Advanced Practice Nursing in the United Kingdom (England, Wales, Scotland, and Northern Ireland)

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Contact:
Nursing & Midwifery Council
Royal College of Nursing

Country Specific Resource Links:
Advanced Practice Toolkit – repository for UK specific resources for practice

Role

The role of Advanced Practice Nurses in the United Kingdom (UK) is primarily represented as Advanced Nurse Practitioners (ANPs; RCN, 2012).  While the title of ANP is used by the Royal College of Nursing (RCN), there had been inconsistencies among the general public as to the term to call ANPs in the country, and various are used as: advanced clinical practice (ACP) nurse, nurse practitioner, registered nurse practitioner, clinical nurse practitioner, senior nurse practitioner, advanced nurse practitioner, and association nurse practitioner (Morgan, 2010; RCGP, 2020).

The ANP role was first introduced in the UK with the initiation of a Nurse Practitioner program focusing on primary health care at the Royal College of Nursing (RCN) in 1991-1992 (NP/APN Network, 2020; Sheer & Wong, 2008).  Much of the push for development of this role was to ease the overbearing workload of the general practitioners (primary care physicians) in the country, and this largely continues to drive the need for this role (NP/APN Network, 2020; Pulcini, Jelic, Gul, & Loke, 2009).  Delamaire and Lafortune (2010), further identified that improving the quality of care additionally drives role development in the UK.

While the role has been continually developed and internationally is considered at a more advanced stage of APN advancement, the role is not formally regulated which greatly prevents further advancement and maintains inconsistencies in both educational and professional standards (Evans et al., 2020; NP/APN Network, 2020).

Currently ANPs in the UK have both prescriptive authority and work autonomously, two role qualities that have demonstrate significant advancement of the advanced practice nurse role (RCN, 2013; RCN, 2022).  Because of the origination in primary care, the ANP role in the UK is to perform the same care as a general practitioner (Morgan, 2010).  Additionally, the role has progressively been integrated and widely embraced in the UK health system (Evans et al., 2020).

Outside of the ANP role in the UK, there are various specializations offered for general nurses allowing them to become a level 2 nurse, which is a role that is registered by the Nursing and Midwifery Council in the UK (NMC, 2013).  While these roles do require additional education, they are not the same as the ANP role described above.

There is a role of the midwife in the UK regulated by the Nursing and Midwifery Board.  This role is unique in that all midwives have a supervisor midwife to provide a check in quality of care, reflecting a role and regulatory structure existing since 1902 (NMC, 2010).

Education and Certification

Education for the Advanced Nurse Practitioner in the UK has been occurring at the masters level for more than 20 years and the majority of ANPs in the UK possess a graduate degree (Delamaire & Lafortune, 2010; RCN, 2022; Savrin, 2009).   While the recommended standard for advanced nurse practitioners in the UK is set by the recommendations by the Royal College of Nursing, it is not required that all educational programs in the country follow these recommendations, and consequentially the role varies according to health institution’s policies (Evans et al., 2020; King, Tod, & Sanders, 2017; Morgan, 2010).

Registration as an Advanced Nurse Practitioner in the UK is required as a nurse, and there is not a separate registry outside of that of the general nursing registry (RCN, 2022b).  Licensure of nursing is accepted from other nations as an Advanced Nurse Practitioner, provided an individual can follow the required process to do so (RCN, 2022b).

To help with APN role standardization, as of 2017 the RCN proposed a national certification to provide regulation for the standard scope of practice.  While the momentum to provide such standardization has been growing over the years, inconsistency in advanced nursing education continues to beleaguer role continuity (Evans et al., 2020; King, Tod, & Sanders, 2017; NP/APN Network, 2020).

Specialties

The role of the ANP in the UK was greatly focused on primary health care (Pulcini et al., 2009).

