Advanced Practice Nursing in Austria

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Role

Austria as well as many other nations worldwide is planning for the future sustainability of its health system with an aging health workforce (Glarcher & Lex, 2020).  There has been significant recent momentum in Austria to develop the role of advanced practice nursing (APN) since 2016 when educational regulation for the registered nurse role was formally embraced.  Since 2016 various academic programs recently have developed APN curriculum for masters-level degrees and graduates have begun to enter the workforce (Glarcher & Lex, 2020).

However, at this time the role is largely limited to the lack of any formal regulation.  As a result the scope of practice exists only as determined by each organization and consequentially does not have advanced permissions for advanced practice by national entities for independent assessment, diagnosis, treatment, and prescription beyond the registered nurse role (Glarcher & Lex, 2020).

References:
Glarcher, M. & Lex, K.M. (2020).  Advanced nursing practice in Austria under consideration of outcome measurement. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 155(2020)11-16. doi: 10.1016/j.zefq.2020.06.012

Advanced Practice Nursing in Panama

Contact:
National Nurses Association of Panama

Role

The role of Advanced Practice Nursing in Panama is not currently observed to be in development. There are several generalized contextual barriers (i.e. pushback from physician organizations, lack of nursing role standardization) in developing the role throughout Latin America and Panama is not and exception to that situation (Zug et al., 2016). In addition, there are barriers based on general availability of healthcare staff per 1000 population. Sheer and Wong (2008) pointed out the disparities of health professionals in Panama whereas the Advanced Practice Nurse role is typically facilitated when there is a greater proportion of nurses per 1000 population and a gap in physician availability (Sheer & Wong, 2008). The following table shows the basic comparisons of two nations with significant APN role advancement compared to Panama:

Sheer and Wong (2008) pointed out the disparities of health professionals in Panama whereas the Advanced Practice Nurse role is typically facilitated when there is a greater proportion of nurses per 1000 population and a gap in physician availability (Sheer & Wong, 2008). The following table shows the basic comparisons of two nations with significant APN role advancement compared to Panama:

[Table: World Bank website. Nurses & Midwives and Physicians per 1000 population]

Additionally, Panama is largely a proponent of supporting host country nationals for specific jobs including physicians and nurses, as a result foreign education is not transferrable unless you are formally a Panamanian citizen or you are formally married to one (Czark, B., n.d.).

Meanwhile, there are significant gaps in healthcare primarily outside of Panama City where the majority of medical providers reside and work. This leaves potential gaps that would be more ideal to allow nurse practice advancement. Currently, there are medical brigades (aka medical missions) permitted allowing healthcare providers from other nations to provide health services on a voluntary basis; such opportunities can be found online in abundance.

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References:
Czark, B. (n.d.). 25 jobs forbidden to foreigners in Panama. Retrieved July 1, 2022 from: https://livinginpanama.com/panama/jobs-forbidden-foreigners/

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

World Bank, The. Statistics: Nurses and midwives per 1000 population for Panama, Netherlands, and United States. Retrieved July 1, 2022 from: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=PA-US-NL

World Bank, The. Statistics: Physicians per 1000 population for Panama, Netherlands, and United States. Retrieved July 1, 2022 from: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=PA-US-NL

Zug, K.E., De Bortoli Cassiani, S.H., Pulcini, J., Bassalobre Garcia, A., Aguierre-Boza, F., & Park, J. (2016). Advanced practice nursing in Latin America and the Caribbean: Regulation education and practice. Revisita Latino-Americana de Enfermagem. 24(2016). doi:10.1590/1518-8345.1615.2807

Advanced Practice Nursing in Latvia

Contact:
Latvian Nurses Association

Role

The role of Advanced Practice Nursing in Latvia is not currently observed to be in development. Most recently Latvia has prioritized standardization of their registered nursing curriculum, identifying that by the end of 2022 to have registered nurses trained at the bachelor’s level (WHO, 2020). Traditionally the health system has allowed for various nursing specialties, but did not have a general nurse role. The initiative ratified by the Latvian Parliament has undergone the establishment of a generalize nursing qualification, and then allow nurses to specialize further afterward (WHO, 2020).

