Introduction and Context
Nurses and midwives in South Africa are educated and trained to function at both entry level and higher level in specific fields of practice. For the purposes of nursing practice, existing nursing education provides for diplomas and advanced diplomas (additional qualifications) that culminate in professional registration with the Nursing Council . For purpose of professional registration, the Council currently does not distinguish between a nurse who obtained the qualification through an advanced diploma qualification and the one who obtained it from a master’s degree. Registration of an additional qualification for a professional nurse is currently dependent on the focus of the additional/specialized discipline, regardless of whether this was obtained through a diploma, a bachelor’s degree, master’s degree or any other qualification. This has resulted in uncertainty about the status and classification of advanced practice nurses in South Africa, and has many implications, some of which impact on remuneration and clinical career-pathing of the advanced practice nurse.

This position statement attempts to address the above uncertainty, changes in the nursing and higher education legislation as well as calls for clarification of the status of nurses practising at an advanced level in the country. This position statement was informed by exploratory and in-depth literature review, both at national and international level as well as focus group discussions with stakeholders.

Evidence has shown that international variations and preferences exist in respect of the title for nurses in this category. These variations are influenced mainly by national context, health needs and legislative framework of different countries. Most of the countries researched subscribe to the International Council of Nurses(ICN) terminology and definition which is explained below. The determining factor that influence the discussion is the fact that professional nurses move from an entry level into the profession, to an advanced level in a specialised field.

Terminology and Definitions
The umbrella term is “Advanced Practice Nurse” (APN), defined by the ICN as follows: ‘’The (APN) is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A master’s degree is recommended for entry level (ICN 2002).

Two predominant categories of the APN are identified:

• Clinical Nurse Specialist (CNS), defined as a person having a qualification in the area of specializing, in-depth knowledge and expertise that enables her/him to focus on facility care and work closely with medical officers on a consultative basis.
• Advanced Nurse Practitioner (ANP), defined as a person who focuses on primary care, health assessment, diagnosis and treatment. This category can work with medical officers on a referral basis. In South Africa, this category is closer to Primary Health Care (PHC) nurse and at time the midwife, psychiatric and paediatric nurse working outside the formal hospital environment.

The view of the International Council for Nurses is that each country should credential nurse categories according to its own context, taking into cognizance its health care system as well as available resources in order to enable the country to model its own level/s of specialisation.

SANC POSITION 
SANC recognizes that beyond a general nurse/midwife practitioner, there is need for the Advanced Practice Nurse.

Within advanced practice nursing should be two levels namely:

• Nurse specialist: This level requires in-depth knowledge and expertise in a specific practice area such as paediatric nursing. To become a nurse specialist would require a post-graduate diploma (PGD) in the specific specialisation. This qualification will yield a professional registration with the Council as a nurse specialist (e.g. nurse specialist: paediatric nursing).
• Advanced Nurse Specialist: This level requires registration with the Council as nurse specialist as an entry requirement. The Advanced Nurse Specialist, in addition to in-depth clinical specialisation knowledge has to acquire broader field dynamics at master’s level e.g. strategic leadership, health service management, research and policy making. The qualification will yield no professional registration but can be logged as an additional qualification with the Council.