An International Pilot Survey on Advanced Practice Nursing: Education, Practice and Regulatory Issue

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An International Pilot Survey on Advanced
Practice NursingEducation, Practice and
Regulatory Issues

• 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, BSN, MSN, CPNP, MPH (USA)

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Background

• 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 programs
  (Affara, 2006).
• Gathering data from different countries on
  regulatory issues is a critical challenge due to
  differing language for educational programs,
  degrees, regulatory titles and practice models.

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Aims

• The study examines NPs/APNs efforts to develop
  their role, the barriers to role development, and
  areas where progress has been made.
• This is a report of the preliminary results of an
  international web-based pilot study by the
  International Council of Nurses International
  NP/APN Network.

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Methodology

• International web-based pilot survey
• Tool used SurveyMonkey
• Online Survey open for 3 weeks in February and
  March, 2007
• 15-25 minutes in length
• Results qualitative and quantitative descriptive
  analyses

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Survey Development

• Survey developed by the Education/Practice
  Subgroup of the INP/APNN.
• Consultation with Core Steering Group and
  Research, and Policy/Standards/Regulation
  Subgroups
• Many drafts circulated in 2006 focusing on
• Content and Outline for Survey
• Language Issues
• Regulatory Terminology
• Nursing Titles

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Survey Categories

• General Information
• NP/APN Education and Programs
• NP/APN Student Profile
• NP/APN Regulatory Issues
• NP/APN Practice/Role
• General Questions
• Comments on the Survey Tool

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Sample

• Participants identified from ICN INP/APNN
  contact lists, subgroups and word of mouth
• Emailed to 70 participants plus INP/APNN
  Education/Practice Subgroup and Core Steering
  groups
• 16 returned undeliverable
• 32 respondents from 18 countries

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18 Countries Represented in the NP/APN Pilot
Survey (n32)

• Argentina
• Australia (n5)
• Bahrain
• Botswana (n2)
• Canada (n3)
• Hong Kong, China (n2)
• Ethiopia
• Finland
• France

• Ireland (n2)
• Nepal (n2)
• Netherlands
• Singapore
• South Africa (n3)
• Switzerland
• Tanzania
• United Kingdom
• USA (n3)

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Findings

• Description of 32 respondents multiple roles
• 17 NPs/APNs
• 5 registered/generalist nurses
• 18 nurse educators
• 22 clinicians
• 18 involved in research
• 9 administrators
• NP/APN title
• 14 different titles for NP/APN identified

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Positions Held by NPs/APNs in Various Countries
(23 Respondents)
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NP/APN Education, Programsand Student Profile

• 58 have formal NP/APN programs in their country
• All NP/APN students must be registered or
  generalist nurses
• 2-5 years registered or generalist nursing
  experience required before entering program
• 24 respondents

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Specialties or Types of NP/APNs Educated in the
NP/APN Programs (19 respondents)
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Credential Granted at Completion of NP/APN
Programs (19 respondents)
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NP/APN Regulatory Issues

• 75 had formal recognition of the NP/APN role (22
  respondents)
• 52 had NP/APN licensure maintenance requirements
  (21 respondents), such as
• Continuing education (92.3)
• Practice requirements (69.2)
• Portfolio maintenance (53.8) (13 respondents)

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NP/APN Practice Requirements (22 Respondents)
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NP/APN Description of Practice and Regulation (22
Respondents)
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General Questions

• Development of NP/APN role
  (19 respondents)
• 68 identified strong support for nursing
  practice
• 42.1 identified need for more health care
  providers for rural/underserved areas
• Health care planning (21 respondents)
• 84 stated that NPs/APNs participate at the local
  level
• 68 stated that NPs/APNs participate at the
  national level
• Professional organizations identified usually as
  the national nurses association rather than
  specific NP/APN organizations (21 respondents)

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Supporters and Advocates of the NP/APN Role (21
respondents)
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Opposition to the NP/APN Role (14 Respondents)
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Summary

• Confusion surrounding nomenclature for the NP/APN
  was found with14 different titles listed.
• NPs/APNs practice represented a broad variety of
  health care settings and a varied scope of
  practice.
• 58.3 stated that NP/APN education was available
  in their own country with most providing a
  Masters Degree upon completion.
• About 75 stated that formal recognition of the
  NP/APN exists in their country by the government,
  hospital/health care agency or professional
  nursing organization.
• Support for the NP/APN role was found primarily
  in domestic nursing organizations and the
  government, while opposition came mostly from
  domestic physician organizations.

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Comments on the Survey Tool

• Feedback from participants was solicited in order
  to refine the tool for future use.
• Length of survey (20 respondents)
• 90 right length
• 10 too long
• Other comments
• More free text space needed
• Explanations of answers
• Suggestions for additional questions
• Need to distinguish between nursing
  organizations, directors of nursing and nurses

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Limitations

• Participants required to have email/internet
  access
• Limited number of participants from each country
  (2-5)
• Unable to go into detail about country specifics
• 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

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Discussion

• Collaboration with other subgroups
• How to best promote NP/ANP education
  internationally
• Language Issues in survey and in future surveys
• Dissemination of results

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Future Plans

• Revise survey using comments from pilot
• Send to full complement of countries represented
  by ICN INP/APNN
• Consider if survey should be translated into
  other languages
• Identify individual programs in countries and do
  survey on educational curriculum