Advanced Practice Nursing in Argentina

Snapshot

APN Role Exists in Country Today:
No

Contact:
Minsterio de Salud y Ambiente de Argentina (Ministry of Health in Argentina)

Role

There is no current Advanced Practice Nursing (APN) role in Argentina today.  The role of nurses in Argentina is also in its development, as nurses have only recently in 2008 established a national licensing registry for nurses (Ministerio de Salud, n.d.).  Only once the nursing role is established to consistent standards, will the nurses be in a position to incorporate an established role of advanced practice.

The health care system in Argentina also presents some difficulties in developing an Advanced Practice Nurse educational programs and system to incorporate them in employment.  As of 2008, according to the Ministerio de Salud (2008), there were 1.5 doctors per every one nurse, and only 1.55 nurses  per every thousand individuals.  Once incorporating nursing related assistive professionals, the country only has 2.21 nursing type workers per thousand habitants in Argentina (Ministerio de Salud, 2008).  While these numbers were reported by the Ministry of Health in Argentina, the World Health Organization (WHO, 2013) reports from 2004 that Argentina had a closer ratio of 4-5 doctors per nursing and midwifery professional in the country, further confirming the desperate shortage of nurses in Argentina.

Because of this significant nursing shortage in Argentina, the Ministry of Health has proposed a plan to improve working conditions and benefits for nurses to increase the number of nurses to at least one per every doctor and hopes to develop a high ration of 4.0 nurses per 1,000 individuals (Durante, 2012; Ministerio de Salud, 2008).  Meanwhile, according to Durante (2012), the country has not had nearly the success it has hoped in increasing the nursing numbers as desired.  One great struggle with this issue is the lack of nursing educators and a significant dropout rate for students in nursing schools of nearly 70% in the first cycle, a lower level of nursing in the country (Durante, 2012).

Specialties

Not applicable at this time.

Have information to add to this page?

References:
Durante, S. (2012, Junio 26). Noticias de enfermería – Misiones.  Sociedad Argentina de enfermería.  Retrieved from: http://blogsdelagente.com/sae/ 

Ministerio de Salud (n.d).  Registro Unico de Profesionales de Salud.  Retrieved October 30, 2013 from: http://rups.msal.gov.ar/turnos/

Ministerio de Salud (2008).  Consejo de Salud 8 y 9 de Mayo, 2008, Recursos humanos: Residencias Enfermería [PowerPoint presentation].  Retrieved from: http://www.msal.gov.ar/images/stories/cofesa/2008/acta-02-08/anexo-4-acta-02-08.pdf

World Health Organization [WHO] (2013).  Aggregated Data: Density per 1000 by country.  Retrieved from: http://apps.who.int/gho/data/node.main.A1444?lang=en

World Health Organization [WHO] (2013b). Disaggregated data: Nursing and midwifery personnel by country.  Retrieved from: http://apps.who.int/gho/data/node.main.HWF1?lang=en

Advanced Practice Nursing in Hong Kong

Snapshot

APN Role Exists in Country Today:
Yes

Titles:
Nurse Specialist
Advanced Practice Nurse

Nationally Certified:
Yes

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Yes

Prescribing Authority:
Uncertain

Practice Autonomously:
Varies

Contact:
The Provisional Hong Kong Academy of Nursing Limited (PHKAN)
Hong Kong Society for Nursing Education Limited
Nursing Council of Hong Kong

Role

Advanced Practice Nurses began as Nurse Specialists in Hong Kong in 1994 (Sheer & Wong, 2008).  This role was primarily created to allow for career development for nurses who had significant expertise in a specific specialty.  In the Hong Kong health system, the Hospital Authority, the national entity responsible for health care in Hong Kong, utilizes Nurse Specialists frequently as consultants in the inpatient hospital system (Chan, Thompson, & Wong, 2006).  These individuals often carry their own patient load, but may also see patients on other wards that have specialty needs.  The roles of these specialists within the hospital systems vary according to hospital and specialty (Chan, Thompson, & Wong, 2006). The role of Nurse Specialist on an outpatient basis is in nurse-led clinics.  This effort was created by the Hospital Authority to help manage individuals on an outpatient basis.

Similarly to several parts of Asia, Hong Kong’s health system does not have a significant entity of primary health care, and individuals will usually first be seen for a significant ailment in the emergency department.  Once diagnosed with some condition and stabilized to no longer need inpatient treatments, they will then be referred to see a specialty clinic on an outpatient basis.  Due to the lack of such clinics, the Hospital Authority of Hong Kong developed the concept of nurse-led clinics with specialty nurses providing care and management to individuals with that ailment (Chan, Thompson, & Wong, 2006).  For example, for an individual with Chronic Obstructive Pulmonary Disease (COPD), an individual would go to a COPD clinic.

Since inception, these nurse-led clinics, run by Nurse Specialists, have been continuing to expand and have demonstrated good improvement to healthcare in Hong Kong today (Shiu, Lee, & Chau, 2012).  The nurses in these clinics can manage up to 90% of patients for outpatient disease-specific care and also take a more holistic approach and rarely prescribe medications (Wong, 2002).  Most often the nurses in these clinics will practice either independent or supervised adjustments of medications and initiating diagnostics or treatments according to protocols (Wong & Chung, 2006).  In some circumstances however, the CNS/NSs will prescribe medication, as nicotine patches for smoking cessation for COPD patients (Wong, 2010). An additional role developed in 2002 was the Advanced Practice Nurse (APN).  This title was designated for individuals who practice in a more promoted position based on nurses being very experienced (Chan, Thompson, & Wong, 2006).  This role most similarly reflects that of the Clinical Nurse Specialist in other nations, and have significant expertise and experience.  Much of the role of APN development in Hong Kong has been in inpatient settings and includes advanced clinical assessment, education, research, and consultation with physicians (Sheer & Wong, 2008).

