The importance of maintaining skilled identity in multidisciplinary advanced clinical practice

This week’s blog authors are Emma Innes (@emmainnes3), Senior Lecturer in Advanced Clinical Practice, and Matthew Harris (@mattdh86), Senior Lecturer in Pharmacology and Medication Optimization within the School of Nursing and Midwifery, Faculty of Midwifery and CPD on the University of Worcester (@UW_AdvPractice ).

Nurses are still the biggest skilled group starting their adventure with advanced clinical practice (1). However, there are an increasing variety of pharmacists and allied health professionals who’re moving into advanced roles that they previously held in isolation within the nursing occupation.

Multiprofessional Framework for Advanced Clinical Practice in England (2017) sets the usual by which all professionals should give you the option to display skills at a complicated level of practice (2). The framework has been written broadly to enable application across quite a lot of settings, occupations, populations and roles to make sure equity in education, performance and performance in any role at a complicated level. There is potential for misinterpretation of the framework by applying it in a rigid and inflexible way, promoting the erroneous assumption that each one advanced clinical practitioners (ACPs) are generic practitioners (3), versus a various group of healthcare professionals who’re developing their practice to work at a complicated level. level to fulfill the needs of its population.

While there are clear options when it comes to the extent of practice an ACP must meet to work at a complicated level, not all professionals will display their skills in the identical way. Each person’s basic job training and work experience will vary, and the differences will likely be greater across occupational boundaries (4). This has vital implications for ACP education and training from the very starting of their education after registration and ongoing development within the workplace.

Anecdotally, ACP trainees struggle with their skilled identity with the sensation that they do not belong anywhere. They report feeling disconnected from their primary occupation and have little affinity for his or her developing identity as ACP. ACP staff job titles often don’t consult with their original occupation, which not only perpetuates a lack of identity but additionally creates confusion amongst patients who may don’t know in regards to the ACP role (3,5). As Nadaf (2018) eloquently states, “when did advanced practice stop being nursing?” Or some other occupation?

The creation of the title “advanced clinical practitioner” has created ambiguity within the identity of a health care skilled. Social identity theory helps explain why health care professionals have historically worked inside skilled silos, maintaining their identity by promoting skilled tribalism (6,7). The creation and expansion of generic ACP roles further undermines the core identity of those looking for to develop their practice while adding one other “tribe” to the combination, ultimately leading to ACP alienation and the absence of any tangible identity.

Anderson et al. (2020) (8) found that a weak advanced practice skilled identity resulted in the event of an isolated identity amongst advanced practice nurses. This has had a cyclical effect of stopping advanced practice nurses from developing a robust and consistent skilled identity, which can impact acceptance and performance of the role.

Professional identity in ACP roles could also be lost as organizations increasingly seek to fill gaps in health care staff turnover (3). The situation is further exacerbated by the dearth of clinical profession development opportunities and further training for people in positions equivalent to specialist clinical nurse, where advanced clinical practice is seen as a separate role slightly than a continuum of specialist nursing practice (9).

It is very important for interested parties to contemplate the unique intent a multi-disciplinary framework for advanced clinical practice in England (2) in workforce planning. Workplace culture is probably going an incentive to advertise tribalism and the hierarchical and stereotypical behaviors experienced in health care settings (7), which perpetuates the parable that advanced clinical practitioners are there to switch junior physicians slightly than develop their very own level of practice related to their core practice identity.

Teachers through curricula should engage in debate with ACP trainees to support them in critically discussing this issue and the underlying theories and research to develop the boldness vital to challenge the misconceptions that they’ll turn into generic practitioners. Instead, advocate for the event of their skilled identity, maximizing their core skill set for the advantage of improving patient care. To achieve this goal, academics must promote a secure, multidisciplinary learning environment to facilitate discourse through which professionals can learn from, from, and about one another.

1. Lawler J, Maclaine K, Leary A. Staff experience of implementing the advanced clinical practice framework in England: a mixed methods evaluation. Resource Health Hum [Internet]. 2020;18(1):1–11. Available at: https://doi.org/10.1186/s12960-020-00539-y
2. Health Education in England. A multi-disciplinary framework for advanced clinical practice in England [Internet]. Health Education in England. 2017. Available at: https://www.hee.nhs.uk/sites/default/files/documents/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf
3. Nadaf C. Perspectives: Post-debate reflections: When does advanced clinical practice stop to be nursing? J Res Nurs. 2018;23(1):91–7.
4. Evans C, Poku B, Pearce R, Eldridge J, Hendrick P, Knaggs R, et al. Characterizing the outcomes, impacts and challenges of implementing advanced clinical practice roles within the UK: a scoping review. Open BMJ. 2021;11(8):20–6.
5. Thompson W, McNamara M. Constructing a complicated nurse practitioner identity within the health care system: a discourse evaluation. J Adv Nurs. 2022;78(3):834–46.
6. Willetts G, Clarke D. Constructing nurses’ skilled identity through social identity theory. Int J. Nursing practice. 2014;20(2):164–9.
7. Braithwaite J., Clay-Williams R., Vecellio E., Marks D., Hooper T., Westbrook M. et al. Foundations of clinical tribalism, hierarchy, and stereotyping: A laboratory-controlled experiment in teamwork. Open BMJ. 2016;6(7):1–10.
8. Anderson H, Birks Y, Adamson J. Exploring the connection between nursing identity and advanced nursing practice: an ethnographic study. J Clin Nurs. 2020;29(7–8):1195–208.
9. Fealy GM, Casey M, O’Leary DF, McNamara MS, O’Brien D, O’Connor L, et al. Developing and maintaining specialist and advanced practice roles in nursing and midwifery: a discourse on enablers and barriers. J Clin Nurs. 2018;27(19–20):3797–809.

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