Currently in health and social care the titles, 'expert', 'specialist' and 'advanced', are used interchangeably, resulting in a lack of consistency and potential confusion. Many organisations, professions and academics have sought to define 'advanced practice'. While all approach from different angles, there are similarities in the concepts and skills such as:
- Breadth and depth of practice
- Leadership, innovation and creativity
- Service improvement/service development
- Education and development of others
- Improve outcomes for service users
It is clear that the 'how', rather than the 'what', is the main factor in determining level of practice. In addition, professional definitions tend to include aspects of development such as advocacy for the profession, dissemination of good practice (publishing and presenting), influencing at a national and international level, active engagement with professional body and mentoring of other dietitians.
Rolfe et al, after Schon (Rolfe, 2001), describes advanced practitioners as 'working in the swampy marshland where the messy, confusing problems' are. This ‘marshland’ has no guide book and the advanced practitioner has to integrate knowledge and skills and reflect on their experience and practice to develop and apply the solutions.
There is, therefore, general agreement that while advanced practice tends to need some years of experience to develop, years of experience do not automatically result in advanced practice; and advanced practice is more than being an excellent practitioner.
Advancing dietetic practice comes in three forms. It is important we put this into context, as depending on the route you are taking the development opportunities will present themselves differently. When advancing clinical practice, it is essential to consider how to formalise this to ensure recognition and access career opportunities appropriately.
Advancing Practice in Dietetics
When we talk about advancing practice in dietetics, we are referring to specialising. This is when you have accessed post graduate training in a specific area of dietetic practice and take clinical leadership of that area. If we link this into our Post-graduate Professional Development Framework this would relate to moving up through the levels here, at your own pace. You may move up one pillar more quickly than others and this is normal. There is no specific training requirement, it depends on your area of specialism, and the continuous professional development you feel is beneficial to advance your practice within that area.
Advanced Clinical Practice
Advanced Clinical Practice (ACP) relates to more than dietetics. This is when your broaden your clinical scope to take on elements of practice that would usually belong to other professions. Advanced clinical Practice will still follow an area of specialism though you will be encompassing more than dietetic practice into your treatment planning and intervention. Examples could include
- A basic psychology screening in a weight management clinic using PHQ9 or GADs7 questionnaires
- A basic physiotherapy to stand assessment as part of a nutrition support clinic
- A basic speech and language assessment on a ward round if a service user reports a swallowing difficulty
Taking on an ACP role requires formal training to ensure the correct governance for safe clinical practice is in place. This will teach you about scope; what is within your remit as an ACP and when to refer on to the relevant healthcare professional i.e. psychologist, physiotherapist, speech and language therapist.
The route of training will differ dependent on whether you are already practicing in this way or would like to develop your practice in this way. You must be practicing at level 7 across all 4 pillars of practice within our Post-graduate Professional Development Framework. An ACP role requires you meet capabilities outlined in the Multi-professional Framework for ACP.
To find out more, visit NHS Health Education England (HEE).