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

Writing task:In order to assess my critical writing skills I was requested to provide a 700 word essay on the following statement: “Advanced Practice and Role Extension: are they the same thing?” This work should be my own and I should use references to support argument.

Once the essay is submitted I must then attend an interview which will focus on the following outcomes:

1. Commitment to study at post-graduate level; effective time & task management.
2. Ability to critically evaluate literature, synthesise information and cite references via the Harvard system.
3. Computing, searching databases and the internet for valid sources of reference.
4. Undertaking 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 inclined to MRI and CT scanning that would be a plus.

Below in blue is the writing I have done thus far based on information taken from 2 attached articles: Maryann Hardy Advance Extend and an internet article called Advance-Extend that I could not download but copied. The purple text that follows is information I have read and thought may be of some value and may be considered for input into the essay. As is evident the work is far from complete and I don’t have the presence of mind to finish it after performing 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 outline but whatever you can produce so long as it’s original and well referenced I will edit so that it speaks like I do…

Once the essay is submitted I will need coaching and a short script so I can discuss the 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 addition to whatever prepping you can render

The terms ‘extended’ and ‘advanced’ practice are used to describe clinical practitioner roles. These terms are integral to the 4 tier structure, implementing Agenda for Change intended to denote clinical radiography structure and establish criteria to award promotion and pay advances. Yet the lines demarking ‘extended’ and ‘advanced’ practice are blurred so that there is no clear distinction between these terms. One approach to add clarity and delineate these terminologies in relationship to radiography is to first examine their literal definitions to which evidence from debates of other health professions can be applied to deduce appropriate applications that coincide with and support the intended and accepted use in structure of these terms in the radiologic profession.

ª 2005 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Evolution in health care is driven by new and advancing technologies and more critically by health care professionals’ willingness to embrace and adapt to its forward progression. For the radiographer and radiographic professional this evolution was historically driven by the introduction of new modalities, techniques, applications and relative hardware. And the radiographer who was adept in the use of these new introductions gained status. But with computer technologies advancing exponentially and creating a chain effect wherein all technologies to include medical imaging are advancing or has potential to advance rapidly beyond prior expectations or set guidelines for advancement the professional who is proactive and skilful in the use of these new technologies and also takes initiative to apply them in ways that improves service delivery locally and 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 mind-set, with professional recognition and promotion being increasingly awarded for an individual’s contribution to healthcare delivery rather than for the imaging system they operate.

* Corresponding 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.
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 nursing
• To extend “to stretch or continue to add to something in order to make it bigger”
• Implication for radiography
Supplementary skills and responsibilities beyond the statutory responsibilities and competencies required for professional registration
• Conventional interpretation Role extension / development into an area previously regarded as the domain of another healthcare profession

• A Definition
“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 a modern health service.

Examples of Role extension
• Competency in technique modifications
• Competency in digital image processing
• Competency in undertaking CT exams as part of on-call system
• Competency in student supervision
• Competency in team communications
• Competency in CT, MRI, angiography, mammography, RNI, US
• Competency in IV cannulation
• Competency in Ba Enemas
• Competency in MSK radiograph interpretation (RD, commenting, reporting)
The radiographer who has gained proficiency in these areas has also extended their role as opposed to that of the new graduate. Nonetheless, competencies 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’ something
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 clinical practice.
•Role extension does not automatically lead to promotion or advanced practitioner status……but why not?

Advanced Practitioner
• Autonomous
• Defining the scope of practice of others
• Continuously developing clinical practice within a defined field
DoH, Radiography Skills Mix, 2003
• Reflective
• Accountable with developed judgment, decision-making, teaching 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* underpinned by a high level of knowledge and skill developed through role extension within a chosen practice specialty.
* Daly & Carnwell, Journal of Clinical Nursing, 2003

“….advanced practice is much more strongly related to a high level of clinical decision making for a discrete caseload of patients than to carrying out highly technical procedures”
Read, New nursing roles, conference proceedings, 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 individual and professional qualities to inspire and motivate improvements in service delivery

Components of Advanced Practice:
Leadership & training
Service management & planning
Recognition & expertise
Service & practice development

Advanced Practice Framework
A considerable amount of work to define advanced practice has been undertaken by a number of different organisations, including the International Council of Nurses (ICN), Skills for Health, the Royal College of Nursing (RCN), the Association of Advanced Nursing Practice Educators (AANPE) and the Nursing and Midwifery Council (NMC). The regional Advancing Clinical Practice Task and Finish Group agreed on a multi-professional definition for regional use:

“An Advanced Clinical Practitioner is a professional who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country 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 Clinical Practitioner (ACP) recognises the range of professional backgrounds from which ACPs may originate, and that often they are working in a hybrid role utilising skills and completing activities more commonly thought of as the domain of other staff groups. Furthermore this definition recognises the contextual nature of the skills which might be exhibited by an Advanced Clinical Practitioner, although the level of practice would be consistent with regard to the generic competencies further detailed in section six.
In order to maintain credibility for roles and ensure professional integrity, appropriate titles must be utilised consistently. Service users must be able to identify Advanced Clinical Practitioners and expectations of the role should be standardised.
All those in ACP training posts must have trainee within their role title until completion of an advanced practice master’s degree. It is important to also note that educational achievement does not, in itself, guarantee ACP status.
Several toolkits and frameworks define 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 principally by high-level clinical competence.

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