Deriving Consensus on the Characteristics of Advanced Practice Nursing

Advanced nurse practitioner (ANP) roles are continuing to emerge and evolve worldwide, including in the Republic of Ireland. Progress has been influenced by a number of factors which include; affording opportunities for nurses to advance their careers while remaining in clinical practice; health care cost containment; improving access to care; continuity of patient care and due to limits on junior doctors working hours. Confusion related to the definition of the ANP role, a multitude of role titles, what the role entails and what differentiates it from other specialist roles has impeded its overall development. This has led to difficulties in measuring clinical impact, and leads to conflicting conceptualizations of the role. This article focuses on the application of two domains of advanced practice as identified by Hutchinson et al. and applies the components of those domains of practice to an emerging advanced practice role in urology. The purpose of the article is to provide a tentative professional development framework for the advanced practice urology nursing role involved in managing a caseload of patients diagnosed with non‐muscle invasive bladder cancer (NMIBC) focusing on autonomous practice and improving systems of care. These domains of practice are discussed in cognisance of the needs of the population, the demands on the health care organization, and within the defined framework of advanced nursing practice in Ireland.

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Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.