Fadwa A. Affara is Nurse Consultant, Education and Regulation Policy undertaking consultancy work for ICN, WHO and other agencies, particularly in the field of regulation. She helped set up the Regulation Network and International Nurse Practitioner/Advanced Practice Nursing Network while at the ICN.

Contents

Foreword ix

Preface xi

Acknowledgements xv

1 Introduction 1

Advanced nursing practice: a growing presence 1

Advanced nursing practice: patterns of development 2

Advanced nursing practice: a global picture 10

Definition of the advanced practice nurse 11

Conclusion 13

References 13

2 Nature of practice 17

Introduction 17

Advanced practice nurse (APN) characteristics 22

ICN official position on APN characteristics 22

Country illustrations 23

Labelling the role 24

Titling 24

Title protection 26

Scope of practice 26

What is scope of practice? 26

What influences scope of practice? 28

Points to consider when defining scope of practice 29

Core competencies 30

Competency: the basis for education and practice 32

Creating a competency map 33

Formulating competency statements 34

Advanced tasks versus advanced roles 35

Controversial practice topics 36

Prescriptive authority 36

The diagnosis debate 39

Hospital privileges 41

Domains of practice 42

Practice settings 45

Conclusion 45

References 45

3 Role and practice development 50

Introduction 50

Striving for the ideal: transitional processes 51

Assessing the opportunity and need for advanced nursing practice 52

Scanning the environment 52

Introducing and supporting advanced nursing practice 56

Interfacing with nurses, physicians, organisations and the public 60

Interface with nursing 60

Interface with medicine 65

Interface with organisational structures 68

Interface with the public 69

Socialisation: role support 71

Strategies to support new APNs 73

Ethical dimensions of the advanced nursing practice role 74

Conclusion 77

References 78

4 Regulation 81

Introduction 81

The regulatory/legislative framework 82

Factors influencing the regulatory/legislative systems 84

Credentialing advanced nursing practice 84

Components of the credentialing framework 86

The credentialee 86

Credentialing mechanisms 88

Credentialer 96

Purpose 96

Powers 97

Standards 97

Processes 98

Term or duration 98

Costs 99

Effectiveness 101

Mutual recognition agreements 101

Model for a regulatory system for advanced nursing practice 102

Exploring your regulatory environment 104

Preparation 104

Forming an overview of the regulatory/legislative systems 104

Understanding regulatory and legal frameworks for advanced nursing practice 105

Advocating for regulatory/legislative change 106

Document analysis 107

Advocacy strategies 107

Conclusion 109

References 109

5 Education for advanced nursing practice 112

Introduction 112

Characteristics of advanced nursing practice education 113

The case for master's level education 114

Debate around master's level education 114

Country variation in education philosophy, approach and development 115

Paths of entry into programmes and length of study 118

Vignettes of advanced nursing practice educational development 118

Assessment of prior experience and bridging mechanisms 120

Curriculum development 121

A curriculum framework to promote flexibility 122

Curriculum: course distribution 124

Advanced practice clinical experience 125

Settings for clinical experience 126

Preceptors and quality of clinical placements 127

Planning for the precepting experience 128

Examples of APN student practicum in new settings 128

Faculty background and preparation 130

Professional development and continuing education 132

Educational standards and programme accreditation 133

Conclusion 133

References 134

6 Research 137

Theoretical perspective of advanced nursing practice 137

Exploring the research perspective 139

Promoting diverse and analytical research 140

Research for advocacy 140

Enhancing knowledge and skills in research 141

The research culture 142

Research competence 142

Writing for publication 143

Searching for research funding 146

International Classification for Nursing Practice® (ICNP): A tool for collaborative nursing research 147

An international research agenda for advanced nursing practice 149

Conclusion 152

References 152

7 Future prospects and critical challenges for advanced nursing practice 154

Introduction 154

Future prospects 155

Preparing a health care workforce for the 21st century 155

Primary health care services 155

Chronic conditions and home care 156

Technology and telehealth 157

Nurse entrepreneurs 158

Critical challenges 158

Critical challenge 1: integrating advanced practice nurses into workforce planning 159

Critical challenge 2: international consensus-building around definitions, scope of practice, core competencies and education 161

Critical challenge 3: capacity building to strengthen advanced nursing practice in health systems internationally 162

Critical challenge 4: defining the gaps and finding the evidence 164

Conclusion 165

References 166

Appendix 1 Key Informant Survey on Advanced Nursing Practice (ANP) Self-Administered Questionnaire 167

Appendix 2 Scope of practice examples 173

Appendix 3 Strengths, Weaknesses, Opportunities, Threats (SWOT) 177

Appendix 4 Principles to guide standards development 178

Appendix 5 Samples of course descriptions in an advanced nursing practice curriculum 181

Appendix 6 Preceptor guidelines, student and preceptor evaluation form 189

Appendix 7 Checklist for authors preparing to submit an article for publication 192

Appendix 8 Example of statements in an ICNP® catalogue on adherence to treatment 194

Resources 196

Bibliography from key informants 204

Glossary 210

Index 219