Another role in development is that of the Nurse Practitioner.  This role is in development today, and a potential additional position to be incorporated in the increasing health care needs in Hong Kong.

In general, the roles of advanced practice nurses in Hong Kong have been developing greater acceptance, greatly due to improved perceptions of the increase in health care quality and safety (Christiansen, Vernon, & Jinks, 2013).  Meanwhile, the greatest perceived challenge of the advancement of APNs in Hong Kong is that of other health care workers’ acceptance of the position (Christiansen, Vernon, & Jinks, 2013).  Another considerable factor is that of ‘brain-drain’ leading to a now 10-year shortage of nursing in Hong Kong (Lee, 2014).  Low financial compensation seems to be a valid concern reducing the number of nurses desiring to stay within the country and therefore able to seek career advancement.

Education and Certification

The role of the Advanced Practice Nurse or Nurse Specialist requires a minimum education of a masters degree (Sheer & Wong, 2008).  To be a Nurse Practitioner in Hong Kong, one would be required to have a master degree with a focus on clinical experience (Loke, 2004). Most recently, desire to standardize clinical care and preparation, there have been efforts to establish accreditation and registration for Nurse Specialists in Hong Kong.  One such effort is being a fellow of the Provisional Hong Kong  Academy of Nursing Limited (2012) and another the College of Nursing, Hong Kong (n.d.).  Such organizations like these have been striving to create standardized care and registration for individuals working in the capacity as a Nurse Specialist (Sheer & Wong, 2008).

Specialties

Various roles associated with the Nurse Specialist include (Chan, 2012; Schober & Affara, 2006):

  • Advanced Medical Nursing
  • Advanced Pediatric Nursing
  • Advanced Surgical Nursing
  • Anesthetic and Recovery Nursing
  • Breast Care
  • Cardiac Care Nursing
  • Cardiac Surgical Nursing
  • Community Nursing
  • Community Psychiatric Nursing
  • Continence Nursing
  • Diabetes Nursing
  • Emergency Nursing
  • Gerentological Nursing
  • HIV/AIDS Nursing
  • Intensive Care Nursing
  • Neonatal Intensive Care Nursing
  • Orthopedics & Traumatology Nursing
  • Pediatric Intensive Care Nursing
  • Peri-operative Nursing
  • Primary Health Care Nursing
  • Psychiatric Rehabilitation Nursing
  • Rehabilitation Nursing
  • Renal Nursing
  • Respiratory Nursing
  • Rheumatology Nursing
  • Substance Abuse Nursing
  • Transplant Nursing
  • Wound/ostomy Nursing
  • Urology Nursing

Have information to add to this page?

References:
Chan, E. (2012).  Hong Kong perspective on nursing workforce planning, development, and education [PowerPoint presentation].  Retrieved from: http://www.ha.org.hk/haconvention/hac2012/proceedings/downloads/S8.3.pdf

 

Christiansen, A., Vernon, V., & Jinks, A. (2013).  Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse-led out-of-hours care in Hong Kong: a questionnaire study.  Journal of Clinical Nursing.  22(7-8),1173-1181.  doi: 10.1111/j.1365-2702.04139.x

College of Nursing, Hong Kong (n.d.).  Clinical nurse specialist accreditation.  Retrieved from: http://www.cnhk.org.hk/eng/Files/Courses/Clinical_Nurse_Specialist_Accreditiation_Leaflet_101101_4.pdf

Kannusamy, P. (2006).  A longitudinal study of advanced practice nursing in Singapore.  Critical Care Nursing Clinics of North America. 18,545-551.  doi:10.1016/j.ccell.2006.08.001

Lee, K. (2014, June 25).  Nurses looking for cure to staff shortages.  The Standard.  Retrieved from: http://thestandard.com.hk

Loke, A. (2004).  Hong Kong scenario: The development of nurse practitioner education program.  Retrieved from: http://international.aanp.org/pdf/LokeHKNP.pdf

Chan, S., Thompson, D.R., & Wong, T. (2006).  Chapter 14: Nurses as agents of quality improvement.  In Leung, G.M. & Bacon-Shone, J. (Eds.), Hong Kong’s health system: Reflections, perspectives and visions [Google e-reader version].  Aberdeen, Hong Kong:  Hong Kong University press.  Retrieved from: http://books.google.com/

Provisional Hong Kong Academy of Nursing Limited, The (2012).  Introduction of PHKAN.  Retrieved from: http://www.hkan.hk/

Schober, M. & Affara, F.A. (2006).  International Council of Nurses: Advanced Nursing Practice [Kindle e-reader version].  Blackwell Publishing Ltd.

