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 Finland

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse (with advanced degree)
Public Health Nurse (with advanced degree)
Nurse Midwife

Nationally Certified:
Uncertain

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Yes

Prescribing Authority:
No

Practice Autonomously:
No

Contact:
Terveydenhuollon Oikeusturvakeskus (National Authority for Medico-Legal Affairs)

Role

There are two chief roles identified for Advanced practice Nurses in Finland, namely that of the Advanced Nurse and Public Health Nurse, both of which are prepared with graduated level schooling (Delamaire & Lafortune, 2010).  There is additionally a nurse midwife role available in Finland, but is understood as a registered nurse specialization rather than that of an advanced practice role (Robinson & Griffiths, 2007).  This will be described further under the specializations category below.  The roles for APNs in Finland can be delineated as follows (Delamaire & Lafortune, 2010):

  • Public Health Nurse
    • Advanced assessment, consultation, diagnosis, ordering and interpretation of diagnostic tests, management of various chronic diseases (follow-up, monitoring, and education), and referral to specialists
  • Advanced Nurse
    • Advanced assessment, consultation, diagnosis, ordering and interpretation of tests, and management of various chronic illnesses (follow-up, monitoring and education for non-acute cases)
    • Triage for prioritization of patients

The first Advanced Practice Nurses in finland graduated in 2006 (Fagerström & Glasberg, 2011).   While this role has recently been added to healthcare in Finland, the role primarily expands the autonomy and scope of practice of current nursing in the country.  According to Fagerström and Glasberg (2011), the role of APNs primarily was observed as beneficial in the care of acute and chronic health conditions.  Acutely, nurses and doctors in Finland have a longstanding cooperative relationship allowing nurses to participate in various roles (Delamaire & Lafortune, 2010).  These may appear as nurses providing greater triage or reception of patients, or even working along side a doctor as a dual discipline team.  Additionally, APNs in Finland also play an influential role in providing care to more rural areas underserved by physicians while also providing care at a lower cost than care provided by physicians (Delamaire & Lafortune, 2010).  Often in these situations, nurses will provide the general examination of patients and have further electronic consultation with doctors for providing complicated care, often providing 70% of patient care (Delamaire & Lafortune, 2010).

Meanwhile, Delamaire and Lafortune (2010), reported that Finland was of the top nations with the highest number of nurses per 1000 people in the country at 15.5; thus indicating a surplus of nurses.  Meanwhile, they indicated that Finland held a mildly below average ratio of doctors per capita (2.7 to 1000 people; European average was 2.8) (Delamaire & Lafortune, 2010).  As a result, Finland presents itself as good place to further develop the Advanced Practice Nursing role, with a higher ratio of nurses and a lower number of doctors per capita, similar to that of the United States and United Kingdom (Delamaire & Lafortune, 2010).

Proposal to expand the role of APN practice in Finland to include limited prescriptive authority to those working in public health centers is currently underway (HAI Europe, 2012; Tynkkynen, n.d.).

Education and Certification

Education for Advanced Practice Nurses in Finland produced it’s first graduates in 2006 (DeGeest et al., 2008; Fagerström & Glasberg, 2011).  Education for the registered nurse usually requires 3.5 years, and 4 years for the public health nurse (Robinson & Griffiths, 2007).  The advanced degrees are available afterward to those who desire further advancement in scope of practice at the graduate level (Delamaire & Lafortune, 2010).  While registration and certification is available for nursing in Finland, it is not currently provided for APNs (Robinson & Griffiths, 2007).  Registration for healthcare individuals within Finland is maintained by the National Authority for Medico-Legal Affairs (Terveydenhuollon Oikeusturvakeskus).

Specialties

At this time, APNs have been working in various roles including rural healthcare, general practice, and acute care (Delamaire & Lafortune, 2010).  However, registered nurses in Finland have the choice of specializing in various categories nearing graduation of nursing school in acute care, geriatric care, mental health, multi-cultural, pediatrics, palliative care and youth and adolescent care (Robinson & Griffiths, 2007).  Additionally, an individual can choose to be a nurse midwife with an additional year of schooling (Robinson & Griffiths, 2007).

