspective of a trainee advanced clinical practitioner (ACP). The commentary explores the four pillars of advanced practice with respect to the frailty specialty, taking both the author and a trainee ACP into account. The evaluation analyses the historical development of advanced clinical practice and the knowledge, skills and competencies expected at the advanced level. It highlights how support, colleague networking and supervision remain vital to the journey of trainee ACP, and influences the overall wellbeing of, and care given to, the patient.
Source: Carter N. International Journal for Advancing Practice, 2024; 2(2): 1-4
Assessing the benefits of advanced clinical practice for key stakeholders
Abstract:
Design: Longitudinal Cohort study.
Methods: Surveys were carried out each year from 2019 to 2022 with the same cohort of ANPs in the United Kingdom (UK). The survey consisted of demographics, questions on contemporary issues in advanced practice, National Health Service (NHS) staff survey questions and validated questionnaires. A core set of questions were asked every year with some changes in response to the COVID-19 pandemic.
Results: Response rate ranged from 40% to 59% and appeared to be affected by COVID-19. Staff satisfaction with pay and the well-being score were stable throughout. Other questions on well-being, job satisfaction and motivation saw statistically significant reductions after 4 years. Open-ended questions about ongoing well-being concerns show participants are concerned about exhaustion levels caused by workload, staffing issues, abuse from patients and colleagues' mental health.
Conclusion: The findings highlight a decline in ANP well-being, job satisfaction and motivation post-COVID-19. Reasons for this, explored in the qualitative data, show that ANPs have faced extremely difficult working conditions. Urgent action is required to prevent a workforce retention crisis as many nursing staff are close to retirement and may not be motivated to remain in post.
Impact: This study has followed ANPs through the most challenging years the NHS has ever seen. Job satisfaction, motivation and enjoyment of the job all significantly reduced over time. In many areas, the ANP role has been used to fill medical workforce gaps, and this will become harder to do if ANPs are dissatisfied, disaffected and struggling with stress and burnout. Addressing these issues should be a priority for policymakers and managers.
Patient or public contribution: None as this study focussed on staff. Staff stakeholders involved in the design and conduct of the study.
Source: Wood E. Nursing Open, 2024; 11(7): e2218
Examining advanced clinical practice from the perspective of a trainee advanced clinical practitioner
Abstract: This article discusses advanced clinical practice from the perspective of a trainee advanced clinical practitioner (ACP). The commentary explores the four pillars of advanced practice with respect to the frailty specialty, taking both the author and a trainee ACP into account. The evaluation analyses the historical development of advanced clinical practice and the knowledge, skills and competencies expected at the advanced level. It highlights how support, colleague networking and supervision remain vital to the journey of trainee ACP, and influences the overall wellbeing of, and care given to, the patient.
Source: Carter N. International Journal for Advancing Practice, 2024; 2(2): 1-4
Assessing the benefits of advanced clinical practice for key stakeholders
Abstract:
Background: Advanced clinical practice roles, usually filled by nurses, have had positive effects on clinical effectiveness, including in patient satisfaction, but their benefits for other stakeholders (such as employers, health professionals, education providers and commissioners and professional/regulatory bodies) are less clear.
Aim: This study aimed to identify UK research on the potential benefits of advanced clinical practice and evaluate the evidence base for key stakeholders in this field.
Method: A mixed-methods systematic literature review was carried out to inform a narrative interpretive synthesis.
Findings: 44 articles of mixed quality were identified. Consensus was found regarding the definition of and barriers and facilitators to advanced clinical practice. This role is split into substitution (eg, of doctors) and supplementation (eg, adding value) aspects, and the clinical practice element dominates. Training for the role varies, as do scope of practice and regulation.
Conclusion: There are several barriers to the implementation of advanced clinical practice and therefore the realisation of its benefits for key stakeholders. Areas requiring attention include training, support from others for role expansion and organisational issues.
Source: Scott V. British Journal of Nursing, 2024; 33(6): 300-305
The evolving role of advanced clinical practitioners: challenges and opportunities
Abstract: This editorial reviews the roles of advanced clinical practitioners, suggesting how the debate could evolve, returning to the original intent behind these roles and progressing towards ways of sustaining high-quality, equitable and safe care under strong medical leadership.
