Advanced Nursing Practice in Thailand

							Advanced Nursing Practice in Thailand: An Initiative or Old Wine in the New Bottle!

Assistant Professor Nanthaphan Chinlumprasert, Ph.D., R.N.
Faculty of Nursing Science,

Assumption University of Thailand

The Development of APN in Thailand
1974
NP

1988
CCS granted “Nursing Expertise”

1994
NNCT approved CNS in 5 areas

2000

Present

NHSR

APN

Existed

NP
PCU

Advanced Practice Nurse (APN)
1. Nurse - Anesthetist 2. Nurse - Midwife *3. Clinical Nurse Specialist *4. Nurse Practitioner

Nurse Practitioner (NP)
In 1974 : NP first established to serve
people in the remote area and to ease the Physician shortage : 4-month-training
Legitimate limitation

: No autonomy
Not well accepted by NNCT

: Work as physician extender

Nursing Experts (NE)
In 1988
: The Commission of Civil Servant (CCS) has granted the career ladder for promoting experienced nurses to become Nursing Experts : Academic report and experiences were used to consider the promotion

: Nursing service system has no distinctive organizational line and scope of practice for Nursing Expert position

: No continuous support by Nursing Organization

Clinical Nurse Specialist (CNS)
In 1994
: The National Nursing Council of Thailand (NNCT) has approved CNS in 5 areas
Family Nursing Occupational Health Nursing

1) Community Nursing

School Health Nursing

2) Mental Health & Psychiatric Nursing
3) Pediatric Nursing 4) Maternal & Child Nursing

5) Medical – Surgical Nursing

Master degree in nursing specialty

CNS
Certification of CNS granted by NNCT

2000  Present : National Health System
Reform (NHSR)

National Health System:
Is the entire system of the national health that interrelated or interconnected as the holism. It effects to the health of all population including other factors such as individual, environment, economic, social, physical, biological, and the factor of health care system.

Principle of NHSR
 Holistic  Participatory  Public Policy for Health  Equity *  Efficiency *  Quality *  Consumer responsiveness and protection

National Health System Health Service System Nursing Service System

Health Service System
University/Regional Hospital

Tertiary Secondary Care Primary Care
Self Care, Self Reliance

Provincial/General Hospital Health Center, PCU, Com. Hospital Village, CPHC

Primary Health Care

Equity Efficiency Quality

National Health Insurance Policy Universal Coverage Primary Care Focus

APN
NP
Nurses

CNS-Com. Nsg

Primary Care Unit

Nurses

CNS
Other APNS

Secondary level Tertiary level

Requirement for APN Certification
1. Master degree in nursing specialty

2. Three years working experiences in the specific area of expertise 3. The curriculum must be approved by NNCT

The number of APN in Thailand
APN CNS-MCH CNS-Ped. CNS-Med. CNS-Surg. CNS-Psy. CNS-Community Total Thailand (2003) 1 8 9 10 12 9 49

The ratio of APN to nursing population
Thailand (2003) U.S. (1996)

Total Nurses Population APN
APN : Nsg Pop

120,000

2.55 million

49 1:2,449

161,700 persons 1:16

Educational requirement for Master degree in Nursing to meet APN requirement

Plan A

Total credit hours

42 Cr.

1. General Core Courses 15 Cr. Master core courses 8 Cr. APN core courses 7 Cr.

2. Specific Courses Theory courses Practicum courses

12 Cr. 6 Cr. 6 Cr.

3. Elective Courses
4. Thesis

3 Cr.
12 Cr.

Plan B

Total credit hours 42 Cr.
15 Cr. 18 Cr. 6 Cr.

1. General Core Courses 2. Specific Courses

Theory courses

Practicum courses Seminar

9 Cr. 3 Cr.

3. Elective Courses 4. Independent Study

3-6 Cr. 3-6 Cr.

Advanced Nursing Practice initiative requires:
Initiation/creativity Professional leadership Vision Good governance : Participative management, Public/Private sectors involvement

Goal & Strategy

Social & Political Movement

: Lobbying, Negotiating power

Evidence-based policy making

: Research utilization

Research:

Public demands

Market driven trend Customer satisfaction Cost effectiveness Job analysis & Evaluation APN-NP positioning Reimbursement/Incentives

What did NNCT accomplish?
 Enactment  Nursing and Midwifery Acts B.E. 2528/2540  Advanced educational degree  Certified NP, CNS in Master level  Set up standard criterion core competency and qualification of APN  Standardize primary medical care as a competency in generic nursing program (BNS)

 Research A study of characteristics of nursing services in Thailand A need survey of Thai people on health care delivery and nursing services A study of nurses’ role in hospitals of the Northern Thailand A study of service efficiency of nursing/midwifery private clinics in Thailand

 Continuing education policy & enforcement

 Exercising power & controlling  Unity & Quality Assurance

Challenging trend : What should nurse leader do?
 Empowerment Unity Quality Assurance Pursue APN

 Actual evidence-based decision making and policy setting
 APN-NP positioning in NHSR/NHIS

 Public relation / Social movement ↑ Nursing Image⊕  Political movement
 Useful research/study  goals attainment

The nursing profession movement can no longer be governed and managed by only opinions and casual intuition of nursing leaders

Continually relevant research will provide definite answers for the challenging question …

Is APN an initiative or old wine in the new bottle?