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Advanced Nursing Practice: Experience, Education and Something Else
Richard Lakeman RCpN, DipNsg, Dip (Herbal Studies), BN Nursing Lecturer, Eastern Institute of Technology, Taradale
The purpose of this paper is to stimulate discussion and debate about the ‘concept’ of ‘advanced practice’ and the wider issue of ‘advancing’ nursing practice. Defining, credentialling and regulating advanced practice promises rich fruits for nursing. Advancing nursing practice will be a consequence only if the right conditions are fostered for the development and provision of nursing expertise in practice. A conscious and collective effort must be made to ensure that the expertise of all nurses is recognised and developed. One process which has shown promise in psychiatric and mental health nursing is ‘clinical supervision’. Evolving nursing leadership roles and more education can provide only a partial solution to the problem of advanced and advancing practice.
Key Words: Advanced practice, Clinical Supervision, Expertise, Reflective Practice
At the present time in nursing circles there appears to be a preoccupation with the concept of ‘advanced practice’. A review of the nursing literature (using the Cumulative Index of Nursing and Allied Health Literature) reveals over 1800 articles with ‘advanced practice’ as a subject heading published within the last 9 years. Present difficulties of recruiting and retaining nurses in the workforce (Peach, 1999) and lack of consistency in recognising the skill of nurses (Ministerial Taskforce on Nursing, 1998, p.77) make grappling with the issue of recognising and developing advanced practice an urgent problem. The Ministerial Taskforce on Nursing (1998, p.29) stated that “… the role of advanced and clinical specialist nurses is central to improved patient services in the context of future changes to health and illness service delivery.” Advanced practice is also inextricably linked with extended and expanded roles for nurses. Gunn (1999) observed that ‘advanced practice’ is interlinked with nurse prescribing. In New Zealand proposed amendments to the Medicines Act (1981), to enable nurse prescribing, have focused the attention of a wide range of groups on advanced practice and the educational preparation needed to facilitate such changes (Jacobs, 1998).