Abstract
The concept of advanced nursing practice is still evolving even as the nursing profession evolves. Davies and Hughes's article was one of the first to transcend the role understandings of clinical nurse specialists (CNSs) and nurse practitioners (NPs) to describe advanced nursing practice in terms of competencies. Their work was seminal to my own thinking about advanced nursing practice, resulting in the definition proposed in Advanced Nursing Practice: An Integrative Approach (Hamric AB, Spross JA, Hanson CM, eds. Advanced Nursing Practice: An Integrative Approach. Philadelphia: WB Saunders; 1996:42-56). This way of understanding advanced nursing practice as a constellation of competencies embedded in a variety of roles, rather than in terms of particular roles, has become the dominant way we define advanced nursing practice today. Davies and Hughes's insight that "the term advanced nursing practice extends beyond roles" has helped to diffuse the intraprofessional rivalry between CNSs and NPs and the divisiveness it created within the profession, even as it has helped extend the understanding of advanced nursing practice in evolving roles.
I think of published scholarship as an ongoing conversation, a series of one-way dialogues, if you will, that builds on previous conversations and lends new insights to our continued efforts to strengthen the nursing profession. It is one of the key reasons why we need to stay abreast of the literature, so we can be responsible contributors to the conversation. We all build our ideas from the insights of others even as we contribute our own insights to the dialogue. Davies and Hughes built upon my earlier conversations about the CNS role, and I in turn built upon their important insights about advanced nursing practice. Since that time, others have contributed to the development of our understanding, and my definition continues to evolve based on these contributions. And so it goes. Let the conversation continue!
Ann B. Hamric, PhD, RN, FAAN
Although the term advanced nursing practice has been used extensively to describe the practice of the CNS, it is difficult to find a clear definition of the term. The role has been articulated as a constellation of subroles: clinician, educator, researcher, and consultant. However, describing various subroles does not capture the broader picture of the CNS's contribution to health care delivery. This has lead to discussions among faculty of one university regarding the need to clarify advanced nursing practice as the first step in redesigning the educational preparation for the CNS as an advanced nurse practitioner. In this article, an overview of advanced practice is provided, differences in practice levels are discussed, and characteristics and competencies inherent to advanced nursing practice are delineated. How these characteristics and competencies interact to present a picture of advanced nursing practice is illustrated in a case study.