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

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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).

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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/

Advanced Practice Nursing in Ireland

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

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 Nicaragua

Snapshot

APN Role Exists in Country Today:
No Role is Officially Identified

Treatment Authority:
Registered nurses do have treatment authority

Prescribing Authority:
N/A

Contact:
Nicaragua Ministry of Health

Role

Nicaragua has significantly underserved rural communities in the nation.  The local health system is primarily run by a low number of general practitioners,  and nurses.  Each individual may be a sole healthcare provider in the local health clinic (Sequeira et al., 2011).  According to Sequeira et al. (2011), the nation’s health force comprises of 1,539 nurses and 1,138 general practitioners for a population of approximately 5.9 million people (Google, 2013).  As a result of the lack of not just general practitioners but also nurses, the undersupply of health care professionals does not lend to development of Advanced Practice Nursing at this time.  To aide the deficit of nursing professionals, another group of more than 4,000 Auxillary Nurses (similar to that of a nursing assistant) drives much of the health care services in the country (Sequeira et al., 2011).  Because the number of trained health professionals in the rural areas are few to none, the Ministry of Health in Nicaragua has utilized a large number of health volunteers to assist as health promoters in the area called the “Red Communidad” (or Net Community).  The nursing role in Nicaragua often encompasses any of the skills required to perform and train these volunteer individuals so they may make better decisions for health promotion in their areas.  These volunteer positions include Promotoras, Parteras, and Brigadistas.

Parteras are the volunteer midwives, trained by their previous local midwife or governmental training.  Promotoras are a basic volunteer who desires to know more medical-based knowledge and will resultantly facilitate decision making when an ill individual should go to the hospital.  Brigadistas may administer immunizations and at times prescribe medications according to protocols established by the Nicaraguan Ministry of Health.  Because the majority of medications in country do not require prescriptions, writing of prescriptions is based on the suggestion of the local medical expert.

There is significant evidence of APNs going to Nicaragua from more developed nations to assist in short-term provision of medical care of the underserved.  APNs going to Nicaragua work according to their education and training in their nation.

Education

The current education system for nurses requires a three year college experience with a forth year of practicum service in an assigned health clinic, post, or hospital.  Once completed, individuals receive a bachelor degree in nursing.  Further education for specialty is available in the capital, Managua for various hospital based nursing specialties (i.e. intensive care, pediatrics).

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References:
Google (2013).  Retrieved from: https://www.google.com/search?q=nicaragua+population&oq=nicaragua+population&aqs=chrome.0.69i57j0l3j69i62l2.3660j0&sourceid=chrome&ie=UTF-8

Sequeira, M., Espinoza, H., Amador, J.J., Domingo, G., Quintanilla, M., & Santos, T. (2011).  The Nicaraguan Health System.  PATH Publications. .Retrieved from: http://www.path.org/publications/files/TS-nicaragua-health-system-rpt.pdf

Updated: Jun 22, 2014
Previous Versions: Jul 30, 2013

Advanced Practice Nursing in Samoa

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Specialist

Nationally Certified:
Uncertain (Nationally Registered)

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Uncertain

Prescribing Authority:
Uncertain

Practice Autonomously:
Uncertain

Contact:
Samoa Ministry of Health

Role

The role of Advanced Practice Nurses (APN) in Samoa is identified by the Nurse Specialist role (Joel, 2013).  Registered nurses in Samoa can be cross-trained as midwives as well (Samoan Ministry of Health, 2006a).  At this time, there is insufficient information on the scope of this role, but the response of the advancement of nursing practice in Samoa appears to be related to a shortage of healthcare professionals in the current health system.  To date, the register of healthcare providers in Samoa is available online with more than 200 professionals in their system providing care of the 188,000 people in the country (World Bank, 2012).  Of these, in 2006 there were reported only 14 general practitioners in the country (Samoan Ministry of Health, 2006a).

According to the Samoan Ministry of Health (2006b), a specific shortage in mental health professionals is desired to be met with an increasing number of Mental Health Nursing Specialists by 2018.  Additionally, as the population has been increasing, there is encouragement to increase the number of skilled nurses trained as midwives by 2018 as well (Samoan Ministry of Health, 2006).

