Advanced practice is associated with many healthcare professions, such as physiotherapy, nursing, pharmacy, paramedic science and occupational therapy amongst others. This is a level of practice, not a job title or role, that is designed to transform and modernise pathways of care, enabling the safe and effective sharing of skills across traditional professional boundaries. Advanced practice is delivered by experienced and registered healthcare practitioners and is characterised by a high degree of autonomy and complex decision making (Health Education England, 2017). This is underpinned by an advanced academic award or equivalent expert and autonomous experience that encompasses the four pillars: clinical practice, leadership and management, education and research, with demonstration of the core capabilities.
In some countries, activity has been undertaken at local, national and international levels to determine how advanced practice is regulated. It is associated with considerable benefits to patients, including patient satisfaction, improvement in standards of care and clinical outcomes. However, there still remains a discrepancy in the recognition and regulation of advanced practice within contemporary healthcare systems. This enduring concern needs to be addressed by key stakeholders as advanced practice gains momentum around the world.
All health professionals working at the level of advanced practice have developed their skills and knowledge to an expert level. As such, advanced practitioners working within a health and care context have the freedom and authority to act and make autonomous decisions in the assessment, diagnosis and treatment of people. Advanced practice embodies the ability to manage care in partnership with individuals, families and carers. It includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance people's experience and improve outcomes. Advanced practitioners are required to operate as autonomous practitioners and should be able to make sound judgements in the absence of full information and manage varying levels of risk when there is complex, competing or ambiguous information or uncertainty. Importantly, all advanced practitioners will have developed their skills and theoretical knowledge to the same standards and should be empowered to make high-level decisions of similar complexity and responsibility. The composition of individual roles will be determined locally.
Leadership and management include identifying the need for change and innovation within practice, developing the case for change, creating a strategic vision, and building a coalition of effective individuals to effect any change. Managing change and service improvement is essential in advanced practice, alongside team development, negotiation and influencing others. Advanced practitioners are expected to initiate, evaluate and modify a range of interventions, which may include prescribing medicines, therapies, providing lifestyle advice and delivering care.
Education is the cornerstone to improving practice within the health and care and education sectors. Within advanced practice, it is necessary for practitioners to apply the principles of teaching and learning across their role with patients and service users, carers and staff alike, promoting an inclusive and creative learning environment. Developing service user and carer education materials, as well as teaching, mentoring and coaching staff, are essential for the continuous improvement of standards and the quality of care. Practitioners must be aware of the evidence underpinning subject-specific competencies, ie they must have the knowledge, skills and behaviours relevant to their role and scope of practice, and understand how to apply these, acting as a role model for other team members. Advanced practitioners are equipped with effective communication skills to support colleagues in making decisions, planning care or seeking alternatives as part of the process of making positive changes.
Research and evidence-based practice are crucial for the advancement of health and care practice. This includes not only practitioners' ability to access research and use the information, but also their involvement in research, to bring about improvements and change in practice and to disseminate their findings. Advanced practitioners are able to demonstrate clinical proficiency, which embodies the ability to manage clinical skills holistically, using clinical decision-making and clinical reasoning skills. They must apply analytical skills when treating people with complex problems and use evidence-based knowledge and skills; they must practise with competence and maintain ethical conduct, to enhance people's experience and improve patient outcomes.
As we launch the International Journal for Advancing Practice and publish the inaugural issue, we welcome readers to mark this important occasion with us. The International Journal for Advancing Practice is written by advanced practitioners and aims to ensure that the services other advanced practitioners provide are safe, effective and responsive to the needs in their local area, from a national and global perspective. We hope you enjoy the journal.