Advancing advanced practice - clarifying the conceptual confusion

Nurse Educ Today. 2014 Mar;34(3):356-61. doi: 10.1016/j.nedt.2013.07.012. Epub 2013 Aug 15.


Background: In recent years, there has been a substantial increase in the number of nurses holding advanced practice nursing positions. However, the lack of clarity regarding key terms such as 'advanced practice nursing', 'advanced nursing practice', 'scope of practice' and 'extended practice', and international variability in how these terms are used has created significant confusion. This lack of clarity is problematic for nurses, other health professionals, health service consumers, educators and policy makers, particularly given the global mobility of the nursing workforce.

Objectives: 1) To highlight the significant international variability in how advanced practice nursing, and associated terms such as extended and expanded practice, are defined and regulated across a variety of different English speaking countries, including the US, UK, New Zealand, Canada and Australia. 2) To propose innovative formulations for how the nursing profession may attempt to ensure greater precision and agreement around advanced practice terminology.

Design: Discursive paper.

Results: It was found that there is a considerable lack of clarity regarding the precise definitions of key terms surrounding the discussion of advanced practice. Additionally, there are large disparities in how the five chosen countries regulate advanced practice nursing, and roles such as that of the nurse practitioner.

Conclusions: It is suggested that the confusion regarding advanced practice terminology can be reduced definitionally by minimising the use of the term 'expanded practice'; defining advanced practice nursing to refer to the type of practice in defined and regulated advanced practice nursing scopes; and defining advanced nursing practice as expert practice within a regulated nursing scope.

Keywords: Advanced nursing practice; Advanced practice nursing; Expanded practice; Nurse practitioner; Scope of practice.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advanced Practice Nursing / organization & administration
  • Advanced Practice Nursing / standards*
  • Internationality
  • Nurse Practitioners / legislation & jurisprudence
  • Nurse Practitioners / standards
  • Nurse's Role*
  • Terminology as Topic*