Education and Certification

An individual is required to have a year of postgraduate education to become a Nurse Specialist in Samoa (Joel, 2013).  Basic nursing education is provided at the bachelor level at the National University of Samoa.  Of note for education in Samoa is also the Oceania University of Medicine, which has a medical program that greatly encourages nurses to become physicians.  While this school has been under scrutiny due to corruption since 2011 and the future of the school is uncertain, such educational opportunities greatly influence the availability of health care professionals in the country (Hazelman-Siona, 2013).  Registration is necessary to practice in any healthcare role by the Ministry of Health in Samoa.

Specialties

Nursing Specialists in Samoa work in mental health nursing (Samoan Ministry of Health, 2006b).  Other specializations may well exist, but there is insufficient available information on the specialties practiced in Samoa.

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References:
International Council of Nurses/Advanced Practice Nursing Network (2013).  Contact information sheet: Western Pacific, Fiji.  Retrieved from: http://www.icn.ch/details/17/116.html

Hazelman-Siona, N. (2013, May 8).  O.U.M.’s future still undecided.  Samoa Observer.  Retrieved from: http://www.samoaobserver.ws/education/4749-oums-future-still-undecided

Joel, L.A. (2013).  Advanced Nursing: Essentials of Role Development [3rd ed.; Electronic Book]. F.A. Davis.  Retrieved from: http://books.google.com/

Samoan Ministry of Health (2006a). Health Sector Plan 2008-2018.  Retrieved from: http://www.health.gov.ws/Portals/189/HEALTH%20SECTOR%20PLAN.pdf

Samoan Ministry of Health (2006b).  Samoa mental health policy.  Retrieved from: http://www.who.int/mental_health/policy/country/SamoaMHPolicy%20Final%20-%20Aug2006.pdf

World Bank (2012).  Population, total.  Retrieved from: http://data.worldbank.org/indicator/SP.POP.TOTL

Advanced Practice Nursing in Singapore

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Practice Nurse

Nationally Certified:
Yes

Recognize Foreign Licensure:
Yes

Treatment Authority:
Yes

Prescribing Authority:
Limited under acute care protocols

Practice Autonomously:
Varies

Contact:
Singapore Nursing Board

Role

An Advanced Practice Nurse (APN) in Singapore is recognized as an APN.  In Singapore, the title “Advanced Practice Nurse” is protected and only allowed to be used by individuals certified by the Singapore Nursing Board (Fee, 2012).  The development of the APN role in Singapore, has been a proactive response to alleviate increased workforce stress due to an aging population with greater health care needs, while also providing career advancement opportunities for nurses (Kannusamy, 2006; Premarani, n.d.).  As a result, Singapore initially developed a master of nursing program training individuals in advanced clinical skills in 2003 and had its first graduates in 2004 (Sheer and Wong, 2008).  Since the development of the APN role, Singapore plans on increasing the APN number to more than 200, approximately 1.4% of the nursing population, by 2014 (Sheer and Wong, 2008; Tan Tock Seng Hospital, 2013).  While this is the goal that has been set for Singapore, the Singapore Ministry of Health (2011) identified currently 88 APNs registered to practice in the country in 2012.

The role of the APN in Singapore is best described as a hybrid of the Clinical Nurse Specialist and the Nurse Practitioner (Fee, 2012; Bee, 2012).  APNs are trained in the advancement of the registered nurse profession to add the role skills of diagnosis and management of common ailments and chronic illnesses (Singapore Nursing Board, 2012).  The scope of practice for the APN in Singapore includes the following (Singapore Nursing Board, 2012; Tan Tock Seng Hospital, 2013):

  • Advanced physical assessment
  • Develop diagnosis and differential diagnoses
  • Interpret laboaratory and diagnostic testing
  • Management of care
  • Performing procedures
  • Collaboration with other healthcare professionals including doctors
  • Advancement of nursing through development and implementation of Evidence Based Practice into current healthcare

APNs in Singapore work in all settings, including primary, secondary, and tertiary care as well as peer and nursing education (Singapore Nursing Board, 2012).  Pharmaceutical prescribing and management is under current investigation and standardization (Tan Tock Seng Hospital, 2013).  While prescribing is recognized to be traditionally under the medical domain, it is acknowledged that by preventing prescribing rights, this prevention would inhibit the effectiveness of the role (Tan Tock Seng Hospital, 2013).  As a result, APNs currently are allowed to provide (furnish) medication prescription privleges in certain acute care settings according to pre-identified protocols (Singapore General Hospital, 2013; Tan Tock Seng Hospital, 2013).

