Advanced Practice and Role Extension: are they the same thing?

Writin" rel="nofollow">ing task:In order to assess my critical writin" rel="nofollow">ing skills I was requested to provide a 700 word essay on the followin" rel="nofollow">ing statement: “Advanced Practice and Role Extension: are they the same thin" rel="nofollow">ing?” This work should be my own and I should use references to support argument. Once the essay is submitted I must then attend an in" rel="nofollow">interview which will focus on the followin" rel="nofollow">ing outcomes: 1. Commitment to study at post-graduate level; effective time & task management. 2. Ability to critically evaluate literature, synthesise in" rel="nofollow">information and cite references via the Harvard system. 3. Computin" rel="nofollow">ing, searchin" rel="nofollow">ing databases and the in" rel="nofollow">internet for valid sources of reference. 4. Undertakin" rel="nofollow">ing structured reflection to evaluate and improve own practice. I am a Radiographer so the Advanced practice v/s role extension theme must be relevant to the field of radiography; and if it is more in" rel="nofollow">inclin" rel="nofollow">ined to MRI and CT scannin" rel="nofollow">ing that would be a plus. Below in" rel="nofollow">in blue is the writin" rel="nofollow">ing I have done thus far based on in" rel="nofollow">information taken from 2 attached articles: Maryann Hardy Advance Extend and an in" rel="nofollow">internet article called Advance-Extend that I could not download but copied. The purple text that follows is in" rel="nofollow">information I have read and thought may be of some value and may be considered for in" rel="nofollow">input in" rel="nofollow">into the essay. As is evident the work is far from complete and I don’t have the presence of min" rel="nofollow">ind to fin" rel="nofollow">inish it after performin" rel="nofollow">ing 12 hours of high impact work as I did today and am scheduled to undertake the next 2 days. I don’t even have and outlin" rel="nofollow">ine but whatever you can produce so long as it’s origin" rel="nofollow">inal and well referenced I will edit so that it speaks like I do… Once the essay is submitted I will need coachin" rel="nofollow">ing and a short script so I can discuss the in" rel="nofollow">intelligibly discuss the Harvard System above. If you manage the essay task that will take pressure off so I can also research the Harvard and prepare myself in" rel="nofollow">in addition to whatever preppin" rel="nofollow">ing you can render The terms ‘extended’ and ‘advanced’ practice are used to describe clin" rel="nofollow">inical practitioner roles. These terms are in" rel="nofollow">integral to the 4 tier structure, implementin" rel="nofollow">ing Agenda for Change in" rel="nofollow">intended to denote clin" rel="nofollow">inical radiography structure and establish criteria to award promotion and pay advances. Yet the lin" rel="nofollow">ines demarkin" rel="nofollow">ing ‘extended’ and ‘advanced’ practice are blurred so that there is no clear distin" rel="nofollow">inction between these terms. One approach to add clarity and delin" rel="nofollow">ineate these termin" rel="nofollow">inologies in" rel="nofollow">in relationship to radiography is to first examin" rel="nofollow">ine their literal defin" rel="nofollow">initions to which evidence from debates of other health professions can be applied to deduce appropriate applications that coin" rel="nofollow">incide with and support the in" rel="nofollow">intended and accepted use in" rel="nofollow">in structure of these terms in" rel="nofollow">in the radiologic profession. ª 2005 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. Evolution in" rel="nofollow">in health care is driven by new and advancin" rel="nofollow">ing technologies and more critically by health care professionals’ willin" rel="nofollow">ingness to embrace and adapt to its forward progression. For the radiographer and radiographic professional this evolution was historically driven by the in" rel="nofollow">introduction of new modalities, techniques, applications and relative hardware. And the radiographer who was adept in" rel="nofollow">in the use of these new in" rel="nofollow">introductions gain" rel="nofollow">ined status. But with computer technologies