The development of these roles presents significant opportunities for workforce/service development and innovation (National Leadership and Innovation Agency for Healthcare (NLIAH), 2013). However, collating recordable data alone did not demonstrate the level at which practitioners were performing, as most of this information only demonstrated the number of procedures or care episodes delivered. Commonly used documents included: A 71-year-old woman presented in accident and emergency complaining of shortness of breath with chest pain over the past six weeks. Cardiff: NLIAH. Record of Learning - All learning activities (these can be grouped into themes e.g. Advanced Nurse Practitioner - National Competencies. This process has been extremely challenging for all involved but particularly the original nurses because the “goal posts” shifted significantly throughout the process as alternative evidence and structures were repeatedly proposed. The patient usually attended her surgery INR clinic and took 13mg of warfarin daily. No medication changes were made during the admission. Currently a capability framework is being devised and a pilot project is underway looking at how best to assess competency. The reason for the sudden rise in the INR was unknown. The work is being shared with all relevant interested parties across Wales as well as other areas of the UK. Developed in collaboration with expert clinical practitioners, this course is suitable for registered nurses, health and social care professionals working in or towards an advanced practice role.The course has been designed to comply with the Scottish Government requirements for advanced practitioners. The Advanced Nurse Practitioner [ANP] is an experienced and autonomous registered nurse who has developed and extended their practice and skills beyond their previous professional boundaries. Trainees are encouraged to regularly write up anonymised reflective accounts relating to patients they have seen or from appropriate learning situations. Professional Portfolio. PROFESSIONAL PORTFOLIO. Advanced Nurse Practitioner E Portfolio For an advanced practice nurse like myself, the relevance of establishing a system and culture that guarantees the … Citation. The group is now examining the potential to roll out the portfolio structure to all registered nurses in the health board, which will hopefully enable practitioners from new registrants onwards to focus their education, skills and learning toward their chosen career pathway, and improve and enable succession planning. The group comprised several specialist nurses and nurse practitioners with diverse roles in an attempt to ensure it was as inclusive as possible. Interestingly, the review of the use of the NLIAH (2013) framework for advanced practice illustrated that the exact number of ANPs working in Wales was still unknown and there was a huge variation between the findings across individual health boards; this is disappointing. The Royal College of Emergency Medicine (RCEM) and Health Education England (HEE) are pleased to announce their co-production of an Emergency Care Advanced Clinical Practitioner (ACP) Curriculum, which has full endorsement by the Royal College of Nursing (RCN). In addition, most nurses’ portfolios kept for the Nursing and Midwifery Council tended to contain certificates of formal training, study days and such like - most of us struggled to understand that these did not demonstrate a specific level of practice. Items listed below can contribute towards evidence of competence achievement and should be cross referenced within the ePortfolio. In early 2012 five group members’ portfolios were successfully signed off and the health board decided that to be able to use the title “advanced practitioner” all ANPs must complete a portfolio, which must be verified by the group and the university. Press Office, latest news and media resources. Advanced Nurse Practitioners are educated at master’s level in clinical practice and have been assessed as competent in practice using their expert clinical knowledge and skills. 06/2003 to present. Some ANPs were able to obtain clinical data from the hospital information department as they had recordable clinical data, while others carried out procedures and were able to record these. Those working in more supporting, rather than medically grounded, roles struggled to decide what evidence was appropriate. ANPs have seen a number of benefits to producing a portfolio, including a clear articulation of roles to non-clinical staff, regulation and protection of the public through clinical governance, ensuring vicarious liability and a demonstration of competence to reassure medical colleagues and other health professionals. Advanced practice is a level of practice, rather than a type or speciality of practice. The audit showed that, although many roles evolved in an unregulated way, ANPs played an integral part in the successful management of the patient journey. The portfolio is a … Search/View all of our locations and facilities. Advanced Critical Care Practitioners (ACCPs) are clinical professionals that form part of the multidisciplinary team responsible for patient care during their critical care admission. This Level 7 training course will qualify you to independently assess, diagnose, treat and manage the care of people with complex clinical problems. The main difficulties for all practitioners concerned what evidence to include and what constituted advanced practice. The article concludes that while advanced nurse practitioners can positively influence clinical outcomes and cost efficiency, they must also be adequately prepared to undertake a leadership role. “An Advanced Nurse Practitioner (ANP) is an experienced and highly educated Registered Nurse who manages the complete clinical care for their patient, not solely any specific condition. The Advanced Practice ePortfolio Trainees are expected to build up a portfolio of evidence throughout their 2-year training. Sign in or Register a new account to join the discussion. They are healthcare professionals educated to Master’s level and have developed the skills and knowledge to allow them to take on expanded roles and scope of practice caring for patients. Nurse Practitioners & Clinical Nurse Specialists, Advanced Nurse Practitioners in General Practice, Recognition and Management of the Acutely Unwell Adult Module (RAM), Care Assurance System (CAS) & Excellence in Care (EiC), Policy, Best Practice and Success Stories, Registered Nursing and Midwifery Induction. The development of these roles presents significant opportunities for workforce/service development and innovation (National Leadership a… They have the freedom and authority to act, making autonomous decisions in the assessment, diagnosis and treatment of patients. Visit our, Developing a portfolio for advanced practice, 100 years: Centenary of the nursing register, 2020: International Year of the Nurse and Midwife, Nursing Times Workforce Summit and Awards, Advanced Level Nursing: A Position Statement, Trust, Assurance and Safety: The Regulation of Health Professionals in the 21st Century, Supporting the Development of Advanced Nursing Practice: A Toolkit Approach, 030615_Developing-a-portfolio-for-advanced-practice.pdf, Table 1 Examples of evidence for endoscopy advance nursing practice.pdf, Fig 1 Four pillars of advanced practice.pdf, Don’t miss your latest monthly issue of Nursing Times, Winners of the 2020 Nursing Times Awards revealed, Announcing our Student Nursing Times editors for 2020-21, Watch: Infection prevention in the community during the Covid-19 crisis, Expert nurses share their knowledge of pressure ulcers in free-to-watch videos, Open letter from an ICU nurse: ‘I need to be strong enough to fight for a bit longer’, Chancellor confirms NHS nurses will be spared from public sector pay freeze, Nursing Times Awards pays tribute to shortlisted nurse following death, New support network launched for Indian nurses in the UK, ‘Nurses forget that health is a human right for them too’, ‘Thank you for your efforts and sacrifices this year’, ‘Nurses are tired and, again, frightened – support is crucial’, Two more FTs sign pledge to support Nursing Times staff campaign, NMC reveals new council member for Scotland and first associates, Copyright © 2020 EMAP Publishing Limited, This content is for health professionals only, This article has been double-blind peer reviewed. Advanced Practice The Portfolio have used an adapted version of Benner’s (1984) model of skill acquisition and skill development, that describes five levels or stages of nursing performance: novice, advanced beginner, competent, proficient and expert. doi: 10.7748/ns.2018.e11044. This Welsh treat, exceptionally high in vitamin K, had kept her INR steady for the past 10 years, until she came into hospital and did not have her usual Saturday tea. The trainee should self-assess and then the Practice Assessor should go through with the trainee. As clinical knowledge and scope of practice of a post nursing graduate is expanded, an advanced practice nurse, whether in the scope of clinical nurse specialist, nurse practitioner, nurse midwife, or nurse anesthetist, will strive to bring his/her patients to good health through plans of care and disease prevention practices and education. Table 1 (attached) outlines what could be included in a portfolio for an ANP in endoscopy. There are plans for a … The patient was asked to stop eating the laverbread until her INR was stabilised. increased understanding of Advanced Practitioner roles and will support NHS organisations and individual Advanced Practitioners to achieve the workforce and service priorities aimed at improving the quality of care to the population of Wales. Trainees may wish to keep this as a spreadsheet or word file and upload into their portfolio periodically. Scottish Government (2008) Supporting the Development of Advanced Nursing Practice: A Toolkit Approach. Nurses in a