Paula McGee is Professor of Nursing in the Faculty of Health at Birmingham City University, where she researches and teaches about advanced practice.

• Contributors xiIntroduction xiii1 The Development of Advanced Nursing Practice in the United Kingdom 1Paula McGeeIntroduction 1Health policies and reforms 2The UKCC and higher-level practice 4The interface with medicine 4The introduction of new roles 8Modern matrons 8Nurse consultants 8Physicians’ assistants 9Nurse practitioners and the Royal College of Nursing 9The Nursing and Midwifery Council 11Conclusion 12Key questions for Chapter 1 12References 122 UK Health Policy and Health Service Reform 15Alistair HewisonIntroduction 15The policy process 16Labour health policy since 1997 17UK health policy and its implications for advanced nursing practice 19Advanced nursing practice 20Advanced nurses as policy implementers 23Conclusion 24Key questions for Chapter 2 25References 253 Advanced Practice in Allied Health Professions 29Paula McGee and David ColeIntroduction 29The introduction of the consultant allied health professional 30Physiotherapy 33Radiography and sonography 35Sonography: an example of advanced radiography role 37Are these new roles in physiotherapy and radiography/sonography advanced? 39Conclusion 41Key questions for Chapter 3 41References 414 The Conceptualisation of Advanced Practice 43Paula McGeeIntroduction 43The context of the development of advanced practice 43The nature of advanced practice 45Professional maturity 46Challenging professional boundaries 46Pioneering innovations 49Is advanced practice a generic term? 53Conclusion 53Key questions for Chapter 4 54References 545 Advanced Assessment and Differential Diagnosis 56Paula McGeeIntroduction 56The nature of advanced assessment 57Types of advanced assessment 58Conducting an advanced assessment 63Limitations of advanced assessment 64Formulating a differential diagnosis 64Conclusion 68Key questions for Chapter 5 68References 686 Prescribing and Advanced Practice 70Sue Shortland and Katharine HardwareIntroduction 70Recent developments in non-medical prescribing 71Preparation for prescribing 72Who may prescribe what? 73Nurses 73Allied health professionals 73Controlled medicines 74Patient group directions 74Emergency situations 74The principles of safe prescribing 75Safety and clinical governance 76The future of non-medical prescribing 77Conclusion 78Key questions for Chapter 6 78References 787 Advanced Practice in Dietetics 81Linda HindleIntroduction 81Reasons for the development of consultant roles in dietetics 82The consultant role 82Working as a consultant in obesity management 83Role development 83Clinical practice 83Professional leadership 84Education, training and professional development 87Service development, research and evaluation 88Setting up a consultant post 89Examples of dietetic consultant roles 90Conclusion – the future for consultant dietitians 93Key questions for Chapter 7 94Acknowledgements 94References 958 Advanced Practice in Occupational Therapy 97Lynne Frith and Janette WalshIntroduction 97Advanced practice in occupational therapy 98Specialist roles in occupational therapy 98Clinical caseload and expertise 99Clinical leadership 99Clinical teaching and mentoring 99Specialist advisory role 99Consultant roles in occupational therapy 100Expert clinical practice 100Practice and service development 100Professional leadership and consultancy 100Research audit and evaluation 101Education, training and development 101The clinical specialist and consultant occupational therapist as advanced roles 101Current issues for consultant occupational therapists 103The future for occupational therapists 104Conclusion 105Key questions for Chapter 8 105References 1059 Working as an Advanced Nurse Practitioner 107Mark RadfordIntroduction 107Defining a need 108Organisational preparation 110Job planning 111Maintaining focus and delivery 112Developing strategic influence 113Consultancy and entrepreneurship 114Review and evaluation 116Career progression 119Conclusion 121Key questions for Chapter 9 121Acknowledgements 121References 12210 Pioneering New Practice 124Kate GeeIntroduction 124Background to the quadrant model 124The quadrant model 127Quadrant 1: pioneering innovations in technical acute cure cultures 128Quadrant 2: pioneering innovations in high-technology/care cultures 130Quadrant 3: pioneering innovation in low-technology/cure cultures – strategies for patient education and rehabilitation 131Development of ICD nursing expertise 132Development of heart failure nursing expertise 132Quadrant 4: pioneering innovations in low-technology/care quadrant 134Conclusion 136Key questions for Chapter 10 137References 13711 Cultural Competence in Advanced Practice 141Paula McGeeIntroduction 141Culture and equality 142Cultural relationships among health, illness, treatment and care 145Theoretical approaches to culturally competent practice 146Papadopoulos, Tilki and Taylor’s theory of cultural competence 147Purnell and Paulanka’s theory of cultural competence 149McGee’s theory of cultural competence 150Relevance of theory to advanced practice 153Conclusion 155Key questions for Chapter 11 155References 15512 Leadership in Advanced Practice: Challenging Professional Boundaries 158Sally ShawIntroduction 158Leadership in advanced practice 159Theories and characteristics of leadership 160What leadership is not 160Leadership can be learned 161What is leadership? 