For registered nurse specialists, there are currently various specialties that level 1 nurses can specialize in (RCN, 2013):

  • Registered specialist community public health nurse (SCPHN) qualification in
    • Family
    • Health visitor
    • Occupational health
    • Non-specific
    • School nurse
  • Specialist Practice Qualification
    • Adult nursing
    • Children’s nursing
    • Community children’s nursing
    • Mental health nursing
    • District nursing
    • General practice nursing
    • Learning disability nurse
    • Mental health

While these are the registration qualifications recognized by the NMC in the UK, nurses can have a specialization in a specific subject of nursing (i.e. epilepsy, Parkinson’s, cancer).

Have information to add to this page?

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

Evans, C., Pearce, R., Greaves, S., & Blake, H. (2020). Advanced clinical practitioners in primary care in the UK: A qualitative study of workforce transformation.  International Journal of Environmental Research and Public Health. 17(4500), doi:103390/ijerph17124500

King, R., Tod, A., & Sanders, T. (2017). Development and regulation of advanced nurse practitioners in the UK and internationally. Nursing Standard, 32(14). pp.43-50.  doi: 10.7748/ns.2017.e10858

Morgan, S. (2010, July 9).  What are the differences in nurse practitioner training and scope of practice in the US and UK?  NursingTimes.net.  Retrieved from: http://www.nursingtimes.net/nursing-practice/clinical-zones/district-and-community-nursing/what-are-the-differences-in-nurse-practitioner-training-and-scope-of-practice-in-the-us-and-uk/5017012.article

NP / APN Network (2020). Guidelines on advanced practice nursing 2020 [online publication].   International Council of Nurses. Geneva, Switzerland.

Nursing and Midwifery Council [NMC] (n.d.).  Registering as a nurse or midwife in the United Kingdom: For applicants outside the European Economic Area [online document].  Retrieved from: http://www.nmc-uk.org/Documents/Registration/Registering%20as%20a%20nurse%20or%20midwife%20from%20outside%20EU%20or%20EEA.pdf

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

Royal College of General Practitioners [RCGP] (2020). Core capabilities framework for advanced clinical practice (nurses) working in general practice / primary care in England [online book]. Health Education England, NHS. England.

Royal College of Nursing [RCN] (2012).  Advanced nurse practitioners: An RCN guide to advanced nursing practice, advanced nurse practitioners and programme accreditation [electronic document].  Retrieved from: http://www.rcn.org.uk/__data/assets/pdf_file/0003/146478/003207.pdf

Royal College of Nursing [RCN] (2013).  RCN Factsheet: Specialist nursing in the UK.  Retrieved from: http://www.rcn.org.uk/__data/assets/pdf_file/0018/501921/4.13_RCN_Factsheet_on_Specialist_nursing_in_UK_-_2013.pdf

Royal College of Nursing [RCN] (2022a). Advanced practice standards. Retrieved June 19, 2022 from: https://www.rcn.org.uk/Professional-Development/Advanced-Practice-Standards

Royal College of Nursing [RCN] (2022b). Register as a nurse or midwife if you trained outside the UK. Retrieved June 19, 2022 from: https://www.nmc.org.uk/registration/joining-the-register/register-nurse-midwife/trained-outside-uk/

Savrin, C. (2009). Growth and development of the nurse practitioner role around the globe.  Journal of Pediatric Health Care 23, (5),310-314.

Sheer, B. (2007).  Nurse practitioners on the move: The journey to the United States.  Topics In Advanced Nursing eJournal. 7(2).  Retrieved from: http://www.medscape.com/viewarticle/560673

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

[Originally Published October 7, 2013. Updated June 19, 2022]

Advanced Practice Nursing in Latvia

Contact:
Latvian Nurses Association

Role

The role of Advanced Practice Nursing in Latvia is not currently observed to be in development. Most recently Latvia has prioritized standardization of their registered nursing curriculum, identifying that by the end of 2022 to have registered nurses trained at the bachelor’s level (WHO, 2020). Traditionally the health system has allowed for various nursing specialties, but did not have a general nurse role. The initiative ratified by the Latvian Parliament has undergone the establishment of a generalize nursing qualification, and then allow nurses to specialize further afterward (WHO, 2020).