Source: Britton Carolina R. British Journal of Hospital Medicine, 2024; 85(2): 1-3
A systemised literature review into the benefits of introducing the advanced clinical practitioner role to palliative care patients
Abstract:
Aim: This study aimed to identify UK research on the potential benefits of advanced clinical practice and evaluate the evidence base for key stakeholders in this field.
Method: A mixed-methods systematic literature review was carried out to inform a narrative interpretive synthesis.
Findings: 44 articles of mixed quality were identified. Consensus was found regarding the definition of and barriers and facilitators to advanced clinical practice. This role is split into substitution (eg, of doctors) and supplementation (eg, adding value) aspects, and the clinical practice element dominates. Training for the role varies, as do scope of practice and regulation.
Conclusion: There are several barriers to the implementation of advanced clinical practice and therefore the realisation of its benefits for key stakeholders. Areas requiring attention include training, support from others for role expansion and organisational issues.
Source: Scott V. British Journal of Nursing, 2024; 33(6): 300-305
The evolving role of advanced clinical practitioners: challenges and opportunities
Abstract: This editorial reviews the roles of advanced clinical practitioners, suggesting how the debate could evolve, returning to the original intent behind these roles and progressing towards ways of sustaining high-quality, equitable and safe care under strong medical leadership.
Source: Britton Carolina R. British Journal of Hospital Medicine, 2024; 85(2): 1-3
A systemised literature review into the benefits of introducing the advanced clinical practitioner role to palliative care patients
Abstract:
Background: By 2040, it is predicted that at least 42% more people will need palliative care services in England and Wales. It is not known if introducing advanced clinical practitioners (ACPs) to palliative care environments is beneficial to patients and healthcare organisations.
Aims: This research aims to evaluate if there is a benefit to incorporating ACPs within palliative care environments through data collection on their effectiveness when working in palliative care.
Methods: A systemised review of the literature with a narrative synthesis.
Findings: The literature shows that the ACP role has positive benefits on palliative care in three domains: (1) for the patient, through improving quality of life; (2) for professionals, through education; and (3) for organisations, through cost-effective models of care.
Conclusions: Incorporating the role of the ACP could enable organisations and trusts to deliver new models of care that are both patient-focused and cost-effective. Further research is needed within palliative care on the impact of nurses educated to an MSc level in advanced clinical practice, compared to the traditional role of the clinical nurse specialist.
Source: Graham A. International Journal of Advancing Practice, 2024; 2(3): 144-148
What are advanced clinical practitioners' expectations of the benefits of pursuing the role, and are these being realised?
Abstract:
Aims: This research aims to evaluate if there is a benefit to incorporating ACPs within palliative care environments through data collection on their effectiveness when working in palliative care.
Methods: A systemised review of the literature with a narrative synthesis.
Findings: The literature shows that the ACP role has positive benefits on palliative care in three domains: (1) for the patient, through improving quality of life; (2) for professionals, through education; and (3) for organisations, through cost-effective models of care.
Conclusions: Incorporating the role of the ACP could enable organisations and trusts to deliver new models of care that are both patient-focused and cost-effective. Further research is needed within palliative care on the impact of nurses educated to an MSc level in advanced clinical practice, compared to the traditional role of the clinical nurse specialist.
Source: Graham A. International Journal of Advancing Practice, 2024; 2(3): 144-148
What are advanced clinical practitioners' expectations of the benefits of pursuing the role, and are these being realised?
Abstract:
Background: Advanced clinical practitioners (ACPs) have been used worldwide to reform health services to address population needs. However, previous research identifies barriers that prevent the effective implementation of ACPs.
Aims: To better understand the expectations ACPs have in relation to their roles, and to evaluate whether they are being met so that focused educational and policy initiatives can be developed to reduce gaps between expectation and reality.
Methods: This online cross-sectional study uses a sequential, mixed-methods, exploratory design, in which themes identified from focus groups were used to construct a follow-up questionnaire. Some 291 UK participants were recruited via social media and ACP educational and policy networks. Exploratory data and reflexive thematic analysis were employed to probe and visualise results, drawing findings together into narrative synthesis.
