A framework for advanced practice nursing.

The empirical and expository literatures about advanced nursing practice have lacked a broad, comprehensive, conceptual framework to organize and guide substantive work. Such a framework is needed during the development of health care policy, educational curricula, role descriptions, and research agendas for this arena of practice. The framework proposed in this article represents an integrative synthesis of previous work on advanced nursing practice. The proposed framework is based on the definition of advanced practice nursing as professional health care activities that (1) focus on clinical services rendered at the nurse-client interface, (2) use a nursing orientation, (3) have a defined but dynamic and evolving scope, and (4) are based on competencies that are acquired through graduate nursing education. Advanced practice nursing is comprised of activities in the domains of advanced clinical practice, health care systems management, and professional involvement in broad health care discourse.