Feature
NURSING MANAGEMENTApril 2009 | Volume 16 | Number 114
Summary
This article provides an overview of an advanced practice initiative developed
at NHS Lanarkshire. The criteria that must be met when determining advanced
practice roles are discussed, and the management and leadership challenges
inherent in defining and implementing advanced practice in nursing are explored.
The article concludes with an outline of future activities in this field.
Keywords
Advanced nursing practice, nursing roles, clinical practice
Marie Cerinus and Paul Wilson explain the development
of an advanced nursing practice model, and the challenges
that healthcare professionals must meet in its implementation
ADVANCED PRACTICE
IN NURSING: FROM
CONCEPT TO REALITY
ThE NEED to develop advanced practice in nursing
is highlighted in the government report Modernising
Nursing Careers: Setting the direction (Department of
health (Dh) 2006).
The advanced practice concept is also recognised
in the Skills for health (2006) careers framework and
has been subject to regulatory consideration by the
Nursing and Midwifery Council (NMC 2005).
NhSScotland has taken a lead role in developing
advanced practice on behalf of the UK, with the
launch last year of the Advanced Nursing Practice
Toolkit (NhSScotland 2008), the key components of
which are shown in Figure 1, page 16.
The toolkit emphasises that advanced practice is
a level of nursing practice, not a role for nurses.
There are two reasons for the recognition and
support of advanced nursing practice: to improve
patient safety and experience of care, and to
enable nursing services to develop new service
delivery models.
This article describes how the director of practice
development and the executive director for nursing
at NhS Lanarkshire have developed a model that
promotes advanced practice in generalist and
specialist nursing roles.
Developing the model
NhS Lanarkshire provides health services
across a large rural and urban population of
around 550,000. It has three district general
hospitals and around 100 community facilities,
and employs about 5,500 nurses, almost
4,500 whole-time equivalents, including
healthcare assistants.
NhS Lanarkshire's workforce statistics listing
the nursing workforce last July by Agenda
for Change (AfC) pay bands are shown in
Table 1, page 16.
There are 11 types of nursing roles in
NhS Lanarkshire's nursing role framework:
healthcare assistants.
Students.
Newly registered nurses.
Nurses in bands 5 and 6.
Associate clinical nurse specialists.
Clinical nurse specialists.
Lead clinical nurse specialists.
Senior charge nurses and team leaders.
Senior nurses.
Nurse consultants.
Associate and nurse directors.

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