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The past, present and future of advanced nursing practice

02 April 2022
9 min read
Volume 33 · Issue 4


Kelly Swaby, Julie Reynolds and Gerri Mortimore explore the historical, professional and national developments that have influenced advanced nursing practice in England

This article considers the past, present and future development of advanced nursing practice. It traces the historical, professional and national developments that have impacted on advanced nursing practice in England. Current influence and future opportunities and challenges are explored, providing a comprehensive overview of advanced nursing practice in England.

The foundations of advanced practice in Britain lay in the late 1960s and 1970s (Castledine, 2002). The Salmon Report ushered in a new clinical nursing hierarchical structure (Ministry of Health et al, 1966), and by the early 1970s, the Royal College of Nursing (RCN, 1975) considered the concept of advanced practice in its New Horizons in Clinical Nursing report. From the 1970s, a perfusion of nurse specialist roles emerged as the Department of Health and Social Security (DHSS) recognised the invaluable contribution nurses could make to health promotion, wellbeing and the prevention of illnesses (DHSS, 1977; Daly and Carnwell, 2003). Those roles evolved into the advanced practice positions seen today.

The advanced practice role developed dramatically during the 1990s, as a response to the growing pressure faced by the NHS to meet the health demands of society (Lindeke et el, 2010). The UK was facing a growing and ageing population, a greater acuity level of patients, many with chronic conditions and multiple co-morbidities, all against a backdrop of rising healthcare costs (Thompson and Astin, 2019). Consequently, during the 1990s, the UK healthcare context expanded politically, environmentally and professionally. The emergence of advanced practice nursing and the development and widening of advanced nursing practitioners' scope of practice was primarily driven by these factors (Ashburner et el, 1997; Dunn, 1997; Frost, 1998; Wilson-Barnett et al, 2000; Department of Health (DH), 2000). The rationale for expanding the boundaries of advanced nursing practice was born out of an absence of appropriate professionals to carry out the tasks in the face of immense demand (Daly and Carnwell, 2003).

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