sense keep a portfolio to show future employers who they are and what they have done. Most were “unconsciously competent” in their roles, and found it difficult to articulate what made their practice advanced. We would recommend all ANPs consider producing a portfolio to support their roles in this way; they can also be used to support revalidation. RCN definition of advanced practice: “Advanced practice is a level of practice, rather than a type of practice. In October 2009, the portfolio guidelines were proposed to the health board’s nursing and midwifery professional forum and gained approval. Advanced nurse practitioners (ANPs) are a senior clinical resource at the front line of care delivery, particularly in terms of addressing the challenges of workforce shortages in the NHS and managing long-term conditions and the ageing population (Townsend, 2014; Department of Health, 2007). Anderson C (2018) Exploring the role of advanced nurse practitioners in leadership. Authors: Alison Townsend is advanced nurse practitioner for urology services; Andrea Croft is lead advanced nurse practitioner in anticoagulation, both at Princess of Wales Hospital, Abertawe Bro Morgannwg University Health Board. Hospital visiting restrictions now in place. In June 2010 the group recognised that due to the diverse nature of ANP roles, we needed an academic to act as an external assessor to review the content so the portfolios could be recognised as universally valid. Advanced Practitioner UCLan works with employers to design and deliver degree apprenticeships and establishes the content and delivery of a programme according to their needs on an individual basis. The group initially examined the available tools for demonstrating a level of practice - none appeared to cover all relevant aspects for each role and some were difficult to apply. Evidence-based decision making (DH, 2010). We agreed to use this as the initial template and adjust it as required by individual ANPs. Examples of criteria demonstrating advanced practice. Advanced nursing practice has existed for decades but, due to the complexities surrounding its development, the field has been led essentially by innovation in practice (Barton et al, 2012). Portfolio. A key element was that the evidence would demonstrate safe practice, as governance was high on the health board agenda. Go to and follow links to register for an account. The aim was to ensure the portfolios contained Master’s-level actions and decision making in line with NLIAH recommendations that all ANPs be working at this level. A blank template can be found on the trainee ANP moodle site. Most of the work involved in collating portfolios involved the ANPs physically collating their evidence and organising it within the portfolio so others were able to easily read and digest it, resulting in their feeling reassured that the ANP was fit for practice at the advanced level. The structured forms in TURAS Portfolio are designed to help you identify, plan and evidence your learning and development. Trainees are expected to get feedback from a variety of different people for components 1-3 described below. For example, evidence of achieving competencies related to prescribing and therapeutics can be added whilst undertaking the prescribing component of your pathway. robust portfolio can demonstrate advanced nursing practice is essential, but is not easily compiled because of the nature and complexity of the individual advanced nurse practitioner’s role. Teaching and mentorship are fundamental parts of registered nurses’ roles, and learning should be managed and promoted in clinical practice to ensure excellence. Reducing pressures in consultant outpatient clinics - using ANPs to review patients in clinic or using telephone consultations/letters; Taking on traditional medical procedures, making diagnoses and initiating treatment (the portfolio enables the health board to provide vicarious liability insurance); Initiating new service models as a result of audits/research - portfolios have raised the profile of the ANPs, who are now seen as a valuable resource; Using some portfolio work to demonstrate cross-boundary and cross-health board work at an external level; Replacing some medical staff with consultant nurses or ANPs to deliver work such as endoscopy and care of older people inpatient services. Copies of the transcripts from the program to educate an advanced practice registered nurse completed by the APRN and from any other institution of higher education attended ... and include: nurse practitioner, clinical nurse specialist, and nurse midwife. Ultimately, the ePortfolio will become a central part of the final sign-off process and trainees should familiarise themselves with the requirements for this on the Final Sign-Off area on this web page. For everyday healthy living advice and services information. Trainees are expected to record the following in their ePortfolio: Remember – no patient identifiable information should be kept