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Advanced Level Nursing: A Position Statement
This statement recognises two levels of nursing practice: first level registration
(entry into the profession) and advanced level, where the registered nurse is
working at a level well beyond initial registration, using their existing knowledge
and skills to inform and further develop their practice. Essential competences
expected at the point of registration are therefore not included here. Similarly,
specific tasks have not been highlighted because tasks do not define advanced
level practice. For example, what were once considered to be extended role
activities – such as intravenous drug administration and cannulation – now form,
following relevant preparation, the expected skills base of all registered nurses
working in areas where these are key elements of nursing practice.
Advanced level practice encompasses aspects of education, research and
management but is firmly grounded in direct care provision or clinical work with
patients, families and populations. Nurses working at an advanced level promote
public health and well-being. They understand the implications of the social,
economic and political context of healthcare. Their expertise, experience and
professional and clinical judgement are demonstrated in the expert nature of their
practice and the depth of their knowledge. Patients, clients and other professionals
acknowledge their highly developed and extensive knowledge in areas such as
diagnostics, therapeutics, the biological, social and epidemiological sciences and
pharmacology, and their enhanced skills in areas such as consultation and clinical
decision-making. Nurses working at an advanced level use complex reasoning,
critical thinking, reflection and analysis to inform their assessments, clinical
judgements and decisions. They are able to apply knowledge and skills to a broad
range of clinically and professionally challenging and complex situations.
Nurses working at advanced level act as practice leaders, they manage their
own workload and work across professional, organisational, agency and system
boundaries to improve services and develop practice. They network, locally,
regionally and nationally. They assess and manage risk and proactively challenge
others about risk.
Advanced level nursing involves constantly working to improve the quality
of services and patient care. Advanced level nurses use a range of data, tools
and techniques to improve practice and health outcomes and can demonstrate
their impact and value. They develop productive relationships with numerous
stakeholders in order to influence the strategic direction of services for the
benefit of patients and clients.
Advanced level nursing
– a definition