How do Advanced Clinical Practitioners make sense of, and shape, their newly established roles? A Case Study

Abstract

Background:
This study aimed to explore how Advanced Clinical Practitioners (ACP) moving into a new role about which there is a lack of clarity, shape and evolve the role so that it is meaningful both to themselves and to their team members. This took place within the context of the NHS recommendations for a broader, more multidisciplinary care team approach to providing patient care. These recommendations promoted expanded roles for non-medical practitioners such as nurses, paramedics, and pharmacists to address workforce shortages and support service transformation by improving capacity and efficiency within multidisciplinary professional teams.
The study was conducted using observations which took place in an A&E department for 3 months from January 2023 to March 2023, and 16 participants interviews during which data were collected from doctors, nurses, managers and ACPs working in the accident and emergency department. Using this qualitative design, the study gave equal importance to both observations and interviews. These methods were used in a complementary way, enabling a deeper understanding of both everyday practice and participant perspective on how the role evolves in the absence of clear regulations.
The findings show how ACPs actively negotiate and shape their roles within clinical teams, balancing organisational expectations with local service needs, therefore showing a nuanced account of how ACPs make sense of and shape a relatively new and evolving role within a complex healthcare system.
The findings demonstrate that ACP practice is constituted through a dynamic interplay between organisational structures and interactional processes. While existing literature has emphasised ambiguity arising from limited standardisation, unclear frameworks, and blurred professional boundaries, this study extends existing understanding by showing that such ambiguity is not merely a structural constraint but an ongoing, productive feature of practice. At the same time, organisational factors, including mentorship and evolving role expectations, both enable and constrain this process, shaping the role’s evolution over time. Importantly, the study identifies both the vulnerability and value of the ACP role, which is susceptible to misunderstanding and structural inconsistency. ACPs simultaneously contribute a distinctive, adaptive capacity that enhances multidisciplinary practice. Collectively, these findings offer to knowledge by reconceptualising ACP role evolution as a multi-level interactionally accomplished process in which the role is not fixed but continually produced, negotiated and legitimised in practice.

Date of Award	24 Jun 2026
Original language	English
Awarding Institution	University of Bath
Supervisor	Nancy Harding (Supervisor)