Findings: This research provides insight from a diverse group of ACPs of their lived experiences, aspirations and driving forces to either enter or remain working in the profession. Five themes were identified during focus group discussions: 1) clinical/non-clinical balance; 2) full use of knowledge, skills and experience; 3) leadership in quality improvement; 4) career progression; and 5) policy, vision and organisation. Gaps between ACPs' expectations and their lived experience of the role were identified.
Conclusion: To achieve the expected growth of the ACP role, attention is needed to narrow the gaps between expectations and reality. This includes ringfencing non-clinical activity; enhancing opportunities for professional development, supervision and leadership; providing greater clarity in career planning; and embedding and evaluating efforts to standardise advanced clinical practice.
Source: Scott V. International Journal of Advancing Practice, 2024; 2(4): 164-171
Supporting advanced practice: feedback from a mental health, community and primary care advanced practice support project in South Yorkshire, UK
Abstract:
Aims: To better understand the expectations ACPs have in relation to their roles, and to evaluate whether they are being met so that focused educational and policy initiatives can be developed to reduce gaps between expectation and reality.
Methods: This online cross-sectional study uses a sequential, mixed-methods, exploratory design, in which themes identified from focus groups were used to construct a follow-up questionnaire. Some 291 UK participants were recruited via social media and ACP educational and policy networks. Exploratory data and reflexive thematic analysis were employed to probe and visualise results, drawing findings together into narrative synthesis.
Findings: This research provides insight from a diverse group of ACPs of their lived experiences, aspirations and driving forces to either enter or remain working in the profession. Five themes were identified during focus group discussions: 1) clinical/non-clinical balance; 2) full use of knowledge, skills and experience; 3) leadership in quality improvement; 4) career progression; and 5) policy, vision and organisation. Gaps between ACPs' expectations and their lived experience of the role were identified.
Conclusion: To achieve the expected growth of the ACP role, attention is needed to narrow the gaps between expectations and reality. This includes ringfencing non-clinical activity; enhancing opportunities for professional development, supervision and leadership; providing greater clarity in career planning; and embedding and evaluating efforts to standardise advanced clinical practice.
Source: Scott V. International Journal of Advancing Practice, 2024; 2(4): 164-171
Supporting advanced practice: feedback from a mental health, community and primary care advanced practice support project in South Yorkshire, UK
Abstract:
Background: Despite the significant input from Heath Education England (HEE), now NHS England (NHSE), there are still significant variations around advanced practice programmes, support and training, particularly in less developed areas such as mental health, community posts and primary care. To help target these areas, and to support the NHS Long Term Plan (2023) to increase the number of advanced clinical practitioners (ACPs), the Faculty of Advanced Practice South Yorkshire recruited three ACP leads from mental health, community, and primary care backgrounds to establish a support project led by one professional lead. These leads were able to utilise their lived experience of completing the ACP MSc programme and working as an ACP to help trainee advanced clinical practitioners (tACPs) navigate their journey. The ACP leads also developed a variety of educational events, which further supported the trainees' needs.
Aim: This article reports the feedback given via an online questionnaire from trainees that accessed the project, which ended in March 2024. Its aim is to highlight the often-undervalued concept of using clinicians personal experience regarding advanced training and practice, to mentor, support and ultimately retain the future ACP workforce.
Methods: An email with a link to a questionnaire was sent to 128 tACPs or recently qualified ACPs that had applied for their training via the Faculty of Advanced Practice South Yorkshire. The questionnaire, created in Microsoft Forms, was completed anonymously, and produced both numerical and free-text data. The questionnaire solicited feedback around: the number of contacts they had and how they contacted; the ACP leads; types of support accessed; and the educational events available. Free text answers were analysed by the author (CJ) and a second reviewer (SF) to generate a consensus on themes.
Results: A total of 64 clinicians responded, of which 43 were tACPs, 10 were ACPs, five had other job titles (community matron, pharmacist, practice nurse) and five did not state what their job title was. Responses suggest that the support accessed from the project was highly beneficial and could not be gained elsewhere. A key factor in the project's success was the ACP leads' lived experience of having previously completed advanced practice training, as well as their ability to tailor learning events to the trainees' needs.