Since the nation has yet to formally establish their nursing fundamental curriculum and qualifications, the advancement of the nursing role toward a master’s degree level and provision of an expounded scope of practice is not yet underway.

Meanwhile, there is a significant gap of healthcare workers throughout the nation, particularly for individuals to work in the traditional physician scope of practice as well in rural settings. Additionally, evaluation of burnout of the nursing force within Latvia has identified that nurses feel a significant gap in feeling empowered and accomplishment (Circenis et al., 2017). In theory, if nurses were given additional opportunities for professional growth and increased autonomy, they may have reduced burn out (Twigg, D. & McCullough, 2014). As a result Latvia does have several significant potential factors to promote the advancement of the nursing role.

Have information to add to this page?

References:
Circenis, K., Deklava, L., Millere, I. et al. (2017). Fatigue and burnout among Latvian nurses. Global Journal of Psychology Research New Trends and Issues. 7(3), 111-116. doi:10.18844/gjpr.v7i3.2856

Twigg, D. & McCullough, K. (2014). Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies. 51(1). 85-92. doi:101016/j.ijnurstu.2013.05.015

Veide, S., Lember, M. & Põlluste, K. (2015). Latvia.  In Kringos, D.S., Boerma, W.G.W., Hutchinson, A. et al. (Eds.) Building primary care in a changing Europe: Case Studies [Internet].  European Observatory on Health Systems and Policies, Copenhagen, Denmark.

World Health Organization [WHO] (2020). Postgraduate training in Latvia. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/336238/WHO-EURO-2020-1304-41054-55734-eng.pdf?sequence=1&isAllowed=y

Advanced Practice Nursing in Norway

Contact:
Norwegian Nurses Organisation (NNO)
Western Norway University of Applied Sciences

Role

The role of Advanced Practice Nursing in Norway has most recently explored and is currently in active development.  According to Holm Hansen et al. (2020) the role was most recently introduced through an extended pilot including both the nurse practitioner and clinical nurse specialist roles (Holm Hansen et al., 2020).  Through this extensive introduction, key barriers to developing the role have been identified.  One of the biggest gaps at this time is the lack of formal role protection in the country (Østvik, 2017).

Education, Certification, and Specialties

Both the bachelor and master’s level educational programs for registered nurses are regulated, creating a solid foundation for the advancement of nursing practice (Holm Hansen et al., 2020).  Since the master’s level degree has been available for nurses since 2015 which allows advanced practice nursing to be able to more easily embrace the APN role (Østvik, 2017). With the piloted roles described by Holm Hansen et al. (2020), advanced practice nursing in Norway has core curriculum and training at the master’s level, with 120 credits for program completion (WNU, 2022).  However because of the lack of formal recognition of the APN role, the APN educational curriculum is not yet nationally regulated (Østvik, 2017)

Have information to add to this page?

References:
Holm Hansen, E., Boman, E., Bing-Jonsson, P., & Fagerstrom, L.M. (2020). Introducing nurse practitioners into Norwegian primary healthcare- Experiences and learning.  Research and Theory for Nursing Practice: An International Journal, 34(1) doi:10.1891/1541.6577.34.1.21

Østvik, E. (2017). Country Practice Profiles: Norway [Webpage]. NP / APN Network. Retrieved June 5, 2022 from: http://icn-apnetwork.org

Western Norway University of Applied Sciences [WNU] (2022). Advanced Practice Nursing. Website.  Retrieved June 4, 2022 from: https://www.hvl.no/en/studies-at-hvl/study-programmes/advanced-nursing-practice/.

Advanced Practice Nursing in Sweden

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Contact:
Vårdförbundet

Role

The role of Advanced Practice Nursing in Sweden has been explored for more than a decade, but the role is still in its infancy. The role has been in development, but not formally established (Bergström, & Lindh, 2018).