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

Shiu, A.T., Lee, D.T., & Chau, J.P. (2012).  Exploring the scope of expanding advanced nursing practice in nurse-led clinics: A multiple-case study.  Journal of Advanced Nursing, 68(8),1780-1792.  doi: 10.1111/j.1365-2648.2011.05868.x

Twinn, S. (2003, December 14).  Advanced nursing practice in public health nursing.  Hong Kong Society for Nursing Education Newsletter.  Retrieved from: http://www.hksne.org.hk/newsletter/200312-04.htm

Wong, F.K. (2002). Development of advanced nursing practice in Hong Kong: a celebration of ten years’ work [PowerPoint presentation]. Retrieved from: international.aanp.org/pdf/fwongicnanpdev_2406031.ppt

Wong, F.K.Y. & Chung, L.C.Y. (2006).  Establishing a definition for a nurse-led clinic: Structure, process, and outcome.  Journal of Advanced Nursing, 53(3),358-369.  doi: 10.1111/j.1365-2648.2006.03730.x

[Updated: Jun 29, 2014]

Advanced Practice Nursing in Samoa

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Specialist

Nationally Certified:
Uncertain (Nationally Registered)

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Uncertain

Prescribing Authority:
Uncertain

Practice Autonomously:
Uncertain

Contact:
Samoa Ministry of Health

Role

The role of Advanced Practice Nurses (APN) in Samoa is identified by the Nurse Specialist role (Joel, 2013).  Registered nurses in Samoa can be cross-trained as midwives as well (Samoan Ministry of Health, 2006a).  At this time, there is insufficient information on the scope of this role, but the response of the advancement of nursing practice in Samoa appears to be related to a shortage of healthcare professionals in the current health system.  To date, the register of healthcare providers in Samoa is available online with more than 200 professionals in their system providing care of the 188,000 people in the country (World Bank, 2012).  Of these, in 2006 there were reported only 14 general practitioners in the country (Samoan Ministry of Health, 2006a).

According to the Samoan Ministry of Health (2006b), a specific shortage in mental health professionals is desired to be met with an increasing number of Mental Health Nursing Specialists by 2018.  Additionally, as the population has been increasing, there is encouragement to increase the number of skilled nurses trained as midwives by 2018 as well (Samoan Ministry of Health, 2006).

Education and Certification

An individual is required to have a year of postgraduate education to become a Nurse Specialist in Samoa (Joel, 2013).  Basic nursing education is provided at the bachelor level at the National University of Samoa.  Of note for education in Samoa is also the Oceania University of Medicine, which has a medical program that greatly encourages nurses to become physicians.  While this school has been under scrutiny due to corruption since 2011 and the future of the school is uncertain, such educational opportunities greatly influence the availability of health care professionals in the country (Hazelman-Siona, 2013).  Registration is necessary to practice in any healthcare role by the Ministry of Health in Samoa.

Specialties

Nursing Specialists in Samoa work in mental health nursing (Samoan Ministry of Health, 2006b).  Other specializations may well exist, but there is insufficient available information on the specialties practiced in Samoa.

Have information to add to this page?

References:
International Council of Nurses/Advanced Practice Nursing Network (2013).  Contact information sheet: Western Pacific, Fiji.  Retrieved from: http://www.icn.ch/details/17/116.html

Hazelman-Siona, N. (2013, May 8).  O.U.M.’s future still undecided.  Samoa Observer.  Retrieved from: http://www.samoaobserver.ws/education/4749-oums-future-still-undecided

Joel, L.A. (2013).  Advanced Nursing: Essentials of Role Development [3rd ed.; Electronic Book]. F.A. Davis.  Retrieved from: http://books.google.com/

Samoan Ministry of Health (2006a). Health Sector Plan 2008-2018.  Retrieved from: http://www.health.gov.ws/Portals/189/HEALTH%20SECTOR%20PLAN.pdf

Samoan Ministry of Health (2006b).  Samoa mental health policy.  Retrieved from: http://www.who.int/mental_health/policy/country/SamoaMHPolicy%20Final%20-%20Aug2006.pdf

World Bank (2012).  Population, total.  Retrieved from: http://data.worldbank.org/indicator/SP.POP.TOTL

Advanced Practice Nursing in Singapore

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Practice Nurse

Nationally Certified:
Yes

Recognize Foreign Licensure:
Yes

Treatment Authority:
Yes

Prescribing Authority:
Limited under acute care protocols

Practice Autonomously:
Varies

Contact:
Singapore Nursing Board

Role

An Advanced Practice Nurse (APN) in Singapore is recognized as an APN.  In Singapore, the title “Advanced Practice Nurse” is protected and only allowed to be used by individuals certified by the Singapore Nursing Board (Fee, 2012).  The development of the APN role in Singapore, has been a proactive response to alleviate increased workforce stress due to an aging population with greater health care needs, while also providing career advancement opportunities for nurses (Kannusamy, 2006; Premarani, n.d.).  As a result, Singapore initially developed a master of nursing program training individuals in advanced clinical skills in 2003 and had its first graduates in 2004 (Sheer and Wong, 2008).  Since the development of the APN role, Singapore plans on increasing the APN number to more than 200, approximately 1.4% of the nursing population, by 2014 (Sheer and Wong, 2008; Tan Tock Seng Hospital, 2013).  While this is the goal that has been set for Singapore, the Singapore Ministry of Health (2011) identified currently 88 APNs registered to practice in the country in 2012.

