Abstract
'This article describes the attempts of a joint working group (Box 1) to define what is meant by levels of practice within orthopaedic and pain management nursing, and to generate discussion among nurses. The group has produced a grid system which they believe successfully links practice level to academic ability At present, the nursing profession has not developed sufficiently to be able to offer a definitive framework for determining the level at which a nurse is practising. For example, the profession is unable to provide concise, valid and reliable definitions for diploma-level practice or advanced practice.

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