Advanced Nurse Practitioner Role Research Articles

The Role, Contribution and Impact of Independent Nurse Prescribers and Advanced Nurse Practitioners to the Children's Hospice Workforce

The care needs of babies, children and young people who use children's hospices have changed over the last decade, with children living for longer, with more complexity. Children's hospice workforces have evolved to continue to meet these needs, including a growth in the number of nurses working at specialist and advanced levels, particularly prescribing. A 15-question survey was sent to all 54 UK children's hospices, which aimed to explore the impact of independent nurse prescribing, and specialist and advanced level nursing practice in UK children's hospices. Forty-one organisations responded, representing 76% of UK children's hospices. Increased autonomy and the ability to respond to the dynamic needs of families, and enabling family choice was recognised and valued by prescribers. Challenges included the breadth of needs of children with life-limiting conditions, and the use of medicines that are either unlicenced or used off-licence. Access to clinical supervision and continuing professional development were highlighted as enablers of prescribing practice.

Advanced nurse practitioner well‐being: A 4‐year cohort mixed methods study

AbstractAimsTo examine changes in advanced nurse practitioner (ANP) well‐being, satisfaction and motivation over a four‐year period.DesignLongitudinal Cohort study.MethodsSurveys were carried out each year from 2019 to 2022 with the same cohort of ANPs in the United Kingdom (UK). The survey consisted of demographics, questions on contemporary issues in advanced practice, National Health Service (NHS) staff survey questions and validated questionnaires. A core set of questions were asked every year with some changes in response to the COVID‐19 pandemic.ResultsResponse rate ranged from 40% to 59% and appeared to be affected by COVID‐19. Staff satisfaction with pay and the well‐being score were stable throughout. Other questions on well‐being, job satisfaction and motivation saw statistically significant reductions after 4 years. Open‐ended questions about ongoing well‐being concerns show participants are concerned about exhaustion levels caused by workload, staffing issues, abuse from patients and colleagues' mental health.ConclusionThe findings highlight a decline in ANP well‐being, job satisfaction and motivation post‐COVID‐19. Reasons for this, explored in the qualitative data, show that ANPs have faced extremely difficult working conditions. Urgent action is required to prevent a workforce retention crisis as many nursing staff are close to retirement and may not be motivated to remain in post.ImpactThis study has followed ANPs through the most challenging years the NHS has ever seen. Job satisfaction, motivation and enjoyment of the job all significantly reduced over time. In many areas, the ANP role has been used to fill medical workforce gaps, and this will become harder to do if ANPs are dissatisfied, disaffected and struggling with stress and burnout. Addressing these issues should be a priority for policymakers and managers.Patient or public contributionNone as this study focussed on staff. Staff stakeholders involved in the design and conduct of the study.

Exploring Factors Affecting the Rollout of a Policy on Registered Advanced Nurse Practitioners in Ireland

Aim. To identify the barriers and enablers to the implementation of a national policy to increase and develop the advanced nurse practitioner (ANP) workforce in Ireland. Background. The Department of Health (Ireland) introduced a policy to increase the number of ANPs to 2% of the nursing workforce. Evaluation provides information to inform successful policy implementation and development of ANP roles in healthcare services. Methods. Qualitative descriptive design. Twenty candidate ANPs participated in four focus groups. Nine key stakeholders were also interviewed. Results. Analysis identified four barriers: lack of infrastructural resources; delay in releasing and arranging replacements for candidate ANPs; role resistance from administration, allied healthcare professionals and other nurses; and lack of organisational readiness. The five enablers were: supportive physicians; Nursing and Midwifery Practice Development Units; supportive directors of nursing; role awareness and clarity; and educational preparation. Conclusions. This evaluation identifies barriers and enablers to the implementation of a national policy to increase the critical mass of advanced practitioners within the healthcare services. Evaluation at the implementation phase informed the roll-out of future advanced practice initiatives. Implications for Nursing Management. To support advanced practice development, leadership, infrastructure, and resource planning are needed to harness known enablers and address identified barriers to the implementation and sustainability of these posts.

How do advanced nurse practitioners enhance healthcare outcomes in frail older patients living in care homes?