advancin" rel="nofollow">ing exponentially and creatin" rel="nofollow">ing a chain" rel="nofollow">in effect wherein" rel="nofollow">in all technologies to in" rel="nofollow">include medical imagin" rel="nofollow">ing are advancin" rel="nofollow">ing or has potential to advance rapidly beyond prior expectations or set guidelin" rel="nofollow">ines for advancement the professional who is proactive and skilful in" rel="nofollow">in the use of these new technologies and also takes in" rel="nofollow">initiative to apply them in" rel="nofollow">in ways that improves service delivery locally and in" rel="nofollow">in a manner that can be emulated on a national scale should also be awarded status. Attitudes towards specialist radiographer status have, over the last decade resultantly evolved to reflect this min" rel="nofollow">ind-set, with professional recognition and promotion bein" rel="nofollow">ing in" rel="nofollow">increasin" rel="nofollow">ingly awarded for an in" rel="nofollow">individual’s contribution to healthcare delivery rather than for the imagin" rel="nofollow">ing system they operate. * Correspondin" rel="nofollow">ing author. Tel.: þ44 1274 236578. E-mail address: [email protected] (M. Hardy). 1078-8174/$ - see front matter ª 2005 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2005.09.004 Radiography (2006) 12, 327e331 The 4 tier structure Student Radiographer /Asst Rad. Practitioner £14000- £18000 Radiographer Practitioner £19000- £26000 Advanced Practitioner £27000- £35000 Asst Rad. Practitioner Consultant £36000- £60000 Role extension • Not a new term – 30 years+ in" rel="nofollow">in nursin" rel="nofollow">ing • To extend “to stretch or contin" rel="nofollow">inue to add to somethin" rel="nofollow">ing in" rel="nofollow">in order to make it bigger” • Implication for radiography Supplementary skills and responsibilities beyond the statutory responsibilities and competencies required for professional registration • Conventional in" rel="nofollow">interpretation Role extension / development in" rel="nofollow">into an area previously regarded as the domain" rel="nofollow">in of another healthcare profession • A Defin" rel="nofollow">inition “Post-qualification acquisition of skills, responsibilities and resultant associated additional professional accountability” Role extension is a natural development for a career radiographer and an expectation of employment in" rel="nofollow">in a modern health service. Examples of Role extension • Competency in" rel="nofollow">in technique modifications • Competency in" rel="nofollow">in digital image processin" rel="nofollow">ing • Competency in" rel="nofollow">in undertakin" rel="nofollow">ing CT exams as part of on-call system • Competency in" rel="nofollow">in student supervision • Competency in" rel="nofollow">in team communications • Competency in" rel="nofollow">in CT, MRI, angiography, mammography, RNI, US • Competency in" rel="nofollow">in IV cannulation • Competency in" rel="nofollow">in Ba Enemas • Competency in" rel="nofollow">in MSK radiograph in" rel="nofollow">interpretation (RD, commentin" rel="nofollow">ing, reportin" rel="nofollow">ing) The radiographer who has gain" rel="nofollow">ined proficiency in" rel="nofollow">in these areas has also extended their role as opposed to that of the new graduate. Nonetheless, competencies in" rel="nofollow">in the afore mentioned does not necessarily equate an advanced practitioner status as the role of the advance practitioner necessitates … Role Advancement To advance To ‘improve’ or to ‘further’ somethin" rel="nofollow">ing Advanced practice •DOES NOT imply that the breadth of skills or knowledge is beyond that of role extension •DOES imply the development of a role through the application of knowledge to benefit, modernise & improve clin" rel="nofollow">inical practice. •Role extension does not automatically lead to promotion or advanced practitioner status......but why not? Advanced Practitioner • Autonomous • Defin" rel="nofollow">inin" rel="nofollow">ing the scope of practice of others • Contin" rel="nofollow">inuously developin" rel="nofollow">ing clin" rel="nofollow">inical practice within" rel="nofollow">in a defin" rel="nofollow">ined field DoH, Radiography Skills Mix, 2003 • Reflective • Accountable with developed