Tag Archives: Europe

Advanced Practice Nursing in Denmark

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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/

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Advanced Practice Nursing in Ireland

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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

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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

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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]

Advanced Practice Nursing in the Russian Federation (Russia)

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Snapshot

APN Role Exists in Country Today:
No

Contact:
Russian Nurses Association (RAMS)
US-Russian Nursing Conference Cruise

Role

There is no current role of advanced practice nurses in Russia today.  According to the World Bank, in 2010 the Russian Federation had approximately 8.5 nurses per thousand individuals, a number showing adequacy of the nursing workforce (WHO, 2013).  Additionally, there were more than four doctors per thousand individuals, also significantly adequate for healthcare today (WHO, 2013).  While these numbers are impressive, the healthcare standards in Russia have been observed to be inadequate; however, there has been consistent improvement over the last several years (Davydov & Shepin, 2010; Tashlein-Van Hueveln, 2009).

In recent years, the Russian Nurses Association (2013) in assistance with the International Council of Nurses has been updating and identifying national nursing standards since 2007 and hope to have a uniform set of standards implemented by 2015.  As the role of nursing is beginning to be established in Russia, development of Advanced Practice Nursing roles will take more time for future establishment.

Specialties

While there are no specific Advanced Practice Nursing roles present in Russia today, on 2012, the Russian Nurses Association defined several nursing specialties including (Russian Nurses Association, 2012):

  • Dietary Nursing
  • Operating Nursing
  • Anesthesia Nursing
  • Pediatric Nursing
  • Psychiatric Nursing
  • Massage Nursing
  • Specialist in Nursing Statistics

In addition, it was established that the title of “Bachelors of Nursing” would be established for senior nurses prepared at the bachelor level, a role implemented earlier in 2013 (Russian Nurses Association, 2012).

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References:
Davydov, M.I. & Shepin, O.P. (2010).  The Russian healthcare system.  Medical Solutions.  Retrieved from: http://www.healthcare.siemens.com/healthcare-magazine

Tashlein Van-Hueveln, D. (2009, August 3).  Russian healthcare: Observing nurses a world way.  Carolina Nursing News.  Retrieved from: http://carolinanursingnews.com/2009/08/03/russian-healthcare-observing-nurses-a-world-away/

Russian Nurses Association (2012).  Professional standards [Google translated version].  Retrieved from: http://translate.google.com/translate?hl=en&sl=ru&tl=en&u=http%3A%2F%2Fwww.medsestre.ru%2Ffiles%2Ffile%2Fstandart%2F0_uvedomlenie.pdf

Russian Nurses Association (2013).  Negotiations in leadership [Google translated version].  Retrieved from: http://www.medsestre.ru/new/info/36

World Bank, The (2010).  Nurses and midwives (per 1,000 people).  Retrieved from: http://data.worldbank.org/indicator/SH.MED.NUMW.P3

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

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

Advanced Practice Nursing in Greece

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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

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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.

Have information to add to this page?

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

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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

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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