The typical picture that is conjured up when one thinks of a nurse is that of a matronly figure, in a uniform and cap, sitting at the patient’s bedside administering care.Associated with this is the traditional view held by the public, in which nurses are beholden to doctors and dependent on them for instruction, and perform a generally subservient role.However, those who have had the misfortune to require treatment more recently will testify to a far different situation, in which nurses perform a more professional and clinically autonomous role, as well as having a caring and compassionate function.In fact, the picture that exists in most clinical environments is one in which nurses are recognised as knowledgeable and capable clinicians, and independent practitioners in their own right, rather than obedient medical handmaidens.The delivery of modern healthcare has also changed beyond recognition, with interventions that were once considered to be the domain of hospital practitioners now provided in a more liberated community-based system.Within this structure, the role of healthcare professionals has similarly been transformed, such that the ‘power’ has shifted away from doctors and towards non-medical clinicians.This has, in turn, resulted in non-medical practitioners, most notably nurses, having more authority, autonomy and responsibility for clinical decision-making, rendering them more equal in the clinical hierarchy and more evenly aligned as professionals.This thesis explores the range of traditional medical activities that are now performed by nurses who have expanded their practice in order to accommodate the additional responsibilities that this 'power' affords.In particular, it looks at those nurses who have advanced their practice such it constitutes a new clinical role and, in some cases, act as medical substitutes. With the further devolution of clinical tasks inevitable, and the creation of more clinical roles likely, this thesis looks at the regulatory framework that underpins advanced nursing practice.In particular, it questions whether the existing framework provides the regulatory safeguards that are required to ensure patient and public protection and asks whether an alternative approach, such as that which is provided by another professional regulator, may be more appropriate.In concluding, this thesis will assert that a compelling case for the statutory regulation of advanced nursing practice can be made, and will suggest a number of options regarding how this regulatory solution can be achieved.
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