Background: As the UK healthcare service strains to meet the demand from its ageing population for 24-hour care, there is an increased need to develop an effective way to provide quality care to frail residents living in care homes. The role of the advanced nurse practitioner (ANP) has evolved over the last 20 years, developing in part to meet the shortfall of GPs and geriatric specialist doctors. Despite research having been previously conducted in the US and Canada into how the ANP role can function within care homes, there has been limited exploration into how the role can enhance UK healthcare outcomes in relation to the 2019 NHS Long-Term Plan, which aimed to provide care closer to home for ageing patients. Aims: This paper was designed to critically review published primary research papers and evaluate the impact of the ANP role on healthcare outcomes for frail elderly care home residents. Its objective was to help guide future healthcare delivery policy within the UK. Methods: A saturated systematic search of primary research literature was conducted. An inclusion/exclusion criterion was also utilised. Key papers identified were subject to critical synthesis, using ratified critical appraisal tools from the Joanna Briggs Institute and mixed-method appraisal tool by Hong et al (2018) . A thematic/narrative approach was employed to evaluate the findings of the mixed-method heterogenic-style research. Results: A total of 14 primary research papers met the criteria, which included mixed methods of study from across four English language-speaking countries. Five outcome themes were recurrent throughout the synthesis of the results, including, in order of prevalence: improved/equivalent quality of care; successful collaborative role; reduced hospitalisations; timely access to primary/secondary care; colleague/patient/family satisfaction. Discussion: Following the review of the highlighted themes, there was a consensus that ANPs positively influence the care quality of elderly patients living within care homes. Although no superiority over a physician approach was found, there was indication of supplementary benefits when including ANPs in the care home setting. These include instilling positive role models into the healthcare environment, increasing the general knowledge and education capacity of care staff, and streamlining communication—especially within advanced care planning and coordination of care. These qualities clearly encompass the current NHS priorities of the 2019 Long-Term Plan and the Enhanced Health in Care Homes Framework, which are set to be fully achieved by 2024.

Advanced Practice Nursing Experience of a Female Adolescent With Leigh Syndrome and Her Family: A Family Strengths-Oriented Therapeutic Conversations Approach

This article applied a family strengths-oriented therapeutic conversations approach to explore the advanced practice nursing experience of a female adolescent with Leigh Syndrome and her family. During the nursing care period from September 20 to November 19, 2022, the author collected data through direct care, observation, interview, telecare, home visits, and medical record reviews and confirmed the nursing problems to be the inadequate coping capability of the family. The author leveraged her advanced nurse practitioner role and used family strength-oriented therapeutic conversations to enable the parents of the patient to reflect on their experiences with this disease and to improve their quality of life and satisfaction with healthcare services. Three modes of care, including accessibility, coordination, and comprehensiveness, were offered to the female adolescent patient and her family to achieve the goal of family-centered, community-based, and medical-system-centered care. It is suggested that before making healthcare decisions, patients and their families should be given the opportunity to participate in the healthcare process and reach consensus on healthcare decisions based on existing evidence and their values and preferences. The medical decisions made by patients and their families after carefully considering their current situation and needs should be supported and assisted.

Navigating advanced nurse practitioner roles in UK mental health services: a scoping review

Background: The advanced nurse practitioner (ANP) role is becoming increasingly prominent in the provision of mental health services, both in the UK and globally. Understanding the experiences associated with these roles is crucial for their effective implementation in practice. This article presents a scoping review that systematically searches and synthesises existing literature on the experiences of ANP roles in mental health services in the UK. Methods: A comprehensive search of databases including CINAHL, MEDLINE, Web of Science, PsychNet, and Google Scholar was conducted to identify relevant peer-reviewed publications and grey literature that had been published between 2010 and 2022. The Patterns, Advances, Gaps, Evidence for Practice, Research recommendations (PAGER) framework was employed to analyse the findings and identify key themes. Findings: The review findings reveal important insights into the experiences of ANP roles in mental health services, highlighting the significance of role understanding, opportunities and challenges. Key themes identified include the need for clear governance, role clarity, support from colleagues and managers, professional development opportunities, and the impact of role implementation on the provision of person-centred care and physical healthcare. Conclusion: ANP roles in mental health services offer opportunities to enhance the provision of person-centred care, improve physical healthcare delivery and provide professional development and career pathways for nurses. However, challenges such as role understanding, planning and support need to be addressed to ensure successful implementation. Further research examining patient experiences, measures to support improved planning and role clarity, and the professional development and career pathways of ANPs would contribute to advancing the field and facilitating the effective future implementation of ANP roles in mental health services in the UK and beyond.