161Theories of leadership 161Key elements of leadership 162Other important leadership characteristics 165The setting for leadership 166The followers 168Leadership styles and their relevance for advanced practice 169Sustaining and nurturing leaders 172Indicators of effective leadership 174Conclusion 175Key questions for Chapter 12 175Acknowledgements 175References 17613 Management Issues in Advanced Practice 177Paula McGee and Mark RadfordIntroduction 177Managing the self 178Management issues and their implications for advanced practitioners 180Current health service priorities 181Modernising health professionals’ careers 183Patient and public involvement in health care 184The strategic and business plans 185Managing advanced practice roles 186The advanced practitioner as manager 188Conclusion 189Key questions for Chapter 13 189References 18914 The Preparation of Advanced Practitioners 192Paula McGeeIntroduction 192The concept of competence 193Competencies for advanced practice 195The educational preparation of advanced practitioners 201Clinical doctorates 204Conclusion 206Key questions for Chapter 14 207References 20815 The Careers of Advanced Practitioners 210Chris Inman and Paula McGeeIntroduction 210Context of the survey 211Findings 212Employment issues 212Perceptions of the role and its effects on practice 214Evaluation of the advanced practice role 217Perceived helpfulness of the preparation for the advanced practice role 217Career development 219Consultant practitioners 220Discussion 221Conclusion 225Key questions for Chapter 15 225References 22516 An International Perspective of Advanced Nursing Practice 227Madrean SchoberIntroduction 227Factors contributing to the emergence of advanced nursing practice globally 228Extent of international presence 229An international presence marked by confusion 230Advanced nursing practice defined: an international view 231Characteristics 231Country illustrations of development 234The role of international organisations 235Scope of practice, regulation and standards 236Practice settings 237Interaction with health professionals 238Future directions in advanced nursing practice 239Conclusion 240Key questions for Chapter 16 240Acknowledgements 241References 24117 The Future for Advanced Practice 243Paula McGeeIntroduction 243An agenda for research 244Direct practice 244Collaboration with service users 245Diversity and inclusiveness 247Professional regulation and control 248Education and assessment 250Recording developments 250Conclusion 251References 253Index 255

"This is an excellent book for students from the United Kingdom who are pursuing advanced degrees, as well as for students and educators from other countries who are interested in advanced practice nursing in the United Kingdom." (The Journal of Continuing Education in Nursing)

Paula McGee is Professor of Nursing in the Faculty of Health at Birmingham City University, where she researches and teaches about advanced practice.

• Contributors xiIntroduction xiii1 The Development of Advanced Nursing Practice in the United Kingdom 1Paula McGeeIntroduction 1Health policies and reforms 2The UKCC and higher-level practice 4The interface with medicine 4The introduction of new roles 8Modern matrons 8Nurse consultants 8Physicians’ assistants 9Nurse practitioners and the Royal College of Nursing 9The Nursing and Midwifery Council 11Conclusion 12Key questions for Chapter 1 12References 122 UK Health Policy and Health Service Reform 15Alistair HewisonIntroduction 15The policy process 16Labour health policy since 1997 17UK health policy and its implications for advanced nursing practice 19Advanced nursing practice 20Advanced nurses as policy implementers 23Conclusion 24Key questions for Chapter 2 25References 253 Advanced Practice in Allied Health Professions 29Paula McGee and David ColeIntroduction 29The introduction of the consultant allied health professional 30Physiotherapy 33Radiography and sonography 35Sonography: an example of advanced radiography role 37Are these new roles in physiotherapy and radiography/sonography advanced? 