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.

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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 Belize

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Psychiatric Nurse Practitioner

Nationally Certified:
Yes

Recognize Foreign Licensure:
Yes

Treatment Authority:
Yes

Prescribing Authority:
Yes (Psychiatric Nurse Practitioner only)

Practice Autonomously:
Yes

Contact:
Belize Ministry of Health

Role

The state of health in Belize has a lack of health professionals in general (BMOH, 2014).  With the lack of a current medical school in the country, providers are frequently trained by neighboring countries as Cuba, Guatemala, Mexico, Nicaragua, and Costa Rica (PAHO, 2009b). As can be imagined, Belize in turn relies heavily on regional international support for their health resource management and it is estimated that up to 30% of their medical providers are immigrated from those other countries.

Because of the lack of health professionals in general, frequently registered nurses autonomously provide care at an advanced practice level including basic diagnosis and treatment at rural health posts (PAHO, 2009b; BMOH, 2014).  Most often, the advanced role in such nursing situations are based on algorithms and protocols for decision making. Frequently they are used as triage agents to determine if an patient may be treated at the rural health post or needs to make the cumbersome trip to a higher level of care and see a medical provider.

Nursing in Belize is regulated by the Ministry of Health through the Nursing and Midwifery Act (Chapter 321, 2003), which currently is under revision by Belize legislature. Nursing according to the 2003 revision is identified according to the curriculum requirements for registration as a registered nurse, but no specific scope of practice is identified. Volunteer opportunities are available for Nurse Practitioners to work according to their scope of practice in their own country.  If an individual desires to work at this level, the would be encouraged to work as a part of a local Non-Governmental Organization and may need to inquire with the Ministry of Health if there are any limitations on their scope of practice.

In general prescribing is permitted for medical doctors and dentists exclusively (Misuse of Drugs Act, Ch. 103, Rev. 2003).  However, as long as there is an overseeing physician, nurses can write and dispense medications according to their understood protocol.

Education and Certification

Certifications for all three nursing specialties are available through the University of Belize.

Specialties

Based on the greatest needs of the Belize population, the University of Belize (2016) currently offers three certificates for an advanced role:

  • Psychiatric Nurse Practitioner
  • Rural Health Nursing
  • Practical Nursing

The main differentiation is that Psychiatric Nurse Practitioners are permitted to prescribe psychochotropic medications within certain protocols (PAHO, 2009b).

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References:
Belize Ministry of Health [BMOH] (2014). Belize Health Sector Strategic Plan 2014-2024.  Retrieved from: http://health.gov.bz/www/attachments/article/801/Belize%20Health%20Sector%20Strategic%20Plan%202014-2024-April%202014.pdf

Pan American Health Organization [PAHO] (2009a). WHO-AIMS report on mental health system in Belize. Retrieved from: http://new.paho.org/blz/index2.php?option=com_docman&task=doc_view&gid=63&Itemid=250

Pan American Health Organization (2009b).  Health Systems Profile: Belize.  Retrieved from: http://www.paho.org/blz/index.php?option=com_docman&view=download&alias=64-health-sytems-profile-belize-monitoring-and-analyzing-health-systems-change-reform-july-2009&Itemid=250

University of Belize (2016).  Program offerings.  Retrieved July 14, 2016 from: http://www.ub.edu.bz/fnahsw/program_offerings.phpUpdated: July 14, 2016

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

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 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 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 Argentina

Snapshot

APN Role Exists in Country Today:
No

Contact:
Minsterio de Salud y Ambiente de Argentina (Ministry of Health in Argentina)

Role

There is no current Advanced Practice Nursing (APN) role in Argentina today.  The role of nurses in Argentina is also in its development, as nurses have only recently in 2008 established a national licensing registry for nurses (Ministerio de Salud, n.d.).  Only once the nursing role is established to consistent standards, will the nurses be in a position to incorporate an established role of advanced practice.

The health care system in Argentina also presents some difficulties in developing an Advanced Practice Nurse educational programs and system to incorporate them in employment.  As of 2008, according to the Ministerio de Salud (2008), there were 1.5 doctors per every one nurse, and only 1.55 nurses  per every thousand individuals.  Once incorporating nursing related assistive professionals, the country only has 2.21 nursing type workers per thousand habitants in Argentina (Ministerio de Salud, 2008).  While these numbers were reported by the Ministry of Health in Argentina, the World Health Organization (WHO, 2013) reports from 2004 that Argentina had a closer ratio of 4-5 doctors per nursing and midwifery professional in the country, further confirming the desperate shortage of nurses in Argentina.