judgment, decision-makin" rel="nofollow">ing, teachin" rel="nofollow">ing and leadership skills CoR, A strategy for education & professional development for radiographers, 2002 Advanced Practice Accountability, responsibility and autonomy for broader aspects of service management and patient care* underpin" rel="nofollow">inned by a high level of knowledge and skill developed through role extension within" rel="nofollow">in a chosen practice specialty. * Daly & Carnwell, Journal of Clin" rel="nofollow">inical Nursin" rel="nofollow">ing, 2003 “….advanced practice is much more strongly related to a high level of clin" rel="nofollow">inical decision makin" rel="nofollow">ing for a discrete caseload of patients than to carryin" rel="nofollow">ing out highly technical procedures” Read, New nursin" rel="nofollow">ing roles, conference proceedin" rel="nofollow">ings, 2003 Role Extension Task orientated development often driven by the needs of the organisation to provide a coherent service Advanced Practice Reliant on the successful synthesis of in" rel="nofollow">individual and professional qualities to in" rel="nofollow">inspire and motivate improvements in" rel="nofollow">in service delivery Components of Advanced Practice: Teachin" rel="nofollow">ing Leadership & train" rel="nofollow">inin" rel="nofollow">ing Service management & plannin" rel="nofollow">ing Recognition & expertise Decision-makin" rel="nofollow">ing Knowledge Service & practice development Research HEYH Advanced Practice Framework A considerable amount of work to defin" rel="nofollow">ine advanced practice has been undertaken by a number of different organisations, in" rel="nofollow">includin" rel="nofollow">ing the International Council of Nurses (ICN), Skills for Health, the Royal College of Nursin" rel="nofollow">ing (RCN), the Association of Advanced Nursin" rel="nofollow">ing Practice Educators (AANPE) and the Nursin" rel="nofollow">ing and Midwifery Council (NMC). The regional Advancin" rel="nofollow">ing Clin" rel="nofollow">inical Practice Task and Fin" rel="nofollow">inish Group agreed on a multi-professional defin" rel="nofollow">inition for regional use: “An Advanced Clin" rel="nofollow">inical Practitioner is a professional who has acquired the expert knowledge base, complex decision-makin" rel="nofollow">ing skills and clin" rel="nofollow">inical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in" rel="nofollow">in which s/he is credentialed to practice. A master’s degree is essential for entry level.” ACP Title The use of the title Advanced Clin" rel="nofollow">inical Practitioner (ACP) recognises the range of professional backgrounds from which ACPs may origin" rel="nofollow">inate, and that often they are workin" rel="nofollow">ing in" rel="nofollow">in a hybrid role utilisin" rel="nofollow">ing skills and completin" rel="nofollow">ing activities more commonly thought of as the domain" rel="nofollow">in of other staff groups. Furthermore this defin" rel="nofollow">inition recognises the contextual nature of the skills which might be exhibited by an Advanced Clin" rel="nofollow">inical Practitioner, although the level of practice would be consistent with regard to the generic competencies further detailed in" rel="nofollow">in section six. Consistency In order to main" rel="nofollow">intain" rel="nofollow">in credibility for roles and ensure professional in" rel="nofollow">integrity, appropriate titles must be utilised consistently. Service users must be able to identify Advanced Clin" rel="nofollow">inical Practitioners and expectations of the role should be standardised. All those in" rel="nofollow">in ACP train" rel="nofollow">inin" rel="nofollow">ing posts must have train" rel="nofollow">inee within" rel="nofollow">in their role title until completion of an advanced practice master’s degree. It is important to also note that educational achievement does not, in" rel="nofollow">in itself, guarantee ACP status. Several toolkits and frameworks defin" rel="nofollow">ine advanced practice as a level of practice, rather than a particular role. Our view is that the current economic and health climate means that this concept is unfeasible and that advanced practice roles should be characterised prin" rel="nofollow">incipally by high-level clin" rel="nofollow">inical competence.