in your portfolio. The ANPs were therefore asked to complete a questionnaire so their roles and workload could be audited. As a result of completing these portfolios the initial members have been able to use them to demonstrate to managers how their roles can support service change by: In spring 2012 this process was rolled out across the health board and is now being used, evaluated and managed by the multidisciplinary workforce group. Create a professional Portfolio of a nurse practitioner that provides evidence of education, skill sets, accomplishments, goals, competencies, professional background, a dedication to life-long learning, and anything else that validates your commitment to your profession. More recently, local regulation and governance by employers that requires them to review their ANPs has been suggested to ensure practitioners are fit for purpose (DH, 2010; NLIAH, 2010). Department of Health (2010) Advanced Level Nursing: A Position Statement. modules completed, eLearning, supervised practice etc). By providing a standard of practice there is a solid governance structure around First Contact roles and advanced practice in primary care. She is now home on 6mg of warfarin daily with a stable INR - but, sadly, no more laverbread for tea. Embracing change and going the extra mile really does make a difference, says advanced nurse... My job. From April 2021 clinicians should have started either the portfolio route of have started an FCP HEI level 7 module to prospectively and retrospectively to meet this deadline. Like other trusts, ours had limited data for managers and peers to understand the diverse nature of these roles, making their contribution difficult to define. Advanced nurse practitioners (ANPs) are a senior clinical resource at the front line of care delivery, particularly in terms of addressing the challenges of workforce shortages in the NHS and managing long-term conditions and the ageing population (Townsend, 2014; Department of Health, 2007). Nursing Standard. Cardiff: NLIAH. So far, 49 health professionals have gone through the process and been accredited as advanced level. The evidence consisted of a number of documents; pieces of evidence could be used in more than one pillar. As well as passing MSc-level modules, you will need to compile a portfolio of evidence to demonstrate your competencies. Use the: • Professional Journey Plan template to identify, plan and evidence your learning. Advice and guidance on Freedom of Information. The directorate of the chief nursing office for Scotland has developed an advanced practice toolkit (Scottish Government, 2008) that has been adopted as a platform to develop and support advanced practice in Wales. They have the freedom and authority to act, making Trainees will begin to build this early in their training and continually contribute evidence to the ePortfolio as they progress through training. Nursing Times has produced a series of videos on infection control and…, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. Development and maintenance of a structured process for the consistent recognition and acknowledgement of the … It was interesting to note how creative the group became in finding evidence relevant to the pillars: those who did not routinely use protocols or pathways often used reflective evidence based on an intervention or annotations from patient notes. The health board co-opted a member of Swansea University’s faculty; throughout the summer the group met regularly and examined a range of documents and information including: During this period the academic member of the group suggested shifting towards more reflective evidence and excluding the robust competencies and protocols required to meet the governance element such as peer review of skills and risk assessment. We currently use the Turas ePortfolio available from NHS Education for Scotland. Every Saturday evening since before her valve replacement, she ate 250g of laverbread for her tea. London: Stationery Office. Barton TD et al (2012) A governance framework for advanced practice. The anticoagulation advanced nurse practitioner was asked to speak to the patient to establish a cause for the high INR. Vacancies, career advice, job packs, Modern Apprenticeships and more. Find out all you need to know! The portfolio would use the four pillars of practice from the Scottish toolkit; this contains specific criteria for each pillar of practice and ANPs must provide evidence demonstrating that they fulfil the specified criteria and illustrating advanced practice (Box 1). As a result of this association with a national agency developing a framework for advanced practice, the work to develop a live portfolio was eventually rolled out across Wales. The executive nurse for workforce was also involved with the NLIAH group working on advanced practice for allied health professionals. Eventually the group agreed the Scottish toolkit and pillars of practice (Scottish Government, 2008) was the most