Spreading the message on advanced practice nursing

The first advanced practice nurses were trained in the United States half a century ago, but in most countries advanced practiced nursing (APN) as a profession remains poorly developed, even though the increased use of nursing practitioners could help to solve many urgent problems facing health services around the world today.

by Fran Weaver

In her keynote presentation at the Helsinki APN Conference, Professor Denise Bryant-Lukosius, Director of the Canadian Centre for APN Research, emphasised that the pressures currently forcing many countries to reform their health care systems have increased interest in APN.

“APN is a great vehicle for addressing health issues in individual countries and globally by giving the best possible care to many kinds of patients,” she said. “Research has given plenty of evidence demonstrating the safety, quality and positive impacts of APN.” Findings on patient satisfaction rates, care continuity and the potential for long-term cost savings have also been positive.

Benefits for both rich and poor countries

Bryant-Lukosius believes that employing more advanced practice nurses in poorer countries could be an effective way to leverage solutions to major global health problems highlighted by the World Health Organisation and in the United Nations’ Millennium Development Goals relating to primary health care issues.

“Aligning international APN role development activities with priorities for improving global health will create opportunities to extend our reach to patient communities and countries who will benefit the most from APN expertise,” she explained.

But she also feels that even in countries where APN exists as a profession, its potential is underused. “More established APN roles are found most often in higher income countries. In the United States APNs make up 6.5% of the nursing workforce, but in most other countries this proportion is less than 1%,” she explained.

Crucial issues such as ageing populations and the need to prevent and manage chronic diseases cost-effectively lie behind the need to develop APN. Bryant-Lukosius also sees a particularly important role for APN in improving access to primary health care in under-served rural and remote communities, and among vulnerable groups in urban settings. “We’re now at a crossroads in the development of APN, when we must look to the future with a focus on the achievable health benefits,” she said.

A need for clear roles
In her presentation Bryant-Lukosius spotlighted several barriers that have hindered the growth of the APN profession in many countries.

She particularly emphasised the degree of confusion among physicians, patients and health administrators about the roles advanced practiced nurses can play. “We need to effectively communicate what APN is about,” she says.

One common misconception is that such nurses could be used to replace doctors. This belief has led to opposition from physicians’ associations in some countries. “In reality, although there is some overlap between the work done by APNs and physicians, their role is more to fill in gaps in health service delivery,” she explained. APNs will largely work in teams in close connection with physicians. To build up a spirit of teamwork it is essential for everyone to understand each other’s roles.

Bryant-Lukosius feels it is still important to work out the right dosage for APN, in terms of the amount of time advanced practice nurses should spend with patients, or when some other kind of health care professional such as a physician or normal registered nurse should be involved instead.

Need for legislation and training
Another barrier in many countries has been slow progress on enacting the legislation needed to give APNs authority to prescribe certain treatments and medicines. At the same time funding should be made available to build capacity for the necessary training courses, which in many cases may be Master’s degree programmes.

Bryant-Lukosius believes that enhancing the APN profession in such ways will provide welcome opportunities for nurses to advance their careers, and also thereby improve nurse recruitment and retention rates.

Looking to the future, Denise Bryant-Lukosius emphasised the need to integrate health systems and develop the role of APN globally. “Consensus needs to be built on the scope for APN, and stakeholders’ understanding of these roles needs to be improved so that health policies can be shaped to meet needs,” she said.