Higher level practice

At this point it would be useful to discuss higher-level practice (UKCC, 1999), despite the fact that it has been replaced, as it has some useful points which shouldn't be lost. Higher-level practice was similar to the Nordic experience of advanced practice, because it is about nursing research to assist nurses in a productive, practical, applicable way (Lorensen et al., 1998). Practitioners working at a higher level understand the social, economic and political implications of health care. They use complex reasoning, critical thinking, and reflective skills, and are able to analyse and synthesise information by generating new solutions.They contribute to the wider development of nursing through publication, and are leaders for change. Effective communicators, they network, and cross organisational and professional boundaries to ensure collaborative working and to develop practice standards and protocols. They are clinical experts who work in the absence of procedure and protocols. They assess risk and promote clinical effectiveness. So with higher-level practice it was not just a matter of acquiring medical skills such as health assessment, and they may have been nurses who would not fit into the 'advanced nurse practitioner' as defined by the NMC but may contribute at a 'higher level' than an initial registration-level nurse. The advanced practice nurse and consultant nurse are characterised by similar sub-roles (Manley, 1997).

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