Title: An International Survey on Advanced Practice Nursing: Education, Practice and Regulatory Issues: 200
1An International Survey on Advanced Practice
NursingEducation, Practice and Regulatory
Issues 2008
- Joyce Pulcini, PhD, APRN, BC, PNP, FAAN (USA)
- Alice Yuen Loke, BSN, MN, PhD (Hong Kong)
- Raisa Gul, RN, RM, MHA, PhD (Pakistan)
- Monika Jelic, MPH, MSN, CPNP (USA)
- Katelyn Carroll (Research Asst)
2Background
-
- Many challenges and opportunities exist in
regards to the increasing numbers of APNs
globally. These include poor role clarification,
proliferation of APN titles, differing
educational requirements and degrees, scope of
practice conflicts, fragmentation/ variability in
standards and quality of educational programmes
(Schober Affara, 2006). -
3- Gathering data from different countries on
regulatory issues is a critical challenge due to
differing language for educational programmes,
degrees, regulatory titles and practice models.
4Aims
- The study examines NPs/APNs efforts to develop
their role internationally, examines educational
programmes and regulation, the barriers and
facilitators to role development, and areas where
progress has been made. - This is a report of the results of an
international web-based study by the
International Council of Nurses International
NP/APN Network (INP/APNN). - http//www.icn-apnetwork.org
5Methodology
- International web-based pilot survey
- Tool used SurveyMonkey
- Online Survey open for 6 weeks in February and
March, 2008 - 15-25 minutes in length
- Results qualitative and quantitative descriptive
analyses
6Sections of the Survey
- Survey developed by the Education/Practice
Subgroup of the INP/APN Network. - Consultation with Core Steering Group and
Research, and Policy/Standards/Regulation
Subgroups - Prior to pilot, many drafts circulated in 2006
focusing on - Content and Outline for Survey
- Language Issues
- Regulatory Terminology
- Nursing Titles
- Pilot survey completed in 2007
- Final survey completed in 2008
7- In spring of 2008, a web-based survey was sent to
174 key informants who were members of the
International Nurse Practitioner/ Advanced
Practice Nursing Network (INP/APNN) using survey
monkey. - Participants were leaders and experts of ANP
development in their respective countries. - The survey was based on a 2007 pilot survey with
network members and the final survey was refined
to reflect cross national cultural, professional
and linguistic differences. - The survey was completed by 91 members of the
INP/APNN from 33 of the 34 countries represented
in the Network with a response rate of 52.2.
8Survey Categories
- General Information
- NP/APN Education and programmes
- NP/APN Regulatory Issues
- NP/APN Practice/Role
- General Questions
- Indepth description of one programmes in country
- NP/APN Educational programmes
- NP/APN Student Profile
9Sample
- Participants identified from ICN INP/APNN
contact lists and subgroups - Emailed to 174 key informants who were members of
the INP/APN Network - 91 respondents from 32 countries
- 33/34 (97) countries in the Network (one of
these removed due to lack of data on form) - Response rate 52.2
10Participants (n91)
- Multiple roles
- 83.5 were practicing nurses
- 55 were educators
- 20.8 were administrators
- 42.8 were involved in research
- Of practicing nurses
- 67.1 (51) were NP/APNs
- 25 (19) were Registered/Generalist nurses
- 21 (16) answered other
- Of educators 16 taught NP/APN students
11Countries of Respondents in the NP/APN Survey
(n33)
- Argentina 1
- Australia 25
- Botswana 2
- Canada 5
- China/Peoples Republic of China 2
- England/UK 6
- Ethiopia 1
- Fiji 1
- Finland 1
- France 1
- Grenada 1
- Hong Kong 1
- India 2
- Ireland 4
- Italy 1
- Jamaica 1
- Japan 2
- Netherlands 1
- New Zealand 1
- Nigeria 2
- Oman 1
- Pakistan 1
- Portugal 1
- Saudi Arabia/KSA 1
- Singapore 1
- South Africa 7
- South Korea 1
- Spain 2
- Switzerland 2
- Taiwan 2
- Tanzania 1
- Thailand 4
- USA 6
12(No Transcript)
13Findings
- Findings are presented in two ways
- Country Level Responses (n32)
- NP/APN Education and programmes
- NP/APN Regulatory Issues
- Role as practicing nurse, educator, administrator
- Types of positions held
- Scope of practice
- Individual level responses (n91)
- NP/APN Practice/Role and Scope of practice
- Role questions
- Skills performed
- Type of continuing education to stay current
- Supporters and opponents to the role
14Country LevelResponses
15NP/APN Education, Practice Questions
- Varying responses on number of NP/APN programmes
in their country - Did not tend to know nurse-physician ratio in the
country - gt 17 titles for NP/APN found
16(No Transcript)
17Country Level Responses
- Does your country have formal NP/APN programmes?