Conclusion: Meeting the demands of ACP training in areas where the role is less established remains an ongoing challenge. It seems some of these challenges relate to the lack of practical support being provided by employers or higher education institutions, such as lived experience of completing the task of ACP training. Support projects, like the one discussed in this article, appear aptly placed to help fulfil these needs and begs the question ‘why aren't there more?’, especially when advanced practitioners are fundamental to the future healthcare workforce.
Source: Jenkinson C. International Journal of Advancing Practice, 2024; 2(3): 139-143
The advanced practice nurse role's development and identity: an international review
Abstract: Healthcare is changing; the physician shortage continues to grow and the complexity of health care continues to increase in relation to aging populations, lower reimbursement rates, and increased documentation requirements; an alternative has to be addressed. Globally, the advanced practice nurse (APN) role has grown enormously. Despite the growing use of APN practitioners worldwide, many facilitators and barriers exist to role implementation. Many countries face similar issues, including a lack of clarity and regulation regarding the APN role. Despite these barriers, APNs continue to make headway. This narrative will review barriers and challenges to role advancement across countries and offer opportunities to facilitate APN role development.
Source: Mackavey C. International Journal for Advancing Practice, 2024; 2(1): 36-44
Advanced nursing practice: key factors that have shaped its development in the Republic of Ireland
Abstract: This article explores the development of advanced practice in the Republic of Ireland, highlighting its progressive journey and the key factors that have shaped it. From the initial proposal of advanced roles in nursing and midwifery in 1998 to the establishment of clinical specialist and advanced practice positions, the evolution of advanced practice has been influenced by significant reports, legislative changes, the development of a national educational framework at a MSc advanced nurse practitioner (ANP) level and close collaboration between stakeholders. The article also discusses the distinctions between ANPs and clinical nurse specialists, highlighting the inclusion of medicinal products and ionising radiation prescriptions within the scope of ANPs. Throughout the paper, the regulatory framework and educational standards governing advanced practice in Ireland are highlighted, along with the collaborative efforts of key stakeholders
Source: Lehwaldt D. International Journal for Advancing Practice, 2024; 2(2): 100-102
Advanced practice in Wales
Abstract: In this spotlight article, three members of the UK's advanced practice (AP) landscape, Anna Jones, Ffion Simcox and Jonathan Thomas, detail the development history of AP throughout Wales. They discuss how the Welsh governance and collaborative style differs from that of the rest of the UK, and explore how Wales is developing, leading and innovating across the UK's wider advanced practice landscape
Source: Jones A. International Journal of Advancing Practice, 2024; 2(1): 49-50
Developing standardised pathways for recognition of advanced practice attainment
Abstract: In the UK, advanced practice has a rich developmental history. Since the mid-1980s, there has been a constant evolution in advanced practice innovation; such developments have inadvertently produced unwarranted variations in approaches to implementation of advanced practice roles. Such variations have their origins in multiple intersecting factors such as: multi-professional dimensions with multiple regulators and professional bodies; differences across the four nations of the UK; advanced practice roles growing organically in response to local need, health service commissioning decisions and profession specific imperatives; definitions and understandings of advanced practice differing between professions; and a proliferation of advanced practitioner roles with different titles, different scopes of practice and different educational requirements. All these evident dissimilarities in advanced practice innovations have led to a lack of consistency in implementing advanced practitioner roles, which has caused potential concern for patient safety and impeded effective workforce planning.
Source: Barratt J. International Journal for Advancing Practice, 2024; 2(2): 58-59
Defining the scope of advanced practice
Abstract: Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the issue of defining and regulating the scope of advanced nursing practice.
Source: Foster S. British Journal of Nursing, 2024; 32(20): 1017
Aim: This article reports the feedback given via an online questionnaire from trainees that accessed the project, which ended in March 2024. Its aim is to highlight the often-undervalued concept of using clinicians personal experience regarding advanced training and practice, to mentor, support and ultimately retain the future ACP workforce.
Methods: An email with a link to a questionnaire was sent to 128 tACPs or recently qualified ACPs that had applied for their training via the Faculty of Advanced Practice South Yorkshire. The questionnaire, created in Microsoft Forms, was completed anonymously, and produced both numerical and free-text data. The questionnaire solicited feedback around: the number of contacts they had and how they contacted; the ACP leads; types of support accessed; and the educational events available. Free text answers were analysed by the author (CJ) and a second reviewer (SF) to generate a consensus on themes.
