Advanced Practice Nursing in Finland

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*Finland will allow transferral of RN licensure from various parts of the EU (FNA)
Not able to find information regarding transferral of advanced practice degrees

Contact:
Finnish Nurses Association
Terveydenhuollon Oikeusturvakeskus (National Authority for Medico-Legal Affairs)

Role

The role of the Advanced Practice Nurse has developed over the years in Finland.  The initial discussions of advancing nursing practice in Finland started in the 1980’s (FNA, 2018).  Over time the advanced practice nursing role grew to two chief roles, that of the Advanced Nurse and Public Health Nurse, both of which were prepared with graduated level schooling (Delamaire & Lafortune, 2010).

Starting in 2001, the first Clinical Nurse Specialists (CNS) started practicing at the Helsinki University Hospital (FNA, 2018, p.29).  Since then the CNS role has grown significantly.  Meanwhile need to improve access for health care services for an aging population has promoted the advancement of the Nurse Practitioner role (NP / APN Network, 2017).

Meanwhile, Delamaire and Lafortune (2010), reported that Finland was of the top nations with the highest number of nurses per 1000 people in the country at 15.5; thus indicating a surplus of nurses.  Meanwhile, they indicated that Finland held a mildly below average ratio of doctors per capita (2.7 to 1000 people; European average was 2.8) (Delamaire & Lafortune, 2010).  As a result, Finland presents itself as good place to further develop the Advanced Practice Nursing role, with a higher ratio of nurses and a lower number of doctors per capita, similar to that of the United States and United Kingdom (Delamaire & Lafortune, 2010).

Specialties and Education

APNs have been working in various roles including rural healthcare, general practice, and acute care (Delamaire & Lafortune, 2010, FNA, 2018).  As described above, the roles of CNS and Nurse Practitioner are prevalent, but in addition to these registered nurses in Finland have the choice of specializing in various categories nearing graduation of nursing school in acute care, geriatric care, mental health, multi-cultural, pediatrics, palliative care and youth and adolescent care (Robinson & Griffiths, 2007, NP / APN Network, 2017).  Additionally, an individual can choose to be a nurse midwife with an additional year of schooling (Robinson & Griffiths, 2007).

Education for Advanced Practice Nurses in Finland produced it’s first graduates in 2006 (DeGeest et al., 2008; Fagerström & Glasberg, 2011).  Education for the registered nurse is comparable to various other EU nations, usually requires a bachelor degree typically taking 3.5 years, and 4 years for the public health nurse (Robinson & Griffiths, 2007; FNA, 2018).  The advanced degrees are available afterward to those who desire further advancement in scope of practice at the graduate level (Delamaire & Lafortune, 2010).  Registration for healthcare individuals within Finland is maintained by the National Authority for Medico-Legal Affairs (Terveydenhuollon Oikeusturvakeskus).

According to the Finnish Nurses Association (2018) the most developed roles of AP Ns in Finland are the Clinical Nurse Specialist and Nurse Practitioner.  Both roles are described as, “At the advanced level, independent clinical nursing and health promotion as well as the related ethical decision-making, teaching and instruction, consultation, evidence-based practices, management, cooperation, research, and development” (p.32).  In addition to this the roles are more clearly differentiated below:

  • Clinical Nurse Specialist (CNS)
    • The role has been in existence since 2001 in Finland (FNA, 2018, p.29).
    • CNSs are employed in various parts of the hospital systems in Finland, more predominantly at the university hospitals (FNA, 2018, p.29).
    • The role has four spheres: patient care, nursing organization, and scholarship.  Any of the CNS roles require a master’s level degree (NP / APN Network, 2017).
    • “Broad-based work aimed to ensure and develop the quality of nursing, foster the implementation of evidence-based nursing and support the organization’s strategic work.” (FNA, 2018, p.32)
  • Nurse Practitioner
    • The FNA (2018) identifies the Nurse Practitioner role as one that more specifically is, “Broad-based and comprehensive nursing, independent examination of patients and assessments of their need for care as well as starting treatment based on symptoms and monitoring both acute and chronic health conditions.” (p.32)
    • The role requires a master’s degree and primarily performed by APNs working in primary care.  Individuals can additionally pursue an academic post graduate degree (doctorate) (FNA, 2018, p.32).
    • The role is not nationally regulated, and as a result it varies according to organizational oversight.

Other roles identified NP / APN Network (2017) are:

  • Specialized Nurses in Clinical Practice
    • Roles largely reflect specialization in a specific area of concentration.  This requires 30-60 ETCS (European Credit Transfer and Accumulation System) and provides advanced professional roles in the selected specialization (NP / APN Network, 2017).
    • The expanded roles are not regulated, and rather institution specific (NP / APN Network, 2017).
  • Nurse Prescriber
    • A role designated for limited prescribing of medications.  This is performed with physician oversight and requires 45 ECTS post graduate training in order to be able to have this permission (FNA, 2018, p.33).
    • According to the NP / APN Network (2017), most APNs in Finland do not have prescribing authority.

Have information to add to this page?

References and Influential Articles:
De Geest, S., Moons, P., Callens, B., Gut., C., Lindpainter, L., & Sprig, R. (2008).  Introducting advanced practice nurses/nurse practitioners in health care systems: A framework for reflection and analysis.  Swiss Med Weekly, 138(43-44),621-628.

