We have seen that there are a number of drivers, predominantly in the form of government reforms, that are guiding this explosion of advanced nursing practice. Nurses are a flexible and adaptable workforce within the health service, and it is this flexibility that has facilitated this role development. Because of this change and nursing initiative there has been a phenomenal development of nursing roles, which has led to there being a number of titles used by advanced practice nurses, which has confused both other healthcare professionals and patients alike. This was fuelled by a lack of direction from the former UKCC, who avoided regulating this practice.

Finally, this chapter aimed to define what 'advanced nursing practice' is. This has proved to be a difficult task. There is a perception that it consists in the development of medical skills such as health assessment. It is easy to understand why: these are indeed 'advanced clinical skills'. However, advanced nursing practice is more than a collection of medical skills. It is about challenging the status quo of what nurses have traditionally been expected to do, and developing clinical practice in which the patients' needs are central. It could be suggested that a ward sister or other senior nurses could practise at this 'advanced level', even though they may not possess advanced clinical skills such as health assessment or nurse prescribing. This is important to remember when discussing advanced nursing practice, or otherwise the value of nursing could be lost at the expense of learning these excit ing new clinical skills. In summary it would be fair to say that currently in the UK there are three levels of practice, not two, and these are initial, specialist and advanced.

With all this in mind this book is concerned with helping nurses acquire and develop these exciting new advanced clinical skills in genito-urinary medicine, with the aim that many of them will go on to become advanced nurse practitioners.

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