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

Delamaire, M. & Lafortune, G. (2010). Nurses in advanced roles: A description and evaluation of experiences in 12 developed countries.  OECD Health Working Papers, 54, OECD Publishing.http://dx.doi.org/10.1787/5kmbrcfms5g7-en

Fagerström, L. & Glasberg, A.L. (2011).  The first evaluation of the advanced practice nurse role in Finland – The perspective of nurse leaders.  Journal of Nursing Management, 19, 925-932.  doi:10.1111/j.1365-2834.2011.01280.x

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

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

Tynkkynen, L.K. (n.d.). Limited right for nurses to prescribe medication.  Health Policy Monitor.  Retrieved from: http://www.hpm.org/en/Surveys/THL_-_Finland/15/Limited_right_for_nurses_to_prescribe_medication.html

Advanced Practice Nursing in Poland

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Specialist
Nurse Midwife

Nationally Certified:
No

Recognize Foreign Licensure:
RN and Midwife Nursing licensure is recognized from EU

Treatment Authority:
Varies according to specialty

Prescribing Authority:
No

Practice Autonomously:
No

Contact:
Ministerstwo Zdrowia (Poland Ministry of Health)

Role

Development of the Advanced Practice Nurse Role in Poland has been greatly driven by the financial benefit that APNs can provide equal care at a lesser cost than that of physicians (Delamaire & Lafortune, 2010).  According to Strózik (2006), Poland has almost 2 nurses per every doctor in the country, and has about 2.3 physicians per 1000 individuals, not significantly lacking.  However, there is also reportedly slower waits to see physicians and consultants (more experienced and knowledgable physicians) and in the emergency rooms than most of the EU (europe-cities.com, 2013).

The expanded roles of nurses in specialty positions perform advanced physiologic and psychologic assessment.  The role of APNs as nurse specialists in Poland are not uniform according to specialty, but are based on the healthcare needs within the country for more urgent care and intensive management.  As a result, such expanses of scope of practice include management of some chronic illnesses (i.e. diabetes and end-stage renal disease), perform triage for patient prioritization, or some emergency procedures (i.e. emergency intubation or tracheotomy) (Delamaire & Lafortune, 2010).  APNs in Poland however do not have prescriptive authority (Delamaire & Lafortune, 2010).

According to Delamaire & Lafortune (2010), the chief barriers to advancing nursing practice in Poland is four fold:

  • Medical association opposition
  • Lack of government funding for new roles
  • Legislation
  • Methods of compensation for physicians

Education and Certification

Nurses are trained regularly at the bachelor level based on a 3 year post high school education.  They can opt for an extended track that allows for midwifery practice, totaling a 5 years of post graduate coursework (Rechel, Dubois, & McKee, 2006).  Coursework is directed and approved by the Poland Ministry of Health and a post graduation licensure exam is required to practice (Nichols, Davis, & Richardson, 2011; Strózik, 2006).

Specialties

Nurses have opportunities to obtain post bachelor graduate education in midwifery, pediatric, psychiatric, and additional opportunities (Strózik, 2006).  While these specializations offer further education and knowledge application, information is lacking on the extent, if any that the scope of practice may be expanded.

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References:
Delamaire, M. & Lafortune, G. (2010). Nurses in advanced roles: A description and evaluation of experiences in 12 developed countries.  OECD Health Working Papers, 54, OECD Publishing.http://dx.doi.org/10.1787/5kmbrcfms5g7-en

europe-cities.com (2013).  Healthcare in Poland.  Retrieved from: http://www.europe-cities.com/en/633/poland/health/

Nichols, B.L., Davis, C.R., & Richardson, D.R. (2011).  Appendix J: International models of nursing.  The Future of Nursing: Leading Change, Advancing Health.  Institute of Medicine.  Retrieved from: http://www.nap.edu/catalog/12956.html

Strózik, M. (2006). Chapter 7: Poland. The Health Care Workforce in Europe: Learning from experience.  World Health Organization: Copenhagen, Denmark.  Retrieved from: http://www.euro.who.int/__data/assets/pdf_file/0008/91475/E89156.pdf

Advanced Practice Nursing in Sweden

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Clinical Nurse Specialist

Nationally Certified:
No (Nurse Specialist title is restricted to individuals graduating from specific programs in Sweden)

Recognize Foreign Licensure:
Uncertain (likely no at this time)

Treatment Authority:
Varies

Prescribing Authority:
Yes

Practice Autonomously:
No

Contact:
Vårdförbundet

Role

The Advanced Clinical Nurse Specialist role was initiated through programs first offered in 2005 (Lindblad, Hallman, Gillsjo, Lindblad, & Fagerstom, 2010).  While the role of Nurse Specialists has existed and the title is protected, the advanced practice nursing (APN) role has been in development.  The role of APNs in Sweden has been under evaluation and experimentation in general practice (primary health care) and has been based on an institutional-specific model allowing varying levels of scope of practice (Lindblad et al, 2010).  Because of the lack of APN role identification, the role is currently under development to be of the greatest benefit to the Swedish health care system (Lindblad et al., 2010).  Further, it appears the Swedish health care system has a strong need for more Nurse Specialists (Vårdförbundet, 2013).  As a result, if there are not enough individuals in the country to provide the supply of Nurse Specialists, there may additionally not be enough supply of individuals who desire additional training to increase their scope of practice.  In Sweden however, nurses have been given the nurse prescribing authority since 1994, initiating nursing prescriptive authority in Europe (HAI Europe, 2012).

