RCN defines levels of nursing beyond registration

The RCN's newly defined levels of nursing reflect the safety-critical role our profession holds. They are one element of the RCN professional framework, and underpinned by our definition and principles of nursing, which were revised and published last year.  

Although advanced level nursing is widely recognised, it has lacked a consistent definition, remains unregulated and covers a wide range of roles and titles. To reflect this, we have updated our own definitions and added a new definition – of consultant level nursing. We have also defined the newer concept of enhanced level nursing. 

Read more about the levels 

These definitions and standards bring clarity and consistency to the levels of nursing practice beyond that which defines the registered nurse. With shared language, we can remove ambiguity that can limit nursing staff throughout their careers. In addition, employers, service users and other health care professionals can recognise the varying complexities of nursing practice. 

The levels consider our workforce of registered nurses, with work still ongoing for our nursing support workers. When finalised, this will include assistant practitioners and registered nursing associate roles.  

The levels we’re launching new definitions today on are: 

• Enhanced – Enhanced level nursing describes a level that can only be delivered by registered nurses who have gained additional post-registration education and experiential learning in a relevant subject area.  
  
  This level is differentiated from other levels by a registered nurse’s expertise in applying specific knowledge and skills to a designated area, such as a client group, skill set or in an organisational context. Nurses working at the enhanced level should know how to manage discrete activities in complex, challenging and changing situations, seeking further guidance when needed.  

• Advanced – Advanced level nursing is a level delivered by registered nurses with substantial experience and expertise. 
  
  The advanced level is differentiated from other levels by a registered nurse’s expertise in applying highly developed theoretical and practical knowledge to complex, unpredictable, and sometimes unfamiliar situations. This involves use of critical thinking, high-level decision making and exercising professional judgement. The RCN strongly supports the ongoing development of nurses working at the advanced level across all areas related to health and social care.  
  
  
• Consultant – Consultant level nursing describes a level of nursing delivered by registered nurses who have progressed from an advanced level within their field or specialty. 
  
  It is differentiated from other levels by a registered nurse’s expertise and credibility; strategic and enabling leadership; learning, developing, and improving across the system; research and innovation as an embedded researcher; and underpinning consultancy as the foundations of putting expertise in place to sustain quality.  

Rachel Hollis, Chair of the RCN Professional Nursing Committee that is overseeing the development of the professional framework, said: “This framework will encompass the whole nursing workforce, from the nursing support worker through to the consultant nurse. 

“The Nursing and Midwifery Council sets the standards of proficiency for the registered nurse, and the knowledge, skills, and behaviours that all nurses must have at the point of registration. 

“Beyond the point of registration, the work of the registered nurse increases in its complexity. This is inconsistently and poorly recognised by employers, policy makers, and the public. We set out to change this, and a working group, made up of expert members and staff from the RCN nursing department have come together to clarify and bring consistency to the levels of nursing practice." 

The standards developed alongside each level definition are aligned to the four pillars of nursing – clinical, research, education and leadership.