Delamaire, M. & Lafortune, G. (2010). Nurses in advanced roles: A description and evaluation of experiences in 12 developed countries.  OECD Health Working Papers, 54, OECD Publishing.http://dx.doi.org/10.1787/5kmbrcfms5g7-en

Fagerström, L. & Glasberg, A.L. (2011).  The first evaluation of the advanced practice nurse role in Finland – The perspective of nurse leaders.  Journal of Nursing Management, 19, 925-932.  doi:10.1111/j.1365-2834.2011.01280.x

Finnish Nurses Association [FNA] (2018). New roles for nurses – Quality to future social welfare and health care services.  Retrieved May 17, 2022 from: https://1553422.169.directo.fi/@Bin/e02495795f0c2e137dc85385beb70747/1652808570/application/pdf/256215/APN_RAPORTTI_ENG_VALMIS_pieni.pdf

HAI Europe (2012). The next chapter in promotion of healthcare professionals: Nurse prescribers [fact sheet]. Retrieved from: http://haieurope.org/wp-content/uploads/2012/02/27-July-2011-HAI-Europe-Nurse-Prescribers-Factsheet.pdf

Jokiniemi K. (2014). Clinical Nurse Specialist Role in Finnish Health Care. Dissertations in Health Science. U niversity of Eastern Finland. Available in: http://epublications.uef.fi/pub/urn_isbn_978‐952‐61‐1579‐ 5/urn_isbn_978‐952‐61‐1579‐5.pdf

NP / APN Network (2017). Country specific practice profiles. Retrieved May 16, 2022 from: https://international.aanp.org/Practice/Profiles

Robinson, S. & Griffiths, P. (2007).  Nursing education and regulation: International profiles and perspectives [online publication].  Retrieved from: http://eprints.soton.ac.uk/348772/1/NurseEduProfiles.pdf

Tynkkynen, L.K. (n.d.). Limited right for nurses to prescribe medication.  Health Policy Monitor.  Retrieved from: http://www.hpm.org/en/Surveys/THL_-_Finland/15/Limited_right_for_nurses_to_prescribe_medication.html

[ORIGINALLY POSTED SEPTEMBER 24, 2013.  UPDATED MAY 17, 2022]

Advanced Nursing Practice in Jamaica

Contact:

Jamaican Association of Nurse Anesthetists (JANA)
Jamaica Association of Nurse Practitioners (Facebook Page)
Jamaica Ministry of Health
Nursing Council of Jamaica
University of West Indies, School of Nursing

Role

The role of the Advanced Practice Nurse (APN) was introduced in Jamaica in the 1970s largely driven by the lack of physicians in the country (NP / APN Network, 2022, p. 5, Zug et al, 2016). There are two main roles, identified as a Family Nurse Practitioner and Nurse Anesthetist.

Nurse Practitioner (NP)

The Nurse Practitioner role revolves around providing primary care services to patients, particularly in underserved and rural areas (Henry, 2019; Zug et al, 2016). More specifically, a Nurse Practitioner in Jamaica performs the following duties (Henry, 2019):

  • Assess patient needs
  • Interpret diagnostic and laboratory tests
  • Diagnose illness and disease
  • Prescribe medication
  • Formulate treatment plans

At this time the role is still regarded as in development to “update and increase the scope of APN practice ” as Nurse Practitioners are not able to independently prescribe medication without oversight by a physician (Henry, 2019; NP / APN Network, 2022, pg. 5; Zug et al, 2016).

Nurse Anesthetist (CRNA)

Also identified largely as the Certified Registered Nurse Anesthetist (CRNA), the role was largely developed in the 1980s to mitigate the anesthesia needs and costs throughout the country as only 40 anesthesiologists were in the country in 2015 and the country at the same time supported the anesthesia needs by having 50 CNRAs (IFNA, 2015).

Education and Certification

As of 2002, education required for practice as a Nurse Practitioner was increased to a master’s level program through the West Indies School of Nursing (Zug et al, 2016). Once completing the educational requirement, the APN obtains certification to practice in the country which is regulated by the Nursing Council of Jamaica (NP / APN Network, 2017). The program at the University of the West Indies (UWI) requires at least 5 years of nursing experience while not attending an educational institution and licensure from any of the 16 countries that the UWI serves (including Bahamas, Barbados, Belize, the British Virgin Islands, Cayman Islands, Dominica, Granada, Jamaica, Montserrat, St. Kitts and Nevis, St. Lucia, St. Vincent, the Grenadines, Trinidad and Tobago and Turks and Caicos (UWI, 2022).

For the role of the Nurse Anesthetist, a master’s level degree has been required since 2007, and educational requirements include a 32 month program that does involve a 6 month internship through the UWI (IFNA, 2015). Biennial re-licensure is required by the Nursing Council of Jamaica (IFNA, 2015).

Specialties

The two main roles of the APN in Jamaica are:

  • Nurse Practitioner
  • Nurse Anesthetist

Have information to update this page?

