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This definition shows that performance
level is a function of the expertise of
the individual and may be considered
a vertical dimension of practice as
represented on the vertical axis of
Figure 1. The definition of 'advanced
practice' adopted by the APPFSC (1a in
Table 1) confirms the link between
advanced practice and demonstration of
additional acquired expertise or a higher
This functional link is evident in each of
the additional definitions (presented in
Table 1) of 'advanced practice' (1b and
1c) and 'advanced clinical practice'
(1d). In this respect all demonstrate
consistency with the APPFSC-adopted
definition of 'advanced practice' (1a)
and the diagrammatic representation
of performance level in Figure 1 as a
vertical dimension of practice related to
the expertise of the individual.
However, there are significant
differences in the above definitions in
the association that has been made
between the acquired additional
expertise and the practitioner's scope
of practice. In Figure 1 it is clear that
advanced practice may exist for either
a broad or narrow scope of practice.
The definition of 'advanced clinical
practice' (1d) is consistent with Figure 1
in explicitly stating that the additional
expertise can be applied in either
generalist (broad scope) or focussed
(narrow scope) professional practice.
However, the two additional definitions
of 'advanced practice' (1b and 1c)
associate the additional expertise of
an advanced practitioner only with a
specialised/focussed/narrow scope of
practice. This may be accounted for
by the fact that these two definitions
were sourced from documents where
advanced practice was being examined
only in the context of a narrow or
focussed scope of practice.
The APPFSC also found reference to the
term 'advanced scope of practice' (1e).
This definition is comparable to the
others in demonstrating an expectation
of the practitioner acquiring additional
expertise across any part of the usual
scope of practice. For this reason,
inclusion of the words 'scope of' in the
defined term seems unnecessary as they
do not enhance understanding but may,
instead, be confusing.
Scope of practice and
In Figure 1 scope of practice is identified
as being a horizontal dimension of
practice which defines the boundaries
or breadth of professional practice.
It is influenced by the tasks, roles and
services provided by the individual
practitioner. Given the obligation of
all health professionals to perform
only those activities in which they are
competent, the scope of practice of any
individual is inevitably determined by
the competencies of that individual.
This perspective and that of the
scope of practice being 'authorised'
in some manner is recognised in
the two definitions, 2a and 2b,
in Table 1. The APPFSC favours the
second definition largely because it
incorporates the concept of professional
practice, and therefore scope of practice,
evolving and changing over time as a
result not only of the choices made by
individual practitioners but also due
to changing professional roles and
In the APPF it is noted that, just as
performance level can be increased by
the acquisition of additional expertise
above that usually observed, scope
of practice 'can be extended at the
discretion of the individual practitioner
by incorporating into their practice the
knowledge, skills and expertise required
to deliver a new professional service'.
Neither term implies a higher quality of
service is being provided but, instead,
is reflective of a directed change in the
competency of the individual either in
the horizontal or vertical direction, or
perhaps in both directions.
Where expertise is acquired at a
performance level that is higher than
is usually observed in the profession,
but for an existing range of professional
Figure 1. Classification of practice type through scope of practice and performance level
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