At the most general level, a NSW CNC is a Registered Nurse who possesses at least five years full-time equivalent post registration experience, and who,

in addition, has attained approved post-registration nursing/midwifery qualifications relevant PLX-4720 supplier to the specialty field in which he or she is appointed (NSW Health, 2011b). Over the years, there has been significant confusion and debate about the CNC role, and how these professionals contribute to improved service delivery (Baldwin et al., 2013, Fry et al., 2013 and Wilkes et al., 2013). There are three grades of CNC in NSW. While job description varies between grades, and corresponding remuneration, there has often been arbitrary application of grade to positions informed in many cases more by budgetary constraints as opposed to rational service planning across NSW. This is one component of the confusion referred to above (Chiarella, Hardford, & Lau, 2007). The three grades are embedded in the industrial award and are paid at different rates ranging from CNC one at the lowest end to CNC three at the highest end. The focus of the grade varies from unit based expectation for a CNC level one to a state level focus for CNC level three. The different levels should require different academic preparation, but at present in NSW formal qualifications are only listed as desirable elements at the time of recruitment as opposed

to mandatory. In attempting to identify SCH772984 concentration the unique elements of CNC practice, and the ‘value add’ (Mundinger et al., 2000a and Mundinger et al., 2000b) of these positions, researchers have often relied upon what is termed the “Strong Model” of advanced practice (Ackerman et al., 1996 and Mick and Ackerman,

2000). The Strong Model was developed selleckchem by Ackerman and co-workers in the mid-1990s, in an attempt to characterize the unique nature of the acute care nurse practitioner role in the United States (Ackerman et al., 1996). The model defines five areas of practice which together comprise the advanced nursing role, namely direct comprehensive clinical care (patient-focused activities); support of systems (which include professional contributions to improve nursing practice within the health care institution); education (of staff, clients, carers, and members of the public); research (including the incorporation of findings from evidence-based practice to improve patient care); and professional leadership (which may include publication of findings beyond the immediate practice setting) (Ackerman et al., 1996). The five components of the Strong Model may be referred to as the “domains” or “pillars” of advanced practice (Barton et al., 2012 and NSW Health, 2011a). Common “conceptual strands” cutting across each domain, namely empowerment; collaboration; and scholarship were also identified. Since publication, the Strong Model, or models very similar to this, have been widely employed by nursing researchers.