References:

Henry, O. (2019). Legislative framework for NPs to practice far advanced. Jamaica Information Service. Retrieved May 16, 2022 from: https://jis.gov.jm/legislative-framework-for-nps-to-practise-far-advanced/

International Federation of Nurse Anesthetists [INFA] (2015). Jamaica. Retrieved May 16, 2022 from: https://ifna.site/country/jamaica/

NP / APN Network (2017). Country specific practice profiles. Retrieved May 16, 2022 from: https://international.aanp.org/Practice/Profiles

NP / APN Network (2022). INP/APN Network Bulletin. 33rd Issue. Geneva. Retrieved from: https://international.aanp.org/Content/Bulletins/May2022.pdf

University of West Indies [UWI] (2022). The UWI School of Nursing. Retrieved May 16, 2022 from: https://www.mona.uwi.edu/nursing/content/family-nurse-practitioner

Zug, et al. (2016). Advanced practice nursing in Latin America and the Caribbean: Regulation, education and practice. Revista Latino-Americana de Enfermagem. 24(e2807):1-9. doi:10.1590/1518-8345.1615.2807

Advanced Practice Nursing in Slovakia

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Contact:
Ministry of Health of the Slovak Republic

Role

The role of the Advanced Practice Nurse (APN) was formally recognized in 2018 by the Ministry of Health in Slovakia (Grešš Halász, 2021).  The role has been relatively recently introduced and evidence by Grešš Halász et al. (2021) demonstrated that APN’s have mixed perceptions about their own competence in practicing at a more advanced level, and practice confidence varied based on region within the country.

Healthcare in Slovakia historically was centralized by the government up until 1990.  Afterward, the nation shifted to privatizing healthcare throughout the country, meanwhile mandating healthcare to remain not-for-profit.  As much of advanced nursing practice is dependent on the abundance of trained nursing staff and the shortfall of more advanced medical professionals, the lower ratio of nurses per 1,000 people at 5.7 within the EU (compared to 8.4 of EU in general) likely contributes to the slower development of the APN role.  Much of this gap is attributed to lower wages and lack of financial investment on behalf of the nation in healthcare staff, including education and health infrastructure (Slovak Spectator, 2021 Sep 14).

Education and Certification

Education for the APN in Slovakia is legislatively defined as “a nurse who graduated from at least the second university degree (equivalent to master’s degree) proceeded by the first university degree (equivalent to bachelor degree) in nursing, with specialization, and at least 5 years’ experience in a particular specialization, or a nurse without a specialization with 8 years of professional experience.” (Ministry of Health of the Slovak Republic, 2018).

Specialties

According to the Ministry of Health of the Slovak Republic (2018) there are several specializations recognized and identified within legislation. The additional roles expand on the level of independence the nurse may function.  The basic nursing role is as follows.

  • Nursing Practice (§ 95.1)
    • Provide nursing diagnoses and follows treatment plans accordingly
    • Perform assessment of the patient
    • Provide ongoing nursing care/monitoring of patient
    • Provide wound/ostomy care
    • Provide patient education

Below are a list of the specializations with their added independent competencies:

  • Nurse Specialist (§95.2)
    • Can choose if a patient will have an intravenous cannula placed or not and can place that apparatus
    • Follow dose range pharmaceutical operations.
  • Nurse with Advanced Experience (§95.3)
    • All care that of the Nurse Specialist (above)
    • Provide advanced assessment
    • Indicate and collect biological specimens (i.e. ordering lab analysis)
    • Indicates treatment for nursing care
    • Indicates treatment for preliminary wound care
  • Nurse Midwife (§95.5)
    • Provide traditional antenatal and postnatal care for mother and infant (up to 6 weeks post-natal)
    • Performs childbirth, including if episiotomy if required
  • Nurse Midwife Specialist (§95.6)
    • All care that of a Nurse Midwife
    • Can indicate and place intravenous cannula
  • Nurse Midwife with Advanced Experience (§95.7)
    • All care that of the Nurse Midwife and Nurse Midwife Specialist
    • Advanced independence of indication of treatment
    • Additional duties to manage nurse midwife care team

Have information to update this page?

References:

Grešš Halász, B. et al. (2021). Developing the advanced practice nursing role in Slovakia: Perception, education, and practice.  Journal of the American Association of Nurse Practitioners. 33(11),916-923. doi: 10.1097/JXX.0000000000000460

Ministry of Health of the Slovak Republic. (2018) Decree determining the extent of nursing practice provided by a nurse independently, based on a medical doctor’s indication and in cooperation with a medical doctor and the extent of midwifery provided by a midwife alone, based on a medical doctor’s indication and in cooperation with a medical doctor. (no. 95/2018). The Ministry of Health Slovak Republic. http://www.epi.sk/zz/2018-95.

Slovak Spectator (2021, Sep 14). Hundreds of nurses have left their jobs in Slovak health care. Retrieved May 7, 2022 from: http://spectator.sme.sk

Advanced Practice Nursing in Puerto Rico

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Specialist

Nationally Certified:
Yes

Recognize Foreign License:
Yes

Treatment Authority:
No (but pending legislation to change)

Prescribing Authority:
No (but pending legislation to change)

Practice Autonomously:
No (but pending legislation to change)

Contact or more information:
Puerto Rico Health Department
Puerto Rico Nursing Practice Law (Ley 9, de 11 do octubre 1987)

Role

Puerto Rico’s integrated relationship with the United States brings many of the advanced practice nursing roles to the island.  Since Puerto Rico is a territory of the united states but is primarily governed under it’s own laws, advanced practice nursing greatly mirrors that of the United States but is still in the process of approving legislature to recognize an autonomous role for advanced nurses similar to nurse practitioners.

