Advanced Practice Nursing in Sierra Leone

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Anesthetist
Nurse Midwife

Nationally Certified:
Uncertain

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Yes

Prescribing Authority:
Yes

Practice Autonomously:
Yes

Contact:
Sierra Leone Nurses and Midwives Board (for registration) – Registrar: Mrs. Hannah Coker; Phone: 076673741 / 033885138 / 030
Sierra Leone Nurses Association

Role

To understand the advanced nursing practice role in Sierra leone, one must understand the basic structure of nursing in the country.  Essentially, there are several levels of nurse training and several specialties offered in their training:

  • Nurse tutor
  • Opthalmic Nurse
  • Public Health Nurse
  • Maternal and Child Health Aides

Additionally, there are two specific roles of APNs in the country:

  • Nurse-Midwife
  • Nurse Anesthetist

Not much information is available on the nurse anesthetist role, however, they have been in practice for at least 5 years (Klopper & Uys, 2012).  The Nurse-Midwife role encompasses an autonomous role with assessment, diagnosis, and treatment authorities including perinatal care and sexually transmitted infection management around that period as well.

Education and Certification

The National School of Midwifery offers a 2 year program to be taken after basic nursing (Klopper & Uys, 2012).  Ongoing education and recertification is required every 2 years, implying a fairly rigorous process to maintain registration.  The Nurse Tutor, opthalmic nursing training, bachelors of science in nursing, and state registered nurse training is offered through the Faculty of Nursing, a college formerly known as the National School of Nursing.  In the meantime, Sierra Leone has been having nursing educational institutions pop-up that are not accepted and credited by the Sierra Leone Nursing and Midwifery Board because of the increased interest of individuals to become professionals in healthcare.  The endeavor to start up such schools in the country has been deemed as an illegal activity; because of this, the Nursing and Midwifery Board have been cracking down and attempting to stop this from occurring by discouraging facilities from hiring individuals with non-accredited nursing education (Sierra Express Media, 2013).

Specialties

Various disciplines of nursing training are offered through the Faculty of Nursing college, namely medical, surgical, basic sciences, and public health.  Additionally this school offers the specialty of opthalmic nursing education (Klopper & Uys, 2012).

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References:
Klopper, H. & Uys, L.R. (2012). The state of nursing and education in Africa: A country-by-country review.  Sigma Theta Tau.  Retrieved from: http://books.google.com/books?id=SzgiwENnd4UC&source=gbs_navlinks_s

Sierra Express Media (2013).  Moves to shut down illegal nursing activities.  Retrieved from: http://www.sierraexpressmedia.com/archives/53712

Advanced Practice Nursing in Australia

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Practice Nurse (clinical nurse, consultant)
Nurse Practitioner

Nationally Certified:
Yes (Nursing and Midwifery Board of Australia)

Recognize Foreign Licensure:
Yes

Treatment Authority:
Yes

Prescribing Authority:
Yes

Practice Autonomously:
No (Advanced Practice Nurse); Yes -based on Province (Nurse Practitioner)

Contact:
Nursing and Midwifery Board of Australia

Role

The Advanced Practice Nurse role in Australia was established in 1990 (Sheer & Wong, 2008).  Additionally, Australia’s Nurse practitioner Role was established in 2000.  The role of the Advanced Practice Nurses give the opportunity for registered nurses to diagnose and consult medical providers, but they may not order tests, refer to specialists, and may or may not have prescribing rights based on some protocols.  The Nurse Practitioner role in Australia does allow for prescribing, ordering of tests, diagnosing, and referral to specialists, but these vary according to Province.  The Nurse Practitioner role is allowed to practice autonomously in some provinces (Government of Western Australia Department of Health, n.d.).

Education and Certification

Education required for both the Advanced Practice Nurse and Nurse Practitioner roles requires a Graduate Diploma (graduate-level education) or Masters Level.  The Nurse Practitioner role also requires 5 years of clinical practice as a residency prior to being able to have prescribing rights.  Several Advanced Practice Nurse and Nurse Practitioner Programs are available in the country.

Specialties

Various specialties exist for Nurse Practitioners.

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References:
Government of Australia Department of Health (n.d.).  What is a nurse practitioner.  Retrieved from: http://www.nursing.health.wa.gov.au/career/np_what.cfm

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

Advanced Practice Nursing in the Czech Republic

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Practice Nurse

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

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

Treatment Authority:
Yes

Prescribing Authority:
No

Autonomy of Practice:
No

Contact:
Health Ministry of the Czech Republic

Role

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

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

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

Education and Certification

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

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

Specialties

Uncertain

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References: 
Delamaire, M. & Lafortune, G. (2010).  Nurses in Advanced Roles: A description and Evaluation of Experiences in 12 Developed Countries, OECD Health Working Papers, 54. doi:10.1787/5kmbrcfms5g7-en

Advanced Practice Nursing in Germany

Snapshot

APN Role Exists in Country Today:
No

Role

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

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

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References:
De Geest, S., Moons, P., Callens, B., Gut., C., Lindpainter, L., & Sprig, R. (2008).  Introducting advanced practice nurses/nurse practitioners in health care systems: A framework for reflection and analysis.  Swiss Med Weekly, 138(43-44),621-628.

