APN Role Exists in Country Today:
Advanced Practice Nurse
Recognize Foreign Licensure:
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).
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
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]