Nurses in Advanced Roles as a strategy for equitable access to health care in the WHO Western Pacific Region: A mixed methods study

Purpose: This study investigated the current responsibilities of nurses in advanced roles (NARs), future healthcare needs, and the implications of these components for professional development of nurses. Design: This study employed a descriptive survey on the current status of NARs in the Western Pacific region (WPR), followed by a Delphi survey and exploratory interviews. Experts from WPR countries who were individuals with recognized national expertise on NARs from clinical, academic, and/or government-related backgrounds were invited to participate in this study from December 2017 to December 2018. Methods: Fifteen experts from ten countries provided descriptive data on the current status of NARs in the WPR via email. The data were used to grasp the spectrum of NAR and construct a working definition of NARs. This formed the basis for the Delphi survey, in which 27 experts from 14 countries completed the following three sections via email: Areas in need of NARs; Strengths, Weakness, Opportunities, and Threats analysis; and the role of NARs in promoting universal health coverage. Descriptive statistics were used for the survey and Delphi survey. For the exploratory interviews, semi-structured individual interviews were conducted with 19 key informants from 12 countries. Content analysis was performed for interview data. Delphi and interview findings were integrated in the final stage. Findings: Thirty-seven roles were identified and categorized according to the regulations for the specific roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for NARs. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary for NAR to improve equitable healthcare access. Conclusions: Demand for NARs is high in the WPR and we presented 15 items across five core strategic areas within the nursing community to enhance NAR development. Governmental-level recommendations include establishing legislative protection, remuneration, supportive channels, and conducting national needs assessments.