title: An ethnographic study exploring the role of ward-based Advanced Nurse Practitioners in an acute medical setting.
abstract: OBJECTIVE
  This article is a report of a study that aimed to examine the role of ward-based Advanced Nurse Practitioners and their impact on patient care and nursing practice.
  
  
  BACKGROUND
  Revised doctor/nurse skill mix combined with a focus on improving quality of care while reducing costs has had an impact on healthcare delivery in the western world. Diverse advanced nursing practice roles have developed and their function has varied globally over the last decade. However, roles and expectations for ward-based Advanced Nurse Practitioners lack clarity, which may hinder effective contribution to practice.
  
  
  METHODS
  An ethnographic approach was used to explore the advanced nurse practitioner role.
  
  
  METHODS
  Participant observation and interviews of five ward-based Advanced Nurse Practitioners working in a large teaching hospital in the North West of England during 2009 were complemented by formal and informal interviews with staff and patients. Data were descriptive and broken down into themes, patterns and processes to enable interpretation and explanation.
  
  
  RESULTS
  The overarching concept that ran through data analysis was that of Advanced Nurse Practitioners as a lynchpin, using their considerable expertise, networks and insider knowledge of health care not only to facilitate patient care but to develop a pivotal role facilitating nursing and medical practice. Sub-themes included enhancing communication and practice, acting as a role model, facilitating the patients' journey and pioneering the role.
  
  
  CONCLUSIONS
  Ward-based Advanced Nurse Practitioners are pivotal and necessary for providing quality holistic patient care and their role can be defined as more than junior doctor substitutes.
authors.affiliation: School of Health, University of Central Lancashire, Preston, UK. swilliamson2@uclan.ac.uk
authors.forename: Susan
authors.initials: S
authors.lastname: Williamson
authors.forename: Timothy
authors.initials: T
authors.lastname: Twelvetree
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Thompson
authors.forename: Kinta
authors.initials: K
authors.lastname: Beaver
mesh_terms: D057179:Advanced Practice Nursing; D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004739:England; D005260:Female; D018939:Holistic Nursing; D006784:Hospitals, Teaching; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D009722:Nurse Practitioners; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015399:Nursing Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000523:psychology; D036301:Qualitative Research; D011787:Quality of Health Care; D013222:State Medicine / Q000458:organization & administration