Strengthening Health systems with the utilisation of advanced practice nurses- a global perspective

Advance Practice Nurses, policy makers and researchers at the ICN Congress Montreal , Canada, June 2023

Researchers, who conducted the first-ever study on advanced practice certification programs worldwide, held a policy forum at the recent International council of Nurses’ Congress in Montreal, Canada, to discuss the need to develop and strengthen health systems through the integration of advanced practice nurses (APNs) working in specialty areas of practice.

The study, Certification of Specialty Practice for Advanced Practice Nursing Roles, comprised of a scoping review of published literature and key informant interviews with 72 participants from 25 countries.

The results showed that despite the heightened demand for APNs to address increasingly specialised and complex patient healthcare needs, there was a lack of systematic approaches, understanding of best practices and education globally.

The researchers said the study’s findings would help to provide strategic guidance for strengthening the specialty and APN workforce at national and international levels.

Speaking to around 60 APNs from around the world at the Congress, Daniela Lehwaldt, Chair of the ICN and ICN Advanced Practice Nursing Network, based in Dublin, said the ICN was working to strengthen the specialty and had already published some guidelines on advanced nurses.

However, Ms Lehwaldt pointed out that there was much more to be done.

Outlining some of the issues and complexities, Ms Lehwaldt said from a global perspective, advanced practice nursing developments were different depending on where you were in the world.

“There are hundreds of titles in different countries,” she said, adding that the title advanced nurse did not always translate well into different languages.

“[For example], somebody from Spain explained to me that advanced nurse translated into Spanish meant more like a commoner,” Ms Lehwaldt said.

“So basically, what we are trying to work on with the ICN and the network is a common understanding of what it actually is that we mean by advanced practice nurse.”

Ms Lehwaldt explained that while titles were important, knowing what they actually meant was also imperative.

“It’s about having this common understanding amongst ourselves and for the regulators, policy decision-makers, and clinicians to know who we are. This is so we can translate it into a common, consistent picture so that at the end of the day, we know what an advanced nurse is because, at the moment, I don’t actually think we quite know that yet. “

Further, Ms Lehwaldt said there was also the question of what was meant by speciality and where that speciality is located.

“Are they located in medicine, in nursing, or at the point of primary care, the point of acute care? What do we mean by specialty? I think that’s something we need to think about. And again, it’s about having this common understanding amongst ourselves and for the regulators, policy decision-makers, and clinicians to know who we actually are.”

Adding to the complexity of a global understanding, Ms Lehwaldt said it was necessary to look at the priorities of each country.

“Some countries have certain areas [of need], such as addressing chronic diseases, where in  others chronic diseases are not an issue,” she said.

“Maybe the need is acute care which needs to be covered. Maybe maternity, maybe women’s health, maybe there are gender issues, societal issues that need to be taken into context.

“So there are many things that we actually need to worry about here. So I think as a recommendation, is we need to look country-wide at what the needs are in terms of specialty.”

Adding to the discussion Leigh Chapman, Chief Nurse of Canada, said advanced practice nursing was very top of mind in her country but that there was a need to integrate APNs into the health system better and a provision for adequate education and funding for the speciality.

“Federally, there’s a real interest in career laddering opportunities, and when we think about nursing integration into the workforce, having options, for nurses to think about where they may want to specialise and what they may want to do. Advanced and graduate education is really critical, but it is also important to integrate them into the workplace,” she said.

“So I think in terms of some of the policy areas, we need to certainly think about research and education as well as policy and then practice the integration into the workforce into the workplace. And I think this is a key retention strategy for nurses to think about where they will be able to practice,” Ms Chapman said.

The business and policy case for advanced practice nurses also needed to be robust, Ms Chapman added.

“One example in Canada is the implementation of physician assistants instead of nurse practitioners or advanced practice nurses. And in Canada physician assistants are unregulated, but there’s a real interest in increasing access with physician assistants as opposed to advancing APNs.

“So the business case [for APNS] must be very strong to sway the political side from the sometimes tendency towards medical dominance. But we also need robust workforce planning.”

To increase the case for advancing ANPs, Ms Chapman said it was essential to harmonise not just within Canada, across the provinces and territories on advanced practice nursing but also working with ICN and harmonising internationally.

“This will help workforce planning and that business case more and more in Canada.”

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