In the USA advanced practice is synonymous with clinical nurse specialists and nurse practitioners (Davies & Hughes, 2002). It is suggested that it is a level of practice that includes but is not exclusive to these roles (Wright, 1997). The development of the 'strong' model of advanced practice, by a group of advanced nurse practitioners in America in 1994, gave clear guidelines as to what the characteristics of advanced practice were. It incorporates comprehensive care, education, and research and publication, and also professional leadership (Mick & Ackerman, 2000).

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