Advanced Clinical Practice Roles Research Articles

The role experience of advanced practice nurses in oncology: An interpretative phenomenological study.

To understand the experiences of advanced practice nurses working in cancer care. Phenomenological qualitative study. Three focus groups were held to collect qualitative data. Participants were recruited through theoretical non-probabilistic sampling of maximum variation, based on 12 profiles. Data saturation was achieved with a final sample of 21 oncology advanced practice nurses who were performing advanced clinical practice roles in the four centers from December 2021 to March 2022. An interpretative phenomenological analysis was performed following Guba and Lincoln's criteria of trustworthiness. The centers' ethics committee approved the study, and all participants gave written informed consent. Data analysis was undertaken with NVivo 12 software. Three broad themes emerged from the data analysis: the role performed, facilitators and barriers in the development of the role and nurses' lived experience of the role. Advanced practice nurses are aware that they do not perform their role to its full potential, and they describe different facilitators and barriers. Despite the difficulties, they present a positive attitude as well as a capacity for leadership, which has allowed them to consolidate the advanced practice nursing role in unfavourable environments. These results will enable institutions to establish strategies at different levels in the implementation and development of advanced practice nursing roles. Reporting complied with COREQ criteria for qualitative research. No patient or public contribution.

The experiences of international students in a Canadian faculty of nursing: A narrative inquiry study

BackgroundIn response to the global need for nursing faculty, and nurses in leadership and advanced clinical practice roles, students from different countries come to Canada for their graduate nursing education. The positive reputation and the perceived advantages of the education system are particularly compelling to applicants from the countries located in the Global South. However, these students come from different social, historical, political, cultural, and educational backgrounds that deeply influence their learning experiences in Canada. Objective and methodologyThe aim of this narrative inquiry study was to understand the experiences of international graduate nursing students. The focus was to unravel two puzzles of this inquiry: What stories across social, historical, political, cultural, and educational borders shaped students' identities and ways of knowing? How did the experience in Canada impact their identities? Setting and participantsParticipants were invited from a Master of Nursing program at a research-intensive University in Western Canada. MethodsParticipants engaged in series of conversations over a period of one year. ResultsMultiplicity of borders and identity making, border making, and border crossing, were the threads that resonated across the narrative accounts. ConclusionThese narrative threads provided insights into the lived experiences of tensions, the shifting of identities, and the day-to-day challenges that international students face while learning in Canada. Being aware of these experiences and acknowledging them could be a significant stride towards addressing the issues of racism, inequity, and exclusion for international students within Canadian graduate nursing education.

Design and implementation of a training programme on ultrasound-guided lower limb peripheral nerve blockade: An Advanced Clinical Practitioner's personal journey.

Increased demand in services, workforce pressures and continued financial constraints has resulted in a significant expansion in advanced clinical practice roles in the United Kingdom. This article will describe the personal experience of a perioperative Advanced Clinical Practitioner in the design and implementation of a training programme to achieve competence in ultrasound-guided lower limb peripheral nerve blockade. Three specific lower limb peripheral nerve blockade were included in the training programme, namely sciatic nerve block at the popliteal fossa, saphenous nerve block, and femoral nerve block. Key service drivers underpinning development, rationale for Advanced Clinical Practitioner involvement in lower limb peripheral nerve blockade and governance will also be discussed.

