October, 2004
Model for Advanced Nursing Practice at the Health Sciences Centre
Introduction
Advanced Practice Nurses at the Health Sciences Centre contribute to the achievement of the
centre’s goals through their roles as both Clinical Nurse Specialists and Nurse Practitioners.
There are advanced practice nurses working throughout the Health Sciences Centre, in # areas.
The following model is the framework that guides and describes advanced nursing practice in all
settings within the centre, whether the nurse is working as a Nurse Practitioner or a Clinical
Nurse Specialist. The differentiation comes in the amount of time and focus spent on each of the
five main areas of practice. Nurse Practitioners spend a majority of their time and effort in direct
patient care, whereas Clinical Nurse Specialists will focus more time in the other areas of
practice. Each of them will differ between them as well. The focus of each Advanced Practice
Nurse will change over time and in response to needs and with individual strengths and
situations.
The Strong Model of Advanced Practice
The Strong Model of Nursing Practice was developed in 1994 at the University of Rochester
Medical Center. This model defines five domains of practice that comprise the Advanced
Nursing Practice role: direct comprehensive care, support of systems, education, research,
publication and professional leadership. The fulfillment of each of the domains varies with the
individual Advanced Nursing Position and is dependent upon the needs of the population served,
the practice setting, and the individual APN interests and strengths. These domains are not
mutually exclusive, as some aspects of practice may fall within the bounds of more than one
domain. Conceptual strands of collaboration, scholarship and empowerment, which describe the
attributes of practice, the approach to care and the professional attitude are included. These
strands are circular and unifying threads that envelop the domains of practice. They influence
each of the domains including direct and indirect care activities. Benner’s principles of
professional advancement are also built into the model to illustrate the five levels of proficiency:
novice, advanced beginner, competent, proficient, and expert. Although most advanced practice
nurses begin in the role as clinical experts there is a progression from novice to expert in the
provision of advanced care in the five domains.
Five Area of Advanced Practice
1. Direct Comprehensive Care: Patient focused activities that include assessments,
procedures, interpretation of data and patient counseling.
2. Support of Systems: Professional contributions to standards, quality initiatives, and
development of policies, procedures and practice guidelines to optimize nursing practice
within the institution.
3. Education: Contributions to caregiver, student and public learning related to health and
illness.
4. Research: Practice that challenges the status quo and seeks better patient care through
scientific inquiry and incorporating evidence-based practice into direct patient care.
5. Publication and Professional Leadership: Promotion and dissemination of nursing and
health care knowledge beyond the individual practice setting.
Underlying Processes of Advanced Practice.
A. Collaboration: Supporting the belief that the unique skills and abilities of various care
providers in combination, contribute to the goal of excellent patient care. Reflects the
multidisciplinary nature of provision of care with complex clinical situations or settings.
B. Scholarship: Signifies the constant inquiry that underlies every nursing action and
decision.
C. Empowerment: The authority to identify and analyze relevant problems and to develop,
implement and evaluate a plan of action.
The Strong Model of Advanced Practice
Direct
comprehensive Support of
care systems
Collaboration
Scholarship
Patient
Publication
and
Education
professional
leadership
Empowerment
Research
Novice Expert
References
Ackerman MH, Norsen L, Martin B, Wiedrich J & Kitzman HJ (1996). Development of a model of advanced practice. American
Journal of Critical Care, 5: 68-73.
Mick AJ & Ackerman MH (2000). Advanced practice nursing role delineation in acute and critical care: Application of the
Strong Model of Advanced Practice. Heart & Lung, 29(3), 210-221.
