I wanted to post some more information and links for people like myself, who are interested in a more global view of the profession.

On Saturday, several speakers discussed the state of advanced practice nursing and the role of the Nurse Practitioner in different countries.  All of the speakers were members of the International Council of Nurses, an organization created to help develop advanced practice nursing roles around the world.

Unfortunately, as is often the case at these conferences – there was no Latin American representation (even though there are several strong doctoral programs and advanced nursing in several Latin American countries – if not the actual NP role, per se.)  But that’s my bias, since I have a strong interest in both my profession and Latin America. (Be careful, Professor, given the opportunity – I just might not leave.. But alas!  No NPs in Mexico yet..)

Of course, none of the European NPs (outside of the UK) were present either, so if you want to be more involved with these nurses you have to attend the ICN or other Region – Specific* conferences.

The actual speakers were interesting and engaging and included speakers from the UK, Singapore, Canada and Australia.  (I was taking notes as fast as I could, so I didn’t manage to get complete titles for everyone, and I apologize).

Singapore

Madrean Schober at the Alice Lee Center for Nursing Studies presented information about nurse practitioners in Singapore.  As the role is quite new, she is a visiting fellow who is helping the National University of Singapore develop and implement this role.

In Singapore, the advanced practice nurse is a legally protected title, meaning that people have to meet rigorous standards to use the title, with penalties enacted for people who appropriate the title wrongfully.  This is similar to the USA but an important distinction that doesn’t apply in many countries.

The title and role of the APN is a hybrid of what we traditionally think of as both the NP and CNS (clinical nurse specialist) roles.

The first training programs were started in 2003 – and now consists of a 24 month program, with over 150 graduates so far.  The majority of graduates function in in-patient (or hospital-based) roles with the majority in intensive care units and mental health facilities.

In contrast to many countries, the push for the development of the APN role wasn’t due to an acute need, it was a deliberate effort to try to retain Singapore nurses and prevent a ‘brain drain’ as nurses from Singapore look for opportunities in other countries.

Advanced Practice Nursing in Singapore

Singapore Nursing Board

* Since the AANP is fairly region specific to the United States.

South Africa

Nelouise Geyer, CEO of the Nursing Education Association talked about the state of nursing in South Africa which is currently undergoing several changes in the classification of different levels of nursing.  There is no formally recognized NP role at present but there are advanced practice nurses such as midwives, clinicians in primary care and wound care specialists.

I found the new proposals for nursing classifications to be somewhat confusing and overly complicated as an outsider, but she was presenting a lot of information in a very short time.

Canada

Christine Buckley from Ontario presented information about Canada.  I find the situation in Canada to be quite encouraging despite having the usual growing pains with licensure requirements being fairly inconsistent across the provinces.  Despite being one of the newest countries to add nurse practitioners to the health care provider team – Canada has come on strong – with over 3400 NPs in just a few short years. (There were only 1129 in 2006).  Nurses in Canada have initiated a very successful (and catchy) slogan to encourage public interest in nurse practitioners, called “It’s about time!”

It’s about time!

Of course, they stress the use of NPs in primary care, but as the use of NPs grows in Canada – hopefully they will start to highlight some of the great things we do in specialty care too..  (They recently recognized a “NP in Anesthesia” role in British Columbia so it’s definitely on the way.)  They have done such an incredible job in just a few years – so kudos to our neighbors up north.  (As a Dalhousie graduate [non-nursing], I am particularly proud.)

Australia

I didn’t get the name of the Australian nurse practitioner (couldn’t write that fast!) but she did an excellent job outlining the history and the current state of the NP in Australia.  In a country of 22.3 million people, there are currently 740 nurse practitioners.  Unfortunately, only 71% (436) of these NPs are able to find work as a nurse practitioner due to a multitude of issues.

However, in the last few years, the NPs in Australia have been able to achieve national registration and well as reimbursement for their services.  (Prior to 2010, patients had to pay out-of-pocket to see an NP.)

United Kingdom

Jenny Ashton talked about the roles of the NPs in the United Kingdom, and explained that due to a lack of formal registration, there is no accurate count of the numbers of NPs currently practicing there.  While there is little consistency across the UK in general, she stated that both Wales, and Scotland have a more formalized process.

While there remain multiple barriers for NPs practicing in the UK, one of the biggest obstacles has already been overcome: NPs in the UK have full prescribing rights – which is something that not even all states in the USA have.

Unfortunately, from her presentation (and this is my interpretation) it sounds like one of their biggest obstacles is the Nursing Council itself which seems uninterested in examining (and resolving) the issues around standardizing educational requirements, formal title protection and registration and other policy issues.  Luckily, it sounds like the medical colleges are more than interested in playing a role in the continued development of APNs.  (Of course, that can be a double-edged sword as well.)

Hopefully, we’ll hear more news about our other nursing colleagues around the world soon – and maybe I’ll be able to attend one of the ICN conferences in the future (and be able to report from there.)

Future of NPs

In my mind, one of the biggest obstacles to the implementation and utilization of the nurse practitioner in other countries is lack of understanding of the role.  In many places, this is due to the perception that NPs can only function in a primary care role.  (This is extremely limiting in countries where there is no shortage or even an overflow of primary care physicians.)  In my [very limited] experience and interactions with surgeons in both the USA and abroad – this obstacle is quickly diminished as surgeons see the utility of having someone trained to handle all the ‘medicine’ aspects of surgical patients, so they can spend more time operating, and not worrying about managing co-morbidities or post-operative care.  This perception has been validated by several of the papers we’ve seen (and talked about before) from Germany, Japan and other nations where the surgeons themselves are trying to import the NP position to their home countries after working with NPs during their fellowships or other training in the United States.

References / Additional Information

The ICN / Nurse Practitioner & Advanced Practice Nurse Network – This organization is for the promotion and support of the development of the APN/ NP role internationally.  The above link takes you to the membership information page.  Membership is free.

The ICN website also contains information on the development of the NP role in other countries (Thailand, for example), a global definition of the NP role, and information about other nursing conferences worldwide. I recommend a look at the FAQ page which explains that the NP role exists (or is in development) in over 70 countries.

This is a link to the definition of the NP role in Spanish for all my friends/ colleagues and everyone else I’ve met who wonders what my job really is (for when my own explanations have them questioning my Spanish language abilities)..