Assistant Practitioners (APs) in radiography: An exploration of perceptions and experiences related to role development

doi:10.1016/j.radi.2013.11.001

Radiography

Volume 20, Issue 2, May 2014, Pages 137-142

https://doi.org/10.1016/j.radi.2013.11.001 Get rights and content

Abstract

A mixed methods study was undertaken to investigate the role of Assistant Practitioners (APs) in radiography from an AP perspective and to explore how their roles have been integrated into the radiography workforce across England. The quantitative survey was followed by a qualitative study utilising semi-structured interviews, findings of which are presented in this paper. Thirty eight face to face, semi-structured interviews were conducted. Thematic analysis allowed the researcher to report experiences and meanings for APs, through a process of identifying, analysis and reporting patterns.

Three main themes and eight sub-themes emerged from the data analyses. The first theme showed how participants felt the AP role developed over time. AP practice revealed a range of roles and responsibilities which resulted in confusing boundaries. Participants felt uncertain about their future role as APs. The second theme reflected on the factors that influenced the participants' perceptions. Findings showed that the acceptance of APs changed over time. Participants believed that they were competent to perform their roles and responsibilities. The third and final theme focused on the facilitating and constraining factors in AP practice. Supervision was seen as a constraining internal factor highlighting the fact that supervision practices varied across departments. In conclusion findings have identified a need for revised supervisory standards to inform departmental protocols and procedures.

Introduction

The role of the Assistant Practitioner (AP) in radiography was introduced at the turn of the century to create a supportive workforce within radiography. Staff shortages were responsible for strategic redesign¹ of the existing workforce to enable adequate service delivery. Recent studies² have shown the importance of gathering information from APs to gain insight into the improvements to embed the role of the AP effectively. The configuration of a four-tier structure allowed APs to take on some roles that were previously performed by radiographers.³ The Society and College of Radiographers (SCoR)4, 5, 6, 7, 8, 9 have produced a range of publications that focused on the scope of practice and educational requirements for these new AP roles. However, no studies have explored how these guidelines have informed practice and role development for the AP workforce in radiography, from the perspective of the AP.

Section snippets

Review of literature

A national cross sectional study was conducted in 2007 to investigate the implementation of the four-tier structure across radiography.³ Even though findings were descriptive in nature and focused on the role of the radiographer across the four-tier structure it did highlight the introduction of the AP across the workforce. Recommendations suggested tracking the continuing implementation of the four-tier structure to establish the precise nature and scope of the roles across NHS Trusts and

Aim

To explore APs' perceptions and experiences of their role development and integration into the radiography workforce.

Method

The study was conducted over three phases utilising a mixed methods design. Phase I was a scoping exercise in which n = 112 radiography sites employing APs were identified through telephone contact to map the location of APs across England. A survey in Phase II distributed n = 357 questionnaires with a response rate of n = 167 (47%) to investigate the role of APs in radiography. Phase III utilised n = 38 semi-structured qualitative interviews to extend the findings of phase II and explore

Results

Three main themes and eight sub-themes emerged from the data analyses which are presented below. Interview extracts are presented using direct, anonymous quotations which are presented separately in Table 1, Table 2, Table 3. The anonymous quotations are referred to in the text by means of a numbering system designed by the researcher to enable tracking of data extracts. For example RM14, 11–15: the first two letters (RM) relates to the site of interview, followed by the participant number (14)

Discussion

The original ‘Scope of Practice’ for APs in Clinical Imaging⁵ and that of Radiotherapy⁶ was intended as a guidance document that would underline the importance of new roles in the clinical department whilst assisting in service delivery; neither compromising the safety of the patient nor the quality of the care. Guidance5, 6 was released 7 years after the introduction. Assumptions were made that defining work roles in practice were clear-cut. However, findings of the present study revealed the

