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).

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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 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

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 Mexico

Snapshot

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

Contact:
Secretería de Salud
Asociación Mexicana de Enfermeras Especializadas en Medicina Crítica y Terapia Intensiva
 (Mexican Association of Specialized Nurses in Critical and Intensive Care [AMEEMCTI])

Role

Currently there is no specific advanced practice nursing role in Mexico.  Nurses are offered the ability to specialize in intensive and critical care, but to date, nursing has not taken a leader role in health care (AMEEMCTI, n.d.; Secretería de Salúd, 2013).  The 20th ANEC conference in Mexico later this year will include the readdressing of the nursing role in Mexico and will be influenced and collaborated with the International Council of Nurses, allowing for more focused role development appropriate to the country’s healthcare needs (Secretería de Salúd, 2013).

In the meantime, Mexico’s health care system provides significant opportunity and potential for development of the Advanced Practice Nursing role (Pérez-Cuevas, Muñoz Hernández, & Gutiérrez Trujillo, 2010).

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References:
Asociación Mexicana de Enfermeras Especializadas en Medicina Crítica y Terapia Intensiva (n.d.).  AMEEMCTI.  Retrieved from: http://www.ameemcti.org/

Pérez-Cuevas, R., Muñoz Hernández, O., & Gutiérrez Trujillo, G. (2010).  Nurses: The “front gate” to provide effective pediatric preventive care.  Boletín Médico del Hospital Infantil de México, 67(4).  Retrieved from: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400010&lng=pt&nrm=iso

Secretería de Salúd (2013). Congreso Nacional de Enfermería, XX ANEC.  Retrieved from: http://www.salud.gob.mx/unidades/cie/cms_cpe/index.php?Id_URL=400despliegue&anio=2013&Id_Nota=222

[Updated: 2013, October 29]