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- Serie: Wiley Series on Cognitive Dynamic Systems
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Advanced Clinical Practice at a Glance The market-leading at a Glance series is popular among healthcare students and newly qualified practitioners for its concise, simple approach and excellent illustrations. Each bite-sized chapter is covered in a double-page spread with clear, easy-to-follow diagrams, supported by succinct explanatory text. Covering a wide range of topics, books in the at a Glance series are ideal as introductory texts for teaching, learning and revision, and are useful throughout university and beyond. Everything you need to know about Advanced Clinical Practice ... at a Glance! Advanced Clinical Practice at a Glance is an inclusive multi-professional resource that provides essential guidance for healthcare students on a myriad of topics related to advanced clinical practice. This book focuses on NMC and HCPC regulatory body requirements and is also aligned to nationally recognised advanced practitioner training curricula such as the Faculty Intensive Care Medicine (FICM), the Royal College of Emergency Medicine (RCEM) and the Royal College of Nursing (RCN). Made for the practicing clinician, Advanced Clinical Practice at a Glance is the perfect size for busy healthcare professionals. The snapshot figures and key points make the information highly accessible. Each chapter is written in a format that enables the reader to review and comprehend chapters individually. This valuable text includes: * Guidance on undergraduate and postgraduate education programmes to allow students to prepare for more advanced level roles * How to achieve transformation in advanced clinical practice via key functions like programme accreditation and recognition of education and training equivalence * A directory of practitioners to recognise those working at an advanced level of practice across specialties Containing essential practical and theoretical guidance, Advanced Clinical Practice at a Glance is a must-have modern resource for all healthcare students looking to get involved in the field, plus professionals working in disciplines that intersect with advanced clinical care. For more information on the complete range of Wiley nursing and health publishing, please visit: www.wiley.com To receive automatic updates on Wiley books and journals, join our email list. Sign up today at www.wiley.com/email All content reviewed by students for students Wiley nursing books are designed exactly for their intended audience. All of our books are developed in collaboration with students. This means that our books are always published with you, the student, in mind. If you would like to be one of our student reviewers, go to www.reviewnursingbooks.com to find out more. This new edition is also available as an e-book. For more details, please see www.wiley.com/buy/9781119833284
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Table of Contents
Cover
Title Page
Copyright Page
Dedication Page
Contributors
Preface
Part 1: Advanced clinical practice
1 Introducing advanced clinical practice
Advanced Practice Toolkit (APT)
Centre for Advancing Practice
Conclusion
2 Scope of practice
Defining scope of practice
Expanding scope of practice
Dunning–Kruger effect
Imposter syndrome
Regulation
3 Professional, legal and ethical considerations of advanced practice
Professional issues
Competence
Responsibility
Accountability
Indemnity
Regulation
Governance
Legal issues
Ethics
Consent
4 Advancing to consultant‐level practice
Consultant‐level practice
The journey from advanced to consultant practice
Conclusion
5 Transitioning to advanced practice
Becoming an advanced clinical practitioner
Acceptance
Prescribing
Uniforms
Academic study
Mentorship and supervision
Transitioning to advanced clinical practice
Scope of practice
Advancing the advanced clinical practitioner
Conclusion
6 Continuing professional development and lifelong learning
Continuing professional development
Continuing professional development and the four pillars of advanced practice
Enablers for effective continuing professional development and lifelong learning
The future of continuing professional development and lifelong learning
7 Consultation models
Classification of consultation models
Calgary‐Cambridge Guide to the Medical Interview
Cone technique
Ideas, concerns and expectations (ICE)
Communication
Triggers to consultation
Consultations with an alternative agenda
Assessing the quality of consultations
Part 2: Advanced history taking and physical examination
8 Principles of history taking and physical examination skills
History taking
Skills needed to elicit information
History taking for special situations
General aspects of physical examination
Physical examination for special situations
Evidence‐based physical diagnosis
9 Principles of diagnostic testing and clinical decision making
Key principles
Diagnostic accuracy and clinical decision making
10 The psychiatric interview: mental health history taking and examination
The psychiatric interview
Components of the psychiatric history
Mental State Examination
11 History taking for patients who lack mental capacity
12 Dermatology history taking and physical examination
Prevalence of dermatological conditions
Presentation of dermatological conditions
History of presenting complaint and past medical history
Drugs
Allergies
Family and social history
Social history
Psychosocial impact
Review of systems
Examination
Investigations
Documentation
Dermatological emergencies
13 Neurological history taking and physical examination
Prevalence of neurological disorders
Presentation of neurological disorders
Past medical history (PMH)
Drug history (DH)
Family history (FH)
Social history (SH)
Review of systems (ROS)
Physical examination
Concept mapping in neurological disorders
Summary
14 Ear, nose and throat history taking and physical examination
Ear
Nose
Throat
15 Lymph node assessment
Lymphadenopathy
Assessing lymphadenopathy
Causes of lymphadenopathy
16 Endocrine history taking and physical examination
Prevalence of endocrine conditions
Presentation of endocrine disorders
Past medical history
Drugs
Family history
Clinical examination
Clinical investigations
Endocrine 'red flags’
Endocrine emergencies
17 Respiratory history taking and physical examination
Prevalence of respiratory disorders
Presentation of respiratory disorders
Past medical history
Drug history
Family history and social history
Clinical examination
Concept mapping in respiratory disorders
Respiratory red flags
Respiratory emergencies
18 Cardiovascular history taking and physical examination
Presentation of cardiac disorders
Drug history
Clinical examination
Concept mapping in cardiac disorders
Cardiac red flags
19 Abdominal history taking and physical examination
Presentation of gastrointestinal disorders
Past medical history
Drug history
Family history and social history
Clinical examination
Differential diagnosis and concept mapping in gastrointestinal disorders
Gastrointestinal red flags
Investigations
20 Genitourinary system history taking and physical examination
Presentation of genitourinary system disorders
Past medical history
Drug history
Family history and social history
Clinical Examination
Genitourinary system red flags
21 Musculoskeletal system history taking and physical examination
Prevalence of musculoskeletal system disorders
Presentation of musculoskeletal system disorders
History of presenting complaint
Past medical history
Drug history
Family history and social history
Clinical examination
Musculoskeletal system red flags
22 Dealing with difficult situations
Duty of care
Informed refusal
Preventing a challenging interaction
Handling a challenging interaction
Breaking bad news
Part 3: Advanced clinical interventions
23 Fundamental ultrasound skills
Basic principles of ultrasound
Clinical application
Training and governance
24 Lung ultrasound
Probe selection and image optimisation
Probe placement and normal sonoanatomy
Image interpretation
Limitations
25 Vascular ultrasound
Indications for use
Relative contraindications
Sonography
Technique
DVT assessment:
26 Focused echocardiography
FUSIC Heart
FEEL
BSE Level 1
Preparing for the examination
Probe and manipulation
Basic views
Echocardiographic assessment
Common pathologies
27 Central venous catheter and arterial catheter insertion
Central venous catheter insertion
Arterial catheter insertion
28 Pleural procedures
Understanding the pleural space
Local Standards for Safe Invasive Procedures (LocSSIPs)
Complications of pleural procedures
Effect of pleural procedures
Investigations
29 Radiology interpretation
Plain radiographs
Radiology referrals
IRMER
Plain X‐ray
Cross‐sectional imaging
Fluoroscopy
30 The advanced practitioner’s role in organ donation and transplantation
Types of donation
Diagnosing death by neurological criteria ('brainstem death testing')
Role of the specialist nurse for organ donation (SN‐OD)
Optimisation of the potential organ donor
UK law and ethics
Tissue donation
31 Verification of death
Diagnosis of death
Legal aspects
Diagnosis of death guidance and practice
Training and Competence
32 Home‐based care, crisis response and rehabilitation
Improving Outcomes
Skills and knowledge
Rehabilitation
33 Frailty
What is frailty?
