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

Have information to add to this page?

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).

Have information to add to this page?

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 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]

Advanced Practice Nursing in the Russian Federation (Russia)

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

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

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

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