The advanced nurse practitioner in context: Systemic processes.

Healthcare systems are becoming increasingly complex. Systems thinking can help us to understand this complexity and how to apply that understanding to design and evaluate interventions that improve health outcomes. With the current emphasis on developing advanced nursing practice, it is timely to examine systemic processes that characterize ANP systems and their interactions with wider healthcare systems, and how these processes enable and constrain the role. To make explicit the systemic processes that characterize the Advanced Nurse Practitioner (ANP) system and how they enable and constrain the role. An interpretive descriptive study. The study was conducted in a large Hospital Group, consisting of eleven acute hospitals, within the Irish Healthcare System. Twenty nine participants, including ANPs, nurses, nurse managers, medics and allied health professionals, participated in the study. Data were collected through seven in-depth interviews and four focus groups. Data were analyzed using the Organic Systems Framework (OSF), where attention was on language indicative of the processes of individuation, integration, differentiation and homogenization. Participants emphasize how ANP systems exert power by individuating and differentiating; however, restrictive regulations and medical control constrain this power. Integration and homogenization are expressed as ANPs encourage and engage in collaborative practice towards common purposes. When hierarchical structures and professional self-interest dominate, however, these processes are submerged, resulting in unbalanced systems. ANP systems realize their power through increased autonomy by individuating and differentiating. Hierarchical structures positioning ANPs in subservient roles should be challenged. Processes of integration and homogenization are expressed in collaborative practices. We recommend that ANPs realize and articulate the value and diversity that they bring to health systems to strengthen their contribution to them. Lack of awareness of the systemic processes that enable and constrain the ANP role affects the role's potential contribution to the healthcare system. Systems thinking and employing the OSF as an analysis framework can help us to understand these processes and their implications, and how to apply that understanding to design and evaluate interventions that improve health outcomes.

Stakeholders' perceptions of a community-based advanced nurse practitioner-led integrated oncology care model for adults receiving oral anti-cancer medication-A qualitative study.

The primary objective was to understand stakeholders' perceptions of a community-based advanced nurse practitioner (ANP)-led integrated OAM care model for adults. Qualitative data from interviews and focus groups were obtained from 33 individuals; either service users who attended ANP-led OAM clinics or stakeholders involved in OAM care. Data were subsequently analysed using thematic analysis. Four themes were identified and included reflection on pre-COVID-19 system, role of ANP in current OAM care, importance of robust communication and infrastructural requirements for transition to an integrated OAM care model. This study demonstrated that patients and HCPs perceived the proposal positively. They identified the ANP as the appropriate HCP to care for this cohort and the importance of communication and strategic planning for transitioning this model of care to the community setting. ISRCTN10401455.

CN45 The Gastrointestinal and Lymphoma Unit Advanced Nurse Practitioner role in clinical research at The Royal Marsden Hospital

The Advanced Nurse Practitioner (ANP) role is a new concept in all fields of nursing practice, dating back to 1990. The role of the ANP is invaluable, allowing patients to receive timely care and negates delays in treatment. In the UK, the role continues to develop in response to the changing healthcare needs of our population including an ageing society, increasing prevalence of chronic conditions, the advancement of new treatments, inefficient healthcare policies and the rising cost of healthcare.

A realist evaluation case study of the implementation of advanced nurse practitioner roles in primary care in Scotland.

AimTo evaluate Advanced Nurse Practitioner (ANP) role implementation in primary care across Scotland in contributing to primary care transformation, and establish what works, for whom, why and in what context.DesignA realist evaluation using multiple case studies.MethodsTwo phases, conducted March 2017 to May 2018: (1) multiple case studies of ANP implementation in 15 health boards across Scotland, deductive thematic analysis of interviews, documentary analysis; (2) in‐depth case studies of five health boards, framework analysis of interviews and focus groups.ResultsSixty‐eight informants were interviewed, and 72 documents were reviewed across both phases. ANP roles involved substitution for elements of the GP role for minor illness and injuries, across all ages. In rural areas ANPs undertook multiple nursing roles, were more autonomous and managed greater complexity. Mechanisms that facilitated implementation included: the national ANP definition; GP, primary care team and public engagement; funding for ANP education; and experienced GP supervisors. Contexts that affected mechanisms were national and local leadership; remote, rural and island communities; and workload challenges. Small‐scale evaluations indicated that ANPs: make appropriate decisions; improve patient access and experience.ConclusionsAt the time of the evaluation, the implementation of ANP roles in primary care in Scotland was in early stages. Capacity to train ANPs in a service already under pressure was challenging. Shifting elements of GPs workload to ANPs freed up GPs but did little to transform primary care. Local evaluations provided some evidence that ANPs were delivering high‐quality primary care services and enhanced primary care services to nursing homes or home visits.ImpactANP roles can be implemented with greater success and have more potential to transform primary care when the mechanisms include leadership at all levels, ANP roles that value advanced nursing knowledge, and appropriate education programmes delivered in the context of multidisciplinary collaboration.

