An International Pilot Survey An International Pilot Survey on Advanced Practice on Advanced Practice

Nursing:Nursing:Education, Practice and Education, Practice and

Regulatory IssuesRegulatory Issues

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

Raisa Gul, RN, RM, MHA, PhD Raisa Gul, RN, RM, MHA, PhD (Pakistan)(Pakistan)Monika Jelic, BSN, MSN, CPNP, MPH Monika Jelic, BSN, MSN, CPNP, MPH (USA)(USA)

BackgroundBackgroundMany challenges and opportunities exist in Many challenges and opportunities exist in regards to the increasing numbers of APNs regards to the increasing numbers of APNs globally. These include poor role clarification, globally. These include poor role clarification, proliferation of APN titles, differing proliferation of APN titles, differing educational requirements and degrees, educational requirements and degrees, scope of practice conflicts, fragmentation/ scope of practice conflicts, fragmentation/ variability in standards and quality of variability in standards and quality of educational programs (Affara, 2006). educational programs (Affara, 2006).

Gathering data from different countries on Gathering data from different countries on regulatory issues is a critical challenge due regulatory issues is a critical challenge due to differing language for educational to differing language for educational programs, degrees, regulatory titles and programs, degrees, regulatory titles and practice models.practice models.

AimsAims

The study examines NPs/APNs’ efforts to The study examines NPs/APNs’ efforts to develop their role, the barriers to role develop their role, the barriers to role development, and areas where progress development, and areas where progress has been made. has been made.

This is a report of the preliminary results of This is a report of the preliminary results of an international web-based pilot study by an international web-based pilot study by the International Council of Nurses the International Council of Nurses International NP/APN Network. International NP/APN Network.

MethodologyMethodology

International web-based pilot surveyInternational web-based pilot survey Tool used: SurveyMonkeyTool used: SurveyMonkey Online Survey: open for 3 weeks in Online Survey: open for 3 weeks in

February and March, 2007February and March, 2007 15-25 minutes in length15-25 minutes in length Results: qualitative and quantitative Results: qualitative and quantitative

descriptive analyses descriptive analyses

Survey Development Survey Development Survey developed by the Education/Practice Survey developed by the Education/Practice

Subgroup of the INP/APNN. Subgroup of the INP/APNN. Consultation with Core Steering Group and Consultation with Core Steering Group and

Research, and Policy/Standards/Regulation Research, and Policy/Standards/Regulation SubgroupsSubgroups

Many drafts circulated in 2006 focusing on: Many drafts circulated in 2006 focusing on: • Content and Outline for SurveyContent and Outline for Survey• Language IssuesLanguage Issues• Regulatory TerminologyRegulatory Terminology• Nursing TitlesNursing Titles

Survey CategoriesSurvey Categories General InformationGeneral Information NP/APN Education and ProgramsNP/APN Education and Programs NP/APN Student ProfileNP/APN Student Profile NP/APN Regulatory IssuesNP/APN Regulatory Issues NP/APN Practice/RoleNP/APN Practice/Role General QuestionsGeneral Questions Comments on the Survey ToolComments on the Survey Tool

SampleSample

Participants: identified from ICN Participants: identified from ICN INP/APNN contact lists, subgroups INP/APNN contact lists, subgroups and word of mouthand word of mouth

Emailed to 70 participants plus Emailed to 70 participants plus INP/APNN Education/Practice INP/APNN Education/Practice Subgroup and Core Steering groups Subgroup and Core Steering groups

16 returned undeliverable16 returned undeliverable 32 respondents from 18 countries32 respondents from 18 countries

18 Countries Represented in 18 Countries Represented in the NP/APN Pilot Survey (n=32)the NP/APN Pilot Survey (n=32)

ArgentinaArgentina Australia (n=5)Australia (n=5) BahrainBahrain Botswana (n=2)Botswana (n=2) Canada (n=3)Canada (n=3) Hong Kong, China (n=2)Hong Kong, China (n=2) EthiopiaEthiopia FinlandFinland FranceFrance

Ireland (n=2)Ireland (n=2) Nepal (n=2)Nepal (n=2) NetherlandsNetherlands SingaporeSingapore South Africa (n=3)South Africa (n=3) SwitzerlandSwitzerland TanzaniaTanzania United KingdomUnited Kingdom USA (n=3)USA (n=3)

Findings Findings

Description of 32 respondents’ Description of 32 respondents’ multiple rolesmultiple roles• 17 NPs/APNs17 NPs/APNs• 5 registered/generalist nurses5 registered/generalist nurses• 18 nurse educators 18 nurse educators • 22 clinicians22 clinicians• 18 involved in research18 involved in research• 9 administrators9 administrators

NP/APN titleNP/APN title• 14 different titles for NP/APN identified14 different titles for NP/APN identified

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

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

NP/APN Education, ProgramsNP/APN Education, Programsand Student Profile*and Student Profile*

