The changing context of advanced practice nursing within the UK community care setting
Advanced practice nursing (APN) roles have developed partly to address demand and workforce issues. In community care settings and general practice, an advanced nursing practitioner is generally understood to mean a nurse who has undertaken additional education and training in clinical assessment, including history-taking and physical examination, clinical reasoning and independent prescribing, so they can safely manage patients presenting with undifferentiated and undiagnosed conditions. Capabilities in the Skills for Health framework cover everything from communication and consultation skills, practising holistically and personalised care, to working with colleagues and in teams. The framework is intended to ensure advanced nursing practitioners work to an advanced level. It is also designed to support them to demonstrate and evidence their capabilities to service commissioners, employers, people accessing healthcare and the public.
There are several key definitions of advanced practice within the context of nursing. The International Council of Nurses (ICN) defines the role specific to nursing as the advanced practice nurse (APN). An APN is ‘a registered nurse who has 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, 2021). The Royal College of Nursing (RCN) (2021) defines advanced practice as a level of practice, rather than a role, type, or specialty of practice. Advanced practitioners are educated at master's level in advanced practice and are assessed as competent in practice, using expert knowledge and skills. They have the freedom and authority to act, making autonomous decisions in the assessment, diagnosis and treatment of patients. Health Education England (HEE) (2017) has a similar definition and identifies advanced clinical practice as provided 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, management, education and research—with demonstration of core capabilities and area-specific clinical competence. In addition, advanced clinical practice embodies the ability to manage clinical care in partnership with individuals, families, and carers.
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