Because of this significant nursing shortage in Argentina, the Ministry of Health has proposed a plan to improve working conditions and benefits for nurses to increase the number of nurses to at least one per every doctor and hopes to develop a high ration of 4.0 nurses per 1,000 individuals (Durante, 2012; Ministerio de Salud, 2008).  Meanwhile, according to Durante (2012), the country has not had nearly the success it has hoped in increasing the nursing numbers as desired.  One great struggle with this issue is the lack of nursing educators and a significant dropout rate for students in nursing schools of nearly 70% in the first cycle, a lower level of nursing in the country (Durante, 2012).

Specialties

Not applicable at this time.

Have information to add to this page?

References:
Durante, S. (2012, Junio 26). Noticias de enfermería – Misiones.  Sociedad Argentina de enfermería.  Retrieved from: http://blogsdelagente.com/sae/ 

Ministerio de Salud (n.d).  Registro Unico de Profesionales de Salud.  Retrieved October 30, 2013 from: http://rups.msal.gov.ar/turnos/

Ministerio de Salud (2008).  Consejo de Salud 8 y 9 de Mayo, 2008, Recursos humanos: Residencias Enfermería [PowerPoint presentation].  Retrieved from: http://www.msal.gov.ar/images/stories/cofesa/2008/acta-02-08/anexo-4-acta-02-08.pdf

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

World Health Organization [WHO] (2013b). Disaggregated data: Nursing and midwifery personnel by country.  Retrieved from: http://apps.who.int/gho/data/node.main.HWF1?lang=en

Advanced Practice Nursing in Hong Kong

Snapshot

APN Role Exists in Country Today:
Yes

Titles:
Nurse Specialist
Advanced Practice Nurse

Nationally Certified:
Yes

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Yes

Prescribing Authority:
Uncertain

Practice Autonomously:
Varies

Contact:
The Provisional Hong Kong Academy of Nursing Limited (PHKAN)
Hong Kong Society for Nursing Education Limited
Nursing Council of Hong Kong

Role

Advanced Practice Nurses began as Nurse Specialists in Hong Kong in 1994 (Sheer & Wong, 2008).  This role was primarily created to allow for career development for nurses who had significant expertise in a specific specialty.  In the Hong Kong health system, the Hospital Authority, the national entity responsible for health care in Hong Kong, utilizes Nurse Specialists frequently as consultants in the inpatient hospital system (Chan, Thompson, & Wong, 2006).  These individuals often carry their own patient load, but may also see patients on other wards that have specialty needs.  The roles of these specialists within the hospital systems vary according to hospital and specialty (Chan, Thompson, & Wong, 2006). The role of Nurse Specialist on an outpatient basis is in nurse-led clinics.  This effort was created by the Hospital Authority to help manage individuals on an outpatient basis.

Similarly to several parts of Asia, Hong Kong’s health system does not have a significant entity of primary health care, and individuals will usually first be seen for a significant ailment in the emergency department.  Once diagnosed with some condition and stabilized to no longer need inpatient treatments, they will then be referred to see a specialty clinic on an outpatient basis.  Due to the lack of such clinics, the Hospital Authority of Hong Kong developed the concept of nurse-led clinics with specialty nurses providing care and management to individuals with that ailment (Chan, Thompson, & Wong, 2006).  For example, for an individual with Chronic Obstructive Pulmonary Disease (COPD), an individual would go to a COPD clinic.

Since inception, these nurse-led clinics, run by Nurse Specialists, have been continuing to expand and have demonstrated good improvement to healthcare in Hong Kong today (Shiu, Lee, & Chau, 2012).  The nurses in these clinics can manage up to 90% of patients for outpatient disease-specific care and also take a more holistic approach and rarely prescribe medications (Wong, 2002).  Most often the nurses in these clinics will practice either independent or supervised adjustments of medications and initiating diagnostics or treatments according to protocols (Wong & Chung, 2006).  In some circumstances however, the CNS/NSs will prescribe medication, as nicotine patches for smoking cessation for COPD patients (Wong, 2010). An additional role developed in 2002 was the Advanced Practice Nurse (APN).  This title was designated for individuals who practice in a more promoted position based on nurses being very experienced (Chan, Thompson, & Wong, 2006).  This role most similarly reflects that of the Clinical Nurse Specialist in other nations, and have significant expertise and experience.  Much of the role of APN development in Hong Kong has been in inpatient settings and includes advanced clinical assessment, education, research, and consultation with physicians (Sheer & Wong, 2008).

Another role in development is that of the Nurse Practitioner.  This role is in development today, and a potential additional position to be incorporated in the increasing health care needs in Hong Kong.

In general, the roles of advanced practice nurses in Hong Kong have been developing greater acceptance, greatly due to improved perceptions of the increase in health care quality and safety (Christiansen, Vernon, & Jinks, 2013).  Meanwhile, the greatest perceived challenge of the advancement of APNs in Hong Kong is that of other health care workers’ acceptance of the position (Christiansen, Vernon, & Jinks, 2013).  Another considerable factor is that of ‘brain-drain’ leading to a now 10-year shortage of nursing in Hong Kong (Lee, 2014).  Low financial compensation seems to be a valid concern reducing the number of nurses desiring to stay within the country and therefore able to seek career advancement.