Education and Certification

Varying degrees exist for nursing in Puerto Rico based on the varying levels of practice.  Individuals who practice at the nursing generalist level require a bachelor’s degree, for advanced practice one needs a masters degree.  Current legislation proposals have suggested that individuals can additionally gain a doctorate of nursing practice (DNP) for further advancement and specialization (Parés Arroyo, 2015, April 4).

Currently, there are several universities in Puerto Rico that offer such advanced degrees for nurses inclduing the Universidad de Puerto Rico, Recintos de Ciencias Médicas, Arecibo, Humacao y Mayagüez; Universidad del Turabo; Universidad Interamericana en Arecibo e Inter Metro; y la UMET (Parés Arroyo, 2015, April 4).

Specialties

The nursing role in Puerto Rico mirrors that similarly to the United states with varying educational degrees and roles of nurses (Parés Arroyo, 2015, April 4):

  • Nurse Specialist – Educated with a masters degree, this specialty allows the nurse to manage more complicated health situations in a particular area of specialization.
  • Nurse Generalist – Has a bachelors degree of Science in Nursing and works with the nurse specialist to direct care of patients.
  • Associate Nurse – Has an associates degree in nursing and collaborates with planning and carrying out of direct nursing care to hospitalized patients.

Various additional roles have been suggested to clarify the advanced nursing practice role through legislation including (Parés Arroyo, 2015, April 4):

  • Doctor of Nursing Practice – Provides autonomous practice with the ability to provide services and be reimbursed through contracting with other agencies for their area of specialty.
  • Advanced Practice Nurse – Includes various specialist including: Clinical nurse specialists, nurse midwifery, anesthesia, nurse practitioners and other areas.

Have information to update this page?

References:
Parés Arroyo, M. (2015, April 4). Se especializan cada vez más las enfermeras: Un proyecto de ley propone atemperar los adelantos de esta profesión.  El Nuevo Dia.  Retrieved from: http://www.elnuevodia.com

Advanced Practice Nursing in Belize

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Psychiatric Nurse Practitioner

Nationally Certified:
Yes

Recognize Foreign Licensure:
Yes

Treatment Authority:
Yes

Prescribing Authority:
Yes (Psychiatric Nurse Practitioner only)

Practice Autonomously:
Yes

Contact:
Belize Ministry of Health

Role

The state of health in Belize has a lack of health professionals in general (BMOH, 2014).  With the lack of a current medical school in the country, providers are frequently trained by neighboring countries as Cuba, Guatemala, Mexico, Nicaragua, and Costa Rica (PAHO, 2009b). As can be imagined, Belize in turn relies heavily on regional international support for their health resource management and it is estimated that up to 30% of their medical providers are immigrated from those other countries.

Because of the lack of health professionals in general, frequently registered nurses autonomously provide care at an advanced practice level including basic diagnosis and treatment at rural health posts (PAHO, 2009b; BMOH, 2014).  Most often, the advanced role in such nursing situations are based on algorithms and protocols for decision making. Frequently they are used as triage agents to determine if an patient may be treated at the rural health post or needs to make the cumbersome trip to a higher level of care and see a medical provider.

Nursing in Belize is regulated by the Ministry of Health through the Nursing and Midwifery Act (Chapter 321, 2003), which currently is under revision by Belize legislature. Nursing according to the 2003 revision is identified according to the curriculum requirements for registration as a registered nurse, but no specific scope of practice is identified. Volunteer opportunities are available for Nurse Practitioners to work according to their scope of practice in their own country.  If an individual desires to work at this level, the would be encouraged to work as a part of a local Non-Governmental Organization and may need to inquire with the Ministry of Health if there are any limitations on their scope of practice.

In general prescribing is permitted for medical doctors and dentists exclusively (Misuse of Drugs Act, Ch. 103, Rev. 2003).  However, as long as there is an overseeing physician, nurses can write and dispense medications according to their understood protocol.

Education and Certification

Certifications for all three nursing specialties are available through the University of Belize.

Specialties

Based on the greatest needs of the Belize population, the University of Belize (2016) currently offers three certificates for an advanced role:

  • Psychiatric Nurse Practitioner
  • Rural Health Nursing
  • Practical Nursing

The main differentiation is that Psychiatric Nurse Practitioners are permitted to prescribe psychochotropic medications within certain protocols (PAHO, 2009b).

Have information to update this page?

