Fothergill LJ, Al-Oraibi A, Houdmont J Nationwide evaluation of the advanced clinical practitioner role in England: a cross-sectional survey. BMJ Open. 2022; 12:(1)

Advancing practice: what exactly is being advanced?

02 January 2023
Volume 1 · Issue 0

Advocating for advanced practice is not always an easy task. There are often numerous issues associated with agreed roles and functions undertaken by advanced practitioners intra and inter country, which has become a global phenomenon. The agreement and definition of the plethora of terms associated with this role is indeed a challenge for those who use the service and for practitioners. The advanced practitioner role has an elusive quality, lacks clarity and is a relatively new concept in some parts of the world, which has huge implications for the provision of services, advanced practitioners themselves and the development of advanced practice. Despite this, advanced practice is picking up momentum and gaining traction.

As a result of increasing pressures on healthcare systems, the role of the advanced practitioner has been extensively implemented around the globe. This is a level of practice that is applicable across many health and care professions, and allows practitioners to exercise a level of autonomy across the four domains or pillars of practice: clinical practice; leadership and management; education; and research, with these health and care professionals practicing to the full extent of their licence. National frameworks concerning this role have been developed, usually with the aim of ensuring consistency across the role. To meet ever growing service demands, there was a need to design innovative care models and create advanced roles to contribute to the workforce transformation agenda. The introduction of advanced practice has been a particularly significant approach.

With an ever-growing demand for the provision of high quality, safe and effective healthcare against a backdrop of financially constrained budgets and a world that is in a constant state of flux, it has become even more important to have the right care staff who are educated and competent to ensure the delivery of the best care possible at the right time for patients. Those who are responsible for the planning and commissioning of services, as a result of changing patterns of healthcare, are being compelled to examine and implement new service delivery models.

Essential to the development and transformation of the workforce and the delivery of the right services and care, alongside improved health and wellbeing outcomes for people, effective leadership and the encouragement of innovative approaches to care provision that are responsive and cost effective are needed. In all spheres of healthcare, practitioners around the world are increasingly extending and expanding their scope of practice beyond their initial registration. Advanced practitioners are developing their skills, competence and confidence.

While previous foundational research has clearly established the efficacy and safety of advanced practice roles, more recent innovations of advanced practitioner roles have been subject to less research scrutiny. For example, there is a lack of governance, education and support associated with the advanced clinical practitioner role (Fothergill et al, 2022). Advanced practitioners are continually having to demonstrate their value, worth, impact and what it is that they actually do. To be able to confidently demonstrate their impact, value, clarify their role and advance their practice, advanced practitioners must continually collect data (in its many forms). There is little point in making your value known if you are unsure or unaware of what your value is. But knowing your worth, and having the data to support it, can be a way of establishing the individual and collective value of advanced practice.

Data collection and dissemination are key, and this has to be done from a global perspective, avoiding silo working. In doing so, like minded communities who aim to find common ground can be brought together to stimulate and harness best practice (in its broadest sense), and demonstrate the power, force and impact for the greater good.

Comment gathering, the generation of data and the dissemination of findings provides a base line that can assist with workforce planning. As the uptake of advanced practice roles grow internationally, research findings will have relevance across professions for global healthcare workforce transformations. It may also encourage an exploration of the various challenges that impact the implementation of advanced-level practice. Generating an evidence base and using a systematic approach allows the assessment of the outcomes and impact of advanced-level practice roles across sectors, specialties and professions. Furthermore, any findings generated through research have the potential to identify the areas that urgently require future investigation, provision and investment (Fothergill et al, 2022).

It is acknowledged that there is a changing landscape in the world of advanced practice, as is the case in all spheres of practice. However, there is still so much more to be done to enable advanced practice. Regardless of the issues that abound, it is vital that a definitive definition of the role or a contextually relevant defined role descriptor is decided upon. Additionally, it is important that the role of advanced practitioner remains dynamic and responsive to ensure that it flexes, because it has to, with local, national and international dynamic health and care sectors.