Advanced Practice Nursing in Puerto Rico

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Specialist

Nationally Certified:
Yes

Recognize Foreign License:
Yes

Treatment Authority:
No (but pending legislation to change)

Prescribing Authority:
No (but pending legislation to change)

Practice Autonomously:
No (but pending legislation to change)

Contact or more information:
Puerto Rico Health Department
Puerto Rico Nursing Practice Law (Ley 9, de 11 do octubre 1987)

Role

Puerto Rico’s integrated relationship with the United States brings many of the advanced practice nursing roles to the island.  Since Puerto Rico is a territory of the united states but is primarily governed under it’s own laws, advanced practice nursing greatly mirrors that of the United States but is still in the process of approving legislature to recognize an autonomous role for advanced nurses similar to nurse practitioners.

Education and Certification

Varying degrees exist for nursing in Puerto Rico based on the varying levels of practice.  Individuals who practice at the nursing generalist level require a bachelor’s degree, for advanced practice one needs a masters degree.  Current legislation proposals have suggested that individuals can additionally gain a doctorate of nursing practice (DNP) for further advancement and specialization (Parés Arroyo, 2015, April 4).

Currently, there are several universities in Puerto Rico that offer such advanced degrees for nurses inclduing the Universidad de Puerto Rico, Recintos de Ciencias Médicas, Arecibo, Humacao y Mayagüez; Universidad del Turabo; Universidad Interamericana en Arecibo e Inter Metro; y la UMET (Parés Arroyo, 2015, April 4).

Specialties

The nursing role in Puerto Rico mirrors that similarly to the United states with varying educational degrees and roles of nurses (Parés Arroyo, 2015, April 4):

  • Nurse Specialist – Educated with a masters degree, this specialty allows the nurse to manage more complicated health situations in a particular area of specialization.
  • Nurse Generalist – Has a bachelors degree of Science in Nursing and works with the nurse specialist to direct care of patients.
  • Associate Nurse – Has an associates degree in nursing and collaborates with planning and carrying out of direct nursing care to hospitalized patients.

Various additional roles have been suggested to clarify the advanced nursing practice role through legislation including (Parés Arroyo, 2015, April 4):

  • Doctor of Nursing Practice – Provides autonomous practice with the ability to provide services and be reimbursed through contracting with other agencies for their area of specialty.
  • Advanced Practice Nurse – Includes various specialist including: Clinical nurse specialists, nurse midwifery, anesthesia, nurse practitioners and other areas.

Have information to update this page?

References:
Parés Arroyo, M. (2015, April 4). Se especializan cada vez más las enfermeras: Un proyecto de ley propone atemperar los adelantos de esta profesión.  El Nuevo Dia.  Retrieved from: http://www.elnuevodia.com

Advanced Practice Nursing in Canada

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Practitioner
Clinical Nurse Specialist

Nationally Certified:
Yes

Recognize Foreign Licensure:
Yes

Treatment Authority:
Yes

Prescribing Authority:
Yes

Practice Autonomously:
Yes

Contact:
Canadian Nurses Association
Nurse Practitioners’ Association of Ontario

Role

Initially, the APN role started in the 1970s (Sheer & Wong, 2008).  It was after individuals from new Nurse Practitioner programs in 1973 in Ontario banded together to create the Nurse Practitioners’ Association of Ontario, that they began to develop a presence and push for a recognized role in Canada (Sheer & Wong, 2008).  While the role was minimal initially, it wasn’t until the 1990’s with additional health care reform that Nurse Practitioners became more prevalent in Canada (Pulcini, Jelic, Gul, & Loke, 2009).  The role was initially designed to meet the primary health care needs of the country (Pulcini et al., 2009).  Since that time, the role of Advanced Practice Nursing (APN) in Canada is represented by Nurse Practitioners and Clinical Nurse Specialists.

Nurse Practitioner
More prevalent and increasing in number is the Nurse Practitioner role in Canada.  The CNA (2013a) identifies, “Nurse practitioners provide direct patient care, focusing on health promotion and the treatment and management of health conditions.  They have an expanded scope of practice and can diagnose, order and interpret diagnostic tests.  They can also prescribe medications and perform certain procedures.”

