Advanced Practice Nurse: Meaning and Examples

Definition

Advanced practice nurses are defined by the level at which they operate. They lead others, work autonomously, manage patients with complex healthcare needs, and practice with relevant expertise. They can be clinical specialists or perform general duties.

This definition captures the key elements of the extended official definition. The Nursing and Midwifery Board of Australia (NMBA) defines advanced practice nursing this way:

Nurses practising at an advanced practice level incorporate professional leadership, education, research and support of systems into their practice.
Their practice includes relevant expertise, critical thinking, complex decision-making, autonomous practice and is effective and safe.
They work within a generalist or specialist context and they are responsible and accountable in managing people who have complex healthcare requirements.

The NMBA also emphasises that advanced practice is demonstrated by the level of practice, not by a job title or pay grade.

Source: Fact Sheet: Advanced Nursing Practice and Specialty Areas Within Nursing

Criteria for Advanced Practice Nursing

The above definition implicitly rules out practice where a nurse has no leadership role, is not an expert in their current field, is routinely supervised, is not responsible for managing complex cases, or has limited decision-making responsibility.

We can tease out the various elements to establish a set of criteria for nursing practice to be advanced:

Job Examples

Although advanced nursing practice is determined by skills and responsibilities, not job title, we can nonetheless identify certain jobs in this sphere. Here are relevant positions within the health systems of Australia.

1. Clinical Nurse Specialist Grade 2

In New South Wales, both Grade 1 and Grade 2 Clinical Nurse Specialists (CNS) are seen as Advanced Practice Nurses (APNs), especially the Grade 2 CNS. Similar roles are found across other Australian regions. The Grade 2 CNS builds upon Grade 1 responsibilities with key distinctions:

Extended autonomy in decision-making, compared to the Grade 1 CNS who works with minimal direct supervision.
Enhanced clinical skills for complex care, going beyond the high level of clinical nursing knowledge required for Grade 1.
Leadership roles in developing nursing practices, in contrast to Grade 1's contribution to clinical practice development.
Responsibility for specialist clinical practice across health facilities or primary case management, not specified in the Grade 1 role.

These additional characteristics of a Grade 2 CNS demonstrate a higher level of responsibility, autonomy, and expertise.

2. Clinical Nurse Consultant

Clinical Nurse Consultants (CNCs) can be considered APNs provided direct care of patients is an integral part of their job. CNCs are known for their specialised knowledge in specific nursing areas and usually require postgraduate education and extensive experience. Their role often merges clinical expertise with leadership and consultation.

For CNCs, involvement in direct patient care is crucial in qualifying them as APNs. Specialist skills need to be directly applied in patient care settings, beyond advisory and leadership capacities.

3. Nurse Practitioner

Almost by definition, Nurse Practitioners (NPs) are also APNs. An NP is endorsed to practise at a higher level. This role involves direct clinical contact, autonomy, and compliance with the Nurse Practitioner Standards for Practice.

NPs must complete 5,000 hours of clinically-based advanced practice over six years, emphasising their extensive experience. They incorporate elements like leadership, education, and research into their practice, managing people with complex healthcare needs.

What Is Advanced Nursing Practice?

Advanced nursing practice refers to higher-level activities that are generally reserved for experienced nurses with relevant expertise. These are difficult, complex, or important tasks beyond the ordinary scope of practice for registered nurses.

For example, a clinical nurse specialist will manage complex nursing care and perform tricky clinical procedures. They offer expert advice on healthcare delivery and clinical practice, mentor and educate junior nursing staff, and drive quality improvements. These specialists may also develop and revise healthcare protocols.

Nurse practitioners are authorised to perform tasks beyond the scope of other nurses. For example, they assess patients, diagnose conditions, order and interpret diagnostic tests, and develop comprehensive treatment plans. NPs are also qualified to prescribe medications and refer patients to specialists.

How to Become an Advanced Practice Nurse

To become an Advanced Practice Nurse (APN) in Australia, there are several common steps. You need to gain the necessary experience and qualifications, and seek positions that allow for an expanded scope of practice.

Start as a Registered Nurse (RN).
- Complete a Bachelor of Nursing degree or, for non-nursing graduates, a Master of Nursing Practice.
- Register with the Nursing and Midwifery Board of Australia (NMBA).
Gain clinical experience.
- Work as an RN to build clinical experience, ideally in a specialty area of interest.
- For Nurse Practitioners, at least three years (or 5,000 hours) of advanced clinical nursing experience within the last six years is required.
Do postgraduate education.
- Enroll in postgraduate programs related to your chosen specialty, such as a Graduate Certificate in Nursing, Graduate Diploma in Nursing, or a Master of Advanced Nursing Practice.
- For a nurse practitioner role, an approved NP master's program or equivalent is needed.
Certification and skills development.
- Obtain any additional certifications required for your specialty or state/territory.
- For Nurse Practitioners, this includes submitting an application for NMBA endorsement.
- Develop your clinical skills, leadership abilities, and specialty expertise.
Apply for clinical roles.
- Seek APN positions, such as clinical nurse specialist, clinical nurse consultant, or nurse practitioner.
Ongoing professional development.
- Continue professional development to maintain skills and keep abreast of advancements in your field.

This pathway provides a general guide to progressing from an RN to various APN roles. Requirements for specific roles can vary across different states/territories and healthcare settings.

Why Senior Nurses Often Aren't APNs

Experienced nurses in high-paying jobs, often with high-level clinical skills, may not be engaged in advanced nursing practice because of the nature of their work.

Clinical Nurse Consultants actually move away from advanced practice as they gain seniority and experience. They tend to focus more on advisory and consultancy roles, rather than direct patient care. This shift is evident in the Victorian healthcare system, where Nurse Consultants are described as providing a clinical resource and advisory role, engaging in research and development activities, rather than hands-on clinical work.

Similarly, Clinical Nurse Educators, despite their vast experience and expertise, primarily concentrate on the education and training of nursing staff. Their role is essential for the professional development of nurses, but it’s oriented towards teaching and mentoring rather than clinical practice, which is a core component of an APN's role.

Nurse Unit Managers are often too busy with administrative and managerial tasks to be immersed in clinical nursing. Their responsibilities involve overseeing nursing units, managing staff, and ensuring smooth administrative operations. They do not typically do the advanced clinical practice that defines an APN role.