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Advanced Practice Nursing in Slovakia

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Contact:
Ministry of Health of the Slovak Republic

Role

The role of the Advanced Practice Nurse (APN) was formally recognized in 2018 by the Ministry of Health in Slovakia (Grešš Halász, 2021).  The role has been relatively recently introduced and evidence by Grešš Halász et al. (2021) demonstrated that APN’s have mixed perceptions about their own competence in practicing at a more advanced level, and practice confidence varied based on region within the country.

Healthcare in Slovakia historically was centralized by the government up until 1990.  Afterward, the nation shifted to privatizing healthcare throughout the country, meanwhile mandating healthcare to remain not-for-profit.  As much of advanced nursing practice is dependent on the abundance of trained nursing staff and the shortfall of more advanced medical professionals, the lower ratio of nurses per 1,000 people at 5.7 within the EU (compared to 8.4 of EU in general) likely contributes to the slower development of the APN role.  Much of this gap is attributed to lower wages and lack of financial investment on behalf of the nation in healthcare staff, including education and health infrastructure (Slovak Spectator, 2021 Sep 14).

Education and Certification

Education for the APN in Slovakia is legislatively defined as “a nurse who graduated from at least the second university degree (equivalent to master’s degree) proceeded by the first university degree (equivalent to bachelor degree) in nursing, with specialization, and at least 5 years’ experience in a particular specialization, or a nurse without a specialization with 8 years of professional experience.” (Ministry of Health of the Slovak Republic, 2018).

Specialties

According to the Ministry of Health of the Slovak Republic (2018) there are several specializations recognized and identified within legislation. The additional roles expand on the level of independence the nurse may function.  The basic nursing role is as follows.

  • Nursing Practice (§ 95.1)
    • Provide nursing diagnoses and follows treatment plans accordingly
    • Perform assessment of the patient
    • Provide ongoing nursing care/monitoring of patient
    • Provide wound/ostomy care
    • Provide patient education

Below are a list of the specializations with their added independent competencies:

  • Nurse Specialist (§95.2)
    • Can choose if a patient will have an intravenous cannula placed or not and can place that apparatus
    • Follow dose range pharmaceutical operations.
  • Nurse with Advanced Experience (§95.3)
    • All care that of the Nurse Specialist (above)
    • Provide advanced assessment
    • Indicate and collect biological specimens (i.e. ordering lab analysis)
    • Indicates treatment for nursing care
    • Indicates treatment for preliminary wound care
  • Nurse Midwife (§95.5)
    • Provide traditional antenatal and postnatal care for mother and infant (up to 6 weeks post-natal)
    • Performs childbirth, including if episiotomy if required
  • Nurse Midwife Specialist (§95.6)
    • All care that of a Nurse Midwife
    • Can indicate and place intravenous cannula
  • Nurse Midwife with Advanced Experience (§95.7)
    • All care that of the Nurse Midwife and Nurse Midwife Specialist
    • Advanced independence of indication of treatment
    • Additional duties to manage nurse midwife care team

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References:

Grešš Halász, B. et al. (2021). Developing the advanced practice nursing role in Slovakia: Perception, education, and practice.  Journal of the American Association of Nurse Practitioners. 33(11),916-923. doi: 10.1097/JXX.0000000000000460

Ministry of Health of the Slovak Republic. (2018) Decree determining the extent of nursing practice provided by a nurse independently, based on a medical doctor’s indication and in cooperation with a medical doctor and the extent of midwifery provided by a midwife alone, based on a medical doctor’s indication and in cooperation with a medical doctor. (no. 95/2018). The Ministry of Health Slovak Republic. http://www.epi.sk/zz/2018-95.

Slovak Spectator (2021, Sep 14). Hundreds of nurses have left their jobs in Slovak health care. Retrieved May 7, 2022 from: http://spectator.sme.sk

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Advanced Practice Nursing in Belize

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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).

Have information to update this page?

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 Nicaragua

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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 Mexico

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Snapshot

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

Contact:
Secretería de Salud
Asociación Mexicana de Enfermeras Especializadas en Medicina Crítica y Terapia Intensiva (Mexican Association of Specialized Nurses in Critical and Intensive Care [AMEEMCTI])

Role

Currently there is no specific advanced practice nursing role in Mexico.  Nurses are offered the ability to specialize in intensive and critical care, but to date, nursing has not taken a leader role in health care (AMEEMCTI, n.d.; Secretería de Salúd, 2013).  The 20th ANEC conference in Mexico later this year will include the readdressing of the nursing role in Mexico and will be influenced and collaborated with the International Council of Nurses, allowing for more focused role development appropriate to the country’s healthcare needs (Secretería de Salúd, 2013).