The role of the APN in Singapore is best described as a hybrid of the Clinical Nurse Specialist and the Nurse Practitioner (Fee, 2012; Bee, 2012).  APNs are trained in the advancement of the registered nurse profession to add the role skills of diagnosis and management of common ailments and chronic illnesses (Singapore Nursing Board, 2012).  The scope of practice for the APN in Singapore includes the following (Singapore Nursing Board, 2012; Tan Tock Seng Hospital, 2013):

  • Advanced physical assessment
  • Develop diagnosis and differential diagnoses
  • Interpret laboaratory and diagnostic testing
  • Management of care
  • Performing procedures
  • Collaboration with other healthcare professionals including doctors
  • Advancement of nursing through development and implementation of Evidence Based Practice into current healthcare

APNs in Singapore work in all settings, including primary, secondary, and tertiary care as well as peer and nursing education (Singapore Nursing Board, 2012).  Pharmaceutical prescribing and management is under current investigation and standardization (Tan Tock Seng Hospital, 2013).  While prescribing is recognized to be traditionally under the medical domain, it is acknowledged that by preventing prescribing rights, this prevention would inhibit the effectiveness of the role (Tan Tock Seng Hospital, 2013).  As a result, APNs currently are allowed to provide (furnish) medication prescription privleges in certain acute care settings according to pre-identified protocols (Singapore General Hospital, 2013; Tan Tock Seng Hospital, 2013).

As APNs have only recently developed an established role in Singapore, the Singapore Nursing Board (2012) also requires the hiring institution to identify the specific scope of practice and role for the APN.

Education and Certification

Registration was first established in Singapore in 2006 (Sheer and Wong, 2008).  To be an APN in Singapore, an individual must be registered with the Singapore Nursing board and have at least 3 years of post registration experience in their specialty (Singapore Nursing Board, 2012).  There is currently one program in Singapore recognized by the Board, the Master of Nursing program at the Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine at the National University of Singapore.   Applications for registration must be made in person.  Once an individual graduates for an accredited program and has submitted for registration, they are required to perform one year of supervised clinical practice with a minimum of 1280 hours of direct patient care at an advanced level (Singapore Nursing Board, 2012).

Specialties

Currently, APNs in Singapore may be qualified as one of four specializations (Singapore Nursing Board, 2012):

  • Acute Care APN
  • Medical/Surgical APN
  • Community Care APN
  • Mental Health APN

The roles of the APN in acute care specializations includes current APNs or interns in (Singapore General Hospital, 2013; Tan Tock Seng Hospital, 2013):

  • Anesthesiology
  • Cardiology
  • Diabetes and Endocrinology
  • Family Medicine Continuing Care
  • Gasteroenterology and Nutrition
  • Gerentology
  • Intensive Care
  • Neurology
  • Neurology Intensive Care
  • Oncology
  • Orthopedics
  • Pelvic Floor Disorders
  • Palliative Care
  • Rehabiliation Medicine
  • Renal and
  • Vascular Surgery

Have information to add to this page?

References:
Bee, T.S. (2012).  Advanced practice nursing in Singapore – Clinical outcomes [PowerPoint presentation].  Retrieved from: http://www.hksne.org.hk/course/DrTanSiokBeeAPNCareOutcomes.pdf

Fee, L.S. (2012).  Pioneering moments of APN in an acute tertiary hospital in Singapore [PowerPoint presentation].  Retrieved from: http://www.hksne.org.hk/course/MsLimSuFeePioneeringMomentsofAPN.pdf

Kannusamy, P. (2006).  A longitudinal study of advanced practice nursing in Singapore.  Critical Care Nursing Clinics of North America. 18,545-551.  doi:10.1016/j.ccell.2006.08.001

Premarani, K. (n.d.).  Advanced practice in Singapore [PowerPoint Presentation].  Retrieved from: https://international.aanp.org/pdf/P13.ppt

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

Singapore General Hospital (2013).  Advanced practice nurse.  Retrieved from: http://www.sgh.com.sg/clinical-departments-centers/nursing/nursingprofession/pages/advanced-practice-nurse.aspx

Singapore Ministry of Health (2011).  Health manpower.  Retrieved from: http://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Health_Manpower.html

Singapore Nursing Board (2012).  Advanced practice nurse.  Retrieved from: http://www.healthprofessionals.gov.sg/content/hprof/snb/en/leftnav/advanced_practice_nurse.html

Tan Tock Seng Hospital (2013).  Advanced practice nurses.  Retrieved from: http://www.ttsh.com.sg/APN/

Advanced Practice Nursing in the Fiji Islands

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Practitioner

Nationally Certified:
Uncertain (Nationally Registered)

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Yes

Prescribing Authority:
Yes

Practice Autonomously:
Yes

Contact:
Fiji Ministry of Health
Fiji School of Nursing

Role

The role of Advanced Practice Nurses (APN) in the Fiji Islands is represented by Nurse Practitioners (Pulcini, Jelic, Gul, & Loke, 2009).  This role was developed to primarily help address the significant primary care needs in the rural communities, especially as 60% of individuals living within Fiji live in such settings with minimal health care access (Joel, 2013).  The first class graduated with their post-graduate diploma in 1999 (Downs, E., Personal Communication, 2013, October 12; Joel, 2013).

The role of NPs in Fiji works under established protocols, allowing individuals some prescriptive privileges (Joel, 2013).  As a result however, there is still need to develop standardized treatment guidelines throughout the region (Joel, 2013).