Images and images: Current roles of therapeutic radiographers

IntroductionTherapeutic radiography is a small profession and has adapted in response to advanced techniques. An increase in on-line adaptive MRI-guided radiotherapy (MRIgRT) will require role extension for therapeutic radiographers (TRs). This study will investigate the current role description for TRs and the activities they currently undertake with regards to MRIgRT. MethodA training needs analysis was used to ask TRs about their current roles and responsibilities and essential skills required for MRIgRT. For the purposes of this paper, the authors present the results from the demographics of the individual, their current job title with roles and responsibilities, and experience with decision making and image assessment. Descriptive statistics was used to analyse the data. Results261 responses were received (n = 261). Only 28% of job titles listed contained the protected title of ‘therapeutic radiographer’. Advanced clinical practice roles were expressed by participants indicating that if a service need is presented, emerging roles will be created. Variation existed across the standardised roles of TRs and this discrepancy could present challenges when training for MRIgRT. TRs are pivotal in image verification and recognition on a standard linac, and skills developed there can be transferred to MRIgRT. Decision making is crucial for adaptive techniques and there are many skills within their current scope of practice that are indispensable for the MRIgRT. ConclusionIt has been demonstrated that TRs have a range of roles that cover vast areas of the oncology pathway and so it is important that TRs are recognised so the pivotal role they play is understood by all. TRs have extensive soft-tissue IGRT knowledge and experience, aiding the evolution of decision-making skills and application of off-protocol judgments, the basis of MRIgRT. Implications for practiceRole development and changes in education for therapeutic radiographers.

Uptake of advanced clinical practice roles in the health service in England: Perspectives at the micro level

Health care organisations in many countries are developing advanced clinical practitioner roles to address workforce shortages and growing demand for services. Even in countries where advanced practice roles are more established there are low numbers, clustered in a limited range of professions, mostly nursing specialities. Successful implementation of national policies encouraging increased advanced practice roles and from a broader range of professions, requires attention to all levels of the health system. There is a lack of evidence as to the motivation to take-up these roles at the micro, individual actor level. This study explored the motivations important at the micro level in influencing a range of health professionals to undertake advanced practice roles. The study used an interpretive methodology with thematic analysis and was framed by theories of motivational domains in the work environment. Semi-structured interviews were undertaken with eighteen advanced clinical practitioners working in health care organisations in England. The motivators for role take-up were found to be predominantly intrinsic reflecting participants’ desires for advancement, both personal and for their profession, and improved efficiency of patient care. Participants described experiencing limited organisational support and sometimes discouragement from other professionals. There is potential for health organisations at the meso level of health care systems to support national growth of advanced practice roles by giving attention to the motivations of diverse health professionals. We propose a new theoretical framework of motivators for advanced clinical practice role uptake at the micro level.

Renal and ureteric stones: a clinical review.

This clinical review on renal and ureteric stones discusses how stones form, the incidence, risks, and complications associated with calculi. It reflects on the management and treatment options available, and highlights the important contribution by nurses and those working in advanced clinical practice roles in using their knowledge and rational clinical decision making to ensure timely recognition, prompt investigation, management and ongoing health promotion.

Nationwide evaluation of the advanced clinical practitioner role in England: a cross-sectional survey

Background and study objectiveIn response to growing pressures on healthcare systems, the advanced clinical practice (ACP) role has been implemented widely in the UK and internationally. In England, ACP is...

A qualitative study of perceptions of senior health service staff as to factors influencing the development of Advanced Clinical Practice roles in mental health services.

WHAT IS KNOWN ON THE SUBJECT?: Advanced clinical practitioners (ACPs) are, typically, non-medical healthcare professionals, who possess advanced clinical skills, a master's level qualification and evidence of leadership, management and research abilities. Most ACPs are nurses and new ACP roles are increasingly being established around the world. The views of senior staff towards new mental health nursing roles in organizations are likely to influence their introduction and sustainability Research on mental health nursing ACP roles is sparse. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper uniquely provides specific information as to factors perceived by senior staff as affecting the implementation of ACP roles in mental health services. A wide range of mental health services were perceived as potentially benefiting from ACPs. Establishing role clarity for MHN ACPs is perceived as being as essential to successful introduction of the role, as has been found for other specialities. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Participants identified a need for early engagement with service users and professions about new ACP roles and for processes that can evaluate ACP roles once they established. Some mental health nurses may require long-term developmental pathways to help prepare them to take on a master's level course and then the ACP role. ABSTRACT: Introduction Advanced clinical practice (ACP) roles are increasingly being developed internationally. Identifying factors perceived as affecting the development of ACP can support effective implementation. Aim To understand the views of senior health service staff as to factors influencing the development of ACP roles in mental health services. Method Focus group and semi-structured interviews. Participants were directors of nursing (n=10) and other senior staff from roles important to workforce development (n=10). Results Content analysis suggested seven categories: understanding the role and national guidelines, attitudes to the role, learning from implementing other roles, understanding prerequisites for development, challenges, opportunities and future support/actions. Prerequisites for success would include early engagement with stakeholders. Medical attitudes towards ACP roles were perceived as generally more positive than previously. Discussion The study provides unique information regarding perspectives of senior staff regarding the implementation of ACP roles in mental health services. A wide range of mental health services were perceived as potentially benefiting from ACPs, with the importance of role clarity being highlighted and long-term developmental pathways for staff. Implications for practice Successful Implementation of ACP roles may require clear role definition, early engagement with stakeholders and processes to evaluate role outcomes.