39Conclusion 41Key questions for Chapter 3 41References 414 The Conceptualisation of Advanced Practice 43Paula McGeeIntroduction 43The context of the development of advanced practice 43The nature of advanced practice 45Professional maturity 46Challenging professional boundaries 46Pioneering innovations 49Is advanced practice a generic term? 53Conclusion 53Key questions for Chapter 4 54References 545 Advanced Assessment and Differential Diagnosis 56Paula McGeeIntroduction 56The nature of advanced assessment 57Types of advanced assessment 58Conducting an advanced assessment 63Limitations of advanced assessment 64Formulating a differential diagnosis 64Conclusion 68Key questions for Chapter 5 68References 686 Prescribing and Advanced Practice 70Sue Shortland and Katharine HardwareIntroduction 70Recent developments in non-medical prescribing 71Preparation for prescribing 72Who may prescribe what? 73Nurses 73Allied health professionals 73Controlled medicines 74Patient group directions 74Emergency situations 74The principles of safe prescribing 75Safety and clinical governance 76The future of non-medical prescribing 77Conclusion 78Key questions for Chapter 6 78References 787 Advanced Practice in Dietetics 81Linda HindleIntroduction 81Reasons for the development of consultant roles in dietetics 82The consultant role 82Working as a consultant in obesity management 83Role development 83Clinical practice 83Professional leadership 84Education, training and professional development 87Service development, research and evaluation 88Setting up a consultant post 89Examples of dietetic consultant roles 90Conclusion – the future for consultant dietitians 93Key questions for Chapter 7 94Acknowledgements 94References 958 Advanced Practice in Occupational Therapy 97Lynne Frith and Janette WalshIntroduction 97Advanced practice in occupational therapy 98Specialist roles in occupational therapy 98Clinical caseload and expertise 99Clinical leadership 99Clinical teaching and mentoring 99Specialist advisory role 99Consultant roles in occupational therapy 100Expert clinical practice 100Practice and service development 100Professional leadership and consultancy 100Research audit and evaluation 101Education, training and development 101The clinical specialist and consultant occupational therapist as advanced roles 101Current issues for consultant occupational therapists 103The future for occupational therapists 104Conclusion 105Key questions for Chapter 8 105References 1059 Working as an Advanced Nurse Practitioner 107Mark RadfordIntroduction 107Defining a need 108Organisational preparation 110Job planning 111Maintaining focus and delivery 112Developing strategic influence 113Consultancy and entrepreneurship 114Review and evaluation 116Career progression 119Conclusion 121Key questions for Chapter 9 121Acknowledgements 121References 12210 Pioneering New Practice 124Kate GeeIntroduction 124Background to the quadrant model 124The quadrant model 127Quadrant 1: pioneering innovations in technical acute cure cultures 128Quadrant 2: pioneering innovations in high-technology/care cultures 130Quadrant 3: pioneering innovation in low-technology/cure cultures – strategies for patient education and rehabilitation 131Development of ICD nursing expertise 132Development of heart failure nursing expertise 132Quadrant 4: pioneering innovations in low-technology/care quadrant 134Conclusion 136Key questions for Chapter 10 137References 13711 Cultural Competence in Advanced Practice 141Paula McGeeIntroduction 141Culture and equality 142Cultural relationships among health, illness, treatment and care 145Theoretical approaches to culturally competent practice 146Papadopoulos, Tilki and Taylor’s theory of cultural competence 147Purnell and Paulanka’s theory of cultural competence 149McGee’s theory of cultural competence 150Relevance of theory to advanced practice 153Conclusion 155Key questions for Chapter 11 155References 15512 Leadership in Advanced Practice: Challenging Professional Boundaries 158Sally ShawIntroduction 158Leadership in advanced practice 159Theories and characteristics of leadership 160What leadership is not 160Leadership can be learned 161What is leadership? 161Theories of leadership 161Key elements of leadership 162Other important leadership characteristics 165The setting for leadership 166The followers 168Leadership styles and their relevance for advanced practice 169Sustaining and nurturing leaders 172Indicators of effective leadership 174Conclusion 175Key questions for Chapter 12 175Acknowledgements 175References 17613 Management Issues in Advanced Practice 177Paula McGee and Mark RadfordIntroduction 177Managing the self 178Management issues and their implications for advanced practitioners 180Current health service priorities 181Modernising health professionals’ careers 183Patient and public involvement in health care 184The strategic and business plans 185Managing advanced practice roles 186The advanced practitioner as manager 188Conclusion 189Key questions for Chapter 13 189References 18914 The Preparation of Advanced Practitioners 192Paula McGeeIntroduction 192The concept of competence 193Competencies for advanced practice 195The educational preparation of advanced practitioners 201Clinical doctorates 204Conclusion 206Key questions for Chapter 14 207References 20815 The Careers of Advanced