Advanced Practice is a 'level of practice', rather than a specific role or title (SGHD 2008).
Advanced nursing practice has four pillars of practice, which the advanced nurse practitioner must have as part of their core role and function. These four pillars are:-
• Clinical practice;
• Facilitation of learning;
• Evidence research and development.
The Advanced Nurse Practitioner role has a specific focus on the clinical pillar, but must demonstrate competence within all four pillars of advanced practice. With regard to the clinical pillar all ANPs must be able to demonstrate competence in:
a) Comprehensive history taking;
b) Clinical assessment;
• Carries out comprehensive clinical examination of the patient in their entirety, inclusive of:
• Physical examination of all systems
• Mental health assessment
c) Differential diagnosis
• Applies high level decision-making and assessment skills to formulate appropriate differential diagnoses based on synthesis of clinical findings. This takes account of managing clinical risk in dealing with undifferentiated client groups across the age spectrum.
• Has the freedom and authority to request, where indicated using judgement and clinical reasoning, appropriate diagnostic tests / investigations based on differential diagnoses.
• Interprets and analyses previously ordered results of tests/investigations and work collaboratively with other healthcare professionals when needed. Acts on the results to confirm diagnosis and thereby optimise treatment and management outcomes.
• Formulates an action plan for the treatment of the patient, synthesising clinical information based on the patient’s presentation, history, clinical assessment and findings from relevant investigations, using appropriate evidence based practice.
• Is an independent non medical prescriber
• Implements non-pharmacological related interventions/therapies, dependent on situation and technical requirements of care
f) Admission, discharge and referral
• Has the freedom and authority to admit and discharge from identified clinical areas, dependent on patient need at time of review. This includes the freedom and authority to refer to all appropriate health care professional groups and agencies, working collaboratively with them.
Banding ANPs are paid at a minimum of Band 7, and within NHSGGC the generic ANP Job Description should be used for any new Band 7 ANP roles.
Education The professional development of an ANP requires significant educational commitment and investment to underpin the provision of high quality safe and effective practice. Key to this is a Masters level qualification in Advanced Practice, with core educational focus on the development of competence:-
• Clinical assessment;
• Clinical reasoning, judgement and diagnostic decision making;
• Anatomy and pathophysiology;
• Non medical prescribing- V300;
• Leading, delivering and evaluating care;
• Practice learning/transferable work based learning. For further information on the ANP role in Scotland please see the Transforming Nursing Roles Phase 1 paper (link in the introduction).