Background: Mark Carroll examines the concept of advanced nursing practice and highlights a number of the difficulties in assessing and defining different levels of practice. Some of the differences and similarities between advanced practice in the US and UK are compared and contrasted.
Conclusion: Issues of élitism and the lack of correlation between the needs of the healthcare system and professional self-interest prevent the advancement of specialist roles in the UK. The continuing focus of local trusts on the medicalisation of roles to meet the demands of the healthcare system appears to ignore the need for nursing to expand from within the profession.