Practitioners 210Chris Inman and Paula McGeeIntroduction 210Context of the survey 211Findings 212Employment issues 212Perceptions of the role and its effects on practice 214Evaluation of the advanced practice role 217Perceived helpfulness of the preparation for the advanced practice role 217Career development 219Consultant practitioners 220Discussion 221Conclusion 225Key questions for Chapter 15 225References 22516 An International Perspective of Advanced Nursing Practice 227Madrean SchoberIntroduction 227Factors contributing to the emergence of advanced nursing practice globally 228Extent of international presence 229An international presence marked by confusion 230Advanced nursing practice defined: an international view 231Characteristics 231Country illustrations of development 234The role of international organisations 235Scope of practice, regulation and standards 236Practice settings 237Interaction with health professionals 238Future directions in advanced nursing practice 239Conclusion 240Key questions for Chapter 16 240Acknowledgements 241References 24117 The Future for Advanced Practice 243Paula McGeeIntroduction 243An agenda for research 244Direct practice 244Collaboration with service users 245Diversity and inclusiveness 247Professional regulation and control 248Education and assessment 250Recording developments 250Conclusion 251References 253Index 255

"This is an excellent book for students from the United Kingdom who are pursuing advanced degrees, as well as for students and educators from other countries who are interested in advanced practice nursing in the United Kingdom." (The Journal of Continuing Education in Nursing)

Paula McGee is Professor of Nursing in the Faculty of Health at Birmingham City University, where she researches and teaches about advanced practice.

• Contributors xiIntroduction xiii1 The Development of Advanced Nursing Practice in the United Kingdom 1Paula McGeeIntroduction 1Health policies and reforms 2The UKCC and higher-level practice 4The interface with medicine 4The introduction of new roles 8Modern matrons 8Nurse consultants 8Physicians’ assistants 9Nurse practitioners and the Royal College of Nursing 9The Nursing and Midwifery Council 11Conclusion 12Key questions for Chapter 1 12References 122 UK Health Policy and Health Service Reform 15Alistair HewisonIntroduction 15The policy process 16Labour health policy since 1997 17UK health policy and its implications for advanced nursing practice 19Advanced nursing practice 20Advanced nurses as policy implementers 23Conclusion 24Key questions for Chapter 2 25References 253 Advanced Practice in Allied Health Professions 29Paula McGee and David ColeIntroduction 29The introduction of the consultant allied health professional 30Physiotherapy 33Radiography and sonography 35Sonography: an example of advanced radiography role 37Are these new roles in physiotherapy and radiography/sonography advanced? 39Conclusion 41Key questions for Chapter 3 41References 414 The Conceptualisation of Advanced Practice 43Paula McGeeIntroduction 43The context of the development of advanced practice 43The nature of advanced practice 45Professional maturity 46Challenging professional boundaries 46Pioneering innovations 49Is advanced practice a generic term? 53Conclusion 53Key questions for Chapter 4 54References 545 Advanced Assessment and Differential Diagnosis 56Paula McGeeIntroduction 56The nature of advanced assessment 57Types of advanced assessment 58Conducting an advanced assessment 63Limitations of advanced assessment 64Formulating a differential diagnosis 64Conclusion 68Key questions for Chapter 5 68References 686 Prescribing and Advanced Practice 70Sue Shortland and Katharine HardwareIntroduction 70Recent developments in non-medical prescribing 71Preparation for prescribing 72Who may prescribe what? 73Nurses 73Allied health professionals 73Controlled medicines 74Patient group directions 74Emergency situations 74The principles of safe prescribing 75Safety and clinical governance 76The future of non-medical prescribing 77Conclusion 78Key questions for Chapter 6 78References 787 Advanced Practice in Dietetics 81Linda HindleIntroduction 81Reasons for the development of consultant roles in dietetics 82The consultant role 82Working as a consultant in obesity management 83Role development 83Clinical practice 83Professional leadership 84Education, training and professional development 87Service development, research and evaluation 88Setting up a consultant post 89Examples of dietetic consultant roles 90Conclusion – the future for consultant dietitians 93Key questions for Chapter 7 94Acknowledgements 94References 958 Advanced Practice in Occupational Therapy 97Lynne Frith and Janette WalshIntroduction 97Advanced practice in occupational therapy 98Specialist roles in occupational therapy 98Clinical caseload and expertise 99Clinical leadership 99Clinical teaching and mentoring 99Specialist advisory role 99Consultant roles in occupational