Tag Archives: advanced nurse practitioner

Advanced Practice Nursing in India

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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 Poland

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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

Advanced Practice Nursing in Switzerland

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Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Practice Nurse
Nurse Anesthetist

Nationally Certified:
Yes

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Uncertain

Prescribing Authority:
No

Practice Autonomously:
No

Contact: 
University of Basel

Role

The role of the Advanced Practice Nurse in Switzerland has been developing since 2000 with the first advanced practice nursing program.  While there is no current scope of practice that is identified in the country, Switzerland has been developing the role of APNs that most closely resemble Clinical Nurse Specialists (Sprig, Schwendimann, Spichiger, Cignacco, & De Geest, 2009).  Often individuals who are prepared at the APN level will function not at the clinical level, but rather in leadership, quality, and process improvement levels (Sprig et al., 2009).  Additionally, APNs in Switzerland have been working with more advanced assessment and specialized patient care as well, but is more done so on an organizational-based program (Imhof, Naef, Wallhagen, Schwartz, & Mahrer-Imhof, 2012).  Because the development of APNs in Switzerland has been more driven on creating new healthcare models and improved outcomes rather than a physician shortage, there is little regulation at this time that defines a clear scope of practice (De Geest et al., 2008).

The Nurse Anesthetist role is also in existence in Switzerland (International Federation of Nurse Anesthetists [IFNA], n.d.).  Reportedly there are approximately 1900 Nurse Anesthetists in Switzerland today, more than that of anesthesiologists in the country (INFA, n.d.).  Regulations vary according to region, but in general Nurse Anesthetists administer general anesthesia under the supervision of an anesthesiologist (INFA, n.d.).

Education and Certification

Education for the APN in Switzerland is provided at the masters level after an individual achieves a bachelor degree in nursing (Sprig et al., 2009).  The programs for APNs in Switzerland require an individual to have English proficiency, 2 years of clinical professional experience in nursing, and have a degree in nursing (Sprig et al., 2009).  Additionally, individuals in nursing have also graduated at the doctorate level (PhD) in nursing (Sprig et al., 2009).

Education for a Nurse Anesthetist in Switzerland requires a nurse after obtaining a four-year nursing diploma an additional 400 hours of classroom education and approximately 200 hours of clinical time (INFA, n.d.).

Specialties

While there are various specializations that APNs may function within Switzerland, those observed in the literature were of HIV/AIDS, gerontology, and general practice (primary health care) (Imhof et al., 2012; Sprig et al., 2004).

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References:
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.

Imhof, L., Naef, R., Wallhagen, M.I., Schartz, J., & Mahrer-Imhof, R. (2012).  Effects of an advanced practice nurse in-home health consultation program for community-dwelling persons aged 80 and older.  Journal of the American Geriatrics Society. 60(12),2223-2231.  doi: 10.1111/jgs.12026

International Federation of Nurse Anesthetists [IFNA] (n.d.). Switzerland Country Page.  Retrieved from: http://ifna-int.org/ifna/page?38

Sprig, R., Nicca, D., Voggensperger, J., Unger, M., Werder, V. & Niepmann, S. (2004).  The advanced nursing practice team as a model for HIV/AIDS caregiving in Switzerland.  Journal of the Association of Nurses in AIDS Care.  15(3),47-55.  doi:10.1177/1055329003261960

Sprig, R., Schwendimann, R., Spichiger, E., Cignacco, E., & De Geest, S. (2009).  The leadership role of the Institute of nursing Science, University of Basel in launching advanced practice nursing in the German speaking European countrires.  Universitat Basel.  Retrieved from: http://nursing.unibas.ch/fileadmin/pflege/redaktion/Institut/090206_ANP_ICN_Website.pdf