As APNs have only recently developed an established role in Singapore, the Singapore Nursing Board (2012) also requires the hiring institution to identify the specific scope of practice and role for the APN.

Education and Certification

Registration was first established in Singapore in 2006 (Sheer and Wong, 2008).  To be an APN in Singapore, an individual must be registered with the Singapore Nursing board and have at least 3 years of post registration experience in their specialty (Singapore Nursing Board, 2012).  There is currently one program in Singapore recognized by the Board, the Master of Nursing program at the Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine at the National University of Singapore.   Applications for registration must be made in person.  Once an individual graduates for an accredited program and has submitted for registration, they are required to perform one year of supervised clinical practice with a minimum of 1280 hours of direct patient care at an advanced level (Singapore Nursing Board, 2012).

Specialties

Currently, APNs in Singapore may be qualified as one of four specializations (Singapore Nursing Board, 2012):

  • Acute Care APN
  • Medical/Surgical APN
  • Community Care APN
  • Mental Health APN

The roles of the APN in acute care specializations includes current APNs or interns in (Singapore General Hospital, 2013; Tan Tock Seng Hospital, 2013):

  • Anesthesiology
  • Cardiology
  • Diabetes and Endocrinology
  • Family Medicine Continuing Care
  • Gasteroenterology and Nutrition
  • Gerentology
  • Intensive Care
  • Neurology
  • Neurology Intensive Care
  • Oncology
  • Orthopedics
  • Pelvic Floor Disorders
  • Palliative Care
  • Rehabiliation Medicine
  • Renal and
  • Vascular Surgery

Have information to add to this page?

References:
Bee, T.S. (2012).  Advanced practice nursing in Singapore – Clinical outcomes [PowerPoint presentation].  Retrieved from: http://www.hksne.org.hk/course/DrTanSiokBeeAPNCareOutcomes.pdf

Fee, L.S. (2012).  Pioneering moments of APN in an acute tertiary hospital in Singapore [PowerPoint presentation].  Retrieved from: http://www.hksne.org.hk/course/MsLimSuFeePioneeringMomentsofAPN.pdf

Kannusamy, P. (2006).  A longitudinal study of advanced practice nursing in Singapore.  Critical Care Nursing Clinics of North America. 18,545-551.  doi:10.1016/j.ccell.2006.08.001

Premarani, K. (n.d.).  Advanced practice in Singapore [PowerPoint Presentation].  Retrieved from: https://international.aanp.org/pdf/P13.ppt

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

Singapore General Hospital (2013).  Advanced practice nurse.  Retrieved from: http://www.sgh.com.sg/clinical-departments-centers/nursing/nursingprofession/pages/advanced-practice-nurse.aspx

Singapore Ministry of Health (2011).  Health manpower.  Retrieved from: http://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Health_Manpower.html

Singapore Nursing Board (2012).  Advanced practice nurse.  Retrieved from: http://www.healthprofessionals.gov.sg/content/hprof/snb/en/leftnav/advanced_practice_nurse.html

Tan Tock Seng Hospital (2013).  Advanced practice nurses.  Retrieved from: http://www.ttsh.com.sg/APN/

Advanced Practice Nursing in the Fiji Islands

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Practitioner

Nationally Certified:
Uncertain (Nationally Registered)

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Yes

Prescribing Authority:
Yes

Practice Autonomously:
Yes

Contact:
Fiji Ministry of Health
Fiji School of Nursing

Role

The role of Advanced Practice Nurses (APN) in the Fiji Islands is represented by Nurse Practitioners (Pulcini, Jelic, Gul, & Loke, 2009).  This role was developed to primarily help address the significant primary care needs in the rural communities, especially as 60% of individuals living within Fiji live in such settings with minimal health care access (Joel, 2013).  The first class graduated with their post-graduate diploma in 1999 (Downs, E., Personal Communication, 2013, October 12; Joel, 2013).