Since the nation has yet to formally establish their nursing fundamental curriculum and qualifications, the advancement of the nursing role toward a master’s degree level and provision of an expounded scope of practice is not yet underway.

Meanwhile, there is a significant gap of healthcare workers throughout the nation, particularly for individuals to work in the traditional physician scope of practice as well in rural settings. Additionally, evaluation of burnout of the nursing force within Latvia has identified that nurses feel a significant gap in feeling empowered and accomplishment (Circenis et al., 2017). In theory, if nurses were given additional opportunities for professional growth and increased autonomy, they may have reduced burn out (Twigg, D. & McCullough, 2014). As a result Latvia does have several significant potential factors to promote the advancement of the nursing role.

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References:
Circenis, K., Deklava, L., Millere, I. et al. (2017). Fatigue and burnout among Latvian nurses. Global Journal of Psychology Research New Trends and Issues. 7(3), 111-116. doi:10.18844/gjpr.v7i3.2856

Twigg, D. & McCullough, K. (2014). Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies. 51(1). 85-92. doi:101016/j.ijnurstu.2013.05.015

Veide, S., Lember, M. & Põlluste, K. (2015). Latvia.  In Kringos, D.S., Boerma, W.G.W., Hutchinson, A. et al. (Eds.) Building primary care in a changing Europe: Case Studies [Internet].  European Observatory on Health Systems and Policies, Copenhagen, Denmark.

World Health Organization [WHO] (2020). Postgraduate training in Latvia. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/336238/WHO-EURO-2020-1304-41054-55734-eng.pdf?sequence=1&isAllowed=y

Advanced Practice Nursing in Norway

Contact:
Norwegian Nurses Organisation (NNO)
Western Norway University of Applied Sciences

Role

The role of Advanced Practice Nursing in Norway has most recently explored and is currently in active development.  According to Holm Hansen et al. (2020) the role was most recently introduced through an extended pilot including both the nurse practitioner and clinical nurse specialist roles (Holm Hansen et al., 2020).  Through this extensive introduction, key barriers to developing the role have been identified.  One of the biggest gaps at this time is the lack of formal role protection in the country (Østvik, 2017).

Education, Certification, and Specialties

Both the bachelor and master’s level educational programs for registered nurses are regulated, creating a solid foundation for the advancement of nursing practice (Holm Hansen et al., 2020).  Since the master’s level degree has been available for nurses since 2015 which allows advanced practice nursing to be able to more easily embrace the APN role (Østvik, 2017). With the piloted roles described by Holm Hansen et al. (2020), advanced practice nursing in Norway has core curriculum and training at the master’s level, with 120 credits for program completion (WNU, 2022).  However because of the lack of formal recognition of the APN role, the APN educational curriculum is not yet nationally regulated (Østvik, 2017)

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References:
Holm Hansen, E., Boman, E., Bing-Jonsson, P., & Fagerstrom, L.M. (2020). Introducing nurse practitioners into Norwegian primary healthcare- Experiences and learning.  Research and Theory for Nursing Practice: An International Journal, 34(1) doi:10.1891/1541.6577.34.1.21

Østvik, E. (2017). Country Practice Profiles: Norway [Webpage]. NP / APN Network. Retrieved June 5, 2022 from: http://icn-apnetwork.org

Western Norway University of Applied Sciences [WNU] (2022). Advanced Practice Nursing. Website.  Retrieved June 4, 2022 from: https://www.hvl.no/en/studies-at-hvl/study-programmes/advanced-nursing-practice/.

Advanced Practice Nursing in Sweden

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Contact:
Vårdförbundet

Role

The role of Advanced Practice Nursing in Sweden has been explored for more than a decade, but the role is still in its infancy. The role has been in development, but not formally established (Bergström, & Lindh, 2018).

Historically in 2005, the Advanced Clinical Nurse Specialist role has been piloted through programs first offered (Lindblad, et al., 2010; Egerod et al., 2021).    This role primarily 

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, there is reported ongoing interest in the Swedish health care system for more Nurse Specialists (Vårdförbundet, 2013; Vårdförbundet 2019).  