A realist review protocol of the role and contribution of the advanced nurse practitioner (ANP) in gastroenterology nursing

Background: The role and contribution of advanced nurse practitioners (ANP) has been well researched and found to be of great value for improving quality patient care and enhancing patient outcomes through education and health promotion. However, the role and the contribution of the ANP to gastroenterology nursing have not been evaluated either nationally or internationally. A review to determine the role and contribution of the ANP in gastroenterology nursing will inform on the contribution of the role and whether the role makes a difference to patient outcomes and cost effectiveness of patient care. Objective: This review aims to investigate the nursing role and contribution of the advanced nurse practitioner in gastroenterology. Furthermore, improved understanding of the underlying causal mechanisms explaining how the ANP role in gastroenterology nursing works, will provide a deeper understanding of how, why, for whom and in what contexts the role and contribution of the ANP to gastroenterology nursing are most successful. Methods: A realist review will consolidate evidence on how, when why and where the ANP role in gastroenterology works or fails through identifying programme theories underlying to the role’s introduction. The following steps will be operationalised; locating existing theories, searching the literature, documenting literature selection, engaging in data extraction and synthesis and refining programme theory. As an iterative approach, review cycles will uncover explanatory and contingent theories through context-mechanism-outcome configurations (CMOCc). Due to the variation in context and mechanisms, different outcomes will be likely across different clinical settings although similar patterns may be identified. Conclusions: Due to the theory-oriented approach of realist reviews, the pragmatic consequences of the review, will lend itself to deeper understanding of how the role and contribution of the ANP in gastroenterology nursing works in practice.

The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review.

To evaluate the effectiveness of the role of advanced nurse practitioners compared to physicians-led/ usual care (care managed by medical doctors or non-advanced nurse practitioners). Advanced nurse practitioners contribute to the improvement of quality patient care and have substantial potential to optimise the health of people globally. Since the formal recognition of advanced nurse practitioners by the International Council of Nurses, among others, the role has been adopted across most departments and clinical specialties, particularly in high-income countries. Systematic review of primary research evidence. MEDLINE, EMBASE, CINAHL, Cochrane registry, Cochrane trials, and Cochrane EPOC (PDQ Evidence) were searched for randomised controlled trials (RCTs) of patient care and health resource utilisation outcomes associated with advanced nurse practitioners. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The chosen articles were restricted to full-text English language trials published in the last 20 years, incorporating comparators of usual care. Search terms were limited to variations of advanced nurse practitioner role and practice. The eligible studies were bias risk assessed and quality assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Clinical and service outcomes were analysed using narrative synthesis as the marked heterogeneity between studies precluded meta-analysis. Thirteen RCTs were reviewed. All of them were conducted across high-income countries within primary care and hospital settings involving paediatric and adult patients. Five trials were assessed as high quality, and eight were of low to moderate quality. Positive effects were demonstrated for the impact of advanced nurse practitioners on usual care; for indigestion, mean difference [MD] 2.3: 95% CI 1.4, 3.1]), perceptions of health status [ (MD -140.6; 95% CI -184.8, -96.5)], satisfaction levels [ (MD ranged from -8.79; 95% CI -13.59, -3.98 to 0.61; 95% CI -4.84, 6.05)], physical function (1.58 [SD 0.76] v. 1.81 [SD 0.90]), and blood pressure control (systolic [133 [SD 21] v. 135 [SD 19] mmHg p=0.04] and diastolic [77 [SD 10] v. 80 [SD 11] mmHg p=0.007]) were looked at. Positive effects related to service provision included improved patient satisfaction and reductions in waiting times and costs, which significantly favored advanced nurse practitioners (all p<0.05). The evidence of this review supports the positive impact of advanced nurse practitioners on clinical and service-related outcomes: patient satisfaction, waiting times, control of chronic disease, and cost-effectiveness especially when directly compared to medical practitioner-led care and usual care practices - in primary, secondary and specialist care settings involving both adult and pediatric populations.

