Advanced Practice Nursing in Sweden

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Clinical Nurse Specialist

Nationally Certified:
No (Nurse Specialist title is restricted to individuals graduating from specific programs in Sweden)

Recognize Foreign Licensure:
Uncertain (likely no at this time)

Treatment Authority:
Varies

Prescribing Authority:
Yes

Practice Autonomously:
No

Contact:
Vårdförbundet

Role

The Advanced Clinical Nurse Specialist role was initiated through programs first offered in 2005 (Lindblad, Hallman, Gillsjo, Lindblad, & Fagerstom, 2010).  While the role of Nurse Specialists has existed and the title is protected, the advanced practice nursing (APN) role has been in development.  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, it appears the Swedish health care system has a strong need for more Nurse Specialists (Vårdförbundet, 2013).  As a result, if there are not enough individuals in the country to provide the supply of Nurse Specialists, there may additionally not be enough supply of individuals who desire additional training to increase their scope of practice.  In Sweden however, nurses have been given the nurse prescribing authority since 1994, initiating nursing prescriptive authority in Europe (HAI Europe, 2012).

Education and Certification

Nurse Specialists are trained at the masters level (Vårdförbundet, 2013).  The current programs in Sweden have been educating individuals for the Advanced Clinical Nurse Specialist role since 2005 (Lindblad et al., 2010).

Specialties

At this time APNs have been primarily working in general practice (primary health care).

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References:
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/

Advanced Practice Nursing in Greece

Snapshot

APN Role Exists in Country Today:
No

Contact:
Hellenic Nurses’ Association

Role

The nursing role in Greece struggles with great job dissatisfaction today.  According to the OECD 2012 health review, Greece’s nurses report a European high of 56% stating they desire to leave their job position.  Once great contributing factor is that there are more physicians that nurses in the country, leading to a shortage of nurses to provide care (Lavdaniti et al., 2008; OECD, 2012).  As a result, there is very little support for advancing the nursing role in the country.

However, there is motivation to expand the nursing role in Greece as there is currently education and seeking out of governance of Nurse Anesthetists in the country (Hellenic Nurses’ Association, 2013).

Education and Certification

Currently, the nursing education system 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.  Nurses can however seek 3 additional years of training to pursue nurse midwifery.

Specialties

While the role is not particularly expanded for nurses in Greece, individuals can regard themselves as a nurse-specialist.  There are several groups of nurse-specialists recognized by the Hellenic Nurses’ Association (2013):

  • Oncology
  • Anesthesiology
  • Administration
  • Emergency and Intensive Care
  • Education
  • Primary Health Care and Community
  • Mental Health
  • Pediatric

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References:
Dimitriadou, A., Lavdanti, M., Theofanidis, D., Psychogiou, M., Minasidou, E. … Sapountzi-Krepia, D. (2008).  Interprofessional collaboration and collaboration among nursing staff members in Northern Greece.  International Journal of Caring Sciences. 1(3),140-146

Hellenic Nurses’ Association (2013).  Notice nursing department of anesthesiology ESNE.  Retrieved from: http://www.esne.gr/

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

Advanced Practice Nursing in Cyprus

Snapshot

APN Role Exists in Country Today:
See Roles Below

Title:
Diabetic Nurse
Community Mental Health Nurse
Mental Health Nurse for Drug and Alcohol Addiction
Community Nurse

Nationally Certified:
Uncertain

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Yes

Prescribing Authority:
No

Practice Autonomously:
No

Contact:
Cyprus Registrar of Nursing and Midwifery Council

Role

The Advanced Nursing practice roles do allow for expanded/specialized practice for registered nurses.  While the roles do not function autonomously or prescribing authorities, they do reflect the following scopes of practice (Delamaire & Lafortune, 2010):

  • Diabetic nurse – Advanced practice nurse offering consultation and diagnosis for diabetic patients.  Offers follow up, monitoring, health education and lifestyle advice for non-acute cases.  Offers referral of patients to specialists.
  • Community Mental Health Nurse – Advanced nurse consultation and diagnosis (advanced psychological assessment), follow-up and monitoring for non acute cases, and referral of patients to specialists.
  • Mental Health Nurse for Drug and Alcohol Addition – Advanced nurse consultation and diagnosis (advanced psychological assessment).
  • Community Nurse – Advanced nurse consultation and diagnosis (advanced psychological and physiological assessment), vaccination without a doctor prescription (health visitors only), referral of patients to specialists, management of a range of chronic diseases (follow-up, monitoring, health education and lifestyle advice for non acute cases).

Key factors influencing development of the role of Advanced Practice Nurses in Cyprus is the financial benefit that APNs may be able to provide equal care at a lesser cost than that of physicians (Delamaire & Lafortune, 2010).

Education

The educational requirements of the nursing specializations require post-graduate courses of 12-18 months (Delamaire & Lafortune, 2010).

Specialties

The four specialties offered are that of diabetic nurse, community mental health nurse, mental health nurse for drug and alcohol addiction, and community nurse (Delamaire & Laforutune, 2010).  The Health Ministry of Cyprus lists slightly different specialties of nursing, labeling them, general nursing, health visiting services, mental health nursing, and midwifery (Cyprus Ministry of Health, 2013).  While these are different to that as reported by Delamaire and Lafortune (2010), there is little description or explanation of the roles and as a result, they are little reported here.