Who has frailty?
How to identify frailty
Why is it important to recognise frailty?
How do I find out more?
34 Advanced practitioner‐led inter‐ and intrahospital transfer
Patient stabilisation and preparation for transfer
During and after transfer
Governance
Conclusion
Part 4: Independent prescribing
35 Principles of pharmacology
Pharmacodynamics
Pharmacokinetics (ADME)
36 Non‐pharmacological and pharmacological interventions
Splinting
Psychology, physiology and pharmacology
Altered pharmacokinetics
Multimodal approach (Figure 36.2)
Distraction techniques
Home remedies
Health promotion
37 Shared decision making
Mental capacity, informed consent and prescribing decisions
Creating a partnership
Reflection and self‐growth to facilitate a better understanding
38 Prescribing practice and patient education
Education
Behaviour change
Case study – Suzanne
Social prescribing
Materials
Part 5: Advanced clinical practice leadership and management
39 Leadership in healthcare settings
Leadership in healthcare settings
Approaches to leadership in healthcare settings
Opportunities for advanced practice
40 Leadership and management theories
Management theory
Leadership theory
Conclusion
41 Clinical leadership
What is clinical leadership?
Clinical leadership vs management
What makes a good clinical leader?
Clinical leadership within advanced practice
Conclusion
42 Educational leadership
Organisational level
Teamwork
Individual level
Distributive leadership and education
Case study – Demonstrating Educational leadership
43 Research leadership
Embracing social responsibilities within research leadership
Impact – an unexplored domain of research leadership in advanced clinical practice
Conclusion
44 Improving quality of care
What is quality improvement in healthcare and why is it important?
Stakeholders and assessing feasibility
Problem identification and models for improvement
Quality improvement methods
Part 6: Advanced clinical practice education
45 Exploring the challenges with advanced clinical practice education
Background/context
System standard setting for, and co‐ordination of, ACP education
Development and delivery of ACP education – workplace‐based and academic support and supervision
46 Opportunities for advanced clinical practice education and associated support mechanisms
Background
Pathways to ACP education
Educational opportunities
47 Education and learning theories
Constructive alignment
Ensuring learning is appropriate
Experiential learning and constructivism
48 Simulated learning and decision‐making theories
Why use simulation‐based education?
How to use simulation‐based education
Decision making in simulation
49 Integrating simulation and virtual reality into clinical practice education
Standards for simulation‐based education
Curriculum design
Virtual reality (VR) in healthcare education
50 The advanced practitioner as clinical educator and supervisor
What is workplace‐based assessment?
Feedback
Ende’s guidelines for effective feedback
Pendleton’s feedback model
Differential attainment and remediation
Part 7: Advanced clinical practice research
51 Ethical and governance principles
Ethical principles
Governance principles
52 Research design and methods
Leading in areas of expertise
Leading on research – self and others
Case studies
53 Critical appraisal skills
Stages of critical appraisal
Critical appraisal frameworks
Further skill development
54 Audit and quality improvement sciences
Lean methodology
Six Sigma
Model for improvement
Experience‐based co‐design
55 From bench to bedside: integrating research into practice
Step 1: Formulating a clinical question – the PICO method
Step 2: Locating the evidence/research – performing a systematic literature review
Step 3: Critical appraisal and the hierarchy of evidence
Step 4: Extracting the most relevant and useful results
Step 5: Implementing research into practice
Conclusion
References
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Key advanced practice resources
Chapter 2
Table 2.1 A timeline of political drivers for advancing and advanced level ...
Chapter 9
Table 9.1 Clinical situation
Table 9.2 Sensitivity and specificity Based on [2]
Table 9.3 True positives and true negatives Based on [2]
Table 9.4 Statistical terms pertaining to evidence‐based diagnosis/diagnost...
Chapter 10
Table 10.1 The Mental State Exam (MSE)
Table 10.2 Common delusions and example questions
Table 10.3 Common hallucinations
Table 10.4 Types of agnosia and their causes
Chapter 11
Table 11.1 Core principles of the MCA 2005
Chapter 12
Table 12.1 Common skin, hair and nail presentations.
Table 12.2 Essential elements of a dermatological history
Table 12.3 Essential elements of a dermatological examination
Chapter 14
Table 14.1 ENT assessment checklist
Chapter 15
Table 15.1 Medications that can cause lymphadenopathy
Table 15.2 MIAMI for differential diagnosis of lymphadenopathy
Chapter 16
Table 16.1 Common clinical symptoms and features of endocrine conditions an...
Chapter 17
Table 17.1 Common clinical symptoms and features of respiratory conditions ...
Chapter 18
Table 18.1 Common clinical symptoms and features of cardiac conditions and ...
Table 18.2 Cardiac conditions and common clinical features featuring their ...
Chapter 20
Table 20.1 GUS examination in males
Table 20.2 GUS examination in females
Chapter 21
Table 21.1 Types of musculoskeletal pain
Table 21.2 Referral, diagnosis and investigations of rheumatoid arthritis
Table 21.3 MSK inspection
Table 21.4 MSK palpation
Chapter 22
Table 22.1 Common communication behaviours to avoid when responding to chal...
