Exploring the Implementation of Advanced Practice Nurses in Healthcare Systems: Factors of Role Identity to Consider with Policy Development

Abstract

Worldwide, countries are seeking answers to the challenge of meeting increasing demands to improve quality of and access to primary healthcare. An increase in communicable and noncommunicable diseases has stimulated governmental and nongovernmental authorities to seek solutions better suited for the healthcare needs of their populations. Significant gaps in primary healthcare along with fragmented healthcare delivery have caught the attention of governments and healthcare planners globally. The World Health Organization and the International Council of Nurses have identified the potential for nurses, as a resource, to enhance the provision of healthcare services. One proposal is the promotion of advanced practice nurses such as nurse practitioners and clinical nurse specialists. The process of integrating advanced practice nursing into the healthcare workforce and diverse healthcare settings is a dynamic process characterized by constant change, alterations in service delivery and progress toward a new era in nursing practice. The nature of these changes is met with both enthusiasm and skepticism. Challenges to successful implementation of advanced practice nurses include lack of role clarity and opposition or confusion from other healthcare professionals. Preparing for the implementation of advanced practice nurses within healthcare systems globally requires comprehending the advanced practice nurse concept and how health policy impacts their clinical practice. Supportive policy formation shapes and influences effective and sustainable implementation of advanced practice nurses. This article describes characteristics that define advanced practice nursing and identifies policy issues that significantly influence optimal scope of practice and appropriate education for this emerging field of nursing. The provision of advanced education, appropriate legislative and regulatory mechanisms along with anticipatory planning need to come together to guide role implementation. As countries assess the possibility of integrating advanced practice nurses into the healthcare workforce and in order to maximize their contributions, service delivery environments need to ensure that practice regulations are up to date and appropriate for advanced practice nurses.