Fourth Edition
Edited by
Paula McGee
Emeritus Professor
Birmingham City University
Birmingham, UK
Chris Inman
Birmingham City University
Birmingham, UK
This edition first published 2019
© 2019 John Wiley and Sons Ltd
Edition History
John Wiley and Sons (3e, 2009)
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Library of Congress Cataloging‐in‐Publication Data
Names: McGee, Paula, editor. Title: Advanced practice in healthcare : dynamic developments in nursing and allied health professions / edited by Paula McGee, Emeritus Professor, Birmingham City University, Birmingham, UK, Chris Inman, Birmingham City University, Birmingham UK, AAPE UK longstanding committee member.
Other titles: Advanced practice in nursing and the allied health professions.Description: 4th edition. | Hoboken, NJ : Wiley‐Blackwell, 2019. | Revision of: Advanced practice in nursing and the allied health professions / edited by Paula McGee. 2009. 3rd ed. | Includes bibliographical references and index. |
Identifiers: LCCN 2019001698 (print) | LCCN 2019003059 (ebook) | ISBN 9781119439127 (Adobe PDF) | ISBN 9781119439110 (ePub) | ISBN 9781119439097 (pbk.)
Subjects: LCSH: Nurse practitioners–Great Britain. | Nursing–Great Britain.
Classification: LCC RT82.8 (ebook) | LCC RT82.8 .A365 2019 (print) | DDC 610.73/7–dc23
LC record available at https://lccn.loc.gov/2019001698
Cover Design: Wiley
Cover Image: © Pobytov / Getty Images
Susan Beaumont, BSc Speech Pathology and Therapeutics, MSc Advanced Practice, MRCSLT, HCPC Reg
Principal Speech and Language Therapist, Worcestershire Health and Care NHS Trust, UK
Sue Beaumont has worked in the field of dysphagia (swallowing disorders) for 18 years and leads this specialism for the pediatric speech and language therapy service across Worcestershire Health and Care NHS Trust. During this time, she has significantly developed the service. She is well known for her clinical expertise and as a resource for advice within the Trust and regionally through her links with other Acute and Community NHS Trusts. She chaired the Speech and Language Therapy Clinical Excellence Network and continues to serve as a member. She is passionate about improving both care for children with dysphagia and support for their parents. She is fascinated by the challenges presented by increasingly complex cases and the ethical dilemmas they present in health and social care.
Andrew Campbell, BSc (Hons) Pharmacy, PG Dip. Clinical Pharmacy, PG Cert. Psychiatric Therapeutics, MSc Clinical Pharmacy, PG Cert. Independent Prescribing, Professional Doctorate in Pharmacy
Chief Pharmacist, Dudley & Walsall Mental Health Partnership NHS Trust, UK
Andrew Campbell is currently the Chief Pharmacist for Dudley and Walsall Mental Health Partnership Trust and is a qualified non‐medical prescriber. He has several years' experience as a visiting lecturer on the non‐medical prescribing program at Birmingham City University, and was formerly the West Midlands regional Non‐Medical Prescribing Lead. Andrew is committed to education and training and has recently completed his professional doctorate, which explored attitudes to prescribing practice in a mental health context.
Jonathan Downham, RN, ACCNP, MSc
Advanced Critical Care Nurse Practitioner, Intensive Care, Warwick Foundation NHS Trust, UK
Jonathan Downham holds a Master’s degree in anesthetic practice and provides a wide range of educative materials for critical care practitioners at Critical Care Practitioner, www.criticalcarepractitioner.co.uk.
