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Deriving Consensus on the Characteristics of Advanced Practice Nursing: Meta-summary of More Than 2 Decades of Research

Hutchinson, Marie; East, Leah; Stasa, Helen; Jackson, Debra

doi: 10.1097/NNR.0000000000000021
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Background: Over recent decades, there has been considerable research and debate about essential features of advanced nursing practice and differences among various categories of advanced practice nurses.

Objectives: This study aimed to derive an integrative description of the defining characteristics of advanced practice nursing through a meta-summary of the existing literature.

Methods: A three-phase approach involved (a) systematic review of the literature to identify the specific activities characterized as advanced practice nursing, (b) qualitative meta-summary of practice characteristics extracted from manuscripts meeting inclusion criteria; and (c) statistical analysis of domains across advanced practice categories and country in which the study was completed. A descriptive framework was distilled using qualitative and quantitative results.

Results: Fifty manuscripts met inclusion criteria and were retained for analysis. Seven domains of advanced nursing practice were identified: (a) autonomous or nurse-led extended clinical practice; (b) improving systems of care; (c) developing the practice of others; (d) developing/delivering educational programs/activities; (e) nursing research/scholarship; (f) leadership external to the organization; and (g) administering programs, budgets, and personnel. Domains were similar across categories of advanced nursing practice; the domain of developing/delivering educational programs/activities was more common in Australia than in the United States or United Kingdom.

Discussion: Similarity at the domain level was sufficient to suggest that advanced practice role categories are less distinct than often argued. There is merit in adopting a more integrated and consistent interpretation of advanced practice nursing.

Marie Hutchinson, RN, RM, PhD, is Senior Lecturer, School of Health and Human Science, Southern Cross University, Australia.

Leah East, BN (Hons), PhD, is Senior Lecturer, School of Nursing and Midwifery, Deakin University, Australia.

Helen Stasa, BA (Hons), BA (Hons), PhD, is Postdoctoral Research Fellow, Sydney Nursing School, The University of Sydney, Australia.

Debra Jackson, PhD, RN, is Professor, Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Australia.

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Accepted for publication November 11, 2013.

The authors have no conflicts of interest to report.

Corresponding author: Marie Hutchinson, RN, RM, PhD, School of Health and Human Science, Southern Cross University, P.O. Box 157, Lismore, NSW, Australia (e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.