Specialist Practice And Advanced Practice

So what is specialist and advanced practice and is there a difference between them? Up until recently in the UK, PREP (UKCC, 1995) identified two levels of practice beyond registration which are specialist and higher (UKCC, 1995; Rolfe & Phillips, 1995). This has been further superseded by the NMC (2005) which is now looking to register 'advanced practice' nurses.


The term 'specialist' is used to denote anyone who is more 'experienced' or more specialised than oneself (Hunt, 1999). Most of the literature when dis cussing 'specialist practice' does so in relation to the clinical nurse specialist role. Other countries, such as the USA, see the terms 'specialist', 'expert' and 'advanced' practice as synonymous with each other (Sutton & Smith, 1995), so it is impossible to draw on their experiences. In the absence of specific literature on specialist practice as a level of practice, guidance is taken from the former UKCC (1998). Cattini and Knowles (1999) identified a framework of core competencies for specialist practice, which are: be a clinical expert in direct clinical practice; deliver research-based practice; act as a clinical resource for patients and staff; and be able to manage the workload and act as an effective communicator. In clinical practice, care management, practice development and leadership specialist practitioners exercise higher levels of judgement, discretion and decision-making (UKCC, 1998).


The UKCC (1998) defined very specific requirements for recording specialist practitioners. They are first level registration and completion of a programme of educational preparation over at least one academic year that consists of 50 per cent clinical work and 50 per cent practice that is at degree level. This is supported by Humphris (1994) (cited by Cattini & Knowles, 1999) who suggests that the education of specialist practitioners should be at degree level. The entry criteria are normally two years experience and a diploma in nursing (Norman, 2000). The UKCC also set out various educational standards for 'specialist practice' for different clinical areas, such as community learning, disabilities nursing and health visiting. New clinical posts that adapt what were previously medical tasks are primarily 'specialist practice' roles if they fulfil the criteria for specialist practice (Elcock, 1996; Manley 1997), and the UKCC agreed that nurse practitioners or clinical nurse specialists could use the title if they met the standards (Norman, 2000).

Examining the standard for specialist community nursing education and practice - general practice nursing (points 15-16) from the UKCC 1998 standard clearly demonstrates that managing episodes of care in the way they would be managed by nurses in sexual health fulfils the criteria for 'specialist' practice:

16.2 assess, diagnose and treat specific disease in accordance with agreed medical/nursing protocols

16.3 provide direct access to specialist nursing care for undifferentiated patients within the practice population

16.4 undertake diagnostic, health screening, health surveillance and therapeutic techniques applied to individuals and groups within the practice population.


Clearly, these points could also easily apply to advanced practice. However, advanced practice is substantially different from other forms of nursing practice such as expert or specialist practice (Sutton & Smith, 1995). It is a pinnacle of nursing that is more than a collection of extended roles (Le-Mon, 2000) and breaking it down into parts would fail to capture the essence of the role (Elcock, 1996). Advanced practice transcends roles: it is a way of thinking and approaching new challenges with vision and acting as a catalyst for change (Davies & Hughes, 2002). In meeting organisational demands, advanced practitioners are 'eclectic', which is probably why there is role ambiguity (Woods, 1999). Clinical expertise in a related sphere of practice is essential (Manley, 1997), as advanced practice is grounded in the nurse-client relationship (Sutton & Smith, 1995). Advanced practice is independent and should be performed without reference to doctors or protocols (Sidani & Irvine, 1999). Advanced practice nurses also demonstrate a level of analytical thought that shapes their perception of practice, and articulate and define nursing practice by constant reference to the client (Sutton & Smith, 1995).

Worldwide, the delivery of health care is changing, and to meet that challenge nurses are adapting their practice and developing advanced practice roles (Mundinger, 1995; Lorensen et al. 1998; Offredy 2000). Although it is useful to explore how advanced practice is developing in other countries such as the USA, which has had these roles for years, drawing from those experiences, it is important to note that advanced practice is defined by the reasons for its development. As there is no clear definition (Davies & Hughes, 2002), describing advanced practice becomes a complex issue. There has been much discussion here in the UK and overseas about the nature and standard of advanced practice (Elcock, 1996; Woods, 1999).

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