Framework for a clinical career structure in nursing.

There is an urgent need to define and clarify a clinical career structure in nursing. The development of a career structure is hindered by the proliferation of titles currently used by nurses when developing their knowledge and skills. It is proposed that the term nurse practitioner be replaced by either generalist or specialist nursing practitioner, depending on the individual's bias, and that nurses with a bias towards medicine be designated paramedical nurse practitioners. A three-band clinical career structure is suggested, based on these categories. This structure would allow nurses to develop their knowledge and competency while either remaining in a broader, generalist area or specializing in a particular field. This structure includes an advanced nursing practitioner level to accommodate those nurses with extensive experience of clinical nursing situations. It is imperative that the nursing profession decides its career pathways, otherwise they may find others doing it for them.