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'Advanced practice nursing' (APN) is the term used to define a level of nursing practice that uses comprehensive skills, experience and knowledge in nursing care.
The Nursing and Midwifery Board of Australia (National Board) has published on its website Guidelines on endorsement as a nurse practitioner that define APN as the application of advanced levels of knowledge, skill and experience by the nurse to the nurse-patient/client relationship.
The basis of advanced practice is the high degree of knowledge, skill and experience applied in the nurse-patient/client relationship in order to achieve optimal outcomes through critical analysis, problem solving and accurate decision-making.
The National Board supports the view that nurses practising at this level are educationally prepared at Masters level and may work in a specialist or generalist capacity.
This definition comes from the best available research. The following are related useful readings from the Journal of Advanced Nursing:
The target audience of this fact sheet on advanced practice nursing is as follows:
- applicants to the National Board for nurse practitioner endorsement
- education providers offering programs for nurse practitioners
- assessors of nurse practitioner applications, and
The related reading from the Journal of Advanced Nursing, as listed in this fact sheet, demonstrates that the following practice domains constitute the levels of APN:
- direct and comprehensive care
- support of systems
- publication, and
- professional leadership.
These domains are applied in the Australian context and appear to be consistent with the diversity of roles and categorisation for advanced practice.
In the case for nurse practitioners, the National Board gives a clear guideline of three years full time equivalent (5,000) hours of advanced practice nursing as demonstration of required clinical focus.
In the Australian context, APN remains less well understood, and APN roles are inadequately defined or supported.
It is, therefore, crucial that employers make sure that registered nurses working at advanced practice levels (i.e. in situations of high clinical work complexity) are clinically and educationally competent through continuing professional development (CPD) within the scope of advanced practice nursing.
The role of the nurse practitioner is highly clinically focused and is tightly regulated by the National Board. In contrast, the APN role has a wider domain of practice and is not regulated.
In Australia, applicants for nurse practitioner endorsement must first be eligible for general registration as a nurse. This means that nurse practitioners are also able to practice as registered nurses.
However, endorsement as a nurse practitioner requires the applicant to demonstrate that they meet Competency standards for the nurse practitioner, which the National Board reviews periodically.
The National Board Guideline on endorsement as a nurse practitioner states:
The nurse practitioner role includes assessment and management using nursing knowledge and skills. The role may include, but is not limited to, the direct referral of patients to other health care professionals, prescribing medications and ordering diagnostic investigations. The role is grounded in the nursing profession’s values, knowledge, theories and practice, and provides innovative and flexible health care delivery that complements other health care providers.
The intention for introducing the nurse practitioner role in Australia was to recognise a clinically focused, highly skilled nursing role that allowed nurse practitioners to function autonomously (in collaborative relationships with other health professionals).
Nurse practitioners have a higher accountability for, and authority in the management of, their patient group than other registered nurses. In order to fulfil this accountability, the nurse practitioner is required to be endorsed by the National Board to prescribe medicines, order diagnostics and make referrals.
Advanced practice nursing, while potentially remaining clinical to some extent, may not purely be confined to clinical work. The nurse practitioner role is expected to be predominantly clinically focused.
When assessing individuals who have applied for nurse practitioner endorsement, the National Board recognises that three years of full time advanced practice nursing demonstrates a corresponding level of clinical focus required. However, it is for the applicant to make the case that their practice meets the definition of advanced practice nursing. Neither they nor the assessor ought to rely solely on an industrial award position as the definition of advanced practice nursing. There may be applicants who are not able to obtain a position that awards the appropriate level of remuneration for the APN work they do and these people ought not to be deterred from attempting to make their case.
In hours, the National Board recognises a minimum of 5,000 hours of clinical focus and the applicant may demonstrate this clinical focus across primary to tertiary care.
Specific competencies define the role and scope of practice for registered nurses. These competencies define the registered nurse’s role at all levels of nurse practice – from that of a clinically prepared new graduate to advanced practice nursing.
The scope of practice necessitates the registered nurse to reflect on their level of expertise, the complexity of the clinical situation in which they find themselves, and the level of supervision.
The National Board’s Decision making framework and the use of the relevant Codes of ethics and Codes of conduct outline the requirements for registered nurses to achieve higher levels of competence and expertise.
Registered nurses may work at levels of advanced practice nursing – where the work is of high complexity and level of supervision may be lower than that of beginner registered nurses.
It is essential that the registered nurses are clinically and educationally prepared to perform at those levels.