Advanced or Advancing Nursing Practice
: The Future Direction for Nursing?

  • Alastair Gray

Student thesis: Doctoral ThesisDoctor of Philosophy


The aim of this study:To examine the features, scope and activity of Advanced Nursing Practice, and explain its relevance and thesignificance of nursing within this role, as experienced by two groups of nurses recognised as Advanced Nurse Practitioners, and the consultant nurses and consultant medical staff who work with them, in a local university hospital NHS trustBackground:The emergence of Advanced Nursing Practice as a distinct role within the NHS began in the mid 1980’s. A variety of factors led to this including: workforce pressures, especially shortages of medical staff; the need for a different response to growing numbers of patients with complex and chronic health needs; and the desire by nursing to achieve its potential as a distinct profession by re-engaging its focus on the delivery of comprehensive patient-centred care. This development however has been hindered by widespread lack of clarity about its character and exact purpose. Some believe its purpose as to fulfil a medical substitution role; others as a flexible role responding to current ‘gaps’ in service provision, be that medical, nursing or both; others still as an Advanced Nursing role focused on patient-centric care and management, but also integrating leadership, education, and research to improve and develop practice and services. MethodsConstructivist grounded theory methodology shaped the conduct of this study. Participants were recruited using purposive sampling with further participants recruited using theoretical sampling. Two case studies were established, and participants were allocated to one of them according to their roles at that time. Case Study 1 represented acute services, and Case Study 2 represented non-acute services. Consultant nurses and consultant medical staff were also recruited, who worked directly with Advanced Nurse Practitioners in one or other of the case studies. 31 participants took part and 19 interviews took place in three phases over a period of 24 months. Data were obtained initially from small group semi-structured interviews, followed by a further round of individual interviews. Literature retrieved from both the contextual review, and during the data collection phase, fed into the constant comparative analysis activity and was present in the findings. FindingsFour concepts were generated; Characteristics, Advanced Nursing, Enablers and Restrictors, and from them the Core Concept: ‘Advanced Nursing Practice is a Personal and Professional Journey not an End Point’. Conclusion The Core Concept was fundamental in the construction of the Grounded Theory explaining that the continuing journey of Advanced Nursing Practice has a momentum inherent within it, and when consistently activated it enables Advanced to become Advancing Nursing Practice: ‘The Advanced Nursing Practice Journey transitions from Advanced to Advancing Nursing Practice when enabled by an Advancing Practice Momentum’. Therefore, the answer to the thesis title question, ‘Advanced or Advancing Nursing Practice: The Future Direction for Nursing?’ is clear: Advancing Nursing Practice is the way forward for Nursing.
Date of Award2023
Original languageEnglish
Awarding Institution
  • Coventry University
SupervisorRosie Kneafsey (Supervisor), Simon Igo (Supervisor), Jane Coad (Supervisor), M. Radford (Supervisor) & Liz Deutsch (Supervisor)

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