Chapter 23
Table 23.1 Advantages and limitations of ultrasound
Table 23.2 UK ultrasound accreditation pathways
Chapter 24
Table 24.1 Sonographic findings of common respiratory pathologies
Chapter 25
Table 25.1 Risk factors for venous thromboembolism.
Chapter 26
Table 26.1 Basic vs advanced echocardiography
Chapter 27
Table 27.1 Site selection
Table 27.2 Central line tip position.
Chapter 28
Table 28.1 Pleural pathologies ' suggested first line management to support...
Table 28.2 Light’s criteria.
Table 28.3 Diagnostic accuracy of Light’s criteria for diagnosing transudat...
Chapter 29
Table 29.1 Comparison of imaging modalities
Table 29.2 Radiation doses by modality
Chapter 30
Table 30.1 Additional resources concerning organ donation and transplantati...
Chapter 31
Table 31.1 Recognition of life extinct
Table 31.2 Documented criteria for the diagnosis of death following cardior...
Chapter 33
Table 33.1 Models of frailty
Table 33.2 How to identify frailty: the five frailty syndromes
4
Chapter 35
Table 35.1 Factors affecting speed and extent of absorption of non‐parenter...
Table 35.2 Terms used to describe lipid and water solubility
Table 35.3 Hydrolysis
Table 35.4 Drugs that commonly induce or inhibit CYP450 enzymes
Table 35.5 First‐order and zero‐order kinetics
Chapter 37
Table 37.1 The two‐stage test and five statutory principles of the Mental C...
Table 37.2 ‘Ask 3 Questions’ advocated by the Health Foundation Campaign
Chapter 39
Table 39.1 Examples of attributes of effective healthcare leadership in tea...
Table 39.2 Examples of consequences of effective healthcare leadership in t...
Chapter 41
Table 41.1 Attributes of a clinical leader
Chapter 42
Table 42.1 Patient‐focused leadership capability domains and capabilities. ...
Chapter 43
Table 43.1 Key research leadership competencies for advanced clinical practi...
Table 43.2
Leadership Skills
Chapter 44
Table 44.1 Principles of quality improvement
Table 44.2 Root cause analysis tools
Table 44.3 Mapping process tools
Chapter 45
Table 45.1 Challenges concerning ACP education and actions identified at sy...
Chapter 46
Table 46.1 UK nations’ definitions, core knowledge and capabilities for adv...
Chapter 48
Table 48.1 Considerations when planning to use SBE as an education tool. ...
Chapter 51
Table 51.1 Defining research
Chapter 53
Table 53.1 Critical appraisal skill development resources
Chapter 55
Table 55.1 The PICO Model and an example research question pertaining to cr...
Table 55.2 Boolean operators and their meaning
List of Illustrations
Chapter 1
Figure 1.1 The four pillars of advanced clinical practice based on the Healt...
Chapter 4
Figure 4.1 Roadmap to consultant practice.
Chapter 5
Figure 5.1 Seven fundamental considerations which underpin supervision in ad...
Chapter 7
Figure 7.1 Consultation models and their differing emphasis on four common d...
Figure 7.2 A pictorial representation of the Open to Closed Cone described i...
Chapter 8
Figure 8.1 Concept map as a history‐taking template.
Figure 8.2 Concept map as a history‐taking template for chest pain.
Chapter 9
Figure 9.1 A receiver operator curve (ROC) to compare hypothetical diagnosti...
Chapter 10
Figure 10.1 Joiner’s interpersonal theory of suicide.
Chapter 11
Figure 11.1 Interviewing the person without capacity
Figure 11.2 Advanced communication skills used whilst interviewing people wh...
Chapter 12
Figure 12.1 Common skin eruptions.
Figure 12.2 Clinical presentations of cutaneous adverse drug reactions. DRES...
Figure 12.3 Acute phase fulminant meningococcemia and purpura fulminans.
Chapter 13
Figure 13.1 Cranial nerve examination.
Chapter 14
Figure 14.1 Examination of the ears, nose, throat and neck.
Figure 14.2 Labelled diagram of the tympanic membrane.
Chapter 15
Figure 15.1 Structure of the lymph node.
Chapter 16
Figure 16.1 Clinical examination findings and features of common endocrine c...
Chapter 17
Figure 17.1 Process for performing a respiratory examination.
Chapter 18
Figure 18.1 Cardiovascular examination.
Figure 18.2 Concept map detailing the potential aetiology of oedema.
Chapter 19
Figure 19.1 Process for performing an abdominal examination.
Chapter 20
Figure 20.1 History taking and physical examination of the GUS in male anato...
Figure 20.2 History taking and physical examination of the GUS in female ana...
Figure 20.3 History taking and physical examination of the pregnant patient...
Chapter 21
Figure 21.1 Physical examination of the MSK system.
Chapter 22
Figure 22.1 Factors that contribute to difficult experiences in breaking bad...
Chapter 23
Figure 23.1 Ultrasound–tissue interaction
Figure 23.2 Echogenicity scale.
Figure 23.3 Modes of ultrasound
Chapter 24
Figure 24.1 Key ultrasound images
Chapter 25
Figure 25.1 Ultrasound detection of a DVT. The probe is held lightly on the ...
Figure 25.2 Duplex ultrasound scan demonstrating lack of flow in the common ...
Figure 25.3 Normal duplex ultrasound scan demonstrating compression of the v...
Chapter 26
Figure 26.1 Standard patient positioning
Figure 26.2 The phased array probe
Figure 26.3 Basic cardiac views
Chapter 27
Figure 27.1 Diagram of the internal jugular vein and its divisions. The inte...
Figure 27.2 Central venous waveform in relation to the electrocardiogram....
Figure 27.3 Stylised diagram of heart and great veins, and areas where cathe...
Figure 27.4 Modified Allen test. (a) With the patient's arm flexed at the el...
Figure 27.5 Arterial waveform.
Chapter 28
Figure 28.1 The pleural space and movement of pleural fluid under normal cir...
Figure 28.2 Triangle of safety for chest drain insertion.
Chapter 29
Figure 29.1 Radiation dose comparisons. Source: Society of Radiographers (20...
Figure 29.2 General principles of plain X‐ray interpretation
Chapter 30
Figure 30.1 (a) DBD donor optimisation care bundle 1. (b) DBD donor optimisa...
Chapter 31
Figure 31.1 Criteria for the diagnosis of death.
Figure 31.2 Tests for the absence of brainstem function
Chapter 32
Figure 32.1 Home‐based care
Figure 32.2 The advanced clinical practitioner’s role in managing long‐term ...