Are advanced clinical practice roles in England's National Health Service a remedy for workforce problems? A qualitative study of senior staff perspectives.

A major issue facing all health systems is improving population health while at the same time responding to both growing patient numbers and needs and developing and retaining the health care workforce. One policy response to workforce shortages has been the development of advanced clinical practice roles. In the context of an English national policy promoting such roles in the health service, we explored senior managers' and senior clinicians' perceptions of factors at the organization level that support or inhibit the introduction of advanced clinical practice roles. The investigation was framed by theories of the diffusion of innovation and the system of professions. We conducted a qualitative interview study of 39 senior manager and clinicians in 19 National Health Service acute, community, mental health and ambulance organizations across a metropolitan area in 2019. Small numbers of advanced clinical practice roles were reported, often in single services. Four main influences were identified in the development of advanced clinical practice roles: staff shortages (particularly of doctors in training grades) combined with rising patient demand, the desire to retain individual experienced staff, external commissioners or purchasers of services looking to shape services in line with national policy, and commissioner-funded new roles in new ambulatory care services and primary care. Three factors were reported as enabling the roles: finance for substantive posts, evidence of value of the posts, and structural support within the organization. Three factors were perceived as inhibiting developing the roles: confusion and lack of knowledge amongst clinicians and managers, the availability of finance for the roles, and a nervousness (sometimes resistance) to introducing the new roles. While the national policy was to promote advanced clinical practice roles, the evidence suggested there was and would continue to be limited implementation at the operational level. Development scenarios that introduced new monies for such roles reduced some of the inhibiting factors. However, where the introduction of roles required funding to move from one part of a service to another, and potentially from one staff group to another, the growth of these roles was and is likely to be contested. In such scenarios, research and business evidence of relative advantage will be important, as too will be supporters in powerful positions. The paucity of publicly available evidence on the effectiveness of advanced clinical practice roles across the specialties and professions in different contexts requires urgent attention.

Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review

ObjectivesIn response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the...

Pharmacists in advanced clinical practice roles in emergency departments (PARED)

Background Following evidence published in the Pharmacists in Emergency Departments (PIED 2016) study Health Education England funded novel advanced clinical practitioner training for pharmacists (ACP-p), to support service delivery.Objective To explore experiences and clinical activity of trainee ACP-p, and opinions and recommendations of both trainees and clinical supervisors.Setting Five Urgent/Emergency Care Departments in London UK.Method Longitudinal mixed-methods study in three phases of registered UK pharmacists appointed as trainee ACP-p. Phase 1 (May-July 2019) – early semi-structured interviews and focus group using an experiences, opinions and recommendations (EOR) framework, Phase 2 (January-December 2019) – prospective recording of trainee clinical activity, standardised using bespoke spreadsheet, Phase 3 (November-December 2019) – as Phase 1 but at conclusion of training.Main outcome measure Experiences, clinical activity, opinions and recommendations of study participants.Results Twelve (92 %) eligible trainee ACP-p and five supervisors were recruited. Identified themes were: trainee personality, educational components, length of programme, support/supervision, career transition, university and placement training alignment, recommendations. Success was dependent on effective support and supervision. Clinical supervisors should be allocated adequate supervision time. Trainees, their supervisors and emergency department staff should be given a clear brief. Study participants agreed that the programme could be successful. Trainee ACP-p reported that they could manage 82 % of 713 pre-selected clinical presentations. Additional training needs include: ECGs, X-rays and CT scans.Conclusions Pharmacists can successfully train as ACP-p in this setting over a two-year period. This career transition needs careful management and clear structures. Training ACP-p is a useful way of enhancing skills and supporting clinical services to large numbers of patients.