Results: A total of 64 clinicians responded, of which 43 were tACPs, 10 were ACPs, five had other job titles (community matron, pharmacist, practice nurse) and five did not state what their job title was. Responses suggest that the support accessed from the project was highly beneficial and could not be gained elsewhere. A key factor in the project's success was the ACP leads' lived experience of having previously completed advanced practice training, as well as their ability to tailor learning events to the trainees' needs.
Conclusion: Meeting the demands of ACP training in areas where the role is less established remains an ongoing challenge. It seems some of these challenges relate to the lack of practical support being provided by employers or higher education institutions, such as lived experience of completing the task of ACP training. Support projects, like the one discussed in this article, appear aptly placed to help fulfil these needs and begs the question ‘why aren't there more?’, especially when advanced practitioners are fundamental to the future healthcare workforce.
Source: Jenkinson C. International Journal of Advancing Practice, 2024; 2(3): 139-143
The advanced practice nurse role's development and identity: an international review
Abstract: Healthcare is changing; the physician shortage continues to grow and the complexity of health care continues to increase in relation to aging populations, lower reimbursement rates, and increased documentation requirements; an alternative has to be addressed. Globally, the advanced practice nurse (APN) role has grown enormously. Despite the growing use of APN practitioners worldwide, many facilitators and barriers exist to role implementation. Many countries face similar issues, including a lack of clarity and regulation regarding the APN role. Despite these barriers, APNs continue to make headway. This narrative will review barriers and challenges to role advancement across countries and offer opportunities to facilitate APN role development.
Source: Mackavey C. International Journal for Advancing Practice, 2024; 2(1): 36-44
Advanced nursing practice: key factors that have shaped its development in the Republic of Ireland
Abstract: This article explores the development of advanced practice in the Republic of Ireland, highlighting its progressive journey and the key factors that have shaped it. From the initial proposal of advanced roles in nursing and midwifery in 1998 to the establishment of clinical specialist and advanced practice positions, the evolution of advanced practice has been influenced by significant reports, legislative changes, the development of a national educational framework at a MSc advanced nurse practitioner (ANP) level and close collaboration between stakeholders. The article also discusses the distinctions between ANPs and clinical nurse specialists, highlighting the inclusion of medicinal products and ionising radiation prescriptions within the scope of ANPs. Throughout the paper, the regulatory framework and educational standards governing advanced practice in Ireland are highlighted, along with the collaborative efforts of key stakeholders
Source: Lehwaldt D. International Journal for Advancing Practice, 2024; 2(2): 100-102
Advanced practice in Wales
Abstract: In this spotlight article, three members of the UK's advanced practice (AP) landscape, Anna Jones, Ffion Simcox and Jonathan Thomas, detail the development history of AP throughout Wales. They discuss how the Welsh governance and collaborative style differs from that of the rest of the UK, and explore how Wales is developing, leading and innovating across the UK's wider advanced practice landscape
Source: Jones A. International Journal of Advancing Practice, 2024; 2(1): 49-50
Developing standardised pathways for recognition of advanced practice attainment
Abstract: In the UK, advanced practice has a rich developmental history. Since the mid-1980s, there has been a constant evolution in advanced practice innovation; such developments have inadvertently produced unwarranted variations in approaches to implementation of advanced practice roles. Such variations have their origins in multiple intersecting factors such as: multi-professional dimensions with multiple regulators and professional bodies; differences across the four nations of the UK; advanced practice roles growing organically in response to local need, health service commissioning decisions and profession specific imperatives; definitions and understandings of advanced practice differing between professions; and a proliferation of advanced practitioner roles with different titles, different scopes of practice and different educational requirements. All these evident dissimilarities in advanced practice innovations have led to a lack of consistency in implementing advanced practitioner roles, which has caused potential concern for patient safety and impeded effective workforce planning.
Source: Barratt J. International Journal for Advancing Practice, 2024; 2(2): 58-59
Defining the scope of advanced practice
Abstract: Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the issue of defining and regulating the scope of advanced nursing practice.
Source: Foster S. British Journal of Nursing, 2024; 32(20): 1017