The nurse to physician ratio in Sweden reportedly was 2.7 to one which reportedly is just under the average among European countries, but unfortunately has the lowest number per 1,000 population at 11.1 (Alenius, Lindqvist, and Tishelman, 2019).  Additionally, there has been a large gap in licensed physicians, largely reflected in the majority (59%) of current physicians being educated in another country (Alenius, Lindqvist, and Tishelman, 2019).  While there is a gap in physician shortage, which facilitates the advancement of nursing practice, assumedly the lack of registered nurses in the country also impedes the progress due to the lack of nursing supply to advance.

In Sweden to help the ongoing needs of the overall population, nurses have been given the prescribing authority since 1994, allowing registered nurses limited prescriptive authority for initial treatment of various acute concerns as urinary tract infections, throat infections (HAI Europe, 2012; Maier, 2019).

 

Education, Certification, and Specialties

Nurse Specialists are trained at the masters level (Vårdförbundet, 2013; Vårdförbundet 2019).  The current programs in Sweden have been educating individuals for the Advanced Clinical Nurse Specialist role since 2005 (Lindblad et al., 2010).  The program primarily focuses on 60 to 75 additional university level education credits (Vårdförbundet 2019).

Various specializations at this time are offered and identified by Vårdförbundet (2019) as:

  • Ambulance Care
  • Anesthesia
  • District Nurse
  • Intensive Care
  • General Medicine
  • Surgery
  • Oncology
  • Surgery
  • Psychiatry
  • Geriatric Care
  • Pediatrics

While there are various programs of specialization that are offered, the major limitation to the role is the lack of legal formal establishment of the role.  As a result the utilization of each role is often limited to the organization’s preference and policies.

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References:
Alenius, L.S., Lindqvist, R., & Tishelman, C. (2019). Sweden.  In Rafferty, A.M., Busse, R., Zander-Jentsch, B. et al. (Eds.) Strengthening health systems through nursing: Evidence from 14 European countries [Internet].  European Observatory on Health Systems and Policies, Copenhagen, Denmark. 

Bergström, P. & Lindh, V. (2018). Developing the role of Swedish advanced practice nurse (APN) through a blended learning master’s program: Consequences of knowledge organisation, Nurse Education in Practice, 28(1471-5953), pp.196-201, doi:10.1016/j.nepr.2017.10.030

Egerod, I., Kaldan, G., Nordentoft, S., Larsen, A., Herling, S. F., Thomsen, T., & Endacott, R. (2021). Skills, competencies, and policies for Advanced Practice Critical Care Nursing in Europe: A scoping review. Nurse Education in Practice, 54, 103142. https://doi.org/10.1016/j.nepr.2021.103142

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/

Vårdförbundet (2019). Specialist Nurse [translated by Google Translate]. Retrieved from: https://www.vardforbundet.se/rad-och-stod/karriar-och-utveckling/karriarvagar/vidareutbildning-till-sjukskoterska/

[Originally published 9 September 2013, revised 2 June, 2022]

Advanced Practice Nursing in Finland

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*Finland will allow transferral of RN licensure from various parts of the EU (FNA)
Not able to find information regarding transferral of advanced practice degrees

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

Role

The role of the Advanced Practice Nurse has developed over the years in Finland.  The initial discussions of advancing nursing practice in Finland started in the 1980’s (FNA, 2018).  Over time the advanced practice nursing role grew to two chief roles, that of the Advanced Nurse and Public Health Nurse, both of which were prepared with graduated level schooling (Delamaire & Lafortune, 2010).

Starting in 2001, the first Clinical Nurse Specialists (CNS) started practicing at the Helsinki University Hospital (FNA, 2018, p.29).  Since then the CNS role has grown significantly.  Meanwhile need to improve access for health care services for an aging population has promoted the advancement of the Nurse Practitioner role (NP / APN Network, 2017).

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).