Chapter 33
Figure 33.1 A pictorial demonstration of how frailty can impact upon recover...
Figure 33.2 Screening tools recommended by the British Geriatric Society
Chapter 35
Figure 35.1 Types of targets for drug action (RICE).
Figure 35.2 Routes of drug absorption.
Figure 35.3 Therapeutic index. Schematic diagram of the dose–response relati...
Chapter 36
Figure 36.1 Neural circuit of gate control of pain. In the top panel, the no...
Figure 36.2 The effect of pharmacological and non‐pharmacological pain manag...
Chapter 37
Figure 37.1 Choose Wisely UK advocated questions (BRAN) to aid the decision‐...
Chapter 38
Figure 38.1 The dimensions of health.
Figure 38.2 The influences that potentially threaten, promote or protect hea...
Figure 38.3 Methods of education delivery
Chapter 40
Figure 40.1 Leadership and management traits.
Figure 40.2 Major management theories.
Figure 40.3 Major leadership theories.
Chapter 41
Figure 41.1 Leadership capabilities of advanced practice (adapted from https...
Chapter 42
Figure 42.1 The leadership capabilities of advanced practitioners.
Chapter 43
Figure 43.1 Plan Do Study Act (PDSA) cycle.
Chapter 44
Figure 44.1 Outline of the quality improvement process.
Chapter 46
Figure 46.1 Issues for consideration and sources of information for aspirant...
Chapter 47
Figure 47.1 Bloom’s taxonomy.
Figure 47.2 Sociocultural theory of human learning
Figure 47.3 Kolb’s learning cycle.
Chapter 49
Figure 49.1 ASPiH Standards for Simulation‐based Education in Healthcare....
Figure 49.2 Schematic illustration of virtual reality, merged reality and au...
Chapter 50
Figure 50.1 The relationship of assessment strategies to educational hierarc...
Figure 50.2 Pendleton’s feedback model.
Figure 50.3 ALOBA principles.
Chapter 52
Figure 52.1 The research cycle.
Figure 52.2 Planning a research study.
Figure 52.3 Service evaluation method.
Figure 52.4 Steps in developing an audit tool.
Figure 52.5 Qualitative observational study methods.
Chapter 53
Figure 53.1 Critical appraisal considerations.
Figure 53.2 The wheel of evidence‐based practice.
Chapter 54
Figure 54.1 Lean methodology – eight wastes.
Figure 54.2 Six Sigma DMAIC and DMADV comparison
9
Figure 54.3 Lean Six Sigma tools overview.
Figure 54.4 Continuous iterative approach to the PDSA cycle.
Figure 55.5 Experience‐based codesign cycle.
Chapter 55
Figure 55.1 Evidence‐based practice triad
Guide
Cover Page
Title Page
Copyright Page
Dedication Page
Contributors
Preface
Table of Contents
Begin Reading
References
Index
WILEY END USER LICENSE AGREEMENT
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Advanced Clinical Practice at a Glance
Edited by
Barry Hill,
MSc AP, PGCAP, BSc (Hons), DipHE/OA Dip,
SFHEA, TEFL, NMC RN, RNT/TCH, V300.
Assistant Professor and Lead for Nursing
Midwifery and Health Employability,
Northumbria University
Sadie Diamond Fox,
MCP ACCP, BSc(Hons) RN, PGC AHP, NMP
(V300), FHEA
Advanced Critical Care Practitioner (FICM
member) and Assistant Professor in Advanced
Critical Care Practice, ACP and ACCP Lead,
Northumbria University
Series Editor: Ian Peate
This edition first published 2023.© 2023 John Wiley & Sons Ltd
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Library of Congress Cataloging‐in‐Publication Data applied forPaperback ISBN 9781119833284
Cover Design: WileyCover Image: © Khakimullin Aleksandr/Shutterstock
DedicationThis book is dedicated to my friends and family, in particular my dad Ray Hill and friend Helen Jackson who passed away in 2021. I will love you for eternity. Thanks to my co‐editor Sadie Diamond‐Fox and the Wiley team for your support, and all the book contributors for sharing your knowledge
BHTo my ‘cheerleaders’; my friends and family, in particular my husband, Alexandra Gatehouse and my co‐editor Barry Hill
SDF
Contributors
Clare AllabyrneChapter 11Associate Professor and Programme Lead for Advanced Clinical Practice Mental Health, London Southbank University
Jill BentleyChapters 37, 38Lecturer in Advanced Clinical Practice, Non‐Medical Prescribing and Adult Nursing, and Advanced Critical Care Practitioner (FICM member), Salford Royal Foundation Trust
Lee BerryChapter 25Advanced Critical Care Practitioner (FICM member), Southampton General Hospital
Helen BoneChapter 17Advanced Critical Care Practitioner (FICM member), James Cook University Hospital
Roberta BorgChapter 8Advanced Critical Care Practitioner (FICM member)
Natalie BradyChapter 51Occupational Therapist and Advanced Clinical Practitioner in Frailty, Warrington and Halton Teaching Hospitals NHS Trust
Phil BroadhurstChapters 47, 50Advanced Critical Care Practitioner (FICM member), Stockport NHS Foundation Trust
Emma BryantChapter 9Advanced Critical Care Practitioner (FICM member), Oxford University Hospitals NHS Foundation Trust
Ashton Burden SelvarajChapter 19Trainee Advanced Critical Care Practitioner University Hospital Coventry & Warwickshire and Intensive Care Society equality, diversity and inclusion group collaborator
Steph BurrowsChapter 35Advanced Critical Care Practitioner (FICM member), Nottingham University Hospitals NHS Trust
Mark CannanChapter 34Advanced Critical Care Practitioner, North Cumbria Integrated Care NHS Foundation Trust
Enrique Castro‐SanchezChapter 43Associate Professor in Infection Prevention and Improvement, University of West London
Eddie ChaplinChapter 11Director of Research and Enterprise at London South Bank University and Head of the Scientific Committee of the European Association of Mental Health in Intellectual Disability
Karen ChiversChapter 14Consultant Nurse and Advanced Clinical Practitioner, Frimley Health NHS Foundation Trust
Esther CliftChapter 32Consultant at Southern Health NHS Foundation Trust, visiting lecturer at University of Winchester, clinical advisor for Wessex Academic Health Science Network, and Professional Adviser for NHSE&I
Rebecca ConnollyChapter 10Advanced Clinical Practitioner at United Lincolnshire Hospitals NHS Trust and Nottingham University Hospitals NHS Trust, and Senior Lecturer at University of Lincoln
Hannah ConwayChapters 23, 26Advanced Critical Care Practitioner, Assistant Professor of Advanced Clinical Practice, University of Nottingham, Intensive Care Society (ICS) FUSIC and Education Committee Member, Deputy Chair Advanced Practitioners in Critical Care Professional Advisory Group (APCC), Co‐Chair Advanced Clinical Practitioners Academic Network (ACPAN) and PRORVnet
Stuart CoxChapter 34Advanced Critical Care Practitioner (FICM member), University Hospital Southampton NHS Foundation Trust and Dorset & Somerset Air Ambulance
Sarah CurrChapter 42Lecturer in Nursing Education, King’s College London
Jo DelréeChapter 11Associate Professor and Head of Division Mental Health and Learning Disability Nursing, London South Bank University
Joanna De SouzaChapters 42, 52Senior Lecturer in Nursing, King’s College London