Historically in 2005, the Advanced Clinical Nurse Specialist role has been piloted through programs first offered (Lindblad, et al., 2010; Egerod et al., 2021).    This role primarily 

The role of APNs in Sweden has been under evaluation and experimentation in general practice (primary health care) and has been based on an institutional-specific model allowing varying levels of scope of practice (Lindblad et al, 2010).  Because of the lack of APN role identification, the role is currently under development to be of the greatest benefit to the Swedish health care system (Lindblad et al., 2010).  Further, there is reported ongoing interest in the Swedish health care system for more Nurse Specialists (Vårdförbundet, 2013; Vårdförbundet 2019).  

The nurse to physician ratio in Sweden reportedly was 2.7 to one which reportedly is just under the average among European countries, but unfortunately has the lowest number per 1,000 population at 11.1 (Alenius, Lindqvist, and Tishelman, 2019).  Additionally, there has been a large gap in licensed physicians, largely reflected in the majority (59%) of current physicians being educated in another country (Alenius, Lindqvist, and Tishelman, 2019).  While there is a gap in physician shortage, which facilitates the advancement of nursing practice, assumedly the lack of registered nurses in the country also impedes the progress due to the lack of nursing supply to advance.

In Sweden to help the ongoing needs of the overall population, nurses have been given the prescribing authority since 1994, allowing registered nurses limited prescriptive authority for initial treatment of various acute concerns as urinary tract infections, throat infections (HAI Europe, 2012; Maier, 2019).

 

Education, Certification, and Specialties

Nurse Specialists are trained at the masters level (Vårdförbundet, 2013; Vårdförbundet 2019).  The current programs in Sweden have been educating individuals for the Advanced Clinical Nurse Specialist role since 2005 (Lindblad et al., 2010).  The program primarily focuses on 60 to 75 additional university level education credits (Vårdförbundet 2019).

Various specializations at this time are offered and identified by Vårdförbundet (2019) as:

  • Ambulance Care
  • Anesthesia
  • District Nurse
  • Intensive Care
  • General Medicine
  • Surgery
  • Oncology
  • Surgery
  • Psychiatry
  • Geriatric Care
  • Pediatrics

While there are various programs of specialization that are offered, the major limitation to the role is the lack of legal formal establishment of the role.  As a result the utilization of each role is often limited to the organization’s preference and policies.

Have information to add to this page?

References:
Alenius, L.S., Lindqvist, R., & Tishelman, C. (2019). Sweden.  In Rafferty, A.M., Busse, R., Zander-Jentsch, B. et al. (Eds.) Strengthening health systems through nursing: Evidence from 14 European countries [Internet].  European Observatory on Health Systems and Policies, Copenhagen, Denmark. 

Bergström, P. & Lindh, V. (2018). Developing the role of Swedish advanced practice nurse (APN) through a blended learning master’s program: Consequences of knowledge organisation, Nurse Education in Practice, 28(1471-5953), pp.196-201, doi:10.1016/j.nepr.2017.10.030

Egerod, I., Kaldan, G., Nordentoft, S., Larsen, A., Herling, S. F., Thomsen, T., & Endacott, R. (2021). Skills, competencies, and policies for Advanced Practice Critical Care Nursing in Europe: A scoping review. Nurse Education in Practice, 54, 103142. https://doi.org/10.1016/j.nepr.2021.103142

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

Lindblad, E., Hallman, E.B., Gillsjo, C., Lindblad, U., & Fagerstom, L. (2010).  Experiences of the new role of advanced practice nurses in Swedish primary health care–A qualitative study.  International Journal of Nursing Practice, 16, 69-74.  doi:10.1111/j.1440-172X.2009.01810.x

Vårdförbundet (2013).  Specialist Nurse [translated by Google Translate].  Retrieved from: https://www.vardforbundet.se/Min-profession/Sjukskoterska/Specialistsjukskoterska/

Vårdförbundet (2019). Specialist Nurse [translated by Google Translate]. Retrieved from: https://www.vardforbundet.se/rad-och-stod/karriar-och-utveckling/karriarvagar/vidareutbildning-till-sjukskoterska/

[Originally published 9 September 2013, revised 2 June, 2022]

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 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 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

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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).

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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

Have information to add to this page?

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]