appropriate and user friendly. Information and guidance for public, NHSGGC staff, and community-based services. When trying to wrap your mind around a nursing portfolio, think of it as a scrapbook that contains everything you have done up to that current moment in your nursing career. In 2009 the nurse in charge of workforce planning in our hospital trust recognised the need to evaluate the “off-ward” nurses. A key element of the educational preparation of Advanced Nurse Practitioners is achievement of advanced-level skills, knowledge, competences and attributes, both at core level and specific to the context in which they practice. All practitioners gained a sense of their own roles and the complexity of them; they also felt more comfortable that the health board was aware of their roles and able to fully support them from a governance perspective once the portfolio was accredited. What's your experience of using our hospitals and services? Edinburgh: Scottish Government. Information for patients and service users, and support for staff. Townsend A (2014) Patients’ views on a nurse-led prostate cancer clinic. Examining the marking grid for Master’s-level education helped with this process. These are free to nurses working within Scotland. The recommendation of the International Council of Nurses, the Department of Health in England, and the equivalents in Scotland and Wales, the Association of Advanced Nurse Practitioner Educators (which consists of 40 universities in the UK), and our North American cousins (from where the role first emerged), is that preparation for the role should be a masters level academic programme. Emergency Care Advanced Clinical Practitioner Curriculum. Buddies would be ANPs who had already successfully completed the process. The patient was admitted for investigations. For everyday ailments, minor injuries or serious emergencies. This site uses cookies to store information on your computer. In the absence of national regulation of advanced nursing practice roles, employers need to ensure adequate governance arrangements are in place. Personal details including NMC PIN Number. A primary concern for all members of the group was what evidence to include in the portfolio. After the publication of the All Wales Framework (NLIAH, 2010) the executive nurse invited university staff to join the group to help with verification. They are highly experienced and educated practitioners who have developed their skills and theoretical knowledge to a very high standard. ‘Congratulations to our 2020 Nursing Times Awards winners’, 01 June, 2015 Download the General Practice Advanced Nurse Competencies [PDF] This competency framework aims to provide guidance for educators, GP employers and aspiring Advanced Nurse Practitioners. It highlights the challenges encountered by nurses in a Welsh Advanced Practice Advanced clinical practitioners come from a range of professional backgrounds such as nursing, pharmacy, paramedics and occupational therapy. However, the executive nursing team were concerned the revised portfolio did not meet the criteria for ensuring safe practice. Health News - Rounding up all the latest news within NHSGGC. Medical history included mechanical aortic valve replacement (taking warfarin), chronic obstructive pulmonary disease and hypertension. London: The Stationery Office. The development and production of a robust portfolio can demonstrate advanced nursing practice is essential, but is not easily compiled because of the nature and complexity of the individual advanced nurse practitioner’s role. This article discusses the advanced nurse practitioner role and the need for the portfolio. The group focused on obtaining evidence that demonstrated the actions taken regularly as a part of their roles. By NT Contributor, A lack of clarity about advanced nursing practice led a Welsh trust to develop a portfolio for advanced nurse practitioners to document the nature of their roles. On admission her international normalised ratio (INR) was 2.2, slightly below the desired therapeutic range of 2.5-3.5. The ANP is able to use their expert knowledge and complex decision making skills, guided by The Code 17 The current evidence on nurse practitioner education, competence, capability and e‑portfolios points to the integration of the use of an e‑portfolio into current nurse practitioner curriculum models to meet the unique needs of nurse practitioner candidates. We reverted to meeting as a nursing group without academic support with a view to focusing initially on the portfolio content required by the health board, and gaining academic validation at a later date. The evidence varied from signed-off protocols and assessments highlighting a level of clinical practice, to audits/contributions to strategic developments illustrating leadership and management elements of the role. Having worked at this level for a long time, ANPs did not appreciate the level of know-ledge behind daily decision making that informed their practice. Already