Canadian Nurses Association, 2013 DOES REGULATION OF ADVANCED
NURSING PRACTICE ROLES ASSIST IN FUTURE GLOBAL DEVELOPMENT Rachel
Bard ICN 25 th Quadrennial Congress Melbourne, Australia, 18 to 23
May, 2013
Slide 2
Outline Introduction Methodology Demographics Regulation of
roles Education Requirements to practice Scope of practice Themes
Discussion
Slide 3
Introduction Background INP/APNN subgroups Pulcini et al 2010
Regulatory Framework
Slide 4
Advanced Practice Nurse A registered nurse who has acquired the
expert knowledge base, complex decision-making skills and clinical
competencies for expanded practice, the characteristics of which
are shaped by the context and/or country in which s/he is
credentialed to practice. A master's degree is recommended for
entry level. International Council of Nurses
Slide 5
Literature Development of APN roles is a global trend (Bryant,
2005) Developed to meet specific needs such as shortages in human
health resources or to address emerging health needs of the
population (ICN, 2008). There is wide variation of APN scope of
practice, education requirements, regulation worldwide (ICN,
2009).
Slide 6
Background Little opportunity for INP/APNN to focus on
regulatory issues in past Particular student interest in
international APN work Challenges globally around the regulation of
APNs
Slide 7
Background Regulation of professional practice is important.
legitimacy through credentialing defines scope of practice,
authorizes clinical tasks and entry requirements helps to ensure
safe and competent practice (Gummer, 1984; Morrison & Benton,
2010; Bryant, 2005).
Slide 8
Methodology International on-line survey Ethics approval
Convenience sample (snowball) Invitation to ICN member countries
Individual recruitment
Slide 9
Survey Development Coordination of information and resources:
Literature 2007 survey by Pulcini et al Consultations: INP/APNN
Core Steering Group INP/APNN Education/Practice Subgroup Health
Policy Subgroup ICN Regulatory Consultant McMaster and Laurentian
Universities, Ontario, Canada 9
Slide 10
Survey Categories General Information Types of APNs Regulation
of roles Education Requirements to practice Scope of practice
Slide 11
Countries Represented in the APN Survey (n=36) Angola Australia
Austria Bahamas Bolivia Botswana Bulgaria Canada Congo, Democratic
Republic of Finland France Gambia, The Greece Iran, Islamic
Republic of Ireland, Republic of Italy Japan Lebanon Malaysia
Mongolia Netherlands New Zealand Poland Sierra Leone Singapore
Spain Sri Lanka Suriname Switzerland Taiwan Tanzania Thailand Togo
Trinidad and Tobago United Kingdom United States
Slide 12
APNs identified NP: 16 countries APN: 12 countries CNS: 18
countries NS: 15 countries Nurse midwives: 2 countries Nurse
anesthetist: 2 countries Clinical nurse consultant: 1 country No
APN role: 4 countries
Slide 13
Slide 14
Regulation of Roles NPs with regulation = 8 (n=15) APN = 5
(n=11) CNS = 4 (n=14) NS = 6 (n=10) Nurse midwives = 2 (n=2)
Clinical Nurse Consultant = 1; not regulated APN roles with
regulation (25) 16 are regulated by federal legislation 9 by
individual jurisdiction (2/3 vs. 1/3)
Slide 15
Educational Requirements 42 (n=52) roles identified across all
the countries require a minimum level of education Educational
requirements ranged from: post basic certificate (non-academic)
baccalaureate masters post masters certificate and doctorate 25
(N=52) require masters preparation
Slide 16
Practice Requirements Title protection =19 (n=48) Licensing
exam = 20 (n=49) yes 4 = varies by jurisdiction Of the
credentialing mechanisms required, an approved education program
was the most commonly cited
Slide 17
Scope of Practice N=47 Diagnosing = 30 Prescribe = 18 Order
Diagnostic Tests = 20 Admit to Hospital = 16 Refer to other health
care providers = 31 Practice without physician supervision = 20
Performs practice independently = 27
Slide 18
Two Open-Ended Questions Has there been opposition to the
regulation of this type of APN role in your country? The majority
responded no. When there was opposition, most identified opposition
from physicians and medical organizations. A few mentioned
opposition to APN roles in some countries by pharmacists,
government and administrations.
Slide 19
Second Question What barriers in your country prevent those in
this type of APN role from functioning to full scope of
practice?
Slide 20
Themes Legislation limitations Patients are reimbursed less for
prescriptions from an NP than from a physician Limited prescribing
list Federal and provincial legislative barriers Lack of nursing
representation in policy development Lack of title protection Lack
of regulation
Slide 21
Themes Education Limited accessibility to APN programs No
accreditation of APN programs Opposition Other health care
providers Requirement of physician supervision
Slide 22
Themes Lack of Leadership Government Nurse leaders No strategic
leadership at different levels Lack of recognition of advanced
roles Lack of standardization (of competencies) Lack of political
strength of nurses
Slide 23
Themes Health Human Resources Working conditions Low
remuneration Lack of facilities Expectations to work beyond scope
of practice Unable to work to full scope of practice Disparities in
APN roles between health care settings Lack of understanding of the
APN role
Slide 24
Themes Economy Health System is designed to a Medical Model
Societal Status of Women APN role development in infancy in many
countries
Slide 25
Limitations Timelines of survey Language and nomenclature
Technology Conflicting responses from one country Determining the
appropriate sample Incomplete survey responses
Slide 26
Discussion Differences in nomenclature (as noted in previous
studies) Multiple APN roles in many countries, often with quite
different credentialing criteria Wide variation in regulation
globally
Slide 27
APNs and Health Policy It is important that nursestake every
opportunity to influence events and contribute to policy debates,
which determine or affect the context of their professional
practice. In this way, they can become agents of constructive
change for public benefit and professional growth, rather than
passive victims of potentially destructive change proposed and
promoted by others (ICN, 2009, p. 21).
Slide 28
ICN & INPAPNN Global database Continue APN regulation
research Country to country, peer-support Access to skill-building
for policy development
Slide 29
References Bryant, R. (2005). Regulation, roles and competency
development. International Council of Nurses. Gaumer, G. (1984).
Regulating health care professionals: A review of the empirical
literature. The Milbank Memorial Fund Quarterly. Health and
Society, 62(3), 380-416. International Council of Nurses. (2008).
The scope of practice, standards and competencies of the advanced
practice nurse. ICN Regulation Series. ICN: Geneva, Switzerland.
International Council of Nurses. (2009). Regulation 2020:
Exploration of the present; Vision for the future. ICN Regulation
Series. ICN: Geneva, Switzerland. Morrison, A., & Benton, D. C.
(2010). Analyzing nursing regulation worldwide. Journal of Nursing
Regulation. 1(1), 44- 48.
Slide 30
Canadian Nurses Association, 2013 Photo credits : Thank
you