References:
Belize Ministry of Health [BMOH] (2014). Belize Health Sector Strategic Plan 2014-2024.  Retrieved from: http://health.gov.bz/www/attachments/article/801/Belize%20Health%20Sector%20Strategic%20Plan%202014-2024-April%202014.pdf

Pan American Health Organization [PAHO] (2009a). WHO-AIMS report on mental health system in Belize. Retrieved from: http://new.paho.org/blz/index2.php?option=com_docman&task=doc_view&gid=63&Itemid=250

Pan American Health Organization (2009b).  Health Systems Profile: Belize.  Retrieved from: http://www.paho.org/blz/index.php?option=com_docman&view=download&alias=64-health-sytems-profile-belize-monitoring-and-analyzing-health-systems-change-reform-july-2009&Itemid=250

University of Belize (2016).  Program offerings.  Retrieved July 14, 2016 from: http://www.ub.edu.bz/fnahsw/program_offerings.phpUpdated: July 14, 2016

Advanced Practice Nursing in Italy

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Infermiere Specialista
(Nurse Specialist)

Nationally Certified:
No

Recognize Foreign Licensure:
Yes

Treatment Authority:
To Be Determined (TBD)

Prescribing Authority:
TBD

Practice Autonomously:
TBD

Contact:
Federazione Nazionale Collegi Infermeri (IPASVI)

Role

The Advanced Practice Nurse (APN) role is currently under development in Italy, and has been so for several years (Barbero, F., Personal Communication, March 2, 2015; Robinson & Griffiths, 2007).  Legislation in 2006 (Legge 43/2006) created national regulation establishing the title of a Nurse Specialist and the educational requirements for this role, but the implementation of the role has yet to be seen (Barbero, F., Personal Communication, March 2, 2015; IPASVI, 2014).  As a result, there is no legal separation between the scope of practice of a registered nurse and nurse Specialist (Barbero, F., Personal Communication, March 2, 2015).  Current legislation has focused on furthering the APN role and hopes to differentiate this role most recently reside on Legge 190/2014, a new law recognizing the role in an APN capacity (Barbero, F., Personal Communication, March 2, 2015; IPASVI, 2014).  While significant legislature has taken place to provide a strong foundation of the role of the Nurse Specialist, the complicated sentiments of resistance to advance the role of the nurse is because of a combination of financial compensation, surplus of physicians, and resistance to relinquish power (OECD, 2012; Rossi, 2015).  As this role has recently progressed, hopefully the near future will help determine to what extent the APN role will exist.

As the current role of the Nurse Specialist is indistinguishable from the role of the regular nurse, it is important to consider the current role of nursing in Italy.  Currently, every nurse is able to “perform any kind of technique and task according to his experience and curricula” (Barbero, F., Personal Communication, March 2, 2015); this excludes prescription and medical diagnosis.  As a result, examples  of this role liberality is that some nurses are able to perform ET intubation, manual defibrillation, and implant PICC lines, all invasive procedures often limited to the scope of practice by physicians in many countries (Barbero, F., Personal Communication, March 2, 2015).

Education and Certification

Currently, the role of a Nurse Specialist requires a masters degree, achieved by completing 60 ECTS (Barbero, F., Personal Communication, March 2, 2015).

The nursing education system further offers master degrees in nursing for educators and individuals in director positions in healthcare (Robinson & Griffiths, 2007).  Additionally, some doctoral degrees are also being pursued, taught and supervised by the medical schools in the country (Robinson & Griffiths, 2007).   There is currently no certification or registration for Advanced Practice Nursing in the country.

Specialties

Registered nurses can seek additional training in specialization.  The categories offered today are (Barbero, F., Personal Communication, March 2, 2015):

  • Critical Care
  • Family Nursing
  • Mental Health
  • Geriatric Nursing
  • Pediatric Nursing

Have information to add to this page?

References:
IPASVI. (2014). Gennaio 2015: arrivano gli infermieri “specialisti.” Retrieved from: http://www.ipasvi.it/attualita

OECD (2012). Health At a Glance: Europe 2012 (2nd ed.).  OECD Publishing.  doi: 10.1787/9789264183896-en

Robinson, S. & Griffiths, P. (2007).  Nursing education and regulation: International profiles and perspectives [online publication].  Retrieved from: http://eprints.soton.ac.uk/348772/1/NurseEduProfiles.pdf

Rossi, R.C. (2015, January 9).  Competenze di medici e infermieri, l’«errore» della legge di Stabilità.  Retrieved from: http://www.sanita.ilsole24ore.com

[Updated: Mar 3, 2015]

Advanced Practice Nursing in Denmark

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Specialist Nurse

Nationally Certified:
Uncertain

Recognize Foreign Licensure:
Yes

Treatment Authority:
Uncertain

Prescribing Authority:
Uncertain

Practice Autonomously:
No

Contact:
Danish Health and Medicines Authority (Sundhedsstyrelsen)
Danish Nurses’ Organiation [DNO] (Dansk Sygeplejeråd)

Role

The role of Advanced Practice Nurses in Denmark has been in development.  Common interests as a part of the European Union have led Denmark to explore the potential use of further Advanced Practice Nursing (Danish Nurses’ Organization, 2008; Pill, Kolbæk, Ottman, & Rasmussen, 2012).  This development however has not been perceived as a substitution for medical doctors (Pill et al., 2012).  Meanwhile, in Denmark there has been an abundance of nurses in the country, leading the European Union and amounting to more than 15 per 1,000 individuals in the population, and with a ration of 4 nurses for every doctor in country (OECD Library, 2012).

Several nursing specialties have been offered for direct practice registered nurses, anesthesia nursing, psychiatric nursing, intensive care nursing, and infection control nursing (European Commission [EC], 2000).  Each allows for more skillful knowledge and potential advanced scope of practice in their respective categories.  Additionally, three other specializations exist for nursing, nursing management and leadership, nursing education, and public health nursing (EC, 2000).  For all specialties except the public health nursing, there is no protected title provided by the national ministry of health (European Commission, 2000).  For public health nursing, the title “health visitor” has been reserved (EC, 2000).