working with us? Build on your existing professional skills and knowledge to become an advanced nurse practitioner on this University of Southampton master’s degree. The group also identified the need for a live portfolio to establish a level of practice. If nurse practitioner chooses not to participate, the employer shall pay the nurse practitioner additional salary, an amount equal to the cost of the maximum annual premiums (NAPNA, 2013). The group found it difficult to decide on suitable evidence to show a level of practice. Nursing Times; 108: 25, 22-24. Nurses are not generally encouraged to keep copies of complex cases indicating decision-making and judgement skills, and do not routinely participate in recorded case-based discussions unless working at specific levels and completing these alongside medical colleagues. Nursing Times; 110: 9, 22-23. Department of Health (2007) Trust, Assurance and Safety: The Regulation of Health Professionals in the 21st Century. An anonymised list of patients seen (gender, approx age, presenting complaint, diagnosis, management/referral and any key learning points). Supporting others to develop knowledge and skills, Decision making /clinical judgement/problem solving, Ability to implement research findings into clinical practice. We currently use the Turas ePortfolio available from NHS Education for Scotland. Health protection, screening, services, improvement and more. National Leadership and Innovation Agency for Healthcare (2010) Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales. Trainees are expected to build up a portfolio of evidence throughout their 2-year training. We suggest that you use this model This requires that ANPs demonstrate their ability to work at advanced levels of competence encompassing all four pillars of practice (Fig 1) so they can use the title “advanced” (NLIAH, 2010; Scottish Government, 2008). On extensive investigation no immediate cause was found, until the patient was asked if she ate the Welsh delicacy, laverbread (seaweed). Help shape your hospital and community services. Due to the difficulties the original group had encountered when preparing their portfolios it was decided that all future ANPs would have an allocated “buddy” to help them to do this. A nursing portfolio is a tool used by nurses to help them secure a nursing job .. UCLan is committed to the principle of an apprenticeship being the development of an individual into a role of which the course is one component. The evidence can be used for many purposes including supervision, appraisal and NMC revalidation. While the Scottish toolkit clearly sets out the “novice to expert” continuum, all the ANPs were very experienced and it was difficult to explain and demonstrate to others what made practice advanced. A database identifies all recognised ANPs within the health board. Nurse Practitioners (NP) will often ask if they can start a business or practice doing “x.” Frequently, this question makes its way to me after the NP has called their state Board of Nursing to ask the same, often without getting the information they need. It highlights the challenges encountered by nurses in a Welsh health board when producing the portfolio, which will be introduced in Wales to demonstrate clinical governance and ensure patient safety. Tell us your experience of our services, have your say, and more. A portfolio used by one of the group was reviewed as a working example, as it contained evidence of achieved competencies and skills training. It has also led to successful rebanding to  a  higher band of roles in some instances and protection of these jobs for future nurses. On day four the patient’s INR was >10, warfarin was omitted and vitamin K given. Citation: Townsend A, Croft A (2015) Developing a portfolio for advanced practice. Nursing Times; 111: 23/24, 23-26. Unit 6 – Advanced Nurse Practitioner Portfolio: This unit is a culmination of your learning and professional practice development, through critical exploration, reflection and demonstration of knowledge, understanding and skills for the Advanced Clinical Practice or Advanced Nurse Practitioner role. Practice was therefore assessed using the health board’s risk matrix and the areas requiring formal competencies or protocols were identified. This was subsequently used to develop an Abertawe Bro Morgannwg University Health Board governance framework (Barton et al, 2012). These are free to nurses working within Scotland. It concludes with production of a personal portfolio of evidence of academic and … ... achievement of the capabilities and in the development of a portfolio. 6 Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales In hindsight this period highlighted the diverse opinions on what was required from a portfolio. 