Tag Archives: United States

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).

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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 Thailand

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Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Practice Nurse

Nationally Certified:
Yes (Thailand Nursing and Midwifery Council)

Recognize Foreign Licensure:
Yes

Treatment Authority:
Yes

Prescribing Authority:
Unknown

Practice Autonomously:
Uncertain

Contact:
Thailand Nursing and Midwifery Council

Role

The initial role in Thailand is that of Advanced Practice Nurses (APNs) and in 2003 they had their first group of individuals certified (Sheer & Wong, 2008).

There are several roles of advanced practice nurses recognized in Thailand.  There are individuals who receive specialty training as registered nurses (i.e. trauma nurse, ostomy nurse) as well as “Nurse Practitioners.” Additionally, there are roles of designated as “Advanced Practice Nurses” of which the previously mentioned specialties (including Nurse Practitioners) are not included.  These roles are expanded further on that of the registered nurse based on further required education and expertise (Thailand Nursing and Midwifery Council [TNMC], 2010).

While the role of the nurse in Thailand has various levels of practice, the TNMC regards all individuals registered to practice nursing as “practitioners in nursing.”  The role of such individuals includes: 1.) to provide education, advice, counseling, ans well as solving health problems; 2.) to act and assist individuals physically and mentally, including their environment, in order to solve problems of illness, alleviate symptoms, prevent dissemination of diseases and provide rehabilitation; 3.) to provide treatment, as mentioned in primary medical care and immunization; and 4.) to assist physicians to perform treatments (TNMC, 2010).

Additionally, the role of midwifery encompasses: 1.) to provide education, advice, counseling, as well as solving health problems; 2.) to act and assist pregnant women, post delivery women, and their newborns physically and mentally, in order to prevent complications during pregnancy, delivery, and post-delivery; 3.) to provide physical examinations, delivery of baby and family planning services; and 4.) to assist physicians to perform treatments.  Individuals can be registered to practice both nursing and midwifery by the Council of nursing (TNMC, 2010).

Education and Certification

APNs in Thailand are identified by a post-masters education (TNMC, 2010).  The term “Nurse Practitioner” is also applied to individuals in Thailand but reflect a post registered nurse certification requiring 4 months of specialty training.  APNs however have expanded roles based on further education (TNMC, 2010).

Specialties

Advanced practice nurses are recognized in various specialties, namely: Community Nurse Practitioner; Medical and Surgical Nurse; Gerentological Nurse; Pediatric Nurse; Maternal and Child Nurse; Advanced Midwifery Practice; Mental Health and Psychiatric Nurse; Nurse Anesthetist; Infection Control Nurse; and Community Nurse (TNMC, 2010).

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References:

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

Thailand Nursing and Midwifery Council (2010).  Thailand Nursing and Midwifery Council.  Retrieved from: http://www.tnc.or.th/en/content/content-135.html

Advanced Practice Nursing in the United States

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Snapshot

APN Role Exists in Country Today:
Yes

Title:
Nurse Practitioner
Nurse Anesthetist
Nurse Midwife
Clinical Nurse Specialist

Nationally Certified:
Yes

Recognize Foreign Licensure:
Uncertain

Treatment Authority:
Yes

Prescribing Authority:
Yes

Autonomy of Practice:
Yes in 36 states, No in 24 states (see here for List)

Contact:
American Academy of Nurse Practitioners
American Academy of Colleges of Nursing

Role

The role of APN’s in the United States has existed since the 1960’s and is of the oldest in the world today.  There are various forms of advanced practice nurses, of which the greatest numbers are Nurse Practitioners, and also include Nurse Midwives, Nurse Anesthetists, and Clinical Nurse Specialists.  Additional other advanced roles are available for nurses who are registered, and certification programs for nursing specialization.  The role of the APN in the United States varies according to state.

The roles can be further identified as:

  • Nurse Practitioner (NP) – 1.) Diagnose and treat patients in both primary and acute care.  2.) Provide initial and ongoing care including comprehensive histories, perform physical examinations, and other health assessment and screening activities.  3.) Treats and manages patients with acute and chronic diseases including ordering laboratory studies, prescribing medication, and making appropriate referrals for patients and families.  4.) Provide health promotion, disease prevention, health education, and counseling.
  • Nurse Anesthetists (CRNA) – 1.) Administer anesthesia.
  • Nurse Midwife – 1.) Provide medical care to women from puberty through menopause, for antepartum, intrapartum, postpartum, and nonsurgically related obstetric and gynecologic care. 2.) Consult, collaborate with other specialties. (The Pennsylvania, n.d.)
  • Clinical Nurse Specialist (CNS)

Supervision

While the number of states requiring physician supervision has been quickly decreasing, still some states including California and New York still require some form of physician supervision.

Education and Certification

APN roles require a minimum of Master-level preparation offered by many universities throughout the country.  There is an organized body of credentialling, the ANCC, that provides guidelines for advanced nursing programs.  Once graduated, APN’s in the Nurse Practitioner, Nurse Anesthetist, and Nurse Midwife roles are required to pass a national certification exam to practice (with a few exceptions).  These certification exams require the students to have had a specific number of hours of on-the-job experience throughout their program in order to take the exam.

For individuals seeking to immigrate to the United States and gain registration/certification as an APN, Sheer (2007) significantly describes the process required, as an individual will need to have a registered nursing license, and then apply for an APN license through the specific state one is desiring to work.

Specialties

Individuals in the Nurse Practitioner role have the option to specialize in various different roles, including geriatrics, pediatrics, acute care, and family care.  While individuals may not take a specific certification for additional medical specialties, they may work in the various specialized fields (i.e. dermatology, cardiology) and often regard themselves as a specialized individual in that category.

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References:
The Pennsylvania (n.d.) Midwife Practice Guidelines.  Retrieved from: http://www.pacode.com/secure/data/049/chapter18/s18.4.html

Sheer, B. (2007).  Nurse practitioners on the move: The journey to the United States.  Topics In Advanced Nursing eJournal. 7(2).  Retrieved from: http://www.medscape.com/viewarticle/560673