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 a:
- 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 it is the how rather than what that is the main factor in determining level of practice. As in addition professional definitions tend to include aspects of development of the profession such as through 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 and development 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.
The BDA Dietetic Career Framework (British Dietetic Association, 2010) describes the capabilities required of dietetic practitioners along the career pathway from support worker to expert or consultant practitioner. The framework is built on the four pillars of practice as described by, for example, NHS Education Scotland (NES) and National Leadership and Innovation Agency for Healthcare (NLIAH).
For advanced practice roles these are:
- Advanced Dietetic Practice.
- Research and evidence based practice.
- Acting as an expert nutrition and dietetic resource and facilitating learning.
The purpose of the Advanced Practice paper is to further describe the advanced practice capabilities and the knowledge, skills and application required to demonstrate these capabilities. Dietetic advanced practitioners will be working across the variety of roles and settings where dietitians practice – clinical, public health, research, education, private practice, acute, community etc. Within any particular role the contribution of each pillar to the role will vary.
All dietetic advanced practice roles will be further supported by the values and principles of advanced practice as articulated by NES and NLIAH:
- Autonomous practice.
- Critical thinking.
- High levels of decision making.
- Values based care.
- Improving practice.