Education and Certification

To be accepted into an Advanced Practice Nursing program in the Fiji Islands, an individual is required to be either or both a Registered Nurse or a midwife and have a minimum of five years of clinical experience in a health care setting (Fiji National University, 2013).  The program currently is offered at the Fiji School of Nursing, which is now a part of the National University, and transitioning the program to offer Masters degrees to graduates.  This program has become regional and has also graduated individuals from the Solomon Islands, Marshall Islands, Tonga, and Tuvalu (Downs, E., Personal Communication, 2013, October 12; Joel, 2013).

Registration is obtained by the Ministry of Health for all individuals in nursing, midwifery and advanced nursing practice (International Council of Nurses/APN Network, 2013).

Specialties

Nurse Practitioners primarily work in the role of primary health care (Joel, 2013).

Have information to add to this page?

References:
Fiji National University (2013).  School of Nursing.  Retrieved from: http://www.fnu.ac.fj/index.php?option=com_content&view=article&id=1501&Itemid=284

International Council of Nurses/Advanced Practice Nursing Network (2013).  Contact information sheet: Western Pacific, Fiji.  Retrieved from: http://www.icn.ch/details/17/116.html

Joel, L.A. (2013).  Advanced Nursing: Essentials of Role Development [3rd ed.; Electronic Book]. F.A. Davis.  Retrieved from: http://books.google.com/

Pulcini, J., Jelic, M., Gul, R, & Loke, A.Y. (2009).  An international survey on advanced practice nursing, education, practice, and regulation.  Journal of Nursing Scholarship, 42(1),31-39.  doi: 10.1111/j.1547-5069.2009.01322.x

Advanced Practice Nursing in Canada

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Practitioner
Clinical Nurse Specialist

Nationally Certified:
Yes

Recognize Foreign Licensure:
Yes

Treatment Authority:
Yes

Prescribing Authority:
Yes

Practice Autonomously:
Yes

Contact:
Canadian Nurses Association
Nurse Practitioners’ Association of Ontario

Role

Initially, the APN role started in the 1970s (Sheer & Wong, 2008).  It was after individuals from new Nurse Practitioner programs in 1973 in Ontario banded together to create the Nurse Practitioners’ Association of Ontario, that they began to develop a presence and push for a recognized role in Canada (Sheer & Wong, 2008).  While the role was minimal initially, it wasn’t until the 1990’s with additional health care reform that Nurse Practitioners became more prevalent in Canada (Pulcini, Jelic, Gul, & Loke, 2009).  The role was initially designed to meet the primary health care needs of the country (Pulcini et al., 2009).  Since that time, the role of Advanced Practice Nursing (APN) in Canada is represented by Nurse Practitioners and Clinical Nurse Specialists.

Nurse Practitioner
More prevalent and increasing in number is the Nurse Practitioner role in Canada.  The CNA (2013a) identifies, “Nurse practitioners provide direct patient care, focusing on health promotion and the treatment and management of health conditions.  They have an expanded scope of practice and can diagnose, order and interpret diagnostic tests.  They can also prescribe medications and perform certain procedures.”

The role of the Nurse Practitioner in Canada does allow for significant autonomy, as is regulated according to province.  Recently, there has been an emerging trend of Nurse Practitioner-Led Clinics in Canada greatly fostered by the desire to meet the primary care needs of Canada, fostered by the developed role of the Nurse Practitioner in the country (DiCenso et al., 2010).   While autonomy is available for Nurse Practitioners in Canada, the majority are employed as a part of practices with physicians (DiCenso et al., 2010).  Such clinics have currently been developing or already functioning in the provinces of Manitoba and Ontario (Krahn, 2013; Adler, 2013).

Clinical Nurse Specialist
According to the Canadian Nurses Association (CNA, 2013a), “Clinical nurse specialists provide expert nursing care and play a leading role in the development of clinical guidelines and protocols.  They promote the use of evidence, promote expert support and consultation, and facilitate system change.”

Essentially, the role of the CNS does not have any expounded role to that of Registered Nurses and as a result, there is no further legislation required to identify the role of the CNS, and resultantly the title is not protected.  According to DiCenso et al. (2010) there have been reports of varying levels of practice, to the point that individuals have been observed to very limited prescribing rights in isolated situations (DiCenso et al., 2010).  As a result, there is significant room for role clarity in the future.

Education and Certification

To become a Nurse Practitioner (NP) in Canada, an individual must be minimally educated at the graduate level and pass the Canadian Nurse Practitioner Exam written by the Canadian Nurses Association (2013a).  Additionally, NPs are then required to hold a license in the province they desire to practice (Robinson & Griffiths, 2007).

As the Clinical Nurse Specialist (CNS) is inconsistent, there has been efforts to distinctly separate the NP and CNS roles in education.  However individuals who are identified as CNSs are educated at the graduate level, holding a masters or doctorate degree (Robinson & Griffiths, 2007).

Certification for nursing specialties is an optional certification available to nurses after two years of clinical experience.  Once qualified, an individual is required to take a certification exam in the specific specialty desired.  This role requires an individual to be a Registered Nurse (RN) and does not require graduate level education.

Specialties

Nurse Practitioner specialties are primarily not offered throughout the various schools of advanced nursing practice in Canada, as most individuals receive generalist NP degrees (DiCenso et al., 2010).  There are several exceptions, primarily in neonatology throughout Canada, and in Quebec where specialty roles are offered in cardiology, nephrology, and neonatology.