The role of the Nurse Practitioner in Canada does allow for significant autonomy, as is regulated according to province.  Recently, there has been an emerging trend of Nurse Practitioner-Led Clinics in Canada greatly fostered by the desire to meet the primary care needs of Canada, fostered by the developed role of the Nurse Practitioner in the country (DiCenso et al., 2010).   While autonomy is available for Nurse Practitioners in Canada, the majority are employed as a part of practices with physicians (DiCenso et al., 2010).  Such clinics have currently been developing or already functioning in the provinces of Manitoba and Ontario (Krahn, 2013; Adler, 2013).

Clinical Nurse Specialist
According to the Canadian Nurses Association (CNA, 2013a), “Clinical nurse specialists provide expert nursing care and play a leading role in the development of clinical guidelines and protocols.  They promote the use of evidence, promote expert support and consultation, and facilitate system change.”

Essentially, the role of the CNS does not have any expounded role to that of Registered Nurses and as a result, there is no further legislation required to identify the role of the CNS, and resultantly the title is not protected.  According to DiCenso et al. (2010) there have been reports of varying levels of practice, to the point that individuals have been observed to very limited prescribing rights in isolated situations (DiCenso et al., 2010).  As a result, there is significant room for role clarity in the future.

Education and Certification

To become a Nurse Practitioner (NP) in Canada, an individual must be minimally educated at the graduate level and pass the Canadian Nurse Practitioner Exam written by the Canadian Nurses Association (2013a).  Additionally, NPs are then required to hold a license in the province they desire to practice (Robinson & Griffiths, 2007).

As the Clinical Nurse Specialist (CNS) is inconsistent, there has been efforts to distinctly separate the NP and CNS roles in education.  However individuals who are identified as CNSs are educated at the graduate level, holding a masters or doctorate degree (Robinson & Griffiths, 2007).

Certification for nursing specialties is an optional certification available to nurses after two years of clinical experience.  Once qualified, an individual is required to take a certification exam in the specific specialty desired.  This role requires an individual to be a Registered Nurse (RN) and does not require graduate level education.

Specialties

Nurse Practitioner specialties are primarily not offered throughout the various schools of advanced nursing practice in Canada, as most individuals receive generalist NP degrees (DiCenso et al., 2010).  There are several exceptions, primarily in neonatology throughout Canada, and in Quebec where specialty roles are offered in cardiology, nephrology, and neonatology.

Have information to add to this page?

References:

Adler, M. (2013, September 20).  Hong Fook Nurse Practitioner-Led Clinic welcomed in Agincourt.  Scarborough Mirror.  Retrieved from: http://www.insidetoronto.com/news-story/4116601-hong-fook-nurse-practitioner-led-clinic-welcomed-in-agincourt/

Canadian Nurses Association [CNA] (2013a).  Nurse Practitioner and Clinical Specialists.  Retrieved from: http://www.cna-aiic.ca/en/professional-development/nurse-practitioner-and-clinical-specialists

Canadian Nurses Association [CNA] (2013b).  Position Statement: Advanced Nursing Practice [Electronic document].  Retrieved from: http://www.cna-aiic.ca/~/media/cna/page%20content/pdf%20en/2013/07/26/10/23/ps60_advanced_nursing_practice_2007_e.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

DiCenso, A., Bourgeault, I., Abelson, J., Martin-Misener, R., Kaasalainen, S. …Kilpatrick, K. (2010).  Utilization of nurse practitioners to increase patient access to primary healthcare in Canada–Thinking outside the box.  Nursing Leadership (Toronto, Ontario). 2010, 239-259.

Krahn, H. (2013, September 25).  Letters to the editor: Fragmenting a workable system.  Winnipeg Free Press.  Retrieved from: http://www.winnipegfreepress.com/opinion/letters_to_the_editor/fragmenting-a-workable-system-225147162.html

Pulcini, J., Jelic, M., Gul, R, & Loke, A.Y. (2009).  An international survey on advanced practice nursing, education, practice, and regulation.  Journal of Nursing Scholarship, 42(1),31-39.  doi: 10.1111/j.1547-5069.2009.01322.x

Robinson, S. & Griffiths, P. (2007).  Nursing education and regulation: International profiles and perspectives [online publication].  Retrieved from:http://eprints.soton.ac.uk/348772/1/NurseEduProfiles.pdf

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