In the meantime, Mexico’s health care system provides significant opportunity and potential for development of the Advanced Practice Nursing role (Pérez-Cuevas, Muñoz Hernández, & Gutiérrez Trujillo, 2010).

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References:
Asociación Mexicana de Enfermeras Especializadas en Medicina Crítica y Terapia Intensiva (n.d.).  AMEEMCTI.  Retrieved from: http://www.ameemcti.org/

Pérez-Cuevas, R., Muñoz Hernández, O., & Gutiérrez Trujillo, G. (2010).  Nurses: The “front gate” to provide effective pediatric preventive care.  Boletín Médico del Hospital Infantil de México, 67(4).  Retrieved from: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400010&lng=pt&nrm=iso

Secretería de Salúd (2013). Congreso Nacional de Enfermería, XX ANEC.  Retrieved from: http://www.salud.gob.mx/unidades/cie/cms_cpe/index.php?Id_URL=400despliegue&anio=2013&Id_Nota=222

[Updated: 2013, October 29]

Advanced Practice Nursing in Colombia

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Snapshot

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

Treatment Authority:
Some registered nurses do have treatment authority

Prescribing Authority:
Uncertain

Contact:
Asociación Nacional de Enfermeras de Colombia
Asociación Colombiana de Facultades de Enfermería

Role

Colombia does not currently have an APN role recognized.  While some nurses may function in an advanced practice capacity by diagnosing, treating, and monitoring with minimal supervision of medical doctors, this role does not appear to be expanding due to no medical provider shortage, and possible surplus in the nation (CartagenaSurgery, Personal communication, 2013 August 14).

However, there is still a recognition in the current Colombian health system to push for more preventive care rather than diagnosing and treating and as mentioned by Atehortúa Rada et al. (2014), there is need and interest in advancing the nursing role to champion preventive medicine.

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References:
Atehortúa Rada, G.M., Soto Chaquir, M., López Villegas, M.E. & Buitrago Malaver, L.A. (2014). La práctica avanzada en enfermería: una oportunidad para la promoción de la salud y la prevención de la enfermedad en Colombia.  Revista Cultura del Cuidado 11(1). Retrieved from: http://repositorio.unilibrepereira.edu.co:8080/pereira/bitstream/handle/123456789/223/6%20EPA%20pp.%2060-69.pdf?sequence=1

[Updated 2017, April 7]

Advanced Practice Nursing in Paraguay

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Snapshot

APN Role Exists in Country Today:
No

Contact:
Ministry of Health – Paraguay

Role

There is minimal regulation of the role of health care professionals and their scope of practice available online (Hanratty & Meditz, 1988).  Currently nurses are trained up to the bachelor level in the country, but more detailed nursing role and specialization is not available.  However, the Ministry of Health in Paraguay will consider allowed expanded scopes of practice for individuals trained further outside of Paraguay (Republic of Paraguay, n.d.).

Meanwhile, nursing has expanded in Paraguay, with organized nursing dating back to the 1930’s.  Graduate education has also been offered since the 1980’s and has continued to expand promising future possibilities of the advanced nursing practice in the future (Paraguay Times, n.d.).

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References:
Hanratty, D.M. & Meditz, S.W. (1988).  Paraguay: A country study. Washington, D.C.: GPO for the Library of Congress.  Retrieved from:  http://countrystudies.us/paraguay/36.htm

Paraguay Times (n.d.).  Nursing jobs in Paraguay – An increasing demand.  Retrieved from: http://www.paraguaytimes.com/business-finance/business/nursing-jobs-in-paraguay-an-increasing-demand.html

Republic of Paraguay (n.d.). Del ejercicio de la enfermería el congreso de la nación Paraguaya sanciona con fuerza de ley, No 3206.  Retrieved from: http://www.enfermeria.uc.edu.py/node/53

Advanced Practice Nursing in Germany

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Snapshot

APN Role Exists in Country Today:
No

Role

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

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

Have information to add to this page?

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

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

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