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Advanced level nursing

Definition of advanced level nursing

Advanced level nursing describes a level which can only be delivered by registered nurses with substantial experience and expertise.

This level can be applied to the full range of registered nurse careers. The advanced level is differentiated from other levels by a registered nurses’ expertise in applying highly developed theoretical and practical knowledge to complex, unfamiliar and unpredictable situations. For example, this could be through the use of critical thinking, high-level decision making and exercising professional judgement.  

RCN Levels of Nursing

This level is underpinned by a comprehensive range of knowledge, skills and capabilities within each of the four pillars of nursing: clinical practice, education, research and leadership. These will have been developed through studying a master’s degree in a relevant subject area with experiential learning or by demonstrating equivalence. Integration of the capabilities across the four pillars, together with critical reflection, enables a nurse working at the advanced level to function to their full potential and feel empowered to make decisions in the workplace.

Background to advanced level nursing

The concept of nurses working at a level significantly higher than that expected from the registered nurse was first recognised in the UK in the 1980s, inspired by examples of nursing innovation and impact in the USA.  

Here at the RCN, we have been a key driver in the recognition of an advanced level of nursing practice, with a definition and an education programme for nurse practitioners that launched in 1990. Subsequently, the governments of all four countries of the UK have published policies and frameworks on this topic. 

The International Council of Nurses (ICN) has revisited its position statement (first published in 2008) to produce broader guidelines on advanced practice, ICN (2020) Guidelines on Advanced Practice Nursing. It describes it as “a field of nursing that extends and expands the boundaries of nursing’s scope of practice, contributes to nursing knowledge and promotes advancement of the profession”.  

In 2021, the European Federation of Nurses Associations (EFN) established a group which uses the ICN’s guidelines as part of a global drive for a consistent approach to this level of nursing practice.  

All publications to date have focused on nurses who are employed in clinical roles, with reference to titles such as advanced nurse practitioner, as highlighted in the ‘Independent report on the regulation of advanced practice in nursing and midwifery’ (Nuffield Trust, 2023).

RCN position on advanced level nursing

We strongly support the ongoing development of nurses working at the advanced level of practice across all areas related to health and social care.  

We are broadly supportive of the ICN and EFN stance in describing this level as requiring additional post graduate education (minimum of a master’s degree), an expert knowledge base and complex decision-making skills and competencies; the characteristics of which are shaped by the context in which they practice. 

We have built on the work to date and recognise that the concept of advanced level nursing practice can and should be applied across all 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.

Developing the definition and standards for advanced level nursing

To support this level of practice, we have revised our previous publications and published a report which sets out a new definition and core standards that differentiate all registered nurses who work at the advanced level.

The development of the definition, standards and capabilities of advanced level nursing practice involved appraisal and synthesis of key content from previous RCN publications and relevant publications from across the UK. The College of Radiographers  Education and Career Framework for the Radiography Workforce - 4th edition (2022) was used as a wider professional reference point.

The Levels of Practice Working Group developed further content to ensure that the definition and standards applied to all contexts in which registered nurses work. To optimise public protection, additional capabilities have been specified for nurses working at an advanced level who primarily provide direct-patient care.

The report includes the capabilities that registered nurses working at the advanced level of practice will demonstrate, aligned to the four pillars of nursing practice. It contains further discussion and definition of terms. Access and download the Advanced Level Nursing Definition Standards.    

Useful resources 

Below you can find a list of related publications:

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