Mary Hutchinson, RGN, BSc (Hons), MSc, FFEN
Senior Lecturer, Birmingham City University, and Advanced Nurse Practitioner, BADGER Medical Services, UK
Mary Hutchinson has a dual role as a Senior Lecturer in Advanced Clinical Practice and an Advanced Nurse Practitioner (ANP) with an out‐of‐hours service co‐located with a local Emergency Department. Her clinical career encompasses many aspects of urgent and emergency care, from Staff Nurse in a community hospital Casualty Department to eight years as Sister in an Emergency Department, during which time she project‐managed development of the Emergency Nurse Practitioner role. Mary has been Service Manager/Professional Lead of two long‐established Minor Injury Units and a Community Rapid Response Team. She served for two years as an ANP in primary care, and latterly has worked as Clinical Lead in a nurse‐led Urgent Care Centre. As a Founding Fellow and Board Member of the Faculty of Emergency Nursing (FEN), and a committee member of the Royal College of Nursing (RCN) Advanced Nurse Practitioner Forum, she continues to work to update the FEN career and competence framework, and is an active participant in the RCN ANP credentialing process.
Chris Inman, RN, DEd, MSc
Former long‐standing Program Director, Master’s in Advanced Practice, Birmingham City University, UK
Having consolidated her nursing qualification for 18 years with experience in a variety of clinical and educational settings and locations, Chris Inman completed an MSc in Sociological Research Methods at Warwick University and became a lecturer at Hull University. She then accepted a post as Head of Nursing developments at the Open University, and was subsequently appointed Program Director for the first MSC Advanced Practice course in the UK. This course developed dynamically over several years, expanded to recruit students from The Netherlands, and continues to produce high‐flying graduates, many of whom have become non‐medical consultants and leaders in healthcare. Christine's doctoral research at King’s College London explored the learning needs of senior healthcare professionals undertaking PhD study. Later investigation involved exploration into the syllabi of advanced practice programs in the UK, which challenged the assumption that courses were consistent across the country. Her recent interest is in exploring the assessment of advanced practitioners and variations in examination. Chris is a long‐standing committee member of the Association of Advanced Practice Educators UK.
Lesley Kavi, MB ChB, DRCOG, DFSRH
General Practitioner (primary care physician), Birmingham, UK.
Lesley Kavi obtained her medical degree at Glasgow University in 1983 and undertook GP training in the Lake District. Having previously worked as a GP partner in inner‐city Dundee, she is currently practicing in Birmingham. Lesley holds postgraduate diplomas in syncope and related disorders, obstetrics and gynecology, and contraception. In addition, she has an interest in heritable connective tissue disorders. She currently teaches physical examination techniques and differential diagnosis on the MSc in Advanced Practice at Birmingham City University. Lesley is a volunteer managing trustee and chair of PoTS UK, a charity that supports patients with postural tachycardia syndrome. She has written a number of journal papers on PoTS and syncope in primary care.
Grainne Lowe, RN, PhD
Lecturer, Deakin University, Australia
Grainne Lowe is a Nurse Practitioner in the specialty area of emergency nursing. She has over 30 years’ experience in a variety of nursing positions, including clinical practice, research, and education, with her current role as a Lecturer at Deakin University. Grainne has researched the Nurse Practitioner role over a number of years, including completion of her doctoral thesis specifically focusing on the integration of Nurse Practitioners into the Australian healthcare system.
Paula McGee, RN, RNT, PhD, MA, BA, Cert. Ed.
Emeritus Professor of Nursing, Birmingham City University, UK
Paula McGee has researched and published about advanced practice for many years and is committed to advancing expertise in this developing field of nursing. She has launched and edited several professional journals, including the British Journal of Nursing, Research Ethics, and Diversity in Health and Care. She has also been an associate editor of the Journal of Transcultural Nursing and has guest edited other journal publications.
Virginia Plummer, RN, RM, PhD
Associate Professor, Director of International Engagement, Monash University and Peninsula Health, Australia
Virginia Plummer’s research interests include local and international approaches to health service management, the nursing workforce, and costing studies. During her PhD she undertook an analysis of nearly two million nursing hours in three countries in a study of patient dependency and nurse–patient ratios. Virginia received an Australian Research Council Linkage grant toward enhancing patient management at point of care using electronic‐based clinical pathways. She has supervised more than 50 Honors, Master’s, and PhD students to completion in research related to midwifery, emergency care, critical care, disaster management, advanced practice roles, and health service evaluation. Virginia is Chair of the Human Research Ethics Committee at Peninsula Health; Executive Member of the Nursing Section, World Association Disaster and Emergency Medicine; and Associate Editor, BMC Nursing and on the International Emergency Nursing Editorial Board.