The role of NPs in Fiji works under established protocols, allowing individuals some prescriptive privileges (Joel, 2013).  As a result however, there is still need to develop standardized treatment guidelines throughout the region (Joel, 2013).

Education and Certification

To be accepted into an Advanced Practice Nursing program in the Fiji Islands, an individual is required to be either or both a Registered Nurse or a midwife and have a minimum of five years of clinical experience in a health care setting (Fiji National University, 2013).  The program currently is offered at the Fiji School of Nursing, which is now a part of the National University, and transitioning the program to offer Masters degrees to graduates.  This program has become regional and has also graduated individuals from the Solomon Islands, Marshall Islands, Tonga, and Tuvalu (Downs, E., Personal Communication, 2013, October 12; Joel, 2013).

Registration is obtained by the Ministry of Health for all individuals in nursing, midwifery and advanced nursing practice (International Council of Nurses/APN Network, 2013).

Specialties

Nurse Practitioners primarily work in the role of primary health care (Joel, 2013).

Have information to add to this page?

References:
Fiji National University (2013).  School of Nursing.  Retrieved from: http://www.fnu.ac.fj/index.php?option=com_content&view=article&id=1501&Itemid=284

International Council of Nurses/Advanced Practice Nursing Network (2013).  Contact information sheet: Western Pacific, Fiji.  Retrieved from: http://www.icn.ch/details/17/116.html

Joel, L.A. (2013).  Advanced Nursing: Essentials of Role Development [3rd ed.; Electronic Book]. F.A. Davis.  Retrieved from: http://books.google.com/

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

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.

Advanced Practice Nursing in the United Kingdom

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Nurse Practitioner

Nationally Certified:
Yes

Recognize Foreign Licensure:
Yes

Treatment Authority:
Yes

Prescribing Authority:
Yes

Practice Autonomously:
Yes

Contact:
Nursing & Midwifery Council
Royal College of Nursing – offers immigration consultation services

Country Specific Resource Links:
Advanced Practice Toolkit – repository for UK specific resources for practice
Nurse Practitioner UK – description of the Nurse Practitioner role in UK

Role

The role of Advanced Practice Nurses in the United Kingdom (UK) is primarily represented as Advanced Nurse Practitioners (ANPs; RCN, 2012).  While the title of ANP is used by the Royal College of Nursing (RCN), there has been inconsistencies among the general public as to the term to call ANPs in the country, and various are used as: nurse practitioner, registered nurse practitioner, clinical nurse practitioner, senior nurse practitioner, advanced nurse practitioner, and association nurse practitioner (Morgan, 2010).

The ANP role was first introduced in the UK with the initiation of a Nurse Practitioner program focusing on primary health care at the Royal College of Nursing (RCN) in 1991 (Sheer & Wong, 2008).  Much of the push for development of this role was to ease the overbearing workload of the general practitioners (primary care physicians) in the country (Pulcini, Jelic, Gul, & Loke, 2009).  Delamaire and Lafortune (2010), further identified that improving the quality of care additionally drives role development in the UK.

Since that time, the role has significantly developed over the last two decades with other specializations, protection of the title “Registered APN,” prescribing, and autonomy (Sheer, 2007; Sheer & Wong, 2008).  Currently ANPs in the UK have both prescriptive authority and work autonomously, two role qualities that have demonstrate significant advancement of the advanced practice nurse role (RCN, 2012).  Because of the origination in primary care, the ANP role in the UK is to perform the same care as a general practitioner (Morgan, 2010).

Outside of the ANP role in the UK, there are various specializations offered for general nurses allowing them to become a level 2 nurse, which is a role that is registered by the Nursing and Midwifery Council in the UK (NMC, 2013).  While these roles do require additional education, they are not the same as the ANP role described above.

