Career advice

Becoming an advanced clinical practitioner: what you need to know

From the four pillars to credentialing, here’s what it takes to achieve an advanced level of practice

From the four pillars to credentialing, portfolios and work-based practice, we outline what it takes to achieve an advanced level of practice

Picture: Tim George

What is an advanced clinical practitioner?

Health Education England (HEE) defines advanced practice as a level of practice characterised by a high degree of autonomy and complex decision-making.

Advanced practitioners are healthcare professionals who have developed the skills and knowledge to work in expanded roles with an increased scope of practice. They come from a range of clinical backgrounds, including nursing, pharmacy and the allied health professions, and make autonomous decisions in the assessment, diagnosis and treatment of patients.

What band are advanced practitioners on?

Trainee advanced practitioners are usually bands 6–7, depending on experience, with qualified advanced practitioners starting at band 8a.

Do I need a master’s degree to become an advanced practitioner?

Under the RCN credentialing programme, advanced practitioners must be educated to master’s level with an MSc in advanced practice or another MSc with a clinical focus that can demonstrate and be mapped to the four pillars of advanced practice.

The RCN has a transitional model in place until December 2021, where practitioners can credential as an advanced nurse practitioner without a full MSc. Master’s level experience must be demonstrated, including a health assessment module at level 6 or 7 and a prescribing qualification. Practitioners must be currently working at advanced level in accordance with the four pillars.

What are the four pillars of advanced practice?

The four pillars are the capabilities that underpin advanced practice and must be demonstrated regardless of profession. They are:

  • Clinical practice.
  • Leadership and management.
  • Research.
  • Education.

Whether you are an advanced practice nurse, paramedic, physiotherapist, speech and language therapist or dietitian, you will need to provide evidence of the four pillars. This enables a level of standardisation irrespective of the diversity in roles.

What is credentialing?

Credentialing is the process that assesses whether nurses are capable of practising at an advanced level. Qualifications, experience, capability and competence are assessed in line with the four pillars of advanced practice, enabling nurses to gain formal recognition of their level of expertise and skill.

RCN credentialing is open to all nurses – members and non-members – who can demonstrate they are working at an advanced level either in the NHS or independent sector.

A relevant master's qualification is required along with a non-medical prescribing qualification and active membership of the Nursing and Midwifery Council.

Advanced clinical practitioners working in emergency departments can also credential as an advanced practitioner with the Royal College of Emergency Medicine.

What is an advanced practice portfolio and why do I need one?

All nurses working towards, or at, an advanced practice level, will need a portfolio of evidence.

This supports the practitioner’s development in their area of practice, demonstrating learning, competence and capability within the four pillars of advanced practice.

This can be evidenced through work-based assessments applicable to the area of practice, demonstrating your learning in one or more of the four pillars.

You must be able to demonstrate all four pillars in your portfolio. Other information to store in your portfolio includes your CV, academic certificates, course certificates, a job plan linked to the four pillars, and published articles.

What are work-based assessments?

Work-based assessments should be applicable to your area of practice and used to evidence one or more of the four pillars of advanced practice. Work-based assessments should be undertaken by experienced and competent assessors, who understand the benchmark level of capability required for advanced practice.

Types of work-based assessments include:

  • Case based discussion – a retrospective interview and evaluation of your input and professional judgement into a patient’s care or clinical case.
  • Direct observation of procedural skills – evaluation of your ability to perform a practical procedure, such as a chest drain insertion.
  • 360-degree feedback – performance evaluation tool that allows anonymised feedback from a range of colleagues.
  • Mini-clinical examination exercise – allows a supervisor or mentor to directly observe you in practice to assess competence in skills essential for good clinical care, such as history-taking, examination and clinical reasoning.
  • Critical reflective account – allows you to critically reflect on an episode of patient care or an incident to evaluate and challenge practice, which will enable further learning and development.

Source: Royal College of Emergency Medicine

I am interested in becoming an advanced practitioner. What should I do?

Speaking to those already working at an advanced practice level is a great start. This will give you a good understanding of the advanced practice role and responsibilities.

You could also request to shadow an advanced nurse practitioner for the day to see what the role involves.

You should explore continuing professional development opportunities and look into master’s-level education to understand how much study will be required.

Significant clinical experience in your specialty is required to practice at advanced level, and it is also worth looking at your transferable skills – what do you already have and what do you need to work on?

HEE’s Centre for Advancing Practice is developing multi-professional frameworks for advanced clinical practice in England, covering a wide range of clinical specialties including acute medicine, older people, surgery, mental health, and learning disabilities and autism.

The frameworks establish the standards required to work as an advanced practitioner within a given specialty and can be used by practitioners to demonstrate learning, development, competence and capability through a structured portfolio.