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

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

Advanced Practice Nursing in Thailand

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Practice Nurse

Nationally Certified:
Yes (Thailand Nursing and Midwifery Council)

Recognize Foreign Licensure:
Yes

Treatment Authority:
Yes

Prescribing Authority:
Unknown

Practice Autonomously:
Uncertain

Contact:
Thailand Nursing and Midwifery Council

Role

The initial role in Thailand is that of Advanced Practice Nurses (APNs) and in 2003 they had their first group of individuals certified (Sheer & Wong, 2008).

There are several roles of advanced practice nurses recognized in Thailand.  There are individuals who receive specialty training as registered nurses (i.e. trauma nurse, ostomy nurse) as well as “Nurse Practitioners.” Additionally, there are roles of designated as “Advanced Practice Nurses” of which the previously mentioned specialties (including Nurse Practitioners) are not included.  These roles are expanded further on that of the registered nurse based on further required education and expertise (Thailand Nursing and Midwifery Council [TNMC], 2010).

While the role of the nurse in Thailand has various levels of practice, the TNMC regards all individuals registered to practice nursing as “practitioners in nursing.”  The role of such individuals includes: 1.) to provide education, advice, counseling, ans well as solving health problems; 2.) to act and assist individuals physically and mentally, including their environment, in order to solve problems of illness, alleviate symptoms, prevent dissemination of diseases and provide rehabilitation; 3.) to provide treatment, as mentioned in primary medical care and immunization; and 4.) to assist physicians to perform treatments (TNMC, 2010).

Additionally, the role of midwifery encompasses: 1.) to provide education, advice, counseling, as well as solving health problems; 2.) to act and assist pregnant women, post delivery women, and their newborns physically and mentally, in order to prevent complications during pregnancy, delivery, and post-delivery; 3.) to provide physical examinations, delivery of baby and family planning services; and 4.) to assist physicians to perform treatments.  Individuals can be registered to practice both nursing and midwifery by the Council of nursing (TNMC, 2010).

Education and Certification

APNs in Thailand are identified by a post-masters education (TNMC, 2010).  The term “Nurse Practitioner” is also applied to individuals in Thailand but reflect a post registered nurse certification requiring 4 months of specialty training.  APNs however have expanded roles based on further education (TNMC, 2010).

Specialties

Advanced practice nurses are recognized in various specialties, namely: Community Nurse Practitioner; Medical and Surgical Nurse; Gerentological Nurse; Pediatric Nurse; Maternal and Child Nurse; Advanced Midwifery Practice; Mental Health and Psychiatric Nurse; Nurse Anesthetist; Infection Control Nurse; and Community Nurse (TNMC, 2010).

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References:

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

Thailand Nursing and Midwifery Council (2010).  Thailand Nursing and Midwifery Council.  Retrieved from: http://www.tnc.or.th/en/content/content-135.html

Advanced Practice Nursing in the United States

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Practitioner
Nurse Anesthetist
Nurse Midwife
Clinical Nurse Specialist

Nationally Certified:
Yes

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Yes

Prescribing Authority:
Yes

Autonomy of Practice:
Yes in 36 states, No in 24 states (see here for List)

Contact:
American Academy of Nurse Practitioners
American Academy of Colleges of Nursing

Role

The role of APN’s in the United States has existed since the 1960’s and is of the oldest in the world today.  There are various forms of advanced practice nurses, of which the greatest numbers are Nurse Practitioners, and also include Nurse Midwives, Nurse Anesthetists, and Clinical Nurse Specialists.  Additional other advanced roles are available for nurses who are registered, and certification programs for nursing specialization.  The role of the APN in the United States varies according to state.

The roles can be further identified as:

  • Nurse Practitioner (NP) – 1.) Diagnose and treat patients in both primary and acute care.  2.) Provide initial and ongoing care including comprehensive histories, perform physical examinations, and other health assessment and screening activities.  3.) Treats and manages patients with acute and chronic diseases including ordering laboratory studies, prescribing medication, and making appropriate referrals for patients and families.  4.) Provide health promotion, disease prevention, health education, and counseling.
  • Nurse Anesthetists (CRNA) – 1.) Administer anesthesia.
  • Nurse Midwife – 1.) Provide medical care to women from puberty through menopause, for antepartum, intrapartum, postpartum, and nonsurgically related obstetric and gynecologic care. 2.) Consult, collaborate with other specialties. (The Pennsylvania, n.d.)
  • Clinical Nurse Specialist (CNS)

Supervision

While the number of states requiring physician supervision has been quickly decreasing, still some states including California and New York still require some form of physician supervision.

Education and Certification

APN roles require a minimum of Master-level preparation offered by many universities throughout the country.  There is an organized body of credentialling, the ANCC, that provides guidelines for advanced nursing programs.  Once graduated, APN’s in the Nurse Practitioner, Nurse Anesthetist, and Nurse Midwife roles are required to pass a national certification exam to practice (with a few exceptions).  These certification exams require the students to have had a specific number of hours of on-the-job experience throughout their program in order to take the exam.

For individuals seeking to immigrate to the United States and gain registration/certification as an APN, Sheer (2007) significantly describes the process required, as an individual will need to have a registered nursing license, and then apply for an APN license through the specific state one is desiring to work.

Specialties

Individuals in the Nurse Practitioner role have the option to specialize in various different roles, including geriatrics, pediatrics, acute care, and family care.  While individuals may not take a specific certification for additional medical specialties, they may work in the various specialized fields (i.e. dermatology, cardiology) and often regard themselves as a specialized individual in that category.

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References:
The Pennsylvania (n.d.) Midwife Practice Guidelines.  Retrieved from: http://www.pacode.com/secure/data/049/chapter18/s18.4.html

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