Have information to add to this page?

References:

Adler, M. (2013, September 20).  Hong Fook Nurse Practitioner-Led Clinic welcomed in Agincourt.  Scarborough Mirror.  Retrieved from: http://www.insidetoronto.com/news-story/4116601-hong-fook-nurse-practitioner-led-clinic-welcomed-in-agincourt/

Canadian Nurses Association [CNA] (2013a).  Nurse Practitioner and Clinical Specialists.  Retrieved from: http://www.cna-aiic.ca/en/professional-development/nurse-practitioner-and-clinical-specialists

Canadian Nurses Association [CNA] (2013b).  Position Statement: Advanced Nursing Practice [Electronic document].  Retrieved from: http://www.cna-aiic.ca/~/media/cna/page%20content/pdf%20en/2013/07/26/10/23/ps60_advanced_nursing_practice_2007_e.pdf

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

DiCenso, A., Bourgeault, I., Abelson, J., Martin-Misener, R., Kaasalainen, S. …Kilpatrick, K. (2010).  Utilization of nurse practitioners to increase patient access to primary healthcare in Canada–Thinking outside the box.  Nursing Leadership (Toronto, Ontario). 2010, 239-259.

Krahn, H. (2013, September 25).  Letters to the editor: Fragmenting a workable system.  Winnipeg Free Press.  Retrieved from: http://www.winnipegfreepress.com/opinion/letters_to_the_editor/fragmenting-a-workable-system-225147162.html

Pulcini, J., Jelic, M., Gul, R, & Loke, A.Y. (2009).  An international survey on advanced practice nursing, education, practice, and regulation.  Journal of Nursing Scholarship, 42(1),31-39.  doi: 10.1111/j.1547-5069.2009.01322.x

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

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

Advanced Practice Nursing in Costa Rica

Snapshot

APN Role Exists in Country Today:
No

Contact:
Colegío de Enfermeras de Costa Rica

Role

There is no current Advanced Practice Nursing (APN) role in Costa Rica today (post by Julie Slivinsky, All Nurses.com, 2011, January 8).  Reportedly from the last World Health Organization (WHO, 2013a) reported in 2000, there were approximately 1.32 physicians per 1000 people, significantly lower than the majority of developed nations.  Meanwhile, there are 0.69 nurses per every physician, creating a healthcare workforce with significantly more physicians than nurses (WHO, 2013b).  This factor is likely a significant inhibiting factor for such APN role development.

Meanwhile, there is reportedly a history of a midwifery role, that has been in existence since 1899 (Colegio de Enfermeras de Costa Rica, 2011).  In 2000, there were reportedly 22 midwives in the country (WHO, 2013b).

Specialties

Not applicable at this time.

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References:
Colegio de Enfermeras de Costa Rica (2011).  Historia de la enfermería en Costa Rica.  Retrieved from: http://www.enfermeras.co.cr/HistoriaEnfermeriaCostaRica.html

World Health Organization [WHO] (2013).  Aggregated Data: Density per 1000 by country.  Retrieved from: http://apps.who.int/gho/data/node.main.A1444?lang=en

World Health Organization [WHO] (2013b). Disaggregated data: Nursing and midwifery personnel by country.  Retrieved from: http://apps.who.int/gho/data/node.main.HWF1?lang=en

Advanced Practice Nursing in India

Snapshot

APN Role Exists in Country Today:
No

Title:
Nurse Practitioner

Contact:
Indian Nursing Council

Role

With 72% of the Indian population residing in rural areas and 75% of medical providers residing in urban areas, India is currently experiencing significant shortages of physicians, particularly in rural areas (Penn Nursing Science, 2013).  In addition, the overall country has a shortage of nurses and physicians, so much so that is it estimated that there is only one physician for every 1700 people (Kumar, 2013).  While the normal standards for nurse to physician ratios often reflect between a 2.0 to 3.0 nurses per physician, India has an alarmingly low nurse to physician ratio estimated around 1.22 nurses per physican (Munjanja, Kibuka, & Dovlo, 2005).  With alarmingly low health care professionals in the country, there is significant need for advancement of those few who have the education as a nurse may well be the exclusive healthcare professional in a rural area.

Recently the region of West Benghal started training Advanced Practice Nurses, identified as Nurse Practitioners (Kumar, 2013).  While this role has just begun, India has found significant resistance to developing an advanced nursing role primarily based on strong pressures by medical organizations to not increase the scope of practice of nurses.  This is primarily related to the country’s health system that has traditionally held very limited roles for nursing and maintained physicians as sole individuals to provide advanced healthcare (Penn Nursing Science, 2013).

Meanwhile, in the region of Kerala, some have reported that graduate level Nurse Practitioner courses are already offered from the Kerala Institute of Medical Sciences (shahinshahul, ClinicalResearchSociety.org, 2012, May 28).  While such programs are offered through various independent schools throughout the country, there is yet a standard identified for a Nurse Practitioner or specific advanced practice role.

Education and Certification

Education standards in India vary from diploma programs for general nursing, bachelor programs consistent with international standards, and masters and PhD programs in nursing (CurrentNursing.com, 2013).  While these programs do offer education allowing individuals to learn advanced practice nursing concepts, the current healthcare structure in the country does not provide ample opportunities for nursing advancement at the bachelor level, let alone at the masters and PhD levels, leading to many individuals leaving their areas and country to pursue more adventitious employment (Baumann & Blythe, 2008; Penn Nursing Science, 2013).  While many of the individuals who practice nursing in India are not bachelor educated, according to Nochols, Davis and Richardson (2009), India has begun to phase out their non-bachelor programs.