therapy 100Expert clinical practice 100Practice and service development 100Professional leadership and consultancy 100Research audit and evaluation 101Education, training and development 101The clinical specialist and consultant occupational therapist as advanced roles 101Current issues for consultant occupational therapists 103The future for occupational therapists 104Conclusion 105Key questions for Chapter 8 105References 1059 Working as an Advanced Nurse Practitioner 107Mark RadfordIntroduction 107Defining a need 108Organisational preparation 110Job planning 111Maintaining focus and delivery 112Developing strategic influence 113Consultancy and entrepreneurship 114Review and evaluation 116Career progression 119Conclusion 121Key questions for Chapter 9 121Acknowledgements 121References 12210 Pioneering New Practice 124Kate GeeIntroduction 124Background to the quadrant model 124The quadrant model 127Quadrant 1: pioneering innovations in technical acute cure cultures 128Quadrant 2: pioneering innovations in high-technology/care cultures 130Quadrant 3: pioneering innovation in low-technology/cure cultures – strategies for patient education and rehabilitation 131Development of ICD nursing expertise 132Development of heart failure nursing expertise 132Quadrant 4: pioneering innovations in low-technology/care quadrant 134Conclusion 136Key questions for Chapter 10 137References 13711 Cultural Competence in Advanced Practice 141Paula McGeeIntroduction 141Culture and equality 142Cultural relationships among health, illness, treatment and care 145Theoretical approaches to culturally competent practice 146Papadopoulos, Tilki and Taylor’s theory of cultural competence 147Purnell and Paulanka’s theory of cultural competence 149McGee’s theory of cultural competence 150Relevance of theory to advanced practice 153Conclusion 155Key questions for Chapter 11 155References 15512 Leadership in Advanced Practice: Challenging Professional Boundaries 158Sally ShawIntroduction 158Leadership in advanced practice 159Theories and characteristics of leadership 160What leadership is not 160Leadership can be learned 161What is leadership? 161Theories of leadership 161Key elements of leadership 162Other important leadership characteristics 165The setting for leadership 166The followers 168Leadership styles and their relevance for advanced practice 169Sustaining and nurturing leaders 172Indicators of effective leadership 174Conclusion 175Key questions for Chapter 12 175Acknowledgements 175References 17613 Management Issues in Advanced Practice 177Paula McGee and Mark RadfordIntroduction 177Managing the self 178Management issues and their implications for advanced practitioners 180Current health service priorities 181Modernising health professionals’ careers 183Patient and public involvement in health care 184The strategic and business plans 185Managing advanced practice roles 186The advanced practitioner as manager 188Conclusion 189Key questions for Chapter 13 189References 18914 The Preparation of Advanced Practitioners 192Paula McGeeIntroduction 192The concept of competence 193Competencies for advanced practice 195The educational preparation of advanced practitioners 201Clinical doctorates 204Conclusion 206Key questions for Chapter 14 207References 20815 The Careers of Advanced Practitioners 210Chris Inman and Paula McGeeIntroduction 210Context of the survey 211Findings 212Employment issues 212Perceptions of the role and its effects on practice 214Evaluation of the advanced practice role 217Perceived helpfulness of the preparation for the advanced practice role 217Career development 219Consultant practitioners 220Discussion 221Conclusion 225Key questions for Chapter 15 225References 22516 An International Perspective of Advanced Nursing Practice 227Madrean SchoberIntroduction 227Factors contributing to the emergence of advanced nursing practice globally 228Extent of international presence 229An international presence marked by confusion 230Advanced nursing practice defined: an international view 231Characteristics 231Country illustrations of development 234The role of international organisations 235Scope of practice, regulation and standards 236Practice settings 237Interaction with health professionals 238Future directions in advanced nursing practice 239Conclusion 240Key questions for Chapter 16 240Acknowledgements 241References 24117 The Future for Advanced Practice 243Paula McGeeIntroduction 243An agenda for research 244Direct practice 244Collaboration with service users 245Diversity and inclusiveness 247Professional regulation and control 248Education and assessment 250Recording developments 250Conclusion 251References 253Index 255

"This is an excellent book for students from the United Kingdom who are pursuing advanced degrees, as well as for students and educators from other countries who are interested in advanced practice nursing in the United Kingdom." (The Journal of Continuing Education in Nursing)