Advanced practitioners: the hidden agenda?

Changes in health-care provision and the increased expectations of clients have precipitated major developments throughout the service. The trend towards specialist and advanced practitioners has been embraced by nurses as the route to professional recognition and increased status. The focus of this paper is consideration of the factors influencing these developments, observing the concurrent erosion of nursing values and strength. Health service management, ill-informed of nurses' function within the service, conclude that task distribution will be cost-effective. To this end, health-care assistants with National Vocational Qualifications (NVQs) performing nursing duties and nurses undertaking junior doctors' work, thereby reducing their hours, have been actively encouraged. Nurses, preoccupied with continuing debates surrounding new titles and improving status through the acquisition of medico-technical skills, have failed to consider the effects of advancing practice without first affirming their own unique identity. Nurses should appreciate the increasing risk to their own profession caused by lack of clarity and apparent compliance, which contribute to the management view of nurses as doctors' assistants--or handmaidens.