Accreditation of advanced clinical practice of musculoskeletal physiotherapy in England: a qualitative two-phase study to inform implementation

ObjectivesTo establish whether international musculoskeletal physiotherapy educational standards and associated governance framework align with advanced clinical practice (ACP) frameworks in England; and to evaluate physiotherapy stakeholders’ perceptions about potential accreditation and governance of ACP for musculoskeletal physiotherapists. DesignA qualitative two-phase study. 1] An explicit documentary mapping process of established international educational musculoskeletal standards to the ACP frameworks for England, in terms of domains, standards and competencies by two independent reviewers. Results were evaluated by a third reviewer and focus group participants. 2] Focus groups enabled maximal insight into perceptions of musculoskeletal stakeholders through the interactive process facilitated by a topic guide. Groups were recorded and transcribed verbatim; data were analysed using thematic coding. SettingThree focus groups in London, Birmingham and Manchester facilitated recruitment from all regions of England. ParticipantsPurposive sampling (n=26) ensured representation of stakeholders for ACP (e.g. Professional Networks, patients). ResultsInternational educational standards fully mapped to both ACP frameworks, with 100% saturation of defined capabilities, and agreement across reviewers and focus groups. Four themes were identified from focus groups: musculoskeletal physiotherapy specific professional factors; fit for purpose, innovative educational opportunities; advocated recognition of musculoskeletal physiotherapy ACP as a discrete professional practice field; and advocating a potential vehicle for musculoskeletal physiotherapy ACP. ConclusionsThis study identifies the importance of musculoskeletal ACP specific to the physiotherapy profession. Fit-for-purpose innovative educational opportunities for musculoskeletal physiotherapists are required at Masters level to support preparation for ACP roles. The established national and international musculoskeletal frameworks afford an opportunity.

The knowledge and skills required of advanced level practitioners for accreditation and safe practice.

Change, for better or worse, seems to be endemic in western societies, and in the past two decades advanced practice has not been exempt. Healthcare leaders and lecturers in the UK have adapted education programmes that are preparing for increasing numbers of health professionals to take on advanced clinical practice roles that meet policy and practice developments emerging from population need and government-influenced changes. Such change has included advanced practice policy from Health Education England (HEE) regarding funding for advanced level students, and the introduction of the advanced clinical practitioner (ACP) title. This article focuses on advanced practice/ACP education.

The development of advanced clinical practice roles in the UK

The development of advanced clinical practice roles in the UK

Scoping the application of primary care advanced clinical practice roles in England

PurposeThis study aims to scope the profile and application of an advanced clinical practitioner (ACP) roles in primary care in the North of England and how these roles meet the requirements of Health Education England's (HEE’s) ACP workforce capability framework.Design/methodology/approachA two-stage design was used. Stage 1 analysed health and social care workforce intelligence reports to inform scoping of numbers of ACPs working in primary care. Stage 2 used two surveys. Survey 1 targeted ACP leads and collected strategic-level data about ACP application. Survey 2 targeted staff who perceived themselves to be working as ACPs. Survey 2 was in three parts. Part 1 collected demographic data. Part 2 required participants to record their perceived competence against each of the HEE ACP framework capability criteria. Part 3 required respondents to identify facilitators and barriers to ACP practice.FindingsDespite the introduction of HEE's ACP capability framework, there is inconsistency and confusion about the ACP role. The results indicated a need for standardisation of role definition and educational and practice requirements. The results also suggested that some ACPs are not working to their full potential, while some staff who are employed as “gap-fillers” to provide routine clinical services perceive themselves as ACPs despite not working at the ACP level.Originality/valueAlthough previous research has explored the application of ACP practice in primary care, few studies have considered ACP application in the light of the introduction of workforce capability frameworks aimed at standardising ACP practice.

Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol

IntroductionA global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce....

