Nursing roles and levels of practice: a framework for differentiating between elementary, specialist and advancing nursing practice

The recent profusion of new nursing roles in the UK has led to much confusion in the minds of health care consumers, employers, nursing practitioners and educationalists regarding the meaning, scope of practice, preparation for, and expectations of such roles. Titles such as Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), Advanced Nurse Practitioner (ANP), Higher Level Practitioner (HLP) and more recently Nurse Consultant (NC) are being adopted in a variety of care settings with little understanding or consensus as to the nature of or differences between such roles. Further, the former United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1992) initiative for extending the scope of professional practice allows for the prospect that nurses can adopt additional clinical tasks or alter the nature of service provision provided that they acquire the appropriate education or training, levels of competence and are prepared to be accountable for their new practices. Consequently, nursing practice is becoming more diverse than ever before and the boundaries of inter- and intraprofessional practices are becoming increasingly blurred. The UKCC (1999a) has recently contributed to an understanding of the levels of clinical practice undertaken at the specialist level but the situation at advanced or consultant levels remains unclear.