A Pilot Survey on Advanced Practice Nursing_ Education_ Practice by pptfiles

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									An International Pilot Survey on Advanced Practice Nursing: Education, Practice and Regulatory Issues
Joyce Pulcini, PhD, APRN, BC, PNP, FAAN (USA) Monika Jelic, MPH, MSN, CPNP (USA) Alice Yuen Loke, BSN, MN, PhD (Hong Kong) Raisa Gul, RN, RM, MHA, PhD (Pakistan)

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.

Aims
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The study examines NPs/APNs’ efforts to develop their role, the barriers to role development, and areas where progress has been made.

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This is a report of the results of an international web-based pilot study by the International Council of Nurses International NP/APN Network (INP/APNN). http://www.icn-apnetwork.org

Methodology
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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

Survey Development
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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

Survey Categories
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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

Sample
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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

18 Countries Represented in the NP/APN Pilot Survey (n=32)
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Argentina Australia (n=5) Bahrain Botswana (n=2) Canada (n=3) Hong Kong, China (n=2) Ethiopia Finland France

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Ireland (n=2) Nepal (n=2) Netherlands Singapore South Africa (n=3) Switzerland Tanzania United Kingdom USA (n=3)

Findings
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Description of 32 respondents’ multiple roles
• 17 NPs/APNs • 5 registered/generalist nurses • 18 nurse educators • 22 clinicians • 18 involved in research • 9 administrators

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NP/APN title
• 14 different titles for NP/APN identified

Examples of APN Titles
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NP (32.3%) APN (12.9%) Clinical Expert Nurse Advanced Nurse Practitioner Advanced Practice Registered Nurse Staff Nurse (Expert) Community Health Nurse Professional Nurse Primary Health Care Nurse Registered Nurse (Extended Practice) PHC-NP, Clinical Nurse Specialist Infirmiere specialiste clinique Infirmiere specialisee

H
50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0%

D os p ita oc t

C

Positions Held by NPs/APNs (16 countries represented)

or 's om of lb fi m un ase ce d ity cl in P u ba ic se bl d ic c H ea linic H lth om /M e O he H H al os L pi S p on t h c t g ec te are al ia fa lty rm cil pr car ity ac e fa tic ci e lity (d i Sc sea O cc hoo se) up lh at io ealt na h lh ea lth A d Fa cu m l in is ty tra tio n O th er

NP/APN Education, Programs and Student Profile
70.6% have formal NP/APN programs in their country Of the programs listed:  All NP/APN students must be registered or generalist nurses  2-5 years registered or generalist nursing experience required before entering program (17 countries represented)
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10%

30% 20%

40%

50%

60%

0%
Hospital/Acute Care NP Specialty Care Disease Specialty Care Age group/Pop'n Family NP Geriatric NP Pediatric NP Adult NP Women's Health/Midwifery Community Health NP Other

Specialties or Types of NP/APNs Educated in the NP/APN Programs (17 countries)

Credentials Granted at Completion of NP/APN Programs (17 countries)
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
de gr ee de gr ee te a Di pl om O th er ica Ce rti f

Ba cc el au re at e

as te r 's

Ad va nc ed

M

NP/APN Regulatory Issues
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94% had formal recognition of the NP/APN role (16 respondents) 53% had NP/APN licensure maintenance requirements (16 countries), such as:
• Continuing education (66.7%) • Practice requirements (55.6%) • Portfolio maintenance (44.4%) (9 countries)

NP/APN Practice Requirements (15 countries)
Other 13%

Sponsorship by clinical agency

20%

Registration/licensure by gov't agency

67%

Completion of educational programme

100%

Academic degree

73%

NP/APN Description of Practice and Regulation (15 countries)
Are consulted by health care professionals Practice independently Receive payment for services from other sources Receive direct payment for services from client Refer to other health care professionals Able to dispense medications Prescribe medications Carry own caseload of clients Maintain malpractice insurance 47% 33% 73% 67% 60% 80% 53% 47% 93%

General Questions
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Development of NP/APN role: Facilitators (16 countries)
• 62.5% identified strong support for nursing practice • 37.5% identified need for more health care providers for rural/underserved areas

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Policy or health care planning (16 countries)
• 81.3% stated that NPs/APNs participate at the local level • 68.8% stated that NPs/APNs participate at the national level

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Professional organizations identified most frequently as the national nurses’ association rather than specific NP/APN organizations (21 respondents)

Supporters and Advocates of the NP/APN Role (16 countries)
Other International organization Private institution 0% Nongovernmental institution Domestic physician organization Domestic nursing organization Government 13% 75% 69% 25% 6% 31%

Opposition to the NP/APN Role (12 countries)
Other International organization 0% 58%

Private institution 0% Nongovernmental institution Domestic physician organization Domestic nursing organization Government 0% 17% 0% 75%

Opposition to the NP/APN Role
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“Other”
• Nurses, including Directors of Nursing, Nurse Managers, and nurses in other leadership positions • Universities where nursing is taught • Certain hospitals • Insurance companies

Summary
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Confusion surrounding nomenclature for the NP/APN was found with 14 different titles listed. NPs/APNs’ practice represented a broad variety of health care settings and a varied scope of practice. 70.6% stated that NP/APN education was available in their own country with most providing a Master’s Degree upon completion.

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About 94% 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 and other nurses.

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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
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Other comments:
• • • • More free text space needed Explanations of answers Suggestions for additional questions/answer options Need to distinguish between nursing organizations, directors of nursing and nurses in who supported and who opposed NP/APN roles.

Limitations
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Participants required to have email or internet access Number of participants from each country (2-5)- Sometimes answers differed. Discerning country level vs state or provincial level 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

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

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


								
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