Advanced Practice Toolkit 

5. Moving into independent practice 

TIP: Consider the emotional impact of transition into independent practice and offer, at a minimum, supportive mentorship. 
TIP: Encourage access to regional and national advanced practice updates and forums. 
Advanced practice is characterised by greater professional autonomy [e.g. 25; 29; 42], with a higher level of uncertainty, faster pace and greater level of responsibility than previously held [32]. New Advanced Practitioners may be “daunted” by this, and GPs have reported that Advanced Practitioners are more risk averse compared to doctors [32]. 
Moving into advanced practice involves multiple transitions [37; 48]. As well as transition from trainee to independent practice, there are transitions from their origin profession, with its own unspoken norms and written codes of conduct, transitions within different settings whilst training, to being an Advanced Practitioner with a different role and responsibilities. Woods et al [48] highlight that people can develop a sense of liminality and isolation whilst transitioning into advanced practice roles, being viewed as a nurse by doctors, but being asked to leave some nursing norms, routines and culture behind, and no longer being viewed as part of the nursing team by nurses. There is no reason to assume this is different for people from other background professions. 
Several studies found a temporary loss of confidence [37], feelings of being a fraud [30], stress, distress and vulnerability [30] and a loss of professional identity [30; 37]. These were compounded where role boundaries were unclear, and some professionals felt that “falling back on” previous professional experience offered comfort but a false sense of security due to the wide range of potential previous experiences that Advanced Practitioners may have [29; 37]. Hulse et al [20] highlight specific preparedness issues in practical procedures and image interpretation, compared with health assessment or chronic illness management, for example, but do not state whether this is a lack of skills, emergent skills or a lack of confidence. 
Where resources are available, studies have shown that transition can be supported by: 
specialist mentorship, with commitment to support the full transition into advanced practice [20; 44] 
longer appointment slots until the advanced practitioner gains experience [10] 
considering designing specific transition roles, such as Fellowships [20]. 
Even where this is not possible, well-structured clinical supervision must be offered and peer support networks can be helpful. Access and membership of the Nottinghamshire Primary Care Advanced Practice network (Community of Practice) can be achieved via the Nottinghamshire Alliance Training Hub. 
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