Fact sheet on advanced practice nursing December 2013

Advanced practice nursing ‘Advanced practice nursing’ (APN) is the term used to define a level of
nursing practice that uses comprehensive skills, experience and knowledge in nursing care.
The Nursing and Midwifery Board of Australia (National Board) has published on its website Guidelines
on endorsement as a nurse practitioner that define APN as the application of advanced levels of
knowledge, skill and experience by the nurse to the nurse-patient/client relationship.
The basis of advanced practice is the high degree of knowledge, skill and experience applied in the
nursepatient/client relationship in order to achieve optimal outcomes through critical analysis,
problem solving and accurate decision-making.
The National Board supports the view that nurses practising at this level are educationally prepared at
Masters level and may work in a specialist or generalist capacity.
This definition comes from the best available research. The following are related useful readings from
the Journal of Advanced Nursing: • Advanced practice nursing role development: factor analysis of a
modified role delineation tool • (2011) A Delphi study to validate an advanced practice nursing tool •
(2010) Making nursing work: breaking through the role confusion of advanced practice nursing (2006)
The target audience of this fact sheet on advanced practice nursing is as follows: • applicants to the
National Board for nurse practitioner endorsement • education providers offering programs for nurse
practitioners • assessors of nurse practitioner applications, and • employers.

What you need to know about advanced practice nursing The related reading from the Journal of Advanced
Nursing, as listed in this fact sheet, demonstrates that the following practice domains constitute the
levels of APN: • direct and comprehensive care • support of systems • education • research •
publication, and • professional leadership.
These domains are applied in the Australian context and appear to be consistent with the diversity of
roles and categorisation for advanced practice. In the case for nurse practitioners, the National
Board gives a clear guideline of three years full time equivalent (5,000) hours of advanced practice
nursing as demonstration of required clinical focus. In the Australian context, APN remains less well
understood, and APN roles are inadequately defined or supported. It is, therefore, crucial that
employers make sure that registered nurses working at advanced practice levels (i.e. in situations of
high clinical work complexity) are clinically and educationally competent through continuing
professional development (CPD) within the scope of advanced practice nursing. However, it is for the
applicant to make the case that their practice meets the definition of advanced practice nursing.
Neither they nor the assessor ought to rely solely on an industrial award position as the definition of
advanced practice nursing. There may be applicants who are not able to obtain a position that awards
the appropriate level of remuneration for the APN work they do and these people ought not to be
deterred from attempting to make their case. Relationship between the nurse practitioner and advanced
practice nursing The role of the nurse practitioner is highly clinically focused and is tightly
regulated by the National Board. In contrast, the APN role has a wider domain of practice and is not
regulated. In Australia, applicants for nurse practitioner endorsement must first be eligible for
general registration as a nurse. This means that nurse practitioners are also able to practice as
registered nurses. However, endorsement as a nurse practitioner requires the applicant to demonstrate
that they meet Competency standards for the nurse practitioner, which the National Board reviews
periodically. The National Board Guideline on endorsement as a nurse practitioner states: The nurse
practitioner role includes assessment and management using nursing knowledge and skills. The role may
include, but is not limited to, the direct referral of patients to other health care professionals,
prescribing medications and ordering diagnostic investigations. The role is grounded in the nursing
profession’s values, knowledge, theories and practice, and provides innovative and flexible health care
delivery that complements other health care providers. The intention for introducing the nurse
practitioner role in Australia was to recognise a clinically focused, highly skilled nursing role that
allowed nurse practitioners to function autonomously (in collaborative relationships with other health
professionals). Nurse practitioners have a higher accountability for, and authority in the management
of, their patient group than other registered nurses. In order to fulfil this accountability, the nurse
practitioner is required to be endorsed by the National Board to prescribe medicines, order diagnostics
and make referrals.

Assessment of advanced practice for nurse practitioner endorsement Advanced practice nursing, while
potentially remaining clinical to some extent, may not purely be confined to clinical work. The nurse
practitioner role is expected to be predominantly clinically focused. When assessing individuals who
have applied for nurse practitioner endorsement, the National Board recognises that three years of full
time advanced practice nursing demonstrates a corresponding level of clinical focus required.
In hours, the National Board recognises a minimum of 5,000 hours of clinical focus and the applicant
may demonstrate this clinical focus across primary to tertiary care.
Relationship between the registered nurse and advanced practice nursing Specific competencies define
the role and scope of practice for registered nurses. These competencies define the registered nurse’s
role at all levels of nurse practice – from that of a clinically prepared new graduate to advanced
practice nursing. The scope of practice necessitates the registered nurse to reflect on their level of
expertise, the complexity of the clinical situation in which they find themselves, and the level of
supervision. The National Board’s Decision making framework and the use of the relevant Code of ethics
and Code of conduct outline the requirements for registered nurses to achieve higher levels of
competence and expertise. Registered nurses may work at levels of advanced practice nursing– where the
work is of high complexity and level of supervision may be lower than that of beginner registered
nurses. It is essential that the registered nurses are clinically and educationally prepared to
perform at those levels.

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