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References:
Cyprus Ministry of Health (2013). Nursing Services.  Retrieved from: http://www.moh.gov.cy/moh/moh.nsf/page20_en/page20_en?OpenDocument

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

Advanced Practice Nursing in Belgium

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Practitioner

Nationally Certified:
Yes

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
No

Prescribing Authority:
No

Practice Autonomously:
No

Contact:
Federal Public Service of Belgium

Role

Belgium is divided into two sections, the North (Flemish) and South (French) sections.  Each functions differently.  The Flemish section has implemented an Advanced Nursing Practice role, the French has not (Sheer & Wong, 2008).  A curriculum for preparing Nurse Practitioners was proposed and awaiting approval as of 2008, but as of 2010 no official role had been established (Delamaire & Lafortune, 2010; Sheer & Wong, 2008).  While the roles of nursing specialties do not appear to include prescribing and diagnosing, they do allow for consultations and referrals to specialists, and ultimately model more of the Clinical Nurse Specialist role elsewhere (Delamaire & Lafortune, 2010; Sheer, 2007).

With the conflicting reports of the current roles, what is certain is that Belgium has had some form of Advanced Practice Nursing roles in two specific titles that have been identified by the Belgian Federal Public Service, namely Intensive and Emergency nurses and Geriatric nurses, and that advanced nursing education is provided in the country (Danish Nurses’ Organization, 2008; Stordeur & Leonard, 2010).  Further, it appears that Advanced Nursing Practice in Belgium is advancing, driven greatly by a health care system with disproportionate general practice and specialist care.  Because of the lack of individuals in certain specialties, there have been more recent pushes encouraging the advancement of nursing practice (Storedur & Leonard, 2010).

Education

Levels of education vary in Belgium.  However, to be a registered Nurse Practitioner of a specialty in Belgium, one needs to have been registered and usually be educated at the bachelors or masters level (Federal Public Service, 2013).

Specialties

For nursing specialists, individuals are able to specialize in intensive care, emergency care, geriatrics, pediatrics and neonatology, mental health and psychiatry, social health care, medical imaging, stomal therapy and wound care, community nursing, oncology, palliative care, anaesthetics, and operations assistant and in instrumentation (operating room) (Robinson & Griffiths, 2007).  The Advanced Practice Nursing roles are more limited in specialty and include the titles of intensive and emergency nursing, geriatric nursing, and transplant nursing (Robinson & Griffiths, 2007; Sheer & Wong, 2008).

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References:
Danish Nurses’ Organization (2008).  Advanced nurse practitioners: Improved health care to chronically ill.  Retrieved from: http://www.dsr.dk/Artikler/Documents/Advanced_Nurse_Practitioners.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

Federal Public Service (2013).  Nurse Practitioners.  Retrieved from: http://www.health.belgium.be/eportal/Healthcare/healthcareprofessions/Nursingpractitioners/

Sheer, B. (2007, April 17).  Advanced practice nurses: Networking in the international arena.  Medscape News Today.  Retrieved from: http://www.medscape.com/viewarticle/554740

Sheer, B. & Wong, F.K.Y. (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

Advanced Practice Nursing in the Czech Republic

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Practice Nurse

Nationally Certified:
Yes for nurse specialists;
Uncertain for Nurse with Clinical Discipline

Recognize Foreign Licensure:
Equivalences are recognized for individuals trained in the EU

Treatment Authority:
Yes

Prescribing Authority:
No

Autonomy of Practice:
No

Contact:
Health Ministry of the Czech Republic

Role

While there are no current roles for APNs in the Czech Republic, there are two roles of specializations for registered nurses.  The are (Delamaire & Lafortune, 2010):

  • Registered nurse with specialization (Nurse specialist) – 1.) advanced nurse consultation and diagnosis, 2.) ordering and interpreting of diagnostic tests (including laboratory test prescription), 3.) management of a range of chronic diseases (follow-up, monitoring, health education, and lifestyle advice for non-acute cases).
  • Nurse with clinical discipline – 1.) advanced nurse consultation and diagnosis, 2.) ordering and interpretation of diagnostic tests (including laboratory test prescription)

Both specialty categories give the nurse the ability to diagnose, consult, and order tests.  However, there is no position of autonomy or prescribing authority given to these roles.

Education and Certification

The position of Registered Nurse with Specialization requires an individual an additional 2 to 3 years of experience/education followed by an examination to assess knowledge.  Certification is offered upon passing the exam (Delamaire & Lafortune, 2010).

The position of Nurse with Clinicial Discipline required a masters level education.

Specialties

Uncertain

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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. doi:10.1787/5kmbrcfms5g7-en

Advanced Practice Nursing in Germany

Snapshot

APN Role Exists in Country Today:
No

Role

Advanced Nursing Practice in Germany does not exist today, nor does it seem to be a nation that will have an established role in the near future.  Much of this is based on the lack of need for advanced practice nurses because of an oversupply of physicians in their nation (Sheer & Wong, 2008).  Additionally, much of current nursing practice in that of Germany is based on hospital-trained diploma programs.  Due to the lack of a nationally standardized nursing role and education system, this becomes a strong limitation on not only the advanced practice nurse, but that of the registered nurse (Robinson & Griffiths, 2007).  However, since 2004 several national universities began providing standardized nursing education at the bachelors level (Robinson & Griffiths, 2007).  There post-registration educational courses available as well allowing nurses to specialize in a specific subject, being offered as 2-year hospital based programs (Robinson & Griffiths, 2007).  Another article by De Geest et al., (2008) verbalized that there is some movement that states physicians and nurses recognize there may be benefit in having more skilled nurses in practice.  Scope of practice is difficult to determine based on the variance of the individual hospital educational systems.

However, a good source of Advanced Practice Nurse networking in Germany can be found here: Deutsches Netzwerk.

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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.

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.