Sadie Diamond FoxChapters 1, 5, 7, 8, 12, 16, 17, 20, 42, 49, 52, 55Advanced Critical Care Practitioner (FICM member) at Newcastle upon Tyne Hospitals NHS Foundation Trust, Assistant Professor in Advanced Critical Care Practice at Northumbria University, Council Member, Education Committee Member and Chair of the Advanced Practitioners in Critical Care Professional Advisory Group (APCC PAG) at the Intensive Care Society (ICS) and Co‐Chair at Advanced Clinical Practitioners Academic Network (ACPAN)
Leanne DolmanChapter 52Lecturer in Nursing, King's College London
Brigitta FazziniChapter 44Advanced Critical Care Practitioner, Royal London Hospital, Deputy Chair of Intensive Care Society (ICS), Advanced Practitioner in Critical Care (APCC) Professional Advisory Group (PAG), and Co‐Chair of Advanced Clinical Practitioners Academic Network (ACPAN)
Jill FeatherstoneChapter 30National Professional Development Specialist in Medical Education for Organ and Tissue Donation and Transplant, NHS Blood and Transplant
Helen Francis‐WengerChapter 2Lecturer in Advanced Clinical Practice (FHEA), University of Plymouth, and Advanced Clinical Practitioner in Emergency Medicine (RCEM Member), Royal Cornwall Hospitals Trust.
Alexandra GatehouseChapters 16, 20, 31, 55Advanced Critical Care Practitioner (FICM member), Newcastle upon Tyne Hospitals NHS Foundation Trust
Kirstin GeerChapter 34Advanced Critical Care Practitioner (FICM Member), North Cumbria Integrated Care NHS Foundation Trust
Daniel GillChapter 30Advanced Critical Care Practitioner, Northern Care Alliance
Jo‐Anne GilroyChapter 41Advanced Critical Care Practitioner (FICM member) and Director of HEE London Advanced Critical Care Programme
Fiona GreenfieldChapter 28Speciality Lead of Pleural Services (BTS & UK Pleural Society member, Northwest Anglia NHS Foundation Trust
Lucy HalpinChapters 4, 5Advanced Critical Care Practice and Program Director in Thames Valley, Advanced Critical Care Practitioner (mFICM)
Jo HardyChapter 29Advanced Physiotherapy Practitioner in Critical Care, Leeds Teaching Hospitals NHS Trust.
Matt HarrisChapter 25Senior Advanced Critical Care Practitioner (FICM member), University Hospital Southampton NHS Foundation Trust
Alex HemsleyChapter 24Trainee Advanced Clinical Practitioner and Emergency Care (RCEM member), Royal Victoria Infirmary at Newcastle upon Tyne Hospitals NHS Foundation Trust
Barry HillChapters 5, 13, 15, 20, 21, 22Director of Education (Employability), Programme Leader and Assistant Professor, Northumbria University
Rebecca HoskinsChapter 40Consultant Nurse in Advanced Practice and NMP lead, University Hospitals Bristol and Weston NHS Foundation Trust, Senior Lecturer and Faculty Strategic Lead Advanced Practice, University of the West of England Bristol
Rachael HosznyakChapter 54Supervision and Assessment Lead for Frailty, Rehabilitation and Social Work and Advanced Practitioner in Urgent Care specialising in Frailty at Health Education England, and Registered Paramedic
Robin HydeChapter 46Assistant Professor (Children’s Nursing) and Advanced Paediatric Nurse Practitioner and Programme Lead in Children’s Nursing, University of Northumbria, Newcastle
Jo JenningsChapter 33Advanced Clinical Practitioner Simulation and Clinical Skills Lead, South Warwickshire NHS Foundation Trust, Assistant Professor in Advancing Practice, Coventry University, and Advanced Practice Development Lead for Older Adults, Health Education England
Maureen JersbyChapter 53Programme Leader in Advance Clinical Practice and Assistant Professor in Adult Nursing, Northumbria University
Timothy KuhnChapter 27Advanced Critical Care Practitioner (FICM member) and Senior Lead Nurse in Critical Care and Critical Care Outreach Team, Croydon Health Services NHS Trust
Laura ElliottChapter 12Programme Lead Advanced Clinical Practice Apprenticeship and Senior lecturer (FHEA) Advanced Practice, University of Northampton
Janine MairChapter 39Acute Care Nurse Consultant, East Kent Hospital University NHS Foundation Trust, and Visiting Senior Lecturer in Advanced Practice, Canterbury Christ Church University
Tracey MaxfieldChapter 29Trainee Advanced Clinical Practitioner in Acute Medicine, Airedale NHS Foundation Trust
Caroline McCreaChapter 18Advanced Critical Care Practitioner (FICM Member), Portsmouth Hospitals NHS Trust
Elizabeth MidwinterChapters 48, 49Matron for Resuscitation and Simulation Services and Advanced Clinical Practitioner in Emergency Medicine, Lancashire Teaching Hospitals NHS Foundation Trust
Gerri MortimoreChapter 5Senior Lecturer Advanced Practice and NICE Nurse Expert Advisor, University of Derby
Stevie ParkChapter 30Trainee Jo Advanced Critical Care Practitioner, University Hospitals Coventry & Warwickshire
Ollie PhippsChapters 2, 3Senior Lecturer & Course Director for MSc Advanced Clinical Practice and Non Medical Prescribing, Canterbury Christ Church University, Hon. Associate Professor, University of East Anglia, & Advanced Clinical Practitioner, Maidstone & Tunbridge Wells NHS Trust
Jaclyn ProctorChapter 51Senior Lecturer Advanced Clinical Practice, Edge Hill University
Julie ReynoldsChapter 5Lecturer in Adult Nursing, Keele University
Vikki‐Jo ScottChapter 44Senior Lecturer, University of Essex, Senior Fellow of Higher Education Academy, and Registered General Nurse in Critical Care Nursing
Ian SetchfieldChapters 3, 4, 6, 39Acute Care Consultant Nurse and Advanced Practice Lead, East Kent Hospitals University Foundation NHS Trust, Visiting Senior Lecturer, Canterbury Christ Church University
Sonya StoneChapters 1, 19Assistant Professor and Programme Director of Advanced Clinical Practice, University of Nottingham, Advanced Critical Care Practitioner (FICM member), Nottingham University Hospitals NHS Trust
Vanessa TaylorChapters 45, 46Deputy Head of School (Nursing) (Students and Teaching) and Professor of Learning, Teaching and Professional Practice (Cancer and Palliative Care), University of Central Lancashire
Dave ThomChapters 35, 36Anaesthesia Associate, Dorset County Hospital
John WilkinsonChapter 7Anaesthetic Registrar, Health Education England North East
Joe WoodChapter 24Advanced Critical Care Practitioner, Physiotherapist and Point of Care Ultrasound Educator, Medway NHS Foundation Trust
Nicki WestonChapter 15Advanced Critical Care Practitioner (FICM Member) Department of Critical Care University Hospitals Sussex NHS foundation Trust Brighton, UK
Preface
Advanced clinical practice is a defined level of expertise within health and care professions such as nursing, pharmacy, paramedics, and occupational therapy. Practice at this level is designed to transform and modernise pathways of care, enabling the safe and effective sharing of skills across traditional professional boundaries. Advanced clinical practitioners (ACPs) are equipped with the skills and knowledge to allow them to expand their scope of practice to better meet the needs of the people they care for.