There is a role of the midwife in the UK regulated by the Nursing and Midwifery Board.  This role is unique in that all midwives have a supervisor midwife to provide a check in quality of care, reflecting a role and regulatory structure existing since 1902 (NMC, 2010).

Education and Certification

Education for the Advanced Nurse Practitioner in the UK has been occurring at the masters level for more than 20 years and the majority of ANPs in the UK possess a graduate degree (Delamaire & Lafortune, 2010; Savrin, 2009).   While the recommended standard for advanced nurse practitioners in the UK is set by the recommendations by the Royal College of Nursing, it is not required that all educational programs in the country follow these recommendations (Morgan, 2010).  Within the UK however, advancement of the standardization of nursing practice will soon require that all programs educating level 1 nurses (general registered nurses) end in a terminal degree (bachelor level) by 2013, eliminating the diploma programs which lend toward greater inconsistency in education (Morgan, 2010).  While this legislation was implemented recently for level 1 nurses, there is yet to be legislation requiring the position of ANPs in the UK to have a required terminal degree (Morgan, 2010).

The majority of experts in the UK concede that education at the graduate level is the standard minimum education as an ANP in the UK, and programs can seek to have accreditation according to the RCN educational standards (RCN, 2012).  As a part of a accredited ANP program, students are required to undergo a minimum of 500 supervised clinical hours and possess a level 1 license in the UK (RCN, 2012).

An additional place of development in the UK is the development of a registry for the ANP.  Currently there is a registry for midwives and level 1 and 2 nurses, which may also show specific additional registered skills for nurses (i.e. prescribing authority), but there is yet to be a ANP registry established (Morgan, 2010).

Registration is required to practice as a midwife in the UK (NMC, n.d.).  It is required that an individual attend a level 1 program to become registered as a midwife (NMC, n.d.).

Specialties

The role of the ANP in the UK was greatly focused on primary health care (Pulcini et al., 2009).

For registered nurse specialists, there are currently various specialties that level 1 nurses can specialize in (RCN, 2013):

  • Registered specialist community public health nurse (SCPHN) qualification in
    • Family
    • Health visitor
    • Occupational health
    • Non-specific
    • School nurse
  • Specialist Practice Qualification
    • Adult nursing
    • Children’s nursing
    • Community children’s nursing
    • Mental health nursing
    • District nursing
    • General practice nursing
    • Learning disability nurse
    • Mental health

While these are the registration qualifications recognized by the NMC in the UK, nurses can have a specialization in a specific subject of nursing (i.e. epilepsy, Parkinson’s, cancer).

Have information to add to this page?

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

Morgan, S. (2010, July 9).  What are the differences in nurse practitioner training and scope of practice in the US and UK?  NursingTimes.net.  Retrieved from: http://www.nursingtimes.net/nursing-practice/clinical-zones/district-and-community-nursing/what-are-the-differences-in-nurse-practitioner-training-and-scope-of-practice-in-the-us-and-uk/5017012.article

Nursing and Midwifery Council [NMC] (n.d.).  Registering as a nurse or midwife in the United Kingdom: For applicants outside the European Economic Area [online document].  Retrieved from: http://www.nmc-uk.org/Documents/Registration/Registering%20as%20a%20nurse%20or%20midwife%20from%20outside%20EU%20or%20EEA.pdf

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

Royal College of Nursing [RCN] (2012).  Advanced nurse practitioners: An RCN guide to advanced nursing practice, advanced nurse practitioners and programme accreditation [electronic document].  Retrieved from: http://www.rcn.org.uk/__data/assets/pdf_file/0003/146478/003207.pdf

Royal College of Nursing [RCN] (2013).  RCN Factsheet: Specialist nursing in the UK.  Retrieved from: http://www.rcn.org.uk/__data/assets/pdf_file/0018/501921/4.13_RCN_Factsheet_on_Specialist_nursing_in_UK_-_2013.pdf

Savrin, C. (2009). Growth and development of the nurse practitioner role around the globe.  Journal of Pediatric Health Care 23, (5),310-314.

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

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