[The debate on the development of advanced competences]

. The debate on the development of advanced nursing competences. The dossier aims to describe and disentagle the present Italian and international debate on the development and recognition of advanced nursing competences. Following a general brief description of the legislative national background, the attention is first of all focused on the lack of clarity on the definition of advanced competence, which is further complicated by the issue of their formal, contractual and economic recognition. To explore these issues a list of contributions is presented and some proposals are formulated to favor a better oriented development of the debate: a. A convenience sample of 139 nurses were interviewed asking to describe problems occurred in the last month that could prompt the intervention of an expert nurse and to list the clinical, managerial and educational competences of a specialized nurse in their ward. The results document the quality and the dispersion of the definitions which are perceived and applied in the general settings of care. b. The issue the post basic courses (master, specialization) offered to nurses in 2015-2016 by Italian universities were described and their aims. While the contribution of the courses in increasing the theoretical knowledge is well defined, the aims and the description of the clinical training are badly developed and an acquisition of advanced competences would seem unlikely. c. The definition of advanced competences was explored in the international literature: while evidences are available on the impact of advanced nursing on patients' outcomes, what is advanced nursing is far from being clear, and an impressive list of roles, activities and functions are considered advanced. d. Although at national level there is no formal recognition for nurses with advanced competences (with the exception of the head nurse that holds mostly an organizational rather than clinical role), the opportunities for promoting the role of specialistic/advanced nurses were described. An interview to 20 nursing managers representing 23 Italian hospitals and districts shows the huge variability of what is recognized and considered specialistic/advanced competence. Competences in stoma care, venous catheters, pressure sores, do not necessarily cover the concept of advanced competence. e. Two further contributions explore how the challenge of what is ill-defined (or cannot be defined) can be transformed in a methodological opportunity and how the growth of an health profession may break the delicate balance of the boundaries between professions.