Specialties and Education

APNs have been working in various roles including rural healthcare, general practice, and acute care (Delamaire & Lafortune, 2010, FNA, 2018).  As described above, the roles of CNS and Nurse Practitioner are prevalent, but in addition to these 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, NP / APN Network, 2017).  Additionally, an individual can choose to be a nurse midwife with an additional year of schooling (Robinson & Griffiths, 2007).

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 is comparable to various other EU nations, usually requires a bachelor degree typically taking 3.5 years, and 4 years for the public health nurse (Robinson & Griffiths, 2007; FNA, 2018).  The advanced degrees are available afterward to those who desire further advancement in scope of practice at the graduate level (Delamaire & Lafortune, 2010).  Registration for healthcare individuals within Finland is maintained by the National Authority for Medico-Legal Affairs (Terveydenhuollon Oikeusturvakeskus).

According to the Finnish Nurses Association (2018) the most developed roles of AP Ns in Finland are the Clinical Nurse Specialist and Nurse Practitioner.  Both roles are described as, “At the advanced level, independent clinical nursing and health promotion as well as the related ethical decision-making, teaching and instruction, consultation, evidence-based practices, management, cooperation, research, and development” (p.32).  In addition to this the roles are more clearly differentiated below:

  • Clinical Nurse Specialist (CNS)
    • The role has been in existence since 2001 in Finland (FNA, 2018, p.29).
    • CNSs are employed in various parts of the hospital systems in Finland, more predominantly at the university hospitals (FNA, 2018, p.29).
    • The role has four spheres: patient care, nursing organization, and scholarship.  Any of the CNS roles require a master’s level degree (NP / APN Network, 2017).
    • “Broad-based work aimed to ensure and develop the quality of nursing, foster the implementation of evidence-based nursing and support the organization’s strategic work.” (FNA, 2018, p.32)
  • Nurse Practitioner
    • The FNA (2018) identifies the Nurse Practitioner role as one that more specifically is, “Broad-based and comprehensive nursing, independent examination of patients and assessments of their need for care as well as starting treatment based on symptoms and monitoring both acute and chronic health conditions.” (p.32)
    • The role requires a master’s degree and primarily performed by APNs working in primary care.  Individuals can additionally pursue an academic post graduate degree (doctorate) (FNA, 2018, p.32).
    • The role is not nationally regulated, and as a result it varies according to organizational oversight.

Other roles identified NP / APN Network (2017) are:

  • Specialized Nurses in Clinical Practice
    • Roles largely reflect specialization in a specific area of concentration.  This requires 30-60 ETCS (European Credit Transfer and Accumulation System) and provides advanced professional roles in the selected specialization (NP / APN Network, 2017).
    • The expanded roles are not regulated, and rather institution specific (NP / APN Network, 2017).
  • Nurse Prescriber
    • A role designated for limited prescribing of medications.  This is performed with physician oversight and requires 45 ECTS post graduate training in order to be able to have this permission (FNA, 2018, p.33).
    • According to the NP / APN Network (2017), most APNs in Finland do not have prescribing authority.

Have information to add to this page?

References and Influential Articles:
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

Finnish Nurses Association [FNA] (2018). New roles for nurses – Quality to future social welfare and health care services.  Retrieved May 17, 2022 from: https://1553422.169.directo.fi/@Bin/e02495795f0c2e137dc85385beb70747/1652808570/application/pdf/256215/APN_RAPORTTI_ENG_VALMIS_pieni.pdf

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

Jokiniemi K. (2014). Clinical Nurse Specialist Role in Finnish Health Care. Dissertations in Health Science. U niversity of Eastern Finland. Available in: http://epublications.uef.fi/pub/urn_isbn_978‐952‐61‐1579‐ 5/urn_isbn_978‐952‐61‐1579‐5.pdf

NP / APN Network (2017). Country specific practice profiles. Retrieved May 16, 2022 from: https://international.aanp.org/Practice/Profiles

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

[ORIGINALLY POSTED SEPTEMBER 24, 2013.  UPDATED MAY 17, 2022]

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 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.

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

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 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