Healthcare in the western world is changing, there are increasing demand on health professionals to provide a higher level of care to an ageing population with increased financial pressure. The Australian Medicare Benefits Schedule has not increased to match the cost of providing imaging services and as such efficiencies need to be found in order to provide more services with less resources. The cost of providing imaging services also increase as consumables become more expensive and health professional salaries increase. To cope with these pressures and cost increases health professionals, radiology departments and practices must evolve. As boundaries between health professional groups blur an opportunity emerges for all health professionals to advance their scope of practice.
Advanced practice occurs when a dominant group enables and facilitates a subordinate group to assume responsibility for completing tasks considered less appealing or more basic. With appropriate guidance and mentoring, the health professional in a subordinate or an adjacent position can assume some of the more menial tasks that have been traditionally the responsibility of a different health professional group. For example, nurses have been increasing their scope of practice and advancing their profession informally since the early 1900’s and formally since the mid 1950’s with significant professional advances taking place in the 1980’s and 1990’s with the formal recognition of the nurse practitioner and other specialty roles.
Advanced practice has a number of positive outcomes which include expert clinician retention in the workforce, specialisation, increased patient and outcome focus, leadership and service improvement. There are numerous universities throughout the western world that offer masters level programs with a focus on advanced healthcare practice. These courses aim to provide the resources and support needed for expert clinicians to take the next step in their professional lives within clinical practice. This next step requires research and collaboration skills, a higher post graduate qualification, teaching and leadership as well as communication skills. Monash University in Australia, Birmingham University and University of Colorado are just three international examples of educational institutions with courses that support advanced practice in healthcare.
The medical radiation practice board of Australia (2017) has recognised that the scope of practice for medical radiation practitioners is directly related to the individual’s education, training and professional development. It is in fact the local department or practice’s requirements which will determine the scope of practice for its employees. Formal training and education are required for any medical radiation practitioner to practice above current standard practice capabilities. For medical radiation practitioners to consider fulfilling the minimum capabilities of other health professionals then they should refer to the professional capabilities document for each regulated health profession available on the AHPRA website. With this information, appropriate training and education can be provided by an appropriate professional mentor and the individual’s employer is able to support the advanced practice, ensuring appropriate clinical governance.
The Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) supports advanced practice in Australia. ASMIRT’s Advanced Practice Advisory Panel administer the Advanced Practice Pathway in Australia. It is a formal pathway that recognises Advanced Practice for Australia’s radiographers and radiation therapists. Radiographers and Radiation Therapists who hold Advanced Practitioner certification with ASMIRT are formally recognised and covered with their professional indemnity insurance they obtain via their ASMIRT membership. However, you do not need to be an ASMIRT member to apply for advanced practice certification.
The essential characteristics of an Advanced Practitioner, as defined by ASMIRT (2017) are: expert communication, internal and external collaboration, high level of professionalism, advanced clinical practice, high level of scholarship and teaching, professional judgement based on evaluation of evidence and clinical situation and clinical leadership. These essential characteristics and the evidence supplied in the application for Advanced Practice ensures the rigour of the assessment process.
Expert Communication is an essential requirement for advanced practice, expert clinicians must be able to communication effectively with patients, colleagues and all members of the multidisciplinary team. The advanced practitioner must be capable, confident and able to tailor communication to relay and receive information from patients and health professionals.
Collaboration, both internal and external, are required to ensure that high quality outcomes for patients are achieved. The advanced practitioner must be involved in specific and general collaborative arrangements with individuals and or groups to support their practice. Collaborative practice provides a pro-active and productive relationship focussing on practice improvement and reducing organisational silos to benefit the patient.
Advanced practitioners require a high level of professionalism and advanced clinical expertise. Advanced practice clinicians must be role models for others and therefore must hold themselves to the highest level of professionalism. They must be experts in their field, capable of demonstrating their distinct body of advanced knowledge, their commitment to ethical conduct and professional integrity.
A high level of scholarship and teaching is required by all advanced practitioners; it is standard internationally for all formally recognised advanced practitioners to hold a masters degree. Advanced practitioners acknowledge the need for continuous research, analysis, learning and improvement. They facilitate education and training for others in their field of speciality and support a learning culture within their workplace and profession.
Advanced practitioners must be able to execute professional judgement based on evaluation of evidence and clinical situations. The advanced practitioner must be able to review a clinical situation and with a strong research ability, be able to examine and recommend appropriate action and follow up. Research and contribution to the professional literature, critical reflection and remaining informed of current knowledge and practice are all essential for appropriate professional judgement for the advanced practitioner.
The final essential characteristic of the advanced practitioner as defined by ASMIRT (2017) is clinical leadership. Advanced practice furthers our profession and leadership skills are required to do this. Advanced practitioners are able to influence and lead change, sharing their vision and working with others to build professional relationships. Advanced practitioners are caring, trustworthy and ensure others have confidence in their abilities whilst leading their clinical specialty.
The radiographer advanced practice role has become an integral part of the National Health System in the United Kingdom (UK), with thousands of radiographers currently employed in advanced practice. In the UK, radiographic advanced practice is often associated with the delegation of practice roles traditionally performed by a radiologist. The significant shortage of radiologists in the UK has led to radiographer advanced practice, specifically in the field of radiographer reporting. In countries where there is not a shortage of radiologists advanced practice is still possible and beneficial. As previously mentioned, advanced practice is born out of individual local needs of a department or practice and therefore advanced practice is able to occur anywhere, however, local support and appropriate resources are required.
Advanced practice for radiographers can occur in any department or practice, it all depends on what is locally required and supported both with appropriate training and resources and with suitable clinical governance by the employer. The types of avenues for advanced practice may include scopes of practice that have traditionally belonged to the radiologist (eg. image interpretation, triaging examinations, basic interventional procedures such as PICC line or Naso-Gastric tube insertion, barium studies etc.), radiology registrar (eg. prescribing contrast along with CT and MRI protocols), medical physicist (eg. radiation dose optimisation) and nurse (eg. aseptic procedural assistance, patient preparation or post procedural care).
There are many avenues available for radiographers to advance professionally, reducing healthcare costs, improving efficiencies, supporting retention of expert clinicians and patient care. The future of advanced practice for radiographers is in the hands of the current and future radiographers, it is our enthusiasm, passion and perseverance that will enable advanced practice for radiographers to expand and flourish. Advanced practice benefits the healthcare industry, the practitioner and most importantly the patient. Australia currently has a number of ASMIRT certified advanced practice radiation therapists, but we do not have a locally practicing advanced practice radiographer. I look forward to the day when we do have formally recognised advanced practice radiographers working in Australia, a change is coming and it is an exciting time to be a radiographer, the future of our profession is in our hands.
Australian Society of Medical Imaging and Radiation Therapy, February 2017, “Pathway to Advanced Practice Summary document and guidelines for application for credentialing”, viewed 10 January 2018, http://www.asmirt.org/cms_files/09_AdvancedPractice/ASMIRT_Pathway_to_Advanced_Practice_Summary_Guidelines_Feb%202017.pdf
Medical Radiation Practice Board of Australia, December 2017, “To advance your scope of practice is to advance your skill set”, News, Issue 17, viewed 20 December 2017, http://www.medicalradiationpracticeboard.gov.au/News/Newsletters/December-2017.aspx