Download A Pilot Survey on Advanced Practice Nursing: Education, Practice

An International Pilot Survey
on Advanced Practice
Nursing:
Education, 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)
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
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.
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:
•
•
•
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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

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
D
H
o s o ct
or
pi
C
's
t
P
o
a
m
l
ub
ba offic
m
lic
s
un
e
he
ity ed
al
b a clin
th
ic
/M
se
in
d
cl
H istr
in
os
y
ic
of
pi
ta
l b he a
H ase lth
D
om
is
d
ea
c
e
se
h e lini
al c
ba
L
se
o n th c
d
ar
g
sp
te
e
rm
ec
O
ia
cc
ca
lt y
up
re
pr
at
io
S ac
na
ch tic
l/ w
oo e
or
lh
kp
ea
la
lt h
ce
Fa
cu hea
lty
lth
po
A
dm sit
i
in on
is
tra
t io
n
O
th
er
Positions Held by NPs/APNs in Various
Countries (23 Respondents)
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
NP/APN Education, Programs
and 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

Specialties or Types of NP/APNs Educated
in the NP/APN Programs (19 respondents)
50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
O
th
er
H
os
pi
ta
S
l/
p
S
ec
A
pe
cu
ia
ci
lty
te
al
ty
C
ca
ar
ca
re
e
re
-D
-A
is
ea
ge
se
/p
op
'n
gr
ou
p
Fa
m
ily
G
er
ia
tr i
c
P
ed
W
ia
om
tri
en
c
's
H
A
ea
du
lt h
lt
/M
C
id
om
w
if e
m
un
ry
ity
H
ea
lt h
0.00%
Credential Granted at Completion of
NP/APN Programs (19 respondents)
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
A
dv
an
ce
d
O
th
er
di
pl
om
a
ic
at
e
C
er
tif
de
gr
ee
e
ac
ca
la
ur
ea
t
B
M
as
te
r 's
de
gr
e
e
0.00%
NP/APN Regulatory Issues
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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)
NP/APN Practice Requirements
(22 Respondents)
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Academic
degree
Completion of Licensure by Sponsorship
educational governmental
by clinical
program
agency
agency
Other
credential
NP/APN Description of Practice and
Regulation (22 Respondents)
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Maintain
malpractice
insurance
Carry own
patient
caseload
Have
Have authority Refer to other Receive direct
Receive
prescriptive to dispense health care payment from payment from
authority
medications professionals
clients
other sources
Practice Are consulted
without
by health care
physician professionals
supervision
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
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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
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Professional organizations identified
usually as the national nurses’ association
rather than specific NP/APN organizations
(21 respondents)
ph
ys
ic
ia
n
nu
rs
in
g
or
ga
ni
z
en
t
at
io
n
G
ov
er
nm
D
om
es
t ic
O
th
er
or
ga
ni
za
tio
n
N
G
D
O
om
/N
on
es
-p
t ic
ro
pr
f it
iv
at
e
In
in
st
te
itu
rn
at
tio
io
n
na
lo
rg
an
iz
at
io
n
D
om
es
t ic
D
om
es
t ic
Supporters and Advocates
of the NP/APN Role (21 respondents)
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
ph
ys
ic
ia
n
nu
rs
in
g
or
ga
ni
z
en
t
at
io
n
G
ov
er
nm
D
om
es
t ic
O
th
er
or
ga
ni
za
tio
n
N
G
D
O
om
/N
on
es
-p
t ic
ro
pr
f it
iv
at
e
In
in
st
te
itu
rn
at
tio
io
n
na
lo
rg
an
iz
at
io
n
D
om
es
t ic
D
om
es
t ic
Opposition to the NP/APN Role
(14 Respondents)
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Summary
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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 Master’s 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.
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:
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More free text space needed
Explanations of answers
Suggestions for additional questions
Need to distinguish between nursing
organizations, directors of nursing and nurses
Limitations
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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
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
Consider if survey should be
translated into other languages
Identify individual programs in
countries and do survey on
educational curriculum