Education and Certification

The role of the Advanced Practice Nurse or Nurse Specialist requires a minimum education of a masters degree (Sheer & Wong, 2008).  To be a Nurse Practitioner in Hong Kong, one would be required to have a master degree with a focus on clinical experience (Loke, 2004). Most recently, desire to standardize clinical care and preparation, there have been efforts to establish accreditation and registration for Nurse Specialists in Hong Kong.  One such effort is being a fellow of the Provisional Hong Kong  Academy of Nursing Limited (2012) and another the College of Nursing, Hong Kong (n.d.).  Such organizations like these have been striving to create standardized care and registration for individuals working in the capacity as a Nurse Specialist (Sheer & Wong, 2008).

Specialties

Various roles associated with the Nurse Specialist include (Chan, 2012; Schober & Affara, 2006):

  • Advanced Medical Nursing
  • Advanced Pediatric Nursing
  • Advanced Surgical Nursing
  • Anesthetic and Recovery Nursing
  • Breast Care
  • Cardiac Care Nursing
  • Cardiac Surgical Nursing
  • Community Nursing
  • Community Psychiatric Nursing
  • Continence Nursing
  • Diabetes Nursing
  • Emergency Nursing
  • Gerentological Nursing
  • HIV/AIDS Nursing
  • Intensive Care Nursing
  • Neonatal Intensive Care Nursing
  • Orthopedics & Traumatology Nursing
  • Pediatric Intensive Care Nursing
  • Peri-operative Nursing
  • Primary Health Care Nursing
  • Psychiatric Rehabilitation Nursing
  • Rehabilitation Nursing
  • Renal Nursing
  • Respiratory Nursing
  • Rheumatology Nursing
  • Substance Abuse Nursing
  • Transplant Nursing
  • Wound/ostomy Nursing
  • Urology Nursing

Have information to add to this page?

References:
Chan, E. (2012).  Hong Kong perspective on nursing workforce planning, development, and education [PowerPoint presentation].  Retrieved from: http://www.ha.org.hk/haconvention/hac2012/proceedings/downloads/S8.3.pdf

 

Christiansen, A., Vernon, V., & Jinks, A. (2013).  Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse-led out-of-hours care in Hong Kong: a questionnaire study.  Journal of Clinical Nursing.  22(7-8),1173-1181.  doi: 10.1111/j.1365-2702.04139.x

College of Nursing, Hong Kong (n.d.).  Clinical nurse specialist accreditation.  Retrieved from: http://www.cnhk.org.hk/eng/Files/Courses/Clinical_Nurse_Specialist_Accreditiation_Leaflet_101101_4.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

Lee, K. (2014, June 25).  Nurses looking for cure to staff shortages.  The Standard.  Retrieved from: http://thestandard.com.hk

Loke, A. (2004).  Hong Kong scenario: The development of nurse practitioner education program.  Retrieved from: http://international.aanp.org/pdf/LokeHKNP.pdf

Chan, S., Thompson, D.R., & Wong, T. (2006).  Chapter 14: Nurses as agents of quality improvement.  In Leung, G.M. & Bacon-Shone, J. (Eds.), Hong Kong’s health system: Reflections, perspectives and visions [Google e-reader version].  Aberdeen, Hong Kong:  Hong Kong University press.  Retrieved from: http://books.google.com/

Provisional Hong Kong Academy of Nursing Limited, The (2012).  Introduction of PHKAN.  Retrieved from: http://www.hkan.hk/

Schober, M. & Affara, F.A. (2006).  International Council of Nurses: Advanced Nursing Practice [Kindle e-reader version].  Blackwell Publishing Ltd.

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

Shiu, A.T., Lee, D.T., & Chau, J.P. (2012).  Exploring the scope of expanding advanced nursing practice in nurse-led clinics: A multiple-case study.  Journal of Advanced Nursing, 68(8),1780-1792.  doi: 10.1111/j.1365-2648.2011.05868.x

Twinn, S. (2003, December 14).  Advanced nursing practice in public health nursing.  Hong Kong Society for Nursing Education Newsletter.  Retrieved from: http://www.hksne.org.hk/newsletter/200312-04.htm

Wong, F.K. (2002). Development of advanced nursing practice in Hong Kong: a celebration of ten years’ work [PowerPoint presentation]. Retrieved from: international.aanp.org/pdf/fwongicnanpdev_2406031.ppt

Wong, F.K.Y. & Chung, L.C.Y. (2006).  Establishing a definition for a nurse-led clinic: Structure, process, and outcome.  Journal of Advanced Nursing, 53(3),358-369.  doi: 10.1111/j.1365-2648.2006.03730.x

[Updated: Jun 29, 2014]