Advanced level practitioners are deployed across all healthcare settings and work at a level of clinical practice that pulls together the four pillars of clinical practice, leadership and management, education, and research. ACPs are educated to master’s level or equivalent, although not all advanced level practitioners in England hold a master’s; they have achieved this level of practice through experience and expertise. The need for master’s level education is advised, but it is not set by law, nor is ‘ACP’ a qualification that can be registered with a professional body; it has yet to be made a legally protected title that requires professional registration.
The increasing demand on health services and continued financial constraints mean that it has never been more important to have educated and competent staff delivering the best care possible. It has therefore been recognised that the changing landscapes of both the NHS and the private sector require an advancing level of practice extending beyond initial registration.
Advanced clinical practice is delivered by experienced, registered health and care practitioners. it is ‘a level of practice characterised by a high degree of autonomy and complex decision making’ and includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance people’s experience and improve outcomes. In addition, advanced clinical practice embodies the ability to manage clinical care in partnership with individuals, families, and carers.
This definition of advanced clinical practice has been developed to provide clarity for service users, employers, service leads, education providers and health professionals, as well as potential ACPs already practising at an advanced level. This is the first time that there has been a common multiprofessional definition that can be applied across professional boundaries and clinical settings. The definition serves to support a consistent title and recognises the increasing use of such roles across the UK.
HEE (2017), in partnership with NHS Improvement and NHS England, developed a multiprofessional framework for advanced clinical practice, which includes a national definition and standards to underpin the multiprofessional advanced level of practice.
The RCN’s (2018) definition of advanced clinical practice is in line with that of HEE, in that it acknowledges ‘advanced practice is a level of practice, rather than a type of practice’.
HEE’s (2017) multiprofessional ACP framework, which built on a preceding NHS England document outlining an advanced practice model (NHS England, 2010), set out a new, bold vision in developing this critical workforce role in a consistent way to ensure safety, quality, and effectiveness. It has been developed for use across all settings, including primary care, community care, acute, mental health and learning disabilities.
The framework recognises that, as the health and care system rapidly evolve to deliver new models of care, health and care professionals have adapted to meet the increasing health needs of individuals, families and communities. For the first time in England, the HEE (2017) framework sets out an agreed definition for advanced clinical practice for all health and care professionals and articulates what it means for individual practitioners to practise at a higher level from that achieved on initial registration.
The multiprofessional framework offers opportunities for mid‐career development of new skills, such as prevention, shared decision‐making, and self‐care. It aims to ensure a common understanding of advanced clinical practice and supports individuals, employers, commissioners, planners, and educators in the transformation of services to improve the patient experience and outcomes.
Written by academics and clinicians, this book provides an essential practical and theoretical resource for healthcare students related to advanced clinical practice. The book utilizes a framework of advanced level practice and is multi‐professional and inclusive. This book is the most contemporary at a glance style book of its kind in the UK aimed at all health and social care professionals aiming to work, or working within advanced level practice. This book is the only book to address advanced clinical practice at a glance focusing on NMC and HCPC regulatory body requirements and also aligned to nationally recognised advanced practitioner training curricula such as Faculty Intensive Care Medicine (FICM), Royal College of Emergency Medicine (RCEM), and the Royal College of Nursing (RCN).
This book has been created specifically for the at a glance series, and it is made for the practicing clinician, being only 150 pages, it is the perfect size for busy healthcare professionals. The snapshot figures and key points make this book accessible, appealing to a variety of learning styles, and focused for busy healthcare professional. Each chapter is written in a format that enables the reader to review the chapter as a complete unit, and therefore the reader can choose in which order they wish to read this book.
A multitude of professional bodies have updated guidance on undergraduate and post graduate education programmes preparing students to prepare for more advanced level roles. The Nursing and Midwifery Council (NMC) updated future nurse pre‐registration programme standards, standards for nurses, standards for midwives, standards for nursing associates and standards for post registration Programmes. Additionally, the HCPC and FICM identify and advocate the importance of advanced level practice and this book facilitates the key points at a glance.
This book adheres to the current at a glance series and provide information in a concise and comprehensive manner, which will engage readers by including full‐colour images and graphics as well as accurate and useful information and a user‐friendly overview of key advanced practice topics utilising nationally recognised competency frameworks set by bodies such as Health Education England (HEE), FICM and RCEM. The book will also be available in a range of formats, including eBook, to increase accessibility. In summary, we hope this book acts as a good source of reference for our readers. We hope that this book creates a desire for our readers to learn more about advanced clinical practice and use key knowledge to teach and support others who are providing care for patients, with the fundamental principles being the provision of safe and effective care for all patients.
