It stated simply that; 'Practice must be sensitive, relevant and responsive to the needs of individual patients and clients and have the capacity to adjust, where and when appropriate to changing circumstances....the range of responsibilities which fall to individual nurses should be related to their personal experience, education and skill' (UKCC, 1992). However, coming as did between the publication of the New Deal for Doctors (NHSME, 1991) and The Calman Report, which respectively initiated reduction of junior doctors hours and shortening of specialist training, scope understandably created considerable tension within the nursing profession (Downie 2000, 1-7). Many were concerned about the 'medicalisation' of nursing and the loss of its intrinsic value. It was feared that in medical terms, the interpretation of 'good' may be to the advantage of medical care and the interests of the physician, but at odds with the interests of the patient and nursing.
The scope of practice appears to give nurses more freedom in practice. Cahill (1996, 791-799) described how scope enabled nurses in one trust to move the boundaries of care in almost unlimited ways, for example, the setting up of nurse led clinics. With the removal of need for certification and the placement of onus on individual nurses to decide in what ways to expand their practice, certain legal and professional issues are raised. These will be discussed later in further detail.In accordance with scope, a range of new roles for nurses have since evolved in response to the major changes in UK healthcare and therefore service delivery, national policies and moves to more patient focused care. Indeed, nurses could be said to have a formal responsibility for exploring way in which quality healthcare can be improved under the auspices of clinical governance.
More recently both 'Making a Difference' and the NHS Plan promote and encourage continued development of the nurses role. However, despite government and professional bodies continued promotion of expansion of nursing roles and support of advanced nursing practice, definition of advanced practice has not been forthcoming. Quinn (2000, 14-20) quotes the UKCC's failure to define advanced nursing practice as the reason for the diverse interpretation of these roles in practice. Bandura (1977, 21-35) bemoans the UKCC's refusal to be more explicit in defining the role of the advanced practitioner in the acute setting, though acknowledging their reason being not wishing to stifle potential development. Cahill 1996 (791-799) reject the notion of the medical model at the centre of specialist nursing and stress that the truly advanced practitioner focuses their efforts on their clients' and situations which enhance positive outcomes for the client. They are at once intuitive, reflexive and empowering practitioners that use their expanded roles to foster a sense of the individual and focus wholly on achieving excellence in caring.
Cahill 1996, (791-799) recognized two schools of thought regarding advanced nursing roles; one relating to the acceptance by nurses of roles previously considered to be those of doctors, and the other,