Introduction and Aims During a period of reduced medical staffing, the Hospice appointed an experienced Hospice Sister in the novel role of a mid-level practitioner on the inpatient unit. The role entailed working alongside the medical team, assisting with clinical reviews and designated tasks previously undertaken by doctors.

A 6 month project piloted the role and made recommendations about future options.

Methods A literature review gathered information on Physician Assistants (PA) and Advanced Nurse Practitioners (ANP).

20 staff were surveyed to ascertain views about the role.

The experiences of 3 ANPs working in different settings/specialties were explored to further understand the potential variety and development of such roles within multidisciplinary teams.

Results We describe and compare different aspects of the roles of PAs and ANPs: the historical context, training, roles, revalidation and salaries.

The key findings of the staff survey are highlighted. The majority of respondents felt the role was of ‘great value’ to the team, to patients and to families.

Improvements were perceived in prioritisation of medical time, continuity of care, psychological and spiritual care of families and carers, communication between medical and nursing/AHP teams and flexibility of roles more widely within the team.

90% of staff surveyed thought it would be ’extremely useful’ to have the role continue.

Discussion and conclusion In our experience, a Senior Sister working as a dependent practitioner alongside the medical team has worked well. However, in order to optimise the potential for this role, additional training is required.

ANPs appear to provide the best option overall for a mid level practitioner in a Hospice setting. The main advantages over a PA are: ability to prescribe, availability of accredited training, autonomy of the role and familiarity of staff and patients with the title and role in other contexts.