XV Colloquio Panamericano de Investigacion en Enfermeria ... · XV Colloquio Panamericano de...

XV Colloquio Panamericano de Investigacion en Enfermeria

Symposium on Advanced Nursing Practice Mexico City, October 6, 2016

Denise Bryant-Lukosius, RN PhD Associate Professor, School of Nursing and Co-Director

Canadian Centre for APN Research (CCAPNR) McMaster University, Hamilton, Ontario, Canada

D. Bryant-Lukosius, 2016 1

Share experiences and lessons learned from a Canadian

context and the School of Nursing at McMaster University

about advancing nursing roles in primary health care (PHC)

Describe collaborations between PAHO and WHO

Collaborating Centres to move the APN agenda forward in

PHC in Latin America and the Caribbean (LAC)


Registered nurse with the expert knowledge base, complex decision-making skills, and clinical competencies for expanded practice

Role characteristics are shaped by the context and/or country where the APN works

•A master’s degree is recommended for entry level

Clinical Nurse Specialist (CNS)

Nurse Practitioner (NP)


1970s Kergin Report: Need for expanded nurse roles in PHC in Canada

McMaster and other universities start programs to prepare nurses

with expanded roles as early NPs for isolated settings and family

practice

Pilot projects including the Burlington RCT of NPs

1980s Closure of NP education programs, despite research evidence about

their effectiveness


1990s Primary Health Care Reform is a provincial/national policy priority

Ontario government funds needs assessment about NP roles for PHC

10 university consortium for post-baccalaureate PHC NP education in Ontario

2000s Shift to NP education at the Master’s level despite lack of government support

National NP competencies developed to guide licensing/regulation and curricula

National Chair in APN (Dr. DiCenso) 2001-2011

Built capacity in developing PhD prepared APN faculty and researchers

Conducted decision-maker linked and policy relevant research

Developed evidence-based tools such as the PEPPA Framework to guide the effective use of CNS and NP roles (Bryant-Lukosius & DiCenso, 2004)


2010 to 2016 2010 Special Edition on APN in the Canadian Journal of Nursing

Leadership (CJNL) profiles research from the APN Chair Program

2011 launch of the Canadian Centre for APN Research (CCAPNR) at McMaster

Expand internationally and focus on Models of Care and Skill Mix as policy priorities, and lead work to optimize RN, NP, and CNS roles in team-based PHC

CCAPNR faculty are editors of 2016 Special Edition on APN in CJNL

Substantive progress in the education, regulation, deployment, and numbers of NPs in PHC, but full health systems integration has yet to be achieved


Strong nursing leadership at clinical, academic and policy

levels is essential to continually drive the introduction,

effective development and integration of APN roles

◦ Formal policies to support APN role implementation such as

legislation, regulation, competencies and education, lag behind

the informal introduction of the roles

◦ Health systems integration evolves slowly and iteratively over

time

◦ Takes time to overcome existing policies that are barriers to APN

roles (e.g., physician fee for service)


A systematic approach to introducing APN roles is essential to design the right roles to address population health, nursing practice, and health system needs


PEPPA has been used in

Canada and over 16 other

countries to successfully

design, implement and evaluate

APN and other advanced health

provider roles (Boyko, Carter &

Bryant-Lukosius, 2016)

Backbone of rural, northern, and remote healthcare

Primary providers for at risk and hard-to-reach populations in urban settings

Increase access to care underserviced communities through NP-led interprofessional teams

D. Bryant-Lukosius, 201610

• To address unmet health needs,

improve the recruitment/retention

of nurses, and improve the quality

of nursing care in high risk areas:

• Maternal and Child Health

• Mental Health and Addictions

• Chronic Disease Management

• Diabetes


• In 2005, Health Canada introduced CNS roles for 600 First Nations and

Inuit communities across the country (Veldhorst, 2006)

A standardized, coordinated and collaborative approach

to APN education among universities was necessary to

address resource and policy issues and reduce

variability in practice

• Ontario NP Education Consortium

• Established standardized education across10 universities

• Shared the costs and scarce faculty resources

• Developed NP faculty and expertise across the province

• Cohesive lobby group to advocate for policy changes related to NP

education


Integrated knowledge translation that engages policy makers and

administrators in research increases their awareness,

understanding and uptake of best practices for using APN roles

to impact on priorities for health care improvement


Pan-Canadian collaboration through the APN Chair Program and CCAPNR has been effective for:

building and sustaining APN faculty for education and research

generating evidence to influence policies and practices

maintaining momentum and profile

establishing a national network of nurse leaders and advocates to address policy issues and role implementation barriers


The world is a small place.

International collaboration and

partnerships benefits APN

role development in countries

with established roles and

where they are new or just

emerging.


2015 McMaster summit

2016

University of Michigan hosts meeting on developing APN competencies

McMaster and PAHO host a webinar series on APN role development, education and regulation

PAHO establishes pan-country advisory committee to develop APN role competencies


Further academic collaboration to align APN roles with policy priorities for UHC and UA to health in Latin America

Illustrates APN outcomes and how the roles can be used to address health care inefficiencies

Cost savings gained through the introduction of APN roles can be used to offset the costs of UHC


McMaster University has a long history in APN role education, research and development

Much progress has been made to increase access to high quality PHC services in Canada through improved APN role deployment

Continued efforts are required to produce and better use evidence to support full APN role integration

D. Bryant-Lukosius, 201619

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