P-153: Is it time for a more holistic approach to the treatment of Multiple Myeloma?

P-153: Is it time for a more holistic approach to the treatment of Multiple Myeloma?

Perceptions and beliefs about the regulation of advanced nurse practitioners.

The role of the advanced nurse practitioner (ANP) is not regulated in the UK, which has led to wide variation in the skills, competencies and academic qualifications of nurses using this title. Urgent treatment centres (UTCs) require a broad and experienced knowledge base to meet the demand of patients presenting with undifferentiated illnesses and injuries, which can be stressful and challenging. To examine the perceptions and beliefs about ANP regulation, and to explore and discuss any ideas about proposed regulation. The author used interpretative phenomenological analysis to uncover valuable insights into the experiences of two ANPs working in an UTC, and their beliefs around regulation of the ANP role. Both ANPs had different backgrounds and qualifications yet still had similar perceptions and beliefs regarding the regulation of ANPs. Five main themes were developed from the interview transcripts. This study identified the need to consider the importance of ANPs' identity and the complex regulatory process required to standardise the role.

Shortcuts in knowledge mobilization: An ethnographic study of advanced nurse practitioner discharge decision-making in the emergency department.

To understand how advanced nurse practitioners use knowledge to inform their discharge decision-making in the emergency department. Advanced nurse practitioner roles have developed globally in a wide range of healthcare settings, including the emergency department, over the past few years. The scope of practice and training vary widely between countries. Little is known about how they use clinical knowledge in the emergency department. An ethnographic study was undertaken in an emergency department in the North of England. Data were collected by observation (n=5) and semi-structured interviews (n=13) between September 2016 and June 2017. Interview transcripts and field notes were coded using Quirkos software. Thematic analysis was used to identify key themes. In boundary blurring with medicine, advanced nurse practitioners in the emergency department need to make timely, autonomous discharge decisions. Knowledge mobilization is messy and complex; however, shortcuts facilitate autonomous discharge decision-making. More experienced advanced nurse practitioners rely less on shortcuts as they draw on experiential knowledge. Boundary blurring in the advanced nurse practitioner role in the emergency department, requires reliable knowledge shortcuts. Support from senior colleagues and accessible smartphone apps enable advanced nurse practitioners to efficiently make discharge decisions. This study adds to previous research on how knowledge is managed in boundary blurring. Advanced nurse practitioners in the emergency department require timely access to relevant, up to date knowledge. This study has highlighted their preferred knowledge sources to inform discharge decision-making. In boundary blurring, shortcuts enable ANPs to use knowledge efficiently to inform patient care in the emergency department. The findings increase our understanding of how to equip advanced nurse practitioners with knowledge to facilitate clinical decision-making. Clinical managers should provide mentorship and relevant up to date knowledge shortcuts to ensure efficient, evidence-based discharge decision-making.

The impact of advanced nurse practitioner (ANP) role on adult patients with cancer: A quantitative systematic review

AimThis study aims to identify how Advanced Nurse Practitioners (ANPs) can contribute to oncology care. BackgroundThe position of ANPs has grown significantly in recent years and ANPs have been shown to make significant contributions to various areas of healthcare. Due to improvements in research and techniques elder cancer patients are living longer, as beneficial, as this is to patients it is putting a strain on the provision of care as support is required at various stages. As there have been discussions about how ANPs +.can be most effectively employed this study identifies that ANPs, due to their skills and knowledge, may be able to assist elderly patients with long-term conditions specifically oncology patients. Therefore, research has been undertaken to identify how ANPs are currently employed in oncology. MethodsA systematic review was conducted in order to gain background information into how the role of ANPs in oncology is perceived and to gain understanding of some of the issues that they face and identify the skills that they have in order to be able to make a positive contribution. This was followed by a study of quantitative Randomized Control Trials, which looked at the roles of ANPs in oncology. Thematic Analysis was conducted in order to gain a perspective of how ANPs are best currently employed with elderly oncology patients. ResultsFive studies were reviewed which showed that ANPs provide support to elder patients which helps to alleviate stress and improve the quality of life of cancer patients. Furthermore, it was seen that ANPs can aid patients in symptom management. ConclusionThis study has shown that ANPs are effectively used in clinical support for cancer patients. Further studies are required to verify the extent of this support and to determine if this support is effective only in the short term or can it be applied just as effectively over a period of time. ANPs have high-level knowledge and skills but more research is required to determine how they work effectively.