Madrean Schober, PhD, MSN, RN, ANP, FAANP
President, Schober Global Healthcare Consulting, International Healthcare Consultants, Indiana, USA
Madrean Schober is President of Schober Global Healthcare Consulting. She is a nurse practitioner, educator, writer, lecturer, and consultant with an aim to promote insightful healthcare services to diverse populations, which includes strategic planning for improved access to all. Her consultancy experience extends to over 40 countries in the process of developing advanced practice nursing roles with expertise in healthcare policy, curriculum design, and program development.
Nicola J Stock, RN, MPhil, MSc, BSc, PGDip, PGCert
After completing nurse training with the British Army, Nicola Stock worked in various locations throughout the world, but predominantly in the UK. Her experience and post‐registration in the UK were in orthopedics. Whilst studying for a BSc (Hons) in Military Nursing Studies with the University of Portsmouth, she developed a greater interest in healthcare law and clinical ethics as drivers to promote standards of patient care, following up her degree with a PGDip in Healthcare Ethics from King’s College London and an MPhil in Medical Law from the University of Glasgow. With a conviction that education was another key to the delivery of good patient care, during this time Nicola also qualified as a Practice Educator and spent 10 years working between Birmingham City University and military deployments, before leaving the army in 2011. Since then she has continued to work as a sessional lecturer and in clinical practice, dividing her time between the UK and an oil and gas project in the Middle East.
Christine de Vries de Winter, MScN, RN
Head of Department Nursing Studies, Faculty Health, Behavior and Society, University of Applied Science Arnhem en Nijmegen, The Netherlands
Christine de Vries de Winter studied nursing in Leiden and nurse science at the University of Antwerp, together with management and leadership at the TIAS School for Business and Society. As national chair of the Master in Education for Advanced Nursing Practice, she was closely involved in the development of advanced nursing roles in The Netherlands, one of the few European countries to develop full advanced practice roles during the early part of the twenty‐first century.
Helen White, MEd, PGDip Clin. Onc., PG Cert L&T in HE, BSc (Hons) Radiotherapy
Head of Department of Radiography, Birmingham City University, UK
Helen White has worked in radiography education for over 15 years, teaching across clinical and academic components of a variety of healthcare programs at undergraduate and postgraduate levels of academic study. She is currently working with postgraduate students studying leadership and advanced practice, and works with clinical service leaders to promote advanced and consultant practice opportunities. Helen is a Visitor for the Health and Care Professions Council, offering expert advice and contributing to decision‐making processes on whether educational programs meet the Council's standards. She is a member of the College of Radiographers' Approval and Accreditation Board and the Radiotherapy Advisory Group, which reports to the College's UK Council on issues relating to therapeutic radiography, including career development pathways. She is also an experienced assessor for the professional body the College of Radiographers.
Nick White, MSc Radiography, BSC (Hons) Human Anatomy, BSC (Hons) Radiotherapy, BA Open
Clinical tutor, Radiotherapy Department, University Hospitals Birmingham, and Senior Lecturer, Department of Radiography, Birmingham City University, UK
Nick White has a dual role as clinical tutor and senior lecturer. He has worked in radiography education for 15 years, teaching on undergraduate and postgraduate courses in radiography and the health professions. He is an experienced lecturer in advanced practice and leadership, and is module leader for post‐registration radiographers studying leadership within programs which support development as advanced and consultant practitioners. He is a Senior Fellow of the Higher Education Academy, this award being received in recognition of his innovative approach to healthcare education, including MSc supervision, the use of skills simulation, and the involvement of students as academic partners. Nick is an experienced course assessor for the College of Radiographers. His current research includes the development and delivery of approaches to the teaching of palliative and end‐of‐life care within healthcare programs, and how this is implemented within clinical practice.