Education and Certification

Education for entry level nursing in Denmark is at the Bachelor’s level.  Specialties are provided by and maintained at the county or regional level (EC, 2000).  Once received permissions by a specific region to practice as a specialty nurse, the Danish nurse may then practice within that specialty in any of the regions of the country, according to the regions’ regulations (EC, 2000).  Each of the programs vary in the length of their post-baccalaureate program as follows (with their received title/degree in parenthesis):

  • Anesthesia Nursing (Proof of specialty training) – 1 1/2 years
  • Psychiatry Nursing (Proof of specialty training) – 1 year
  • Infection Control Nursing (Proof of specialty training) – 3 months
  • Intensive Care Nursing (Proof of specialty training) – 1 1/2 years
  • Public Health Nursing (Nursing Diploma) – 10 months
  • Nursing Management and Leadership (Nursing Diploma) – 10 months
  • Nursing Education (Nursing Diploma) – 10 months

Masters level education is available for nurses interested in advancing their career particularly in nursing education, public health, and nursing management and leadership requiring 2 years and 6 months of training (Aarhus School of Advanced Nursing Studies, 2014; EC, 2000).

Foreign citizens are allowed to apply and participate in the Masters level studies provided they are able to pass a Danish proficiency exam and have received an acceptable Bachelors degree (UASANS, 2014).  Individuals interested in working within one of the specialized nursing categories would be required to be evaluated by the regional councils overseeing each (EC, 2000).  As an international working within Denmark, their specialty-specific permissions would then only be valid for the region from which they received permission (EC, 2000).

Specialties

While an old reference, four areas of specialty have been identified: anesthesia nursing, intensive care nursing, psychiatric nursing, and infection control nursing (EC, 2000).  For each of the specialties in intensive care, anesthesia, and psychiatry training is organized at the county level and therefore varies within the country (EC, 2000).

Beyond that of direct practice nursing specialties, the other three nursing specialties of public health nursing, psychiatric nursing, and nursing management and leadership has been offered at the University of Aarhus School of Advanced Nursing Studies (UASANS, 2014).  This school also offers a Master’s Degree for advancement of a nursing career.  This degree is suggested to offer career advancement primarily related to the advancement of the latter three non-direct practice specialties (EC, 2000).  The course curriculum allows the student to adapt their education in whichever career path interests them the most (UASANS, 2014).

Have information to add to this page?

References:
Danish Nurses’ Organization (2008).  Advanced nurse practitioners – Improved health care to the chronically ill [Electronic document].  Retrieved from: http://www.dsr.dk/Artikler/Documents/Advanced_Nurse_Practitioners.pdf

European Commission (2000).  Nursing in Denmark [Electronic Document].  Retrieved from: http://ec.europa.eu/internal_market/qualifications/docs/nurses/2000-study/nurses_denmark_en.pdf

OECD Library (2012).  Health At A Glance: Europe 2012.  Retrieved from: http://www.oecd-ilibrary.org/sites/9789264183896-en/03/03/index.html?itemId=/content/chapter/9789264183896-30-en

Pill, K., Kolbæk, R., Ottman, G., & Rasmussen, B. (2012).  The impact of the expanded nursing practice on professional identify in Denmark. Clinical Nurse Specialist, 26(6),329–335.

University of Aarhus School of Advanced Nursing Studies [UASANS] (2014).  Masters degree in nursing – Introduction.  Retrieved from: http://kandidat.au.dk/en/nursing/

Advanced Practice Nursing in Ireland

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Registered Advanced Nurse Practitioners (RANPs)

Nationally Certified:
Yes

Recognize Foreign Licensure:
Yes (with acceptance of an employment placement offer)

Treatment Authority:
Yes

Prescribing Authority:
Yes

Practice Autonomously:
Tes

Contact:
An Bord Altranais Nursing Board
Irish Association of Advanced Nurse and Midwife Practitioners

Role

The role of the Registered Advanced Nurse Practitioner (RANP) in Ireland encompasses an application of specialty-focused knowledge and skills to improve quality of care.  This role includes (Delamaire & Lafortune, 2010):

  1. assessment, planning, delivery and evaluation of care,
  2. participation in and dissemination of nursing research and audit,
  3. working closely with medical and paramedical colleagues, including making alterations in prescribed clinical options along agreed protocol guidelines,
  4. providing consultancy in education and clinical practice to nursing colleagues and wider interdisciplinary team,
  5. prescribing medication and ionizing radiation (with additional education, training and education) [Prescriptive authority was initially passed through legislation in 2007 (HAI Europe, 2012).]

Further, there are four driving concepts that guide RANPs (Lehwaldt, Perosevic, Kingston, Lodge, & Kearns, 2014)

Autonomy in Clinical Practice
Within a collaboratively agreed scope of practice, RANPs are accountable and responsible for advanced decision making in the management of patient care.  They provide expert clinical diagnosis and treatment according to their agreed scope of practice (Lehwaldt et al., 2014).

Expert Practice
They provide both practical and theoretical expertise on nursing practice and the role of advanced nursing practice.  This is provided through a minimum of a Masters degree education with an area of specialization (Lehwaldt et al., 2014).

