A mixed-method study using a sequential, cross-sectional, exploratory design to determine Advanced Clinical Practitioners expectations of the benefits in pursuing this role, whether these are being realised and the associated factors for this.

• Background Advanced Practitioners (ACPs) have been utilised worldwide to reform health services to address population needs. However, previous research identifies barriers which prevent the effective implementation of ACPs. • Aims To better understand the expectations ACPs have regarding the role, and to evaluate whether they are currently being met so that focused educational and policy initiatives can be developed to reduce gaps between expectation and reality. • Methods This on-line cross-sectional study uses a sequential, mixed method, exploratory design where themes were created from focus groups to construct a follow up questionnaire. 291 UK participants were recruited via social media and ACP educational and policy networks. Exploratory data and reflexive thematic analysis were employed to probe and visualise results, drawing findings together into narrative synthesis. • Findings This research provides insight from a diverse group of ACPs of their current lived experiences, aspirations, and driving forces to come into or stay working in the role. Five themes were constructed from focus group discussions. 1) clinical/ non-clinical balance, 2) full use of knowledge, skills and experience, 3) leadership in quality improvement, 4) career progression and 5) policy, vision, and organisation. Gaps between ACPs expectations and their lived experience of the role were identified. • Conclusion To achieve the expected growth of ACP, attention is needed on narrowing the gaps between the expectation and reality of working in this role. This includes ring fencing non-clinical activity, enhancing opportunities for professional development, supervision, and leadership, providing greater clarity in career planning, and embedding and evaluating efforts to standardise ACP.