INR APN Special Issue Commentary

Abstract

It has been my privilege as the inaugural International Council of Nurses (ICN) Chief Nurse (2021–2023) to collaborate with Professor Parveen Ali, International Nursing Review (INR) Editor-in-Chief, and with my esteemed co-editor Dr. Daniela Lehwaldt, Chair of the ICN Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN). We have worked collaboratively to curate and share with you this INR Issue on Advanced Practice Nursing: Towards Health and Well-being for All. As the former ICN NP/APN Network Liaison, I wish to recognize and thank the Core Steering Group, Subgroups and the network members for their leadership, dedication and unwavering volunteerism and relay my respect for their valued contributions to advance the profession and population health.

In January of 2024, I transitioned roles to become the Chief Executive Officer (CEO) of the Nurse Practitioners’ Association of Ontario (NPAO) in Canada, representing over 5100 nurse practitioners who improve access to quality care across our provincial health system. In addition to my executive leadership role, I continue to uphold all the APN dimensions of practice, including teaching, as well as delivering direct clinical primary health care for health equity-seeking populations. Dr Daniela Lehwaldt is Chair of the ICN NP/APN Network and find her role incredibly rewarding as it enables her to constantly learn from advanced nurses from all over the globe. She is a former Nurse Practitioner in Cardio-Thoracic Surgery. As native German, she is also serving as President of the Subgroup ‘International’ (Akademische Fachgesellschaft International) of the German Network APN & ANP g.e.V.. She is a certified Global Nurse Consultant with CGFNS, and is an academic member of the Irish Association of Advanced Nurse and Midwife Practitioners (IAANMP), and is a founding member of the Ireland-Africa Alliance for Non-communicable Diseases (IAAfNCDs).).

Advanced practice nurses (APNs), which include graduate-prepared NPs, clinical nurse specialists (CNS), nurse anaesthetists (NA) and nurse midwives, all uphold crucial service delivery and leadership roles towards achieving Universal Health Coverage (UHC) and advancing the Sustainable Development Goals (SDG) by 2030. Especially in the context of a fragile post–COVID-19 system, challenged further by a strained health workforce globally. APNs are competently and capably poised to deliver and lead primary health care and specialty care services that include health promotion, disease prevention, communicable and noncommunicable disease management, person-centred care, emergency preparedness as well as build team and system capacity (Acorn, 2021a, 2021b, 2023a, 2023b).

Globally, APN roles are at various stages of development, implementation and integration (ICN, 2020, 2021a, 2021b). Given the diversity of country-specific contexts and population health system needs, this INR special issue showcases APN role contributions, influences and impacts locally to internationally. It also highlights regional and country case studies and exemplars including experiences in the field showcasing innovations in practice such as APN-led services, original research and literature reviews in Spain, Italy, France, Germany, Finland, Kenya, Singapore, the United States and in Canada. One of the challenges that we face in to understand each country's context where advanced nursing is developing. Understanding the three pillar of APN such as Practice, Education and Regulation, is the key to successfully developing NP/APN roles (ICN 2020). In most recent times we have been challenged to think more diversely and to support other disciplines in their endeavors to advance their clinical practice.

We are delighted to have achieved a wide geographical spread of content for this issue, including representation from some of the countries where we know that NP/APN developments are fairly recent. We are looking forward to continuing to work with all countries across the WHO Regions (World Health Organization 2017). Our goal within the ICN NP/APN Network is to support one another, to be a resource and to share knowledge and experiences relating to development, implementation and evalution of NP/APN roles (International Council of Nurses NP/APN Network 2023).

This INR