58% have formal NP/APN programs 58% have formal NP/APN programs in their countryin their country

All NP/APN students must be All NP/APN students must be registered or generalist nursesregistered or generalist nurses

2-5 years registered or generalist 2-5 years registered or generalist nursing experience required before nursing experience required before entering programentering program

*24 respondents*24 respondents

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

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

50.00%

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

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

NP/APN Regulatory IssuesNP/APN Regulatory Issues

75% had formal recognition of the 75% had formal recognition of the NP/APN role (22 respondents)NP/APN role (22 respondents)

52% had NP/APN licensure 52% had NP/APN licensure maintenance requirements (21 maintenance requirements (21 respondents), such as:respondents), such as:• Continuing education (92.3%)Continuing education (92.3%)• Practice requirements (69.2%)Practice requirements (69.2%)• Portfolio maintenance (53.8%) (13 Portfolio maintenance (53.8%) (13

respondents)respondents)

NP/APN Practice Requirements NP/APN Practice Requirements (22 Respondents)(22 Respondents)

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Academicdegree

Completion ofeducational

program

Licensure bygovernmental

agency

Sponsorshipby clinical

agency

Othercredential

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

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Maintainmalpracticeinsurance

Carry ownpatient

caseload

Haveprescriptive

authority

Have authorityto dispensemedications

Refer to otherhealth care

professionals

Receive directpayment from

clients

Receivepayment fromother sources

Practicewithout

physiciansupervision

Are consultedby health careprofessionals

General QuestionsGeneral Questions Development of NP/APN role Development of NP/APN role

(19 respondents)(19 respondents)• 68% identified strong support for nursing 68% identified strong support for nursing

practice practice • 42.1% identified need for more health care 42.1% identified need for more health care

providers for rural/underserved areasproviders for rural/underserved areas Health care planning (21 respondents)Health care planning (21 respondents)

• 84% stated that NPs/APNs participate at the 84% stated that NPs/APNs participate at the local levellocal level

• 68% stated that NPs/APNs participate at the 68% stated that NPs/APNs participate at the national levelnational level

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

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

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

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

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Summary Summary Confusion surrounding nomenclature for the Confusion surrounding nomenclature for the

NP/APN was found with14 different titles listed.NP/APN was found with14 different titles listed. NPs/APNs’ practice represented a broad variety of NPs/APNs’ practice represented a broad variety of

health care settings and a varied scope of health care settings and a varied scope of practice. practice.

58.3% stated that NP/APN education was 58.3% stated that NP/APN education was available in their own country with most providing available in their own country with most providing a Master’s Degree upon completion. a Master’s Degree upon completion.

About 75% stated that formal recognition of the About 75% stated that formal recognition of the NP/APN exists in their country by the government, NP/APN exists in their country by the government, hospital/health care agency or professional hospital/health care agency or professional nursing organization. nursing organization.

Support for the NP/APN role was found primarily Support for the NP/APN role was found primarily in domestic nursing organizations and the in domestic nursing organizations and the government, while opposition came mostly from government, while opposition came mostly from domestic physician organizations. domestic physician organizations.

Comments on the Survey ToolComments on the Survey Tool

Feedback from participants was solicited in Feedback from participants was solicited in order to refine the tool for future use. order to refine the tool for future use.

Length of survey (20 respondents)Length of survey (20 respondents)• 90% right length90% right length• 10% too long10% too long

Other comments:Other comments:• More free text space neededMore free text space needed• Explanations of answersExplanations of answers• Suggestions for additional questionsSuggestions for additional questions• Need to distinguish between nursing Need to distinguish between nursing

organizations, directors of nursing and nursesorganizations, directors of nursing and nurses

LimitationsLimitations Participants required to have Participants required to have

email/internet accessemail/internet access Limited number of participants from each Limited number of participants from each

country (2-5)country (2-5) Unable to go into detail about country Unable to go into detail about country

specificsspecifics Most participants are affiliated with the Most participants are affiliated with the

ICN and appreciate the international scope ICN and appreciate the international scope of development of the NP/APN role – may of development of the NP/APN role – may bias their answers.bias their answers.

Currently survey is available in English Currently survey is available in English onlyonly

DiscussionDiscussion

Collaboration with other subgroupsCollaboration with other subgroups How to best promote NP/ANP How to best promote NP/ANP

education internationallyeducation internationally Language Issues in survey and in Language Issues in survey and in

future surveysfuture surveys Dissemination of resultsDissemination of results

Future PlansFuture Plans

Revise survey using comments from Revise survey using comments from pilotpilot

Send to full complement of countries Send to full complement of countries represented by ICN INP/APNNrepresented by ICN INP/APNN

Consider if survey should be Consider if survey should be translated into other languagestranslated into other languages

Identify individual programs in Identify individual programs in countries and do survey on countries and do survey on educational curriculumeducational curriculum