Education and Certification

Nurse Specialists are trained at the masters level (Vårdförbundet, 2013).  The current programs in Sweden have been educating individuals for the Advanced Clinical Nurse Specialist role since 2005 (Lindblad et al., 2010).

Specialties

At this time APNs have been primarily working in general practice (primary health care).

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References:
HAI Europe (2012). The next chapter in promotion of healthcare professionals: Nurse prescribers [fact sheet]. Retrieved from: http://haieurope.org/wp-content/uploads/2012/02/27-July-2011-HAI-Europe-Nurse-Prescribers-Factsheet.pdf

Lindblad, E., Hallman, E.B., Gillsjo, C., Lindblad, U., & Fagerstom, L. (2010).  Experiences of the new role of advanced practice nurses in Swedish primary health care–A qualitative study.  International Journal of Nursing Practice, 16, 69-74.  doi:10.1111/j.1440-172X.2009.01810.x

Vårdförbundet (2013).  Specialist Nurse [translated by Google Translate].  Retrieved from: https://www.vardforbundet.se/Min-profession/Sjukskoterska/Specialistsjukskoterska/

Advanced Practice Nursing in China

Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Specialist

Nationally Certified:
Uncertain

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Uncertain

Prescribing Authority:
No

Practice Autonomously:
Uncertain

Contact:
Ministry of Health

Role

Nursing in China today has been pursuing the development of Advanced Practice Nursing roles (Wong et al., 2010).  While this initiative has begun there are several key influencing hurdles that will need to be addressed if such a role will be developed: 1. there are twice as many physicians in the country as that of nurses (Wong et al., 2010).  As a result much of the more advanced patient care that is currently provided in other developed nations is provided by physicians (Wong et al., 2010).  Additionally, nursing in China is a female-driven profession in a male-driven society, causing a gender-centric perspective (Wong et al., 2010).

The nursing role in China today has been developing as well.  Traditionally, the majority of nurses are educated at the diploma-level (64.5%) which incorporated 12 years of specialized primary and secondary schooling (Wong et al., 2010).  Another 24.3% have degrees at the associates level, which have been compared to nursing diploma schools in the United States, and approximately 1.3% hold bachelor degrees in nursing (Nichols, Davis, & Richardson, 2011; Wong et al., 2010).

An initiative by China’s Health Ministry has set to double their nurses to 4.45 million by 2020 (Xiang, 2011).  Registration and licensure of nurses has also been a recent initiative of China and since mid 2009 all nurses are required to pass the Chinese licensure exam (Nichols, Davis, & Richardson, 2011).  While the current education level of nursing in China has been lesser than that of other nations, China has been increasing in the exportation of nurses on the international level and as a result more programs are providing education focusing on passing the NCLEX exam necessary for more international regulation (Nichols, Davis, & Richardson, 2011; Wong et al., 2010).  With increased education provided in China, the advancement of nursing will also increase in quality.

Because of these strong factors that influence the nursing role in China, the emerging APN role resembles more the clinical nurse specialist, allowing nurses to gain expertise in content areas rather than that of a similar role to physicians (Wong et al., 2010).

Education and Certification

The current education provided for the few individuals who seek advancement in their nursing is provided at the masters level (Wong et al., 2010).  Reportedly, there are more than 30 master-level programs and 4 doctoral programs available in Mainland China as of 2005 (Yan, n.d.).

Specialties

The specialties recognized by China are (Yan, n.d.): 1. Intensive care, 2. Emergency nursing, 3. Organ transplantation, 4. Operating room, and 5. Oncology.

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References:
Nichols, B.L., Davis, C.R., & Richardson, D.R. (2011).  Appendix J:  International models of nursing [pp. 565-642].  The Future of Nursing: Leading Change, Advancing Health.  Institute of Medicine.

Wong, F.K., Peng, G., Kan, E.C. (2010).  Description and evaluation of an initiative to develop advanced practice nurses in Mainland China.  Nurse Educator Today, 30, 344-349.

Xiang, Z. (Ed.) (2011, April 28).  China to double number of nurses by 2010: Health Ministry.  China Weekly English News.  Retrieved from: http://news.xinhuanet.com/english2010/china/2011-04/28/c_13850662.htm

Yan (n.d.).  Advanced nursing practice development in Mainland China [PowerPoint Presentation].  Retrieved from:  http://www.psdas.gov.hk/content/doc/2005-2-03/Yan%20Hu%20-%202005-2-03.pdf