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Whilst supporting new roles, the framework presented offers a wider dimension for enhancing organizational thinking and working practices. It is open to debate, which would be welcomed by the authors, yet provides a challenge to health care organizations in assessing how integrated their systems are in meeting its business, aspirations and new targets.

The last 10 years has seen a surge in the development of academic pre- and postregistration courses. With the movement of colleges of nursing and midwifery into higher education it has become difficult for lecturers of nursing to remain engaged in clinical practice. However, the professional bodies, the students themselves and their employers expect lecturers of nursing to be clinically able, clinically credible and knowledgeable about contemporary practice in order to produce practitioners who are 'fit for purpose'. This article outlines one innovative approach employed by an educational organization to enable lecturers of postregistration specialist nursing programmes to achieve clinical credibility by undertaking a minimum of 300 contracted hours of clinical experience. This approach was found to be beneficial to the lecturers, the students and the ongoing relationships between the trusts and the department of nursing.

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The UKCC has recently released its consultation document on a higher level of practice (UKCC, 1998). The proposals include setting a UK-wide generic standard for a higher level of practice, a mechanism of marking practitioners who reach this level with a prefix letter after their initial registration, introducing a system of assessment based on current competence and future development plans and the initiation of a charge for the whole process.