What are advanced clinical practitioners' expectations of the benefits of pursuing the role, and are these being realised?

Background: Advanced clinical practitioners (ACPs) have been used worldwide to reform health services to address population needs. However, previous research identifies barriers that prevent the effective implementation of ACPs. Aims: To better understand the expectations ACPs have in relation to their roles, and to evaluate whether they are being met so that focused educational and policy initiatives can be developed to reduce gaps between expectation and reality. Methods: This online cross-sectional study uses a sequential, mixed-methods, exploratory design, in which themes identified from focus groups were used to construct a follow-up questionnaire. Some 291 UK participants were recruited via social media and ACP educational and policy networks. Exploratory data and reflexive thematic analysis were employed to probe and visualise results, drawing findings together into narrative synthesis. Findings: This research provides insight from a diverse group of ACPs of their lived experiences, aspirations and driving forces to either enter or remain working in the profession. Five themes were identified during focus group discussions: 1) clinical/non-clinical balance; 2) full use of knowledge, skills and experience; 3) leadership in quality improvement; 4) career progression; and 5) policy, vision and organisation. Gaps between ACPs' expectations and their lived experience of the role were identified. Conclusion: To achieve the expected growth of the ACP role, attention is needed to narrow the gaps between expectations and reality. This includes ringfencing non-clinical activity; enhancing opportunities for professional development, supervision and leadership; providing greater clarity in career planning; and embedding and evaluating efforts to standardise advanced clinical practice.