Feature
NURSING MANAGEMENTApril 2009 | Volume 16 | Number 116
Nurse leaders at NhS Lanarkshire wanted both
generalist and specialist nurses to have opportunities
to work as advanced practitioners, so they set out
to ensure that advanced practice is acknowledged as
a level, not as a role.
The model in Figure 2 shows the trajectory
of advanced practice where processes of care,
which are usually more explicit in specialist
practice, and where patients' journeys of care,
which are usually more explicit in generalist practice,
are addressed fully.
The fact that this trajectory is equidistant from
both axes indicates the importance, relevance and
value of generalist and specialist practice, and
suggests that both kinds of practice can incorporate
advanced practice.
A definition of the nurse consultant role was
entered on the trajectory to act as a point of
reference because the essential domains of this role
are also part of advanced practice (Table 2).
Defining scope of practice
Using the work of the Association of Advanced
Nursing Practice Educators (2006) and the RCN
(2008), a definition of scope of advanced nursing
practice was formulated at NhS Lanarkshire
(Box 1, page 18).
Advanced practice includes research,
education and management, but its most critical
component is clinical practice, which requires the
highest degree of professional responsibility and
accountability. Consequently, the emphasis in this
definition was placed on the clinical components
of the role.
As a result, there is great breadth and depth to
the advanced nurse practitioner role, which spans
the processes of care and patients' care journeys,
and combines the professional competencies and
capabilities of specialist and generalist practice.
Identifying roles
having established a practical definition of advanced
nursing practice, the next challenge was to identify
which of the current nursing roles met its criteria.
Four of NhS Lanarkshire's 11 nursing roles were
identified as potential advanced practice roles.
Nursing practice at NhS Lanarkshire can be
categorised as either `generalist' or `specialist', where
generalist nurses are defined as those who practise
across patient journeys, and specialist nurses as
those who use their specialist knowledge and skills
to focus on specific aspects of these journeys.
Care should be provided by both generalist and
specialist nurses to ensure that patients' journeys
are supported at all times by the most appropriate
healthcare professionals.
Recent figures show that NhS Lanarkshire has
140 designated clinical nurse specialists (Scottish
Government 2008), although there are many
generalist nurses who have specialist practitioner,
or equivalent, qualifications and who operate at high
levels of practice.
Table 1 NHS Lanarkshire nursing workforce
Pay band 2 3 4 5 6 7 8 Not AfC Total
Whole-time equivalents
Hospital 907.92 113.38 10.75 1,515.39 558.10 237.77 22.00 0.53 3,365.85
Community 67.22 132.65 3.25 296.44 408.65 199.30 9.50 6.67 1,123.68
Total 975.14 246.03 4.00 1,811.83 966.75 437.07 31.50 7.20 4,489.53
Figure 1 The key components of the Advanced Nursing Practice Toolkit
Scottish Government (2008)
Links
Workforce planning
support
Regulatory
guidance
Activity
analysis
Definitions
The advanced practice
toolkit
Educational
framework
Job profile and
Knowledge and
Skills Framework
outline
Development needs
analysis

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