Midwifery is a standard of general nursing practice in India.  Regulation varies according to state and in the country no nurse is allowed to have permission to practice in more than one state at a time.  In some states, it is illegal for males to perform midwifery and obstetrics care and as it is a part of general education, there is a greater shortage of nurses in those regions (Nichols, Davis, & Richardson, 2009).

Individuals interested in attaining permission to practice in India require permission by the Equivalency Council at selected charities for a limited duration (Indian Nursing Council, 2013).  Such provisional permission to practice in India is granted for diploma, bachelor, and master prepared nurses and granted permissions.

While an individual of foreign education may have a master degree in nursing, the provisional permissions currently in India allow them to work in the administration, but no part of the application requires specific education on patient care, indicating an individual can likely not practice at any Advanced Nursing level without exclusive permission by the nursing council (as has been granted to Penn State in the region they are attempting to initiate Nurse Practitioner education) (Indian Nursing Council, 2013).

Specialties

  • Critical Care

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References:

Baumann, A. & Blythe, J. (2008). Globalization of higher education in nursing.  The Online Journal of Issues in Nursing, 13(2), manuscript 4.  doi: 10.3912/OJIN.Vol13No02Man04

CurrentNursing.com (2013).  Nursing Education In India.  Retrieved October 2, 2013 from: http://currentnursing.com/nursing_education/nursing_education_in_india.html

Kumar (2013, September 23).  India has just one doctor for every 1700 people.  The New Indian Express.  Retrieved from: http://newindianexpress.com/magazine/India-has-just-one-doctor-for-every-1700-people/2013/09/22/article1792010.ece

Indian Nursing Council (2013).  Home.  Retrieved October 2, 2013 from: http://www.indiannursingcouncil.org/

Khanna, R. (2018). Personal Communication.

Munjanja, O.K., Kibuka, S., & Dovlo, D. (2005).  Issue Paper 7: The Nursing Workforce In Sub-Saharan Africa.  International Council of Nurses.  Retrieved from: www.ghdonline.org/

Nichols, B.L., Davis, C.R., & Richardson, D.R. (2011).  Appendix J: International models of nursing.  The Future of Nursing: Leading Change, Advancing Health.  Institute of Medicine.  Retrieved from: http://www.nap.edu/catalog/12956.html

Penn Nursing Science (2013).  Utilizing APNs to Solve Provider Shortage in Rural India.  Retrieved October 2, 2013 from: http://www.nursing.upenn.edu/gha/Pages/UtilizingAPNstoSolveProviderShortageinRuralIndia.aspx

[Updated 2022, May 07]

Advanced Practice Nursing in Japan

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Midwife
Public Health Nurse
Certified Nurse
Certified Nurse Specialist

Nationally Certified:
Yes

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Uncertain

Prescribing Authority:
No

Practice Autonomously:
No

Contact:
Japanese Nursing Association

Role

Advanced Practice Nursing in Japan has been historically a reflection of a higher ratio of doctors and a low ratio of nurses per capita (Delamaire & Lafortune, 2008).

There are varying roles of advancement for nurses beyond that of the registered nurse and include: Nurse Midwife, Public Health Nurse, Certified Nurse Specialist, Certified Nurse, and Certified Nurse Administrator.  The Nurse Midwife and Public Health Nurse roles, primarily resemble extensions of nursing practice, giving nurses a specialization in the subject.

In Japan, the roles that most closely resemble Advanced Practice Nursing are that of Certified Nurses and Certified Nurse Specialists.  The role of certified nurses reflects that of nurses who are educators, consultants for nursing care, and excellent care providers (JNA, n.d.).

The role of However, the APNs in Japan primarily resemble the role of clinical nurse specialists, as nurses can gain specific specialist knowledge on a subject (Japanese Nurses Association [JNA], n.d.).  According to the JNA, the role of the Certified Nurse Specialist (CNS) is to, “contribute to the development of healthcare and welfare as well as to improve nursing science by forwarding CNSs with specific advanced nursing knowledge and skills into society to provide high-level nursing care efficiently for individuals, families and groups having complex and intractable nursing problems.”

As a result, the role of the CNS in Japan reflects the following (JNA, n.d.):

  • Excellent nursing practice
  • Coordination with patients, families, and concerned individuals for healthcare
  • Consultation with nurses and physicians
  • Ethics coordination
  • Education of personnel, and
  • Clinical research

Currently there is no comparable role to that of a Nurse Practitioner (NPs) in Japan, but efforts have been underway to determine if such a role would be appropriate for the advancement of nursing practice in Japan and a pilot program to introduce Nurse Practitioners is underway (Bugle Newspapers, 2013; Kondo, 2013).  While physicians appear to be welcoming of the potential new role of an advanced nurse counterpart, the greatest barrier to such a role development is that of perceived lack of evidence that NPs should be able to practice autonomously (Kondo, 2013).

