Enhanced level nursing
Definition of enhanced level nursing
Enhanced level nursing describes a level that can only be delivered by registered nurses who have gained additional post-registration education and experiential learning in a relevant subject area.
This level can be applied to the full range of registered nurse careers. The enhanced level is differentiated from other levels by a registered nurse’s expertise in applying specific knowledge and skills to a designated area. For example, this could be a client group, skill set or in an organisational context.
RCN Levels of Nursing
Registered nurses working at an enhanced level are expected to be able to manage discrete activities in complex, challenging and changing situations and environments. They should also be confident to seek further guidance when they reach the boundaries of their competence.
This level is underpinned by a broad foundation of skills and capabilities across all four pillars of nursing: clinical practice, education, research and leadership. These, together with critical reflection, enable a nurse working at the enhanced level to function to a high level of autonomy within their designated area and role.
Background to enhanced level nursing
The concept of enhanced level nursing emerged in 2019 from modelling by Professor Alison Leary MBE and RCN Fellow for Health Education England (HEE). This acknowledged how the multiprofessional, experienced, registered health and social care workforce should be recognised and valued (Leary A (HEE funded) (2022) Enhanced Level Practice).
Leary found that the proportion of the registered nursing workforce working at an enhanced level is considerably larger than those working at the advanced or consultant level of practice.
The work of Leary et al has been used by NHS Wales for a Health Education Improvement Wales initiative to define three levels of practice. See NHS Wales (2023) Professional Framework for Enhanced, Advanced and Consultant Clinical Practice, Health Education Improvement Wales (HEIW).
A new apprenticeship standard for (multiprofessional) enhanced practice was published by the Institute for Apprenticeships and Technical Education (2021) Enhanced Clinical Practitioner Apprenticeship standard and is now being offered across England. Other professions defining enhanced level practice include the Society and College of Radiographers, which published the Education and Career Framework for the Radiography Workforce - 4th edition (2022).
RCN position on enhanced level nursing
Although we have not previously published a definition of enhanced level nursing, this term was referred to as a level of practice in the Career Pathway and Education Framework for Cancer Care (RCN, 2022).
Here at the RCN, we support the ongoing development of nurses working at an enhanced level across all areas. This may be a stepping stone to working at an advanced level; however, for some registered nurses, it will be a destination or career choice.
The enhanced level can, and should, be applied across all contexts in which registered nurses work in clinical roles. This includes leaders, managers, educators and researchers, to ensure that all are valued and their impact on the quality of patient care is acknowledged.
The levels of practice working group agreed that that word 'specialist' should not be used to describe this level of practice, as specialist knowledge and skills may be applied across all levels of nursing within health and social care.
Developing the definition and standards for enhanced level nursing
To support this level of nursing, we have published a report which sets out definition and core standards that differentiate registered nurses who work at the enhanced level.
The report includes the capabilities that registered nurses working at the enhanced level of practice will demonstrate, aligned to the four pillars of nursing practice. It also contains further discussion and definition of terms. Access and download the Enhanced Level Nursing Definition Standards.
Useful resources
Below you can find additional related publications:
- NHS Employers (2022) Advanced practice.
- NHS Education for Scotland (2021) Nursing, Midwifery and Allied Health Professions (NMAHP) Development Framework.
- Skills for Health (2020) Career Framework (Version 2) (PDF).
