Levels of nursing

Shortly after, we published our definition of the levels of nursing practice, outlining the complexity and scope of practice, to clarify and bring consistency to the understanding of each level.

It should be recognised that there may be some overlap at each level; for example, a nurse may be practising at an enhanced level for some areas of practice, but not in others. Therefore, this resource is intended as a guide to support career progression.

Additionally, the Framework identifies educational opportunities for health care support workers, Nursing Associates (NAs) and each level of practice for nurses and midwives.

It outlines specific courses, depending on personal journey plans, and recognises that not all areas of practice have accredited education programmes available; however, more generic course content can be applied to a range of areas of clinical practice in sexual health and reproductive health.

This can be achieved with support from a course tutor, reflective practice and by developing a personal professional practice portfolio of evidence. If using this route, it is importance that competence can be demonstrated.

Nursing is a safety-critical profession founded on four pillars: clinical practice, education, research and leadership.

This nursing framework takes account of the four pillars, identifying several educational resources which can be used to progress a nursing career through different levels of practice.

Some will be more explicit, and the following outline of the different pillars can be used to ensure all four arenas are being met when undertaking educational opportunities.

The clinical pillar includes the knowledge, skills, and behaviours and nursing proficiencies needed to ensure high-quality care is provided that is safe, effective and person-centred. Depending on the level of practice, this may include the following elements:

• clinical skills, knowledge and understanding
• communication skills
• level of decision making
• clinical judgement skills
• ability to problem solve
• critical thinking
• reflection.

The research pillar includes the knowledge, skills and behaviours and nursing proficiencies needed to lead and deliver research, as well as source and use high-quality evidence to inform practice, education activities and improve services. Depending on the level of practice, this may include the following elements:

• using evidence to support best practice and critical appraisal skills
• using research in clinical and educational practice to underpin and develop protocols and guidelines
• involvement in research, audits and supporting/leading service change
• using publications to source information and best practice
• keeping up to date on changes to practice following the latest research
• critically engaging with research or quality improvement projects within the service or area of expertise
• using evidence-based practice in your role
• disseminating best practices and research findings to other team members
• networking with other academic and clinical colleagues to work on research projects and advance the chosen field of practice.

The education pillar includes the knowledge, skills, and behaviours and nursing proficiencies needed to enable reflective practice, ongoing self-development and effective learning in the workplace. It includes the following elements:

• that education is key to self-development and always consider opportunities available for improving skills knowledge and understanding of the area of work
• understanding the principles of teaching and learning and the different styles
• supporting others in developing both knowledge and skills
• promoting and fostering a culture and environment of learning
• teaching clients/patients and giving information to patients
• teaching and developing other health care professionals
• mentoring/coaching.

The leadership pillar includes the knowledge, skills, behaviours and nursing proficiencies needed to work effectively in a team, lead in a manner appropriate to their level within the career framework and fulfil management responsibilities (if applicable). Depending on the level of practice, this may include the following elements:

• identifying change
• supporting and/or leading innovation in the practice environment
• supporting and/or managing change
• service development
• building and developing cases for change
• negotiating and influencing skills
• identifying and collaborating with relevant networks
• being part of a team/team building or development of teams.

This nursing framework has two fundamental sections for those working in primary care and sexual health services. These sections reflect the different demands of each setting, and it should be recognised that this may vary further for those working in specialised services.

It is important to recognise that career development encompasses more than accumulating academic qualifications and completing courses.

Career development must be accompanied by critical reflection, mentor support and feedback, and the consolidation of clinical knowledge and skills to equip the professional to deliver excellence in wellbeing and sexual health.