(31 countries responding) - Yes (71)
- No (29)
18Types of credentials granted to NP/APNsin your
country (20 countries)
- MS degree 56
- BS degree 28.1
- Certificate 25
- Advanced Diploma 21.9
- No credential 0
19Most prevalent credential granted to NP/APNs in
country (20 countries)
- MS degree 50
- BS degree 15
- Certificate 15
- Advanced Diploma 20
20SPECIALTIES OR TYPES OF NP/APNSEDUCATED IN THE
NP/APN PROGRAMMES (22 COUNTRIES)
21Level of practice of majority of NP/APNs in
country (28 Countries)
- RN/Generalist Nurse 17.4
- Post RN/Generalist Nurse 69.6
- Other 9.4
- Examples APN, Post RN generalist plus midwifery
cert., RN/Registered midwife with public health
certification
22POSITIONS HELD BY NPS/APNS (25 COUNTRIES)
23Types of positions that exist in the Country
- Hospital 75
- Hospital-based clinic 62.5
- Community-based Clinic 62.5
- Mental Health 62.5
- Specialty practice (disease based) 59.4
- Public Health or ministry of health agency 56.3
- Faculty Position 53.1
- Administration 50
- Research 40.6
- Home health care facility 40.6
- Independent Nsg. Practice 37.5
- Long term care facility 34.4
- School Health 34.4
- Occupational Health 31.3
- Doctors office 31
- Other 6.3
24NP/APN SCOPE OF PRACTICE (24 COUNTRIES)
- Results may vary at the provincial/state level
25Formal Recognition of NP/APNs in your country
(23 countries)
- Government 53.1
- Hospital or other health care agency 53.1
- Professional Org 59.4
- Other 15.6
- Examples Health professions counsel, National
professional counsels, no recognition
26Requirement for NP/APN Practice (25 countries)
27NP/APNs without formal education (28 countries)
- 42 said that there are nurses undertaking/working
in NP/APN role who have not been formally
educated in the role at a Post RN or graduate
level. Of these, - 42.9 said all had at least post RN level
education - 21.4 said all or most had some education either
formal or informal - One respondent said there is no additional
education
28Requirements for renewal (maintenance) of NP/APN
licensure(27 countries)
- 48 said that there were specific requirements
for renewal or maintenance of NP/APN license or
registration - Annual 21.4
- Every 5 years 50
- Other (i.e. 3-5 yrs) 28.6
29License or Registration Renewal Requirements (16
countries)
30Individual LevelResponses
31NP/APN Scope of Practice (73 Respondents)
32Performance of specific skills by NPs (70
Respondents)
- Minor surgery (38.6)
- Suturing (85.7)
- Treating fractures (50)
- Midwifery (74.3)
33Performance of specific skills only by MDs (81
Respondents)
- Major surgery (100)
- Minor surgery (56.8)
- Diagnosis (25.9)
- Treatment (21)
34Type of education which would help NP/APNs to
stay current in their areas of practice (78
Respondents)
- CE online 76.9
- Other CE 80.8
- Conferences 91
- Mentoring experiences for new techniques 85.9
- Formal educational programmes 79.5
- Other 5 examples
35General Questions
- Development of NP/APN role Facilitators (78
Respondents) - 57.7 identified strong support for nursing
practice - 79.5 identified need for more health care
providers for rural/underserved areas - 71.8 identified consumer demand for increased
access to health care
36Supporters and Advocates of the NP/APN Role (77
Respondents)
37Opposition to the NP/APN Role(60 Respondents)
38Opposition to the NP/APN Role
- Other opponents
- Nurse leaders
- Universities where nursing is taught
- Certain hospitals
- Government agencies
- Summary Support for the NP/APN role was found
primarily in domestic nursing organizations and
the government, while opposition came mostly from
domestic physician organizations and other nurses.
39NP/APN Involvement in Policy
- Policy or health care planning (79
Respondents) - 76.9 stated that NPs/APNs participate at the
local level - 61.3 stated that NPs/APNs participate at the
national level - 85 said that NP/APNs are organized as a
professional group in the country (80
Respondents) - Professional organizations identified most
frequently as the national nurses association
rather than specific NP/APN organizations
40Conclusion
- The survey provides information on a broad
representation of countries on NP/APN education,
practice and regulatory issues. - The findings advance knowledge on role
development issues of NP/APNs internationally and
highlight the challenges ahead. - NP/APNs will increasingly be important health
care providers globally. Tracking the progress of
these roles will facilitate educational
interventions and regulatory policy development
worldwide.
41Summary
- Confusion surrounding nomenclature for the NP/APN
was found with different titles listed. - NPs/APNs practice represented a broad variety of
health care settings and a varied scope of
practice. - 71 stated that NP/APN education was available in
their country with half reporting that the
Masters Degree was the predominant credential
for NP/APNs.
42Limitations
- Participants required to have email or internet
access - Number of participants from each country (1-25)-
Sometimes answers differed. Leaders consulted
when there were discrepancies. - Most participants are affiliated with the ICN and
appreciate the international scope of development
of the NP/APN role may bias their answers. - Currently survey is available in English only
43Discussion
- Collaboration with other subgroups
- How to best promote NP/ANP education
internationally - Language issues in survey and in future surveys
- Dissemination of results
44Future Plans
- Consider if survey should be translated into
other languages - Further analyze individual educational
programmes and student information provided in
current survey - Consider survey of individual educational
programmes who are identified in this survey