Barry Hill and Sadie Diamond Fox
Part 1Advanced clinical practice
Chapters
1
Introducing advanced clinical practice
2
Scope of practice
3
Professional, legal and ethical considerations of advanced practice
4
Advancing to consultant-level practice
5
Transitioning to advanced practice
6
Continuing professional development and lifelong learning
7
Consultation models
1Introducing advanced clinical practice
Figure 1.1 The four pillars of advanced clinical practice based on the Health Education England Multiprofessional Framework.
Table 1.1 Key advanced practice resources
Resource
Website
Advanced Clinical & Critical Care Practitioner Academic Network (ACCPAN)
www.accpan.net
Council of Deans for Health
www.councilofdeans.org.uk/
HEE Advanced Practice Credentials
https://advanced‐practice.hee.nhs.uk/credentials/
https://advanced‐practice.hee.nhs.uk/hee‐commissioned‐advanced‐practice‐learning‐and‐development‐resources/
https://advanced‐practice.hee.nhs.uk/centre‐credential‐approval‐and‐assurance‐process‐faqs/
HEE Advanced Practice Toolkit
www.hee.nhs.uk/our‐work/advanced‐clinical‐practice/advanced‐clinical‐practice‐toolkit
HEE Advanced Practice reports and publications
https://advanced‐practice.hee.nhs.uk/resources/reports‐and‐publications/
HEE Centre for Advancing Practice
https://advanced‐practice.hee.nhs.uk/
Institute for Apprenticeships and Technical Education Apprenticeship standards
www.instituteforapprenticeships.org/apprenticeship‐standards/
?
NHS Leadership Academy
www.leadershipacademy.nhs.uk/
Royal College of Paediatric and Child Health – Advanced Clinical Practitioner (ACP) paediatric curricular framework
www.rcpch.ac.uk/education‐careers/supporting‐training/acp‐curriculum
Faculty of Intensive Care Medicine Curriculum for Training for Advanced Critical Care Practitioners
www.ficm.ac.uk/careersworkforceaccps/accp‐curriculum
Royal College of Emergency Medicine Emergency Care Advanced Clinical Practitioner Curriculum
https://rcem.ac.uk/emergency‐care‐advanced‐clinical‐practitioners/
Respiratory ACP Network
www.respiratoryacpnetwork.co.uk/
The evolution of advanced clinical practice roles within the UK began in the 1980s1 and has continued to develop in various forms internationally since.
The NHS Long‐Term Plan2 together with Health Education England’s (HEE) Multiprofessional Framework (MPF)3 have been the most recent key drivers for advanced clinical practice within England. The MPF outlines the capabilities expected of practitioners working at advanced level across the four key pillars of advanced practice: clinical practice, leadership and management, education and research3 (Figure 1.1).
‘Advanced clinical practice is delivered by experienced, registered health and care practitioners. It is a level of practice characterised by a high degree of autonomy and complex decision making. This is underpinned by a master’s level award or equivalent that encompasses the four pillars of clinical practice, leadership and management, education and research, with demonstration of core capabilities and area specific clinical competence.’3
Both the MPF and the NHS Long‐Term Plan acknowledge that advanced practitioners (APs) are central to transforming service delivery to meet dynamic local healthcare needs, and as such there has been a large investment in the training and development of these roles. Increasing life expectancy, complexity and disease burden, the European Working Time Directive and a subsequent shortage of medical personnel have often been cited as drivers for the implementation of AP roles. However, caution is advised when rationalising their introduction and development to that of the medical substitution paradigm. Advanced practice roles complement existing medical models and are not designed to replace them.
Since their inception, there has been great diversity in AP roles along with some controversy surrounding them. Nevertheless, a colossal effort from professional bodies such as the Council of Deans of Health (CoDoH), the Association of Advanced Practice Educators (AAPE UK) and the royal colleges as well as HEE has led to a huge investment in workforce development in this area of service delivery, to meet patients’ needs in the future. Development in this area has also included the introduction of a multiprofessional definition of advanced clinical practice, the first of its kind, to provide clarity for employers, service leads, education providers, health professionals and APs themselves.
Before the release of the NHS Long‐Term Plan, the CoDoH was commissioned by HEE, as part of the development and implementation of the multiprofessional framework for advanced clinical practice in England,3 to revolutionise the interface between HEE and universities. Since the seminal CoDoH report4 and in line with the Five Year Forward View,5,6 there have been several important developments for the advanced clinical practice arena. As a result of significant investment and infrastructure, multiple initiatives are either well established or under way, including the following.
Advanced Clinical Practitioner Level 7 Apprenticeship standard – the standard, published by the Institute for Apprenticeships and Technical Education
7
and created in consultation with key stakeholders including healthcare providers and higher education institutes (HEIs), incorporates skills development, technical knowledge and practical experience through a work‐based training programme. This integrated training model allows for achievement of both a Master’s degree in advanced clinical practice and an apprenticeship, whilst providing an important alternative funding stream for NHS and private sector healthcare providers.
HEE accreditation of ACP university training programmes.
Guidance for the supervision of advanced practitioners.
8
Launch of the Centre for Advancing Practice to support education and training for advanced practitioners.
Centre for Advancing Practice directory of practitioners to recognise those working at an advanced level of practice across specialties.
Development and adoption of national specialist standards into university training programmes.
Development of core capability and credentialling frameworks for ACP roles – several credentialing schemes already exist, such as the Faculty of Intensive Care Medicine (FICM)
9
for advanced critical care practitioners (ACCPs) and the Royal College of Emergency Medicine (RCEM)
10
for emergency care ACPs (ECACPs).
There remains variation in the adoption of AP roles across the UK. However, much work is ongoing to develop standardised governance processes, training expectations and supervision for this group to bring parity and ensure quality. This work will be central to promoting recognition of the level of practice, and ensuring patient safety across all sectors.
Advanced Practice Toolkit (APT)
The APT is an online, interactive repository for ‘consistent, credible and helpful resources relating to Advanced Practice’. There are specific areas for practitioners, apprentices, employers, workforce and commissioners and those involved in higher education, training and accreditation. The toolkit is hosted by HEE e‐learning for healthcare: https://cs1.e‐learningforhealthcare.org.uk/public/ACP/ACP_01_001/index.html#/
Centre for Advancing Practice
A central resource commissioned by HEE to help with delivery of workforce transformation for advanced clinical practice via five key functions.
Programme accreditation
Recognition of education and training equivalence
Advanced Practice Directory
HEE credentials
Workforce solutions
The website also hosts details of the multiprofessional AP faculties which are present in seven regions across England (https://tinyurl.com/y3a4eyju).
