Unpacking the question: What is

advanced practice in nursing?

Alison McMillan

Chief Nurse and Midwifery Officer Department of Health Victoria

Who are we?

• Created in August 2009

• 2011-12 output budget of $13.1b

• Portfolios:

– health

– mental health & drugs

– aged care

Context – Department of Health Victoria

Our roles

• System management

• Policy, planning & strategy

• Funding & performance management

• Health promotion & protection

Context – Department of Health Victoria

Chief Nurse & Midwifery Officer!

The Chief Nurse & Midwifery Officer is a key thought

leader and advisor to government and the public health

system of Victoria in relation to the nursing and

midwifery professions. The role aims to build effective

relationships with key industry and professional bodies

across the spectrum of nursing and midwifery practice,

as well as the broader clinical stakeholder community.

The Chief Nurse & Midwifery Officer role motivates

debate and developmental thinking in representing

government and the Victorian health sector on matters

of strategic and operational significance to the health

system around professional nursing and midwifery

issues.

Rules of Dialogue

• Treat everyone as a colleague

• Conduct a shared inquiry into mutual concerns

• It’s okay to disagree

• Build shared understanding that leads to something new

• Discuss the undiscussable

Robert Hargreaves

Your First 100 days in an Executive Job 2011

Looking ahead – the challenge

Sustainability/efficiency

Ageing population/workforce

Changes in technology

Therapeutic advances

Diminishing workforce supply (esp

nursing)

Improving Patient Outcomes

Reducing waiting times

Seamless care

Clinician owned and lead reform

Providing consistently high quality

care is an ongoing challenge for

healthcare systems, despite huge

improvements in science,

technology and clinical practice.

This challenge is magnified by the

continued increase in complexity,

demand and variability across the

system.

Professor Nick Black BMJ April 2010

Putting it nicely

What is advanced practice in nursing?

What is the problem we are trying to solve?

The International Council of Nurses

definition for advanced

practice nurse

The advanced practice nurse (APN) is a registered nurse who has

acquired an expert knowledge base, complex decision-making skills

and clinical competencies for expanded practice, the characteristics of

which are shaped by the context and/or country in which s/he is

credentialed to practice.

Titles in this category vary from country to country and are applied

inconsistently, even within the same country. Titles such as nurse

practitioners, clinical nurse specialist, and clinical nurse are used in

conjunction with this category. A Masters degree is recommended for

entry level. (Nursing care continuum framework, ICN 2008)

The Strong Model of Nursing Practice

Five Areas of Advanced Practice

1. Direct Comprehensive Care Patient focused activities that include assessments, procedures, interpretation of data and patient counselling.

2. Support of Systems Professional contributions to standards, quality initiatives, and development of policies, procedures and practice guidelines to optimize nursing practice within the institution.

3. Education Contributions to caregiver, student and public learning related to health and illness.

4. Research Practice that challenges the status quo and seeks better patient care through scientific inquiry and incorporating evidence-based practice into direct patient care.

5. Publication and Professional Leadership Promotion and dissemination of nursing and health care knowledge beyond the individual practice setting.

In the United Kingdom

The characteristics demonstrated by an individual when

functioning at an advanced practice level, including:

• Clinical/direct care practice

• Leadership and collaborative practice

• Improving quality and developing practice

• Developing self and others

The Canadian Nurses Association 2008

Advance practice nurses build on their expertise in a specialty area, integrating and consistently displaying specific features and characteristics. They further describe the specific

knowledge, skills, judgement and personal attributes required for advanced nursing practice:

• Provision of effective and efficient care, delivered with a high degree of autonomy, to an identified population;

• Demonstration of leadership and initiation of change to improve client, organisation and system outcomes;

• Deliberate, purposeful and integrated use of in-depth nursing knowledge, research and clinical expertise, as well as integration of knowledge from other disciplines;

• Depth and breadth of knowledge that draws on a wide range of strategies to meet the needs of clients and to improve access to and quality of care;

• Ability to explain and apply the theoretical, empirical, ethical and experiential foundations of nursing practice;

• Understanding, development and dissemination of evidence based nursing knowledge;

• Ability to initiate or participate in planning, coordinating, implementing and evaluating programs to meet client needs and support nursing practice;

• Demonstration of advanced judgement and decision making skills; and

• Critical analysis of and influence on health policy.

2008

What is advanced practice in nursing?

What is the problem we are trying to solve?

“The nursing profession must now

delineate what is advanced practice from

the practice profile of other nursing roles

and titles, in order to inform new nurse led

service delivery models in the

contemporary Australian health care

system “. Gardner et al, 2012

Some questions we need to consider

What are the key issues?

What do other professions do in this space?

What are the risks?

Does all reform need to be nurse led?

How will this benefit patients?

How will this effect efficiency?

How will this stimulate innovation?

Is clarity of roles and titles necessary?

Let’s discuss