Advanced practice is an evolving field of healthcare in which experienced nurses and members of allied health professions undergo further preparation to improve health, prevent disease, and provide treatment and care for patients in a wide range of settings. Their enhanced expertise enables advanced practitioners to address inequalities in access to healthcare, particularly for people who are marginalized and socially excluded. Tackling what may be entrenched disadvantage requires a willingness to try new approaches to ensure that health services are designed and provided in ways that meet the needs of local populations. Advanced practitioners are, therefore, pioneers of new forms of practice that may not only increase the availability of healthcare, but also provide it in ways that are experienced by patients as appropriate and meaningful. This last point is important because, whilst care and caring are universal phenomena, the actions, values, and beliefs that underpin them vary considerably between and within social groups. Thus, care and caring require a deep engagement with people in order to understand what is important to them and a flexible, adaptable approach to professional practice.
The development of advanced practice challenges established ideas about professional roles. It forms part of the global reconceptualization of the current and future healthcare workforce as being at the forefront of meeting Sustainable Development Goals to ensure “equitable access to health workers within strengthened health systems” by 2030 (United Nations 2015; World Health Organization [WHO] 2016, p. 3). Nurses in particular form the largest part of any healthcare workforce and have the potential to make a considerable difference, particularly in underserved areas. Members of allied health professions also have potential which could be more widely used. Utilizing this potential places non‐medical health professionals at the forefront in the global plan to reduce significantly the complex factors that affect health: changing needs, finance, quality, new technology, workforce preparation, gender, deployment, and accessibility, urban versus rural settings, and health policies (WHO 2014). In this context, advanced practitioners have the expertise to make a significant contribution to the achievement of the Sustainable Development Goals.
Advanced practitioners are now an established part of healthcare workforces, in many countries, as a level of practice beyond initial registration. Advanced practitioners are clinical experts whose main activity is the provision of direct patient care in their specialty. They practice autonomously in many settings, particularly those in which they deliver complete episodes of care and treatment. Their work in direct care is complemented by a set of generic competences which inform their ability to challenge professional boundaries and pioneer innovations.
The aims of this book are to consider the following:
Each chapter in this book begins with an introductory panel which highlights the key issues and objectives. Interaction with the text is facilitated through short exercises which are set within the text and can be undertaken individually or in a group discussion. Each chapter also contains a case study through which different aspects of advanced practice are examined, with particular reference to the
At the end of each chapter there are:
This book is divided into four sections.
Part 1: Five chapters focus on the diverse nature of advanced practice at an international level and introduce a number of issues that are further explored later in the book. Chapter 1 focuses on the conceptualization of advanced practice in relation to competence and variation. The specific areas of competence in advanced practice are well rehearsed in the literature, as is the belief that preparation for the role should be at Master’s level. However, as this chapter points out, the term “Master's level” is open to interpretation, which raises potential concerns about whether all advanced practitioners are equipped to practice at the same level. Competence, it is argued, is not enough; advanced practitioners must also demonstrate capability to cope effectively with unpredictable situations and adapt practice accordingly. Variation is discussed through the medium of a case study which demonstrates how advanced practice has developed in different ways in each of the four countries that make up the UK, and provides insight into factors that will continue to have an impact over the next decade.
This concept of variation leads into the following four chapters. Chapter 2 presents a broad overview of the global development of advanced nursing practice and the disparate issues that shape it. Chapters 3, 4, and 5 offer detailed accounts of advanced practice in the Netherlands, Australia, and the UK. Each account gives a different perspective, which reflects variation in the nature and stage of development and provides insight into local needs and issues. Despite the differences, there are similarities in practice which are illustrated through the case studies: direct patient care, holistic patient assessment based on a body systems approach, and the management of long‐term conditions. There are also some similarities in the issues faced in every country: acceptance by medical staff, determining the impact of advanced practice, and the influence of health policies.