Conclusion
Exciting times lie ahead for the development of new AP roles and the expansion of existing AP posts within the NHS. We still have a way to go when considering the long‐term workforce development support for this group of clinicians, who, by nature of the career path they have chosen, are inherently driven to progress. The HEE Centre for Advancing Practice will no doubt prove to be the hub for such activity. Medical colleges and professional groups such as the RCEM, FICM and the Intensive Care Society (ICS) have representation from advanced practitioners on central committees, and in clinical lead roles for key workstreams, giving this workforce an important opportunity to shape the development of these specialties for the future. Other networks created to provide education, support and research opportunities are now developing, building an important infrastructure to support this growing workforce (Table 1.1).
2Scope of practice
Table 2.1 A timeline of political drivers for advancing and advanced level practice
Date
Policy/document name and organisation
1994
United Kingdom Central Council for Nursing, Midwifery & Health Visiting
The Future of Professional Practice Following Registration
2004
NMC
Consultation on a Framework for the Standard for Post‐registration Nursing
2007
Health Professions Council (now HCPC)
Standards of Proficiency: Generic Statement
2008
Council for Healthcare Regulatory Excellence (CHRE)
Advanced Practice: Report to the Four UK Health Departments
2009
NHS Wales
Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales
2010
Department of Health
Advanced Level Nursing: A Position Statement
2012
NHS Education for Scotland
Scottish toolkit
(updated); first released in 2008
www.advancedpractice.scot.nhs.uk/
2014
NHS England
Five Year Forward View
2015
Department for Health and Social Care
NHS Constitution
2017
NHS Health Education England
Multiprofessional Framework for England
2018
NMC
Future Nurse: Standards of Proficiency for Registered Nurses
2019
NHSE
NHS Long‐Term Plan
2020
International Council of Nurses
Guidelines on Advanced Practice Nursing
2020
NHS
We are the NHS: People Plan for 2020/2021 – Action for Us All
2021
Health and Care Professions Council
Advanced Practice: Research Report
There have been many drivers for the evolution, growth and governance of advanced practice and all have shaped and sculpted the landscape. These changes have all attempted to realign alternative solutions to the provision of healthcare services in the UK based on several different factors. The European Working Time Directive (for junior doctors’ working hours) has expedited this evolution and needs to be considered; however, it is not the only influencing factor.
Table 2.1 details the main policy drivers and key documents that have shaped the trajectory of advanced practice. These need to be considered, fully recognised and understood before we can truly determine where the level of advanced practice sits within UK healthcare.
Defining scope of practice
For healthcare professionals, acknowledging one’s scope of professional practice is important, as it defines the limit of knowledge, skills and experience. This scope is supported by professional activities undertaken in the working role and essential boundaries must be identified, acknowledged and maintained. It is acknowledged that a professional’s scope will change over time as their knowledge, skills and experience develop.
With the evolution of advanced practice and the expansion of entrustable professional activities, traditional professional boundaries, for example of the nurse, paramedic and physiotherapist, have significantly changed, and this is demonstrated as the multiprofessional workforce comes together at an advanced level.
The provision of healthcare has evolved and is incorporated into many settings, from primary care to secondary care, from a generalist stance or within specialties. This variability and breadth have meant that advanced practice has become immersed in attempts to define and provide structure. Competency frameworks are developed based on interpretation of the clinical environment but two main factors remain ever present: advanced practice must include elements of clinical work, and it is a level of practice, not a job role or title. This level of practice will be different depending on the work environment but involves work in direct care and is complemented by generic competencies that inform the individual’s ability to challenge professional boundaries and pioneer innovations.
As this level of practice is unique to the work setting, it is acknowledged that no one profession can encompass all the expertise needed to treat and care for patients. For all, it must include the four fundamental strands of advanced practice: clinical element, research element, educational element and management/leadership element. Technological and clinical advances across all sectors have brought about changes to practice and have contributed to the level and quantity of postqualification education required to advance.
Often contentious is the definition of what advanced practice is. No one definition will fit perfectly to all advanced practitioners or indeed all work environments. Advanced practice is occasionally described as a blurring of the boundaries of traditional roles of registered healthcare professionals. Yet this blurring of boundaries implies assuming aspects of a variety of roles which is needed to provide better, more holistic care to all, which can be seen as a positive evolution of healthcare.
Expanding scope of practice
Those training and working at an advanced level must be aware of their competence and capability. With various curriculums and capability frameworks being developed and implemented, advanced practitioners have guidance on where their knowledge, skills and professional behaviour must sit. However, someone beginning their advanced practitioner journey must acknowledge that it will take years to acquire the knowledge, skills and experience to work at an advanced level.
For some, advanced practice touches upon the knowledge and skills which were traditionally associated with medicine. However, with the development of the multiprofessional workforce, bringing a different set of knowledge and skills, the advanced practitioner is seen as being ‘value added’ rather than a role substitute. After all, the word substitution has no place in advanced practice.
Dunning–Kruger effect
The Dunning–Kruger effect is pertinent in advanced practice. Here, incompetence and metacognitive defects can lead to an overestimation of an individual’s abilities and performance. People in this group find it a challenge to recognise genuine levels of competence when applied to themselves or (objectively) in more competent peers. Gaining insight into one’s own limitations and inadequacies is also a challenge by social comparison demonstrating an inability to 'see' their own deficits in relation to their peers’ performance. The presence and prevalence of this effect in advanced practice must be recognised and challenged to counterbalance the effect of imposter syndrome, thus creating a balanced, objective practitioner.
Imposter syndrome
Imposter syndrome is a common phenomenon amongst advanced practitioners and can be interpreted both positively and negatively. Here, the practitioner doubts their credentials and their ability to function, and is often plagued by a fear of being exposed as inadequate. This phenomenon is driven by anxiety and self‐doubt, or because of attempted perfection. Often, it is associated with high‐pressure environments, especially in healthcare, and with comparing oneself to another colleague. Imposter syndrome is the sense that someone else is better than you.
Regulation
As this evolution of an alternative ‘arm’ to provide healthcare in the UK continues, mechanisms of governance have been difficult to hone due to the variability in roles and environments where advanced practice can be found. In 2008, calls to have a new part added to the NMC and HCPC registers were not acted upon as the Council for Healthcare Regulatory Excellence (CHRE) deemed that regulators should ensure that their codes of conduct adequately reflect the requirement for health professionals to stay up to date and operate safely within their areas of competence.