7. The health board portfolio guidance agreed by the group included a completed evidence matrix to help others decide what evidence was appropriate and relevant to demonstrate advanced practice. Trainees are expected to work through the appropriate competency document and upload a scanned copy to their ePortfolio prior to any supervision meetings (relevant competency documents will be given to trainees during the training). advanced nurse practitioner. Professional Portfolio Create a professional Portfolio of a nurse practitioner that provides evidence of education, skill sets, accomplishments, goals, competencies, professional background, a dedication to life-long learning, and anything … Board Members, meetings and reports and finances. The INR was generally stable. Although advanced nursing practice is not a new concept, there is no single, universally agreed definition - it should be viewed as a level of practice rather than a specific role (DH, 2010; NLIAH, 2010; Scottish Government, 2008). The workforce group continues to support the portfolio development and revalidation processes on an annual basis for practitioners on the advanced database, thereby continuing to comply with governance requirements. This framework provides a standard and greater clarity on the capabilities for nurses working at the advanced clinical practice level within general practice. This framework provides a standard and greater clarity on the capabilities for nurses working at the advanced clinical practice level within general practice. Learning Plan – the ‘Professional Journal Plan’ in the ePortfolio can be used for this purpose. The draft framework for Wales on advanced practice; Assessments of procedures (most of which were previously done by medical staff), signed off by a peer, including protocols (clinical pillar); Reflective accounts of particular incidents demonstrating the decision-making process, such as a critical incident and how the practitioner dealt with this, critical thinking skills, assessment and decision-making skills (clinical pillar); Anonymised clinic letters and referrals to other health professionals, and referrals such as GP letters from a clinic consultation recommending treatment/ alteration of treatment (clinical pillar); Anonymised copies of patient notes illustrating the care and decisions taken (clinical pillar); Formal competencies from specialist bodies and clinical assessments by a medical practitioner or other health professional (clinical pillar); Copies of national guidelines practitioners had been involved in (leadership pillar); Copies of audits/research that had been implemented and improved practice (research pillar); Annual reports indicating the purpose and effectiveness of the role and its value (leadership pillar); Copies of teaching programmes for staff/patients/others (education pillar); Case studies illustrating advanced knowledge and problem solving, as in Box 2 (clinical pillar). What to expect, treatment, care, travel, rights and responsibilities. Advanced Nurse Practitioners are educated at Masters Level in clinical practice and have been assessed as competent in practice using their expert clinical knowledge and skills. The nursing executive subsequently used this data to create a database of ANPs, and quickly recognised a need to ensure robust governance arrangements were in place to protect the public, organisation, and the ANPs - particularly in light of how many of the roles had evolved. Competencies should be signed as complete when the assessor has seen satisfactory evidence, within the ePortfolio, that the competency has been met. The basis of advanced nursing practice is a high degree of knowledge, skill and experience applied to achieve optimal outcomes through: However, despite significant debate, advanced nursing roles are not subject to regulation, and the plethora of job titles makes it difficult for the general public to understand the level of care they can expect from ANPs. Box 1. Group members producing a portfolio also identified a workplace assessor to evaluate their evidence and validate their level of clinical practice. I'm an Advanced Nurse Practitioner, how can Turas Portfolio support me? National Leadership and Innovation Agency for Healthcare (2013) Review of the Utilisation of the NHS Wales Advanced Practice Framework. Although advanced nursing practice has existed for decades there is no universally agreed definition, Wide variations in roles and job titles make it difficult for patients to understand what they can expect from ANPs, Effective clinical governance requires evidence from ANPs to demonstrate the advanced nature  of their practice, A portfolio tailored to ANPs’ needs can help them to define and collate this evidence, Evidence clarifying the nature of advanced practice can increase understanding among both patients and other health professionals. Following the audit the executive nurse for workforce planning invited some of the more experienced ANPs to join a task group to assist with the process of governance. 60 seconds with homeless health advanced nurse practitioner Wendy Ann Webb. This article discusses the advanced nurse practitioner role and the need for the portfolio.