Service user and carer experiences of the advanced nurse practitioner role in a memory assessment team.

Advanced nurse practitioners (ANPs) within memory services can support prompt diagnoses of dementia. Further understanding of the role is necessary as evidence on its effectiveness is limited. To assess service user and carer satisfaction with the ANP role within Kirklees memory assessment team. A cross-sectional survey was undertaken to evaluate carer and patient perceptions of the ANP role in a local memory assessment team. The survey was developed using the Royal College of Nursing's four pillars as a structure: clinical/direct care practice, leadership and collaborative practice, improving quality and developing practice, and developing self and others. One hundred and fifteen surveys were sent out, and 85 were completed, a response rate of 73.9%. Patients expressed significant satisfaction with the ANP, in particular in the areas of direct clinical practice (84%) and quality of care received (87%). Patients and families are highly satisfied with the service provided by the ANP. High-quality research is needed on the cost effectiveness and outcomes of ANP interventions.

Complexity Science Fosters Professional Advanced Nurse Practitioner Role Emergence.

This article discusses role emergence from master's-prepared nurse practitioners to Doctor of Nursing Practice (DNP) innovative leaders who utilize Complexity science to impact health care organizations. DNP leaders are in position to disrupt linear traditional leadership and embark on new ideas for improvements in care delivery, organizational system processes, and policies within health care. Complexity science provides the necessary theoretical framework for nurse executives and stakeholders to interact with DNP leaders by engaging in collaborative efforts, cultivating communication from point of service providers to administrators, and coordinating interdisciplinary teams to approach gaps in practice, clinical issues, health care policy, and organizational sustainability. The DNP leader is aware that health care organizations are complex adaptive systems, continuously changing. These require skilled and knowledgeable leaders to support growth within an uncertain environment, and bring evidence to practice while promoting organizational wellness.

Advanced Nurse Practitioners' (Emergency) perceptions of their role, positionality and professional identity: A narrative inquiry.

To explore Advanced Nurse Practitioners' (ANP) (Emergency) perceptions of their role, positionality and professional identity. Advanced nursing practice was formally established in the Republic of Ireland in 2001 with 336 ANPs currently registered, projection increasing to a critical mass of 750 by 2021. Advanced practitioners (Emergency) give full emergency care for a specific cohort of clients with unscheduled, undifferentiated and undiagnosed conditions. Qualitative narrative inquiry using Bourdieu's concepts of habitus, field and capital as the theoretical framework was undertaken. Data were collected in 10 in-depth interviews and thematic analysis applied. Five key themes emerged: participants' career pathways, personal and professional transitions, role dimensions and core concepts, and position in the organization and emergent professional identity. Role transitioning and a change in habitus, field and capital revealed the uniqueness of their nursing role. Minimizing waiting times, timely patient care and patient satisfaction were key performance indicators. A heightened awareness regarding higher-level decision-making, autonomy and accountability is integral to advanced practice. This study presents unique insights into the ANP role covering recruitment, organizational culture changes required and support to ease transition emerged. Better understanding the motivation to undertake the role, the transition experience and use of advanced practice skills sets will inform the targets for the future recruitment and retention of ANPs are met nationally and internationally. Dissatisfaction with previous management roles and wanting to be clinically close to patients were motivations to follow an advanced practice clinical career trajectory. Positionality and emergent professional identity are key enablers ensuring that advanced practitioners' roles demonstrate the attributes of advanced practice. Educators could use the findings to develop recruitment, retention and progression strategies. Disseminating the role and scopes of practice could positively influence collaborative models of service delivery and policy development.

‘What about us?’ – Reflections on how a psychologically informed advanced nurse practitioner role in primary care might support individuals who may decline referral to secondary care

‘What about us?’ – Reflections on how a psychologically informed advanced nurse practitioner role in primary care might support individuals who may decline referral to secondary care