Recommendations

(i)
Development of a more defined Scope of Practice for APs in which consideration should be given to areas of practice where skilled and trained APs undertake additional roles and responsibilities.
(ii)
Current supervision practices need to be adapted according to an updated framework (including direct and indirect supervision) to ensure standardisation for all areas of practice.
(iii)
Further research is recommended to explore the impact on patient care and patient experience to substantiate the continuing

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Assistant radiographer practitioners: Creating capacity or challenging professional boundaries?
2018, Radiography
Citation Excerpt :
The specific aim of the skill mix strategy was to expand the imaging workforce by implementing a four-tier structure, from assistant to non-medical consultant. This was seen as a way to cope with burgeoning demand, providing a development route for support staff and enabling the expansion of the role of registered radiographers.1–3 Within healthcare, assistant practitioners are defined as:
Over the last 2 decades the assistant radiographer practitioner (ARP) role has been introduced into NHS diagnostic imaging departments as a strategy to expand the workforce and create capacity. This skill mix initiative has not been implemented in a standardised way and there is limited knowledge of the current role scope within general radiography (X-Ray).
An electronic survey of ARPs working within UK diagnostic imaging departments was conducted. Both open and closed questions sought information regarding basic demographic data (age category; gender; geographic region), scope of practice (patient groups; anatomical regions; imaging outside of the diagnostic imaging department), limitations placed on practice, supervision and additional roles.
A total of 108 responses, including 13 trainees, were received. Most sites employ three or less ARPs in general radiography (n = 43/66; 65.2%), although 11 sites have five (range 1–15). The majority undertake imaging of both adults and children (n = 85/108; 78.7%), although limitations on age were described. Their scope of practice covers a broad anatomical range and included some non-ambulant patients. The level of supervision varied with some sites empowering ARPs to check the referral prior to examination (n = 25) or images post acquisition (n = 32) (both n = 20/66; χ² = 16.003; 1df; p = 0.000).
ARPs are helping to maintain capacity in imaging departments but we suggest there is further scope for expansion. The practice described by the post holders suggests that many are working beyond the scope envisaged by the radiography professional body.
Designing a curriculum for the assistant practitioner of the future: Ensuring interprofessional care aspects and other stakeholder requirements are met
2016, Radiography
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The foundation degree offers this group an important opportunity to progress, but there is a distinct lack of information from research about the learners' experiences and aspirations associated with foundation degree programmes. Stewart-Lord, Ballinger and Mclaren38 (2014) acknowledge that competence in radiographic skills can enhance not only other AP skills, but the self confidence of the AP. However, the uncertainty around the boundaries of the AP role persisted, challenging the AP's confidence in their ability. (
The role of the Assistant Practitioner in radiography has been established for over 10 years. Wakefield, Spilsbury, Atkin and McKenna¹³ (2009) describe how the role was originally introduced to overcome a shortage of registered staff at that time. Whilst there are clear overarching descriptions of what the role of the Assistant Practitioner is, Wakefield et al. concluded that there are many interpretations of the role and that there are inconsistencies between employers and subsequent uncertainty in workforce planners. Stewart-Lord, McLaren and Ballinger¹⁸ (2011) also found that there were a variety of roles and responsibilities undertaken by Assistant Practitioners in the field of radiography.
This article outlines the curriculum design process for a foundation degree to develop Assistant Practitioners in diagnostic imaging and the associated challenges faced.
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Assistant Practitioners (APs) in radiography: An exploration of perceptions and experiences related to role development

Abstract

Introduction

Section snippets

Review of literature

Aim

Method

Results

Discussion

Recommendations

Radiography

Radiography

Radiography

Radiography

Radiography

Int J Nurs Stud

Radiography skills mix

A curriculum framework for radiography

The scope of practice of Assistant practitioners in clinical imaging

The scope of practice of APs in radiotherapy

The scope of practice of assistant practitioners in clinical imaging; additional information

The scope of practice of APs in radiotherapy

Scope and practice of Assistant practitioners

Assistant practitioners: issues of accountability, delegation and competence

Int J Ther Rehabil