Education and Certification

There is national certification for registered nurses, public health nurses, and midwives in Japan, by which individuals can take the exam after completion of an appropriate school (Japanese Nursing Association, n.d.).  Education requirements vary according to the specialty, but individuals will be required to have an additional year of training to become a midwife or public health nurse (JNA, n.d.).  As Japan has both 3-year nursing certificate and 4-year bachelor degree options to become a registered nurse, some programs offer a dual nursing and midwife or public health nurse bachelor option as a 4-year program.

To become a CNS, an individual is required to be educated at the master level (JNA, n.d.).  National certification is available through the JNA (n.d.) for the CNS’s, which is available to individuals after they have completed an accredited masters program and achieved a specified level of experience.

Specialties

The various specialties of Advanced Practice Nurses currently certified in Japan are the following (JNA, n.d.):

  • Cancer nursing
  • Psychiatric Mental Health Nursing
  • Community Health Nursing
  • Gerentological Nursing
  • Child Health Nursing
  • Women’s Health Nursing
  • Chronic Care Nursing
  • Critical Care Nursing
  • Infection Control Nursing
  • Family Health Nursing
  • Home Care Nursing

The various specialties Certified Nurses are (JNA, n.d.):

  • Emergency Nursing
  • Wound, Ostomy, and Continence Nursing
  • Intensive Care
  • Palliative Care
  • Cancer Chemotherapy Nursing
  • Cancer Pain Management Nursing
  • Visiting Nursing
  • Infection Control
  • Diabetes Nursing
  • Infertility Nursing
  • Neonatal Intensive Care
  • Dialysis Nursing
  • Perioperative Nursing
  • Breast Cancer Nursing
  • Dysphagia Nursing
  • Pediatric Emergency Nursing
  • Demential Nursing
  • Stroke Rehabilitation Nursing
  • Radiation Therapy Nursing
  • Chronic Respiratory Nursing
  • Chronic Heart Failure Nursing

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References:
Bugle Newspapers (2013, October 1).  Japanese Nursing Association Visits St. Francis.  Retrieved from: http://www.buglenewspapers.com/joliet/article_01ee4386-2ad7-11e3-a331-0019bb30f31a.html

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

Japanese Nurses Association (n.d.).  Nursing in Japan.  Retrieved October 1, 2013 from: http://www.nurse.or.jp/jna/english/nursing/

Kondo, A. (2013).  Advanced practice nurses in Japan: Education and Related Issues.  Journal of Nursing Care, S5(4),1-6.  doi:10.4172/2167-1168.S5-004

Advanced Practice Nursing in Poland

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Specialist
Nurse Midwife

Nationally Certified:
No

Recognize Foreign Licensure:
RN and Midwife Nursing licensure is recognized from EU

Treatment Authority:
Varies according to specialty

Prescribing Authority:
No

Practice Autonomously:
No

Contact:
Ministerstwo Zdrowia (Poland Ministry of Health)

Role

Development of the Advanced Practice Nurse Role in Poland has been greatly driven by the financial benefit that APNs can provide equal care at a lesser cost than that of physicians (Delamaire & Lafortune, 2010).  According to Strózik (2006), Poland has almost 2 nurses per every doctor in the country, and has about 2.3 physicians per 1000 individuals, not significantly lacking.  However, there is also reportedly slower waits to see physicians and consultants (more experienced and knowledgable physicians) and in the emergency rooms than most of the EU (europe-cities.com, 2013).

The expanded roles of nurses in specialty positions perform advanced physiologic and psychologic assessment.  The role of APNs as nurse specialists in Poland are not uniform according to specialty, but are based on the healthcare needs within the country for more urgent care and intensive management.  As a result, such expanses of scope of practice include management of some chronic illnesses (i.e. diabetes and end-stage renal disease), perform triage for patient prioritization, or some emergency procedures (i.e. emergency intubation or tracheotomy) (Delamaire & Lafortune, 2010).  APNs in Poland however do not have prescriptive authority (Delamaire & Lafortune, 2010).

According to Delamaire & Lafortune (2010), the chief barriers to advancing nursing practice in Poland is four fold:

  • Medical association opposition
  • Lack of government funding for new roles
  • Legislation
  • Methods of compensation for physicians

Education and Certification

Nurses are trained regularly at the bachelor level based on a 3 year post high school education.  They can opt for an extended track that allows for midwifery practice, totaling a 5 years of post graduate coursework (Rechel, Dubois, & McKee, 2006).  Coursework is directed and approved by the Poland Ministry of Health and a post graduation licensure exam is required to practice (Nichols, Davis, & Richardson, 2011; Strózik, 2006).

Specialties

Nurses have opportunities to obtain post bachelor graduate education in midwifery, pediatric, psychiatric, and additional opportunities (Strózik, 2006).  While these specializations offer further education and knowledge application, information is lacking on the extent, if any that the scope of practice may be expanded.

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References:
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

europe-cities.com (2013).  Healthcare in Poland.  Retrieved from: http://www.europe-cities.com/en/633/poland/health/

Nichols, B.L., Davis, C.R., & Richardson, D.R. (2011).  Appendix J: International models of nursing.  The Future of Nursing: Leading Change, Advancing Health.  Institute of Medicine.  Retrieved from: http://www.nap.edu/catalog/12956.html

Strózik, M. (2006). Chapter 7: Poland. The Health Care Workforce in Europe: Learning from experience.  World Health Organization: Copenhagen, Denmark.  Retrieved from: http://www.euro.who.int/__data/assets/pdf_file/0008/91475/E89156.pdf