dr. Petrie F. Roodbol, Hanze University of Applied Science, UMCG Netherlands,

Chair ICN APN/NP

Advanced practice nursing; an expanded nursing role on an international level

Content

APN in context of the ICN- scope and definitionsAPN WorldwideNetherlandsFuture

International Council of Nurses

RegulationSocio-economic welfare Professional practice

ICNP Lederschip in change APN

APN: an umbrella term

RN APN

Specialization

BACHELOR

APN

RN

NPCNSMidwifeAnesth.

Characteristics

Educational preparationNature of practiceRegulatory mechanism

Educational preparation

Educational preparation on advanced levelFormal recognition of educational programsA formal system of licensure, registration

certification or credentialing

Nature of practice

Integration research, education, clinical management

Independency, autonomyAdvanced assessment, decision-making skillsRecognized advanced clinical competenciesRecognized first point of serviceConsultation

Http://www.youtube.com/watch?v=WmYBxOVo4oc -

Right to diagnoseAuthority to prescribeAuthority to refer to other professionalsAuthority to admit to hospitalsTitle protectionLegislation specific to advanced practice

Regulatory Mechanism (country specific)

NP HOW

Patient

service Staff

Input Process outcome

Review N=70

effectiveness, efficiency, and quality

Patient

Satisfaction equal or increase (special groups) Increase compliance Less antibiotics, shorter hospitalizedSelf management

Quality

Health: equal or increased (assessment, treatment, less complications)

Safety; equal or increased

Service

Shorter waiting times, faster accessRural areas, vulnerable populationsLess hospitalizationEqual mortalityCost effectiveEqual number of consultations for patients longer

consultancies

Impact on the staff

SubstitutionIncrease coordination and organization

Disease, illness Consequences of diseases, illnesses

Starting an APN…….

A definition of the ANP roleRecommendations for collaborative practiceA curriculumRecruitment, retention and deployment strategiesRecommendations for legislation and regulationStrategies to reduce barriers to practice

Country Physicians Nurses

Netherlands 3,8 13,73South Africa 0,77 4,08 UK 2,2 9,9Italy 3,8 7,79Greece 5 4,2Germany 3,9 9,2Mexico 1,9 2,3US 2,4 10,5Hong Kong 1,7 5,28Korea 2,0 3,58

AsiaTaiwanHong KongJapanSingaporeMacauThailandKorea

European Nations

UK (England, Wales, Scotland, Northern Ireland)Sweden, FinlandNetherlands, BelgiumFranceGermany, Switzerland

Characteristics

16.4 Million inhabitantsLife expectancy 77.3 – 80.4HDI no.6Healthy 81,2%Required insurance

Health Care typology Affordable, accessible Solidarity Focus on primary care Government determines

Healthcare problemsChronically ill (1 million diabetes!)Hearth diseases, cancer Child obesity Elderly (frailty)

History

NP 1997 (CNS: 1986)Hospital based Individual initiative Answer on human resource problems Fast, uncontrolled growGovernmental (financial) support 2002

2011Program in nine citiesNational competency profileAssociation Number +/-Legislation

IndependencyPrescriptive authority Registration (previously acquired skills)

Positive effects (1)

Bridging the cap: physicians/nurses Integration cure and care (Cost) effective care Self management Patient centred care Easily accessible Innovation, quality driven

Experienced, motivated nursesIncreasing continuity Role models in holistic careOrganizational innovation Positive research results

Positive effects (2)

Negative effects

Medical socializationMedical classificationMoney drivenDiverse perceptionUnverified grow

Acceptance Government +++Public ++Physicians +RN ++(overcapacity of physicians; Physician assistants

less acceptance)

Healthy Aging: statistics

Prevalence of selected chronic diseases 65+

20,40%

49,20%

19,90%

15,20%

8,60%

35,90%

0,00% 10,00% 20,00% 30,00% 40,00% 50,00% 60,00%

heart desease

hypertension

cancer

diabetes

stroke

artritic symptoms

Key strategiesHealthy life style behaviorInjury preventionDelivery of culturally clinical preventive

servicesImmunization and preventive screeningsSelf management for chronically ill

Fit as possible

Dementia

Advanced nursing practice