For the first time, the RCN has set out clear definitions and standards for each level beyond the point of registration – enhanced, advanced and consultant. Here’s what these definitions and standards say, and a look at how you can use them to help advance your career.

Advanced nursing is defined as a level of nursing that can only be delivered by registered nurses with substantial experience or expertise

Picture credit: Tim George

What are the differences between enhanced, advanced and consultant levels?

The RCN says it wants the definitions to bring clarity and consistency to the different levels nurses work at as they gain experience and expertise. Each of the levels is mapped against the four pillars of nursing:

The definitions say enhanced level can only be delivered by nurses who have gained additional post-registration education and experiential learning on the job. It requires working with a high level of autonomy and sharing knowledge, including mentoring.

RCN nursing workforce professional lead Lena Johnson says this is a large grouping and basically describes any nurse a few years into their career who has completed their preceptorship and done some extra training and development.

‘A staff nurse, for example, who is taking charge of other staff and taking responsibility for care on the ward is working at an enhanced level,’ she says.

In comparison, advanced nursing is a term that is more widely recognised, but the RCN says there is not always consensus or consistency in how the title is used.

Advanced nursing is defined as a level of nursing that can only be delivered by registered nurses with substantial experience or expertise. A master’s qualification or equivalent is required.

It involves applying highly developed knowledge to complex, unpredictable and unfamiliar situations, and demonstrating high-level decision-making and judgement.

The RCN says the definition should complement the work that the Nursing and Midwifery Council is doing on creating a system of regulation for advanced practice.

Meanwhile, a consultant nurse has to demonstrate all this and more. They should act as an ‘expert’ in their area of practice, leading the development of services and new ways of working.

How can nurses use the RCN’s levels of practice definitions?

Ms Johnson says the definitions have been designed to be of practical help to nurses at every level across the full range of settings.

‘We want this to give newly qualified nurses a roadmap for their careers,’ she says. ‘We want them to be ambitious and to see how nursing careers progress with experience and training.

‘Too often advanced nursing and consultant nursing is seen as being out of reach – or something that takes 20 years or more to get to.

‘But working at an advanced level is something that should be achievable within five to ten years of qualifying, having undertaken additional training, education and expertise. And while becoming a consultant nurse is, of course, not for everyone, it should be seen as achievable for those who want to.’

She says to assess where they are at, nurses should look at what they are doing and consider how this relates to the standards at each level. ‘For example, a hospital staff nurse is demonstrating leadership when they are taking a lead role on a shift and also in education when they mentor newly qualified nurses.

‘But this isn’t just about clinical settings. We have nurses in education, leadership and research, too. In research, you may start off taking samples and then progress on to leading research – that’s a nurse working at an advanced level.’

Will definitions of nursing practice levels help with pay?

While the levels of practice are not mapped to pay bands, RCN professional nursing committee chair Rachel Hollis says nurses can still use them to make the case for higher pay.

‘We didn’t map them to pay because they do not relate to specific nursing roles and we wanted the levels to apply to all settings – whether in the NHS or in other settings, such as community and social care, where Agenda for Change (AfC) bandings may not even be used.

‘But NHS nurses can certainly use them to make the case for pay. They provide clarity on what practice looks like at each level.

‘So if you are an experienced staff nurse at the top of pay band 5, which is common, you can demonstrate that you are indeed working at an enhanced level and that this should be reflected in your salary.

‘Or if you are a clinical nurse specialist it is clear with these definitions that you are likely to be working at an advanced level and should be remunerated as such – generally above band 6.

‘Lots of expert and experienced nurses are in that position – just because they haven’t got advanced nurse in their title it doesn’t mean they are not working at an advanced level.

‘We also want employers to use the definitions when they are reviewing jobs and mapping them to pay. It’s not just for the individual nurse to make the case – good employers will want to recognise the responsibilities of the staff they are employing.’

What about non-NHS nurses?

Ms Hollis hopes the definitions will help those working outside of the NHS even though they are not on the AfC contract.

‘There are many nurses working in social care in particular, who may be working at enhanced and advanced levels with significant responsibilities – and this will hopefully help them get their employers to recognise that,’ she says.

The publication of the definitions should also be helpful to general practice nurses, for whom ‘pay often comes down to how good you are at negotiating,’ says RCN general practice nursing forum member Sarah Hall.

‘There’s not the clear banding structure that AfC nurses have,’ she says. ‘So this is really good for general practice nurses as it lays down a clear structure and pathway. It should allow them to negotiate better pay and have their experience and skills acknowledged.

‘We have advanced nurse practitioners in general practice, but a lot of really experienced general practice nurses do not want to go down that route. It takes them away from general practice nursing and into the more acute, on-the-day care.

‘But they do want their skills and expertise recognised. There are nurses, such as lead general practice nurses and those specialising in long-term conditions running clinics and doing annual reviews, but stuck on what is equivalent to band 6 pay.

‘They can now use this to make their case – and I would suggest if your employer is not receptive, you should think about looking for another job. Experienced general practice nurses are in short supply – you hold all the cards.’

Further information

RCN (2024) The Levels of Nursing: Setting Definitions and Standards for Nursing Practice Beyond Registration. www.rcn.org.uk/Professional-Development/Levels-of-nursing