Part 2: Three chapters focus on advanced practice in allied health professional roles. This is a development that seems only have occurred in the UK, and that has expanded considerably since the last edition of this book. The chapters demonstrate the diverse and multifaceted advanced roles that are developing in allied health professions and their potential on a global scale with regard to the achievement of the Sustainable Development Goals (United Nations 2015).
Part 3: Four chapters examine particular aspects of advanced practice in the clinical setting and focus particularly on nursing. Chapter 9 presents an updated account of the prescribing regulations for non‐medical practitioners in the UK: nurses, pharmacists, optometrists, and some allied health professionals. Whilst this is a country‐specific example of one approach to regulation, it also takes the reader through the principles of good prescribing, which are applicable in any setting and are illustrated in the case study. That is followed by a discussion of the systematic and detailed assessment performed by an advanced clinical nurse practitioner in Chapter 10. This is based around a case study which takes the reader through a complete episode of care, beginning with meeting the patient and progressing to history taking and the physical examination, using simple tools that can be memorized as mnemonics. This process informs the formulation of a differential diagnosis and the choice of subsequent interventions. This case study also raises issues about the nature of advanced practice, and whether it is an extension of a professional role or a means of plugging gaps in services because of a shortage of doctors.
Chapter 11 takes up this point by examining the advanced nurse practitioner's role in relation to critical care, an environment in which patients are seriously ill and require support with two or more vital systems. This is an intellectually and ethically challenging context, and we are indebted to Dr. Pat James of Birmingham City University for clarifying some aspects of the physiology of acute respiratory distress syndrome. This chapter discusses two important issues in relation to advanced critical care practice and advanced practice more generally. The first is the process of developing new professional roles, which may, over time, lead to the establishment of a new profession. That raises questions about whether it is absolutely necessary to have a background in an already established health profession, or whether direct entry to, for example, advanced critical care practitioner roles might be possible as part of workforce transformation. The second is the relationship between advanced practice and medicine, particularly in fields such as critical care, where there is a certain amount of overlap between medical and nursing roles.
Chapter 12 examines the interface between advanced nursing practice and medicine more closely within the context of general practice. The pressures facing general practitioners have created opportunities for advanced nurses to develop new skills, plug gaps in services, and develop new approaches to care. Here again, a close alignment with medicine is evident through collaboration between the Royal Colleges of Nursing and General Practitioners, which culminated in the publication of specific competences for advanced nurses in general practice. This is a positive sign that doctors and advanced nurses can work together, and provides balance to the image that medical practitioners are inevitably hostile. However, doctors do have to be confident that advanced practitioners are competent in providing treatment and care. Variations in the level of preparation undertaken by advanced practitioners can cause some unease among doctors, and may also affect what the advanced nurse can achieve.
Part 4: This part looks beyond competence in direct patient care to examine the wider role of advanced practitioners. Modern healthcare is very complex. It requires the ability to make decisions not only about what is possible, but also about what is appropriate. The increasing range of new technologies creates many exciting possibilities, but this must not be allowed to obscure the needs and wishes of individual patients. An ethical working environment is one in which day‐to‐day practice is conducted in an open, respectful manner among professionals and between patients and professionals. As clinical and professional leaders, advanced practitioners must be able to play a leading role in developing and sustaining this environment. Ethical practice is not limited to direct patient care, but applies to all aspects of their work, so that patients, relatives, and staff are treated equally, irrespective of any individual distinguishing characteristics. Thus, ethical practice also informs the advanced practitioner's ability to identify and investigate what needs to change and why, to challenge accepted ways of doings things, and to lead others toward new and better patient care. All of these raise issues about preparation of advanced practitioners and the methods used to determine proficiency.
The final chapter brings the book to a close with a reflection on the issues raised and how advanced practice may develop in future as a vital part of health services.