Addressing Issues Impacting Advanced Nursing Practice Worldwide.

AbstractAdvanced practice nursing roles are developing globally, and opportunities for advanced practice nursing are expanding worldwide due to the need for expert nursing care at an advanced level of practice. Yet it is well recognized that barriers exist with respect to APRNs being able to practice to the full extent of their education and training. Addressing barriers to APRN practice worldwide and ensuring that APRNs are able to practice to the full extent of their education and training can help to promote optimal role fulfillment as well as assessment of the impact of the APRN role.DOI: 10.3912/OJIN.Vol19No02Man05Key words: Advanced practice; Advanced practice nursing; Advanced practice registered nurse; Advanced nursing practice; international advanced practice nursingAdvanced practice nursing roles are developing globally, and opportunities for advanced practice nursing (APRN) are expanding worldwide due to the need for expert nursing care at an advanced level of practice. APRN is a term used to encompass certified nurse midwife, certified registered nurse anesthetist, clinical nurse specialist, and nurse practitioner. The International Council of Nursing defines an advanced practice nurse as a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice (International Council of Nursing 2013!. A master's degree is recommended for entry level, yet in some countries such as the United States, a clinical practice doctorate is being recommended for APRN practice (National Council of State Board of Nursing. 2008!.International APRN Role DevelopmentRegulatory mechanisms and country specific practice regulations underpin APRN practice, yet it is well acknowledged globally that APRN practice encompasses several components including the ability to diagnose, prescribe medication, prescribe treatments, and perform and interpret diagnostic testing, among aspects of advanced practice as outlined in Table 1.The Institute of Medicine (IOM) report on the future of nursing has highlighted the importance of promoting the ability of APRNs to practice to the full extent of their education and training and to identify further nurses' contributions to delivering high-quality care (IOM. 20101. Yet it is well recognized that barriers exist with respect to APRNs being able to practice to the full extent of their capabilities. A number of challenges exist in regards to the increasing numbers of APRNs globally. These include poor role clarification, proliferation of APRN titles, differing educational requirements and degrees, scope of practice conflicts, fragmentation/variability in standards and quality of educational programs (Schober & Affara. 2008: Hanson. 2013).In a survey assessing international trends of nurse practitioners- advanced practice nurses (NP-APNsJ(Pulcini et. al. 20101. respondents from 31 countries identified a number of barriers related to NP-APN practice including access to educational programs globally, lack of understanding of the NP-APN role, and lack of respect of the nursing profession, among others as outlined in Table 2. Variation in scope of practice, prescriptive authority and licensure requirements were also reported.A new report from IOM identifies that specific country regulations can impose restrictions on various aspects of APRN care including legal/regulatory barriers, institutional barriers and cultural barriers. Specific examples include whether APRNs can admit patients, serve as primary care providers, sign orders for long-term care services, be reimbursed for services, or be recognized by health insurance companies as providers or reimburse them directly (Robert Wood Johnson Foundation. 20131.Institutional and cultural barriers exist which can also impose barriers to APRN practice. …