Early adopters of paramedic prescribing: a qualitative study.

Aims:To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the United Kingdom.Methods:Following a public consultation by NHS England in 2015, the decision was made in March 2018 to amend legislation to enable advanced paramedics to independently prescribe medicine in UK settings. Capturing the experience of these ‘early adopters’ will help to identify where paramedic prescribing can produce optimum benefits in healthcare systems, as well as enabling early scoping out of challenges to implementation and strategies for resolving challenges. This exploratory qualitative study involved interviews with 17 paramedics who have undertaken the independent prescribing programme in the United Kingdom. Participants were recruited via social media and regional paramedic networks between May and July 2019. Interviews were conducted by telephone or video call and explored use/anticipated use of prescribing, benefits and challenges to prescribing and support for the prescribing role. Thematic analysis was conducted to identify key themes.Results:Of the 17 participants, six were currently prescribing and the remainder were awaiting annotation. Participants worked in a range of settings, including: primary care, emergency departments, urgent care, walk in centres and rapid response services. Key benefits to prescribing were similar to those reported by other non-doctor prescribers and included: streamlining care for patients, improving safety, improving efficiency and facilitating new advanced clinical practice roles. Key challenges included: administrative IT issues, lack of ability to prescribe controlled drugs and managing patient/colleague expectations around paramedic prescribing. In general, participants felt supported in their prescribing role, both by doctors and other non-doctor prescribers, and felt confident to prescribe following the prescribing course. Concerns were raised about potential isolation in some settings, lack of parity in prescribing legislation across different professions and the way this is taught in prescribing programmes.Conclusion:Indications are that paramedic prescribing is rolling out successfully in line with expectations. Barriers and facilitators are similar to those reported by other non-doctor prescribers and independent prescribing is already an essential component to advanced practitioner roles in settings such as primary care. Findings highlight a need for greater alignment of prescribing legislation across non-doctor prescribers from different professions undertaking advanced roles.

The value of Master's degrees for registered nurses.

The value of graduates in the nursing workforce has been recognised in the move to all-graduate preparation of pre-registration nurses in England ( Nursing and Midwifery Council, 2010 ). Increasingly, after registration continuing professional development programmes for nurses are being offered at Master's level. However, there is limited evidence of the relationship between postgraduate study and improved patient outcomes. Evidence that does exist suggests that nurses who engage in postgraduate study are more likely to have improved critical thinking and decision-making skills, demonstrate leadership qualities to empower them to challenge poor practice, and have the skills needed for advanced clinical practice roles. This article explores these issues and makes recommendations for further work in this area.

Effective consulting and historytaking skills for prescribing practice

There is increasing emphasis on the need for nurses to develop history-taking and consultation skills for prescribing and advanced clinical practice roles. This article discusses both theoretical and practical aspects that could facilitate the development of these skills using safe and structured approaches. It explores some of the origins of consultation theory, and the challenge that nurses face in integrating new consultation skills with existing nursing assessment practice. This article outlines practical generic approaches to history taking in the clinical consultation and considers the main areas that need to be covered to support safe prescribing decisions.

Using an action learning set (ALS) to support the nurse and allied health professional consultant role

Advanced clinical practice roles are now an integral feature of many healthcare services and have been adopted in a diversity of areas. However, mentoring of these roles is not well documented in the literature and formal mechanisms of support are limited. An action learning set (ALS) was developed to provide support for consultants currently in post. The purpose was to facilitate clinicians in developing and meeting the demands of these posts by providing peer supervision, identifying strategies for leading service developments, providing a focus for problem solving and reflection. The ALS meets bi-monthly and is externally facilitated with the option to attend individual sessions with the facilitator. Participants also completed questionnaires measuring coping skills and stress, which were fed back in the individual sessions, providing opportunity for further opportunities for reflection. Initial evaluation was conducted formally using a structured questionnaire and reflective accounts, and provided evidence of the value of the ALS and an indication of how the criteria for success were being met, with greatest achievement reported in the area of work–life balance. The evaluation demonstrates the ongoing value of this ALS and the effectiveness of this method of supporting senior clinical staff.