Professional and Clinical Leadership
As leaders within their profession, each RANP provides leadership and management skills appropriate to seek out and improve patient care and management in new and innovative ways.  This may be at the local, community, or national level (Lehwaldt et al., 2014).

Research
Including both initiation and implementation, each RANP provides a level of expertise to implement evidence based practice within their workplace.  This also includes expertise in providing methods of monitoring and evaluation (Lehwaldt et al., 2014).

Education and Certification

The advanced nurse practitioner in Ireland requires a minimum of a master level education (Delamaire & Lafontaine, 2010; Sheer & Wong, 2008).  There are current programs to meet this educational need in Ireland today (Storeur & Leonard, 2010).

Specialties

At this time there are Advanced Nurse Practitioner and Advanced Midwife Practitioner roles.  Currently there are various Advanced Nurse Practitioners working in the following areas (Lehwaldt, Perosevic, Kingston, Lodge, & Kearns, 2014):

  • Acute Adult Care
  • Psychiatric Care
  • Children’s Care
  • Public Health Care
  • Midwifery
  • Intellectual Disability Care

Advanced Nurse Practitioners were also evaluated in the Emergency Department (Thompson & Meskell, 2012).

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References:
An Bord Altranais Nursing Board (n.d.)  Advanced nurse practitioners and advanced midwife practitioners.  Retrieved from: http://www.nursingboard.ie/en/news-article.aspx?article=79557603-f337-4982-9465-bcf0bb9c18ae

Delamaire, M. & Lafortune, G. (2010). Nurses in advanced roles: A description and evaluation of experiences in 12 developed countries.  OECD Health Working Papers, 54, OECD Publishing.http://dx.doi.org/10.1787/5kmbrcfms5g7-en

HAI Europe (2012). The next chapter in promotion of healthcare professionals: Nurse prescribers [fact sheet]. Retrieved from: http://haieurope.org/wp-content/uploads/2012/02/27-July-2011-HAI-Europe-Nurse-Prescribers-Factsheet.pdf

Lehwaldt, D., Perosevic, M., Kingston, M., Lodge, E., & Kearns, G. (2014).  Featured Countries: Ireland.  INP/APN Network Bulletin, 21(2). Retrieved from: http://international.aanp.org/pdf/May14.pdf

Sheer, B. & Wong, F.K. (2008).  The development of advanced nursing practice globally.  Journal of Nursing Scholarship, 40(3),204-211.

Stordeur, S. & Leonard, C. (2010).  Challenges in physician supply planning: The case of Belgium.  Human Resources for Health, 8(28),1-11.  doi:10.1186/1478-4491-8-28

Thompson, W. & Meskell, P. (2012).  Evaluation of an advanced nurse practitioner (emergency care).  Journal for Nurse Practitioners, 8(3), 200-205.  Retrieved from: http://www.medscape.com/viewarticle/760656

[First Published: 15 August 2013; Updated: 29 June 2014]

Advanced Practice Nursing in France

Snapshot

APN Role Exists in Country Today:
In development

Title:
In development

Nationally Certified:
No

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Uncertain

Prescribing Authority:
Uncertain

Practice Autonomously:
Uncertain

Contact:
French Advanced Practice Nursing Network (REPASI)
School of Public Health, Ecole des Hautes Etudes en Sante Publique, Paris [EHESP]
Université de Versailles, St-Quentin-en-Yvelines [UVSQY]

Role

Advanced Practice Nursing (APN) in France has recently begun with the recent introduction in 2010 of graduate level education in the country (Bonnel, 2014).  The greatest motivator of developing the role of advanced practice nursing in France is to increase the access of the public to specialists, by increasing the number of specialists available and at a more affordable rate for an impending physician shortage (Bonnel, 2013; SNPI, 2013).  The goal of the APN role in France is to provide an “intermediary” professional to meet the medical needs within the country (Joel, 2013).  Based on the current education that is promoting this role, individuals are educated to (UVSQY, 2013):

  • Provide evaluation of patients with complex diseases
  • Diagnosis of health conditions
  • Provide disease specific treatments
  • Supervise collaboration with other health professionals
  • Develop and apply research to improve health care and outcomes
  • Develop educational methods to meet the needs of health care

While the country has been developing this role for several years, the greatest difficulties in establishing an APN role in France is that of agreement of what that role is to be and how the role will be solidified in the country (Joel, 2013).  At this time however, there is no protected title and educational programs are not consistent with their teachings according to a standard (Joel, 2013).  Since the role is in development, it is uncertain to what type of advance practice nursing each professional will work at resembling the nurse practitioner, clinical nurse specialist, or case management role (Bonnel, 2014).

Meanwhile, current momentum based on graduate level education has developed a group of Advanced Practice Educated nurses who are developing the foundation of their role in France.  According to Bonnel (2014), the French advanced practice nurses have initiated a nursing organization, the French Advanced Practice Nursing Network (REPASI) in collaboration with the current French nursing organization (Anfiide, 2014, February 24).

Education and Certification

Education for Advanced Practice Nurses in France has been minimally at the master level since 2010 at the School of Public Health, Ecole des Hautes Etudes en Sante Publique, Paris (Bonnel, 2014; Bellini & Cusson, 2012).   This program offers both master and doctoral degrees (Bellini & Cusson, 2012).  Since the beginning of graduate nursing education in France, a second program has also developed by the Faculty of Health Sciences at the University of Versailles Saint Quentin en Yvelines (SNPI, 2013).

Specialties

Education for several specialties are offered for Advanced Practice Nurses in France (Bonnel, 2014; EHESP, 2013; SNPI, 2013):

  • Oncology
  • Gerontology
  • Psychiatric and Mental Health
  • Pain and Palliative Care
  • Chronic Illness

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References:
Anfiide (2014, February 24).  Press release on the creation of the French Advanced Practice Nursing Network.  Retrieved from: file:///Users/administrator/Documents/Nurse%20Practitioner/Articles/International%20Nurse%20Practitioners/France/press_release_repasi_france.pdf

Bellini, S. & Cusson, R.M. (2012).  The doctor of nursing practice for entry into advanced practice.  Medscape.  Retrieved from: http://www.medscape.com/viewarticle/760749_7

Bonnel, G. (2013).  Evolvement of French advanced practice nurses.  Journal of the American Association of Nurse Practitioners (online publication).  doi: 10.1002/2327-6924.12061

Bonnel, G. (2014, June).  An American NP’s involvement in the French APN movement: Galadriel Bonnel.  AANP Members Abroad.  Retrieved from: http://www.aanp.org/international/aanp-members-abroad

Ecole des Hautes Etudes en Sante Publique [EHESP] (2013).  Masters in clinical nursing sciences [Google translated version].  Retrieved from: http://www.ehesp.fr/formation/formations-diplomantes/master-sciences-cliniques-infirmieres/

Joel, L.A. (2013).  Advanced Practice Nursing: Essential of Role Development.  F.A. Davis.  Retrieved from: http://books.google.com

Syndicat National des Professionnels Infirmiers [SNPI] (2013, October 13).  Master in clinical nursing: Foreign experience [Google translated version].  Retrieved from: http://www.syndicat-infirmier.com/Master-en-sciences-cliniques.html

Université de Versailles, St-Quentin-en-Yvelines [UVSQY] (2013).  Clinical sciences master in nursing.  Retrieved from: http://www.uvsq.fr/master-1-sciences-cliniques-en-soins-infirmiers-197753.kjsp?RH=FORM_5

[First Published: 2013, October 29; Updated: 2014 June 29]

Advanced Practice Nursing in Nicaragua

Snapshot

APN Role Exists in Country Today:
No Role is Officially Identified

Treatment Authority:
Registered nurses do have treatment authority

Prescribing Authority:
N/A

Contact:
Nicaragua Ministry of Health

Role

Nicaragua has significantly underserved rural communities in the nation.  The local health system is primarily run by a low number of general practitioners,  and nurses.  Each individual may be a sole healthcare provider in the local health clinic (Sequeira et al., 2011).  According to Sequeira et al. (2011), the nation’s health force comprises of 1,539 nurses and 1,138 general practitioners for a population of approximately 5.9 million people (Google, 2013).  As a result of the lack of not just general practitioners but also nurses, the undersupply of health care professionals does not lend to development of Advanced Practice Nursing at this time.  To aide the deficit of nursing professionals, another group of more than 4,000 Auxillary Nurses (similar to that of a nursing assistant) drives much of the health care services in the country (Sequeira et al., 2011).  Because the number of trained health professionals in the rural areas are few to none, the Ministry of Health in Nicaragua has utilized a large number of health volunteers to assist as health promoters in the area called the “Red Communidad” (or Net Community).  The nursing role in Nicaragua often encompasses any of the skills required to perform and train these volunteer individuals so they may make better decisions for health promotion in their areas.  These volunteer positions include Promotoras, Parteras, and Brigadistas.

Parteras are the volunteer midwives, trained by their previous local midwife or governmental training.  Promotoras are a basic volunteer who desires to know more medical-based knowledge and will resultantly facilitate decision making when an ill individual should go to the hospital.  Brigadistas may administer immunizations and at times prescribe medications according to protocols established by the Nicaraguan Ministry of Health.  Because the majority of medications in country do not require prescriptions, writing of prescriptions is based on the suggestion of the local medical expert.

There is significant evidence of APNs going to Nicaragua from more developed nations to assist in short-term provision of medical care of the underserved.  APNs going to Nicaragua work according to their education and training in their nation.

Education

The current education system for nurses requires a three year college experience with a forth year of practicum service in an assigned health clinic, post, or hospital.  Once completed, individuals receive a bachelor degree in nursing.  Further education for specialty is available in the capital, Managua for various hospital based nursing specialties (i.e. intensive care, pediatrics).

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References:
Google (2013).  Retrieved from: https://www.google.com/search?q=nicaragua+population&oq=nicaragua+population&aqs=chrome.0.69i57j0l3j69i62l2.3660j0&sourceid=chrome&ie=UTF-8

Sequeira, M., Espinoza, H., Amador, J.J., Domingo, G., Quintanilla, M., & Santos, T. (2011).  The Nicaraguan Health System.  PATH Publications. .Retrieved from: http://www.path.org/publications/files/TS-nicaragua-health-system-rpt.pdf

Updated: Jun 22, 2014
Previous Versions: Jul 30, 2013