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Joyce Pulcini, PhD, APRN, BC, PNP, FAAN (USA) Alice Yuen Loke, BSN, MN, PhD (Hong Kong)

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.

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Joyce Pulcini, PhD, APRN, BC, PNP, FAAN (USA) Alice Yuen Loke, BSN, MN, PhD (Hong Kong)

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  1. 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)

  2. 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.

  3. 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.

  4. Methodology • 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

  5. Survey Development • 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

  6. Survey Categories • 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

  7. Sample • 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

  8. Argentina Australia (n=5) Bahrain Botswana (n=2) Canada (n=3) Hong Kong, China (n=2) Ethiopia Finland France Ireland (n=2) Nepal (n=2) Netherlands Singapore South Africa (n=3) Switzerland Tanzania United Kingdom USA (n=3) 18 Countries Represented in the NP/APN Pilot Survey (n=32)

  9. 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

  10. Positions Held by NPs/APNs in Various Countries (23 Respondents)

  11. NP/APN Education, Programsand 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

  12. Specialties or Types of NP/APNs Educated in the NP/APN Programs (19 respondents)

  13. Credential Granted at Completion of NP/APN Programs (19 respondents)

  14. NP/APN Regulatory Issues • 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)

  15. NP/APN Practice Requirements (22 Respondents)

  16. NP/APN Description of Practice and Regulation (22 Respondents)

  17. 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 • 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 • Professional organizations identified usually as the national nurses’ association rather than specific NP/APN organizations (21 respondents)

  18. Supporters and Advocates of the NP/APN Role (21 respondents)

  19. Opposition to the NP/APN Role (14 Respondents)

  20. Summary • 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.

  21. 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 • Other comments: • More free text space needed • Explanations of answers • Suggestions for additional questions • Need to distinguish between nursing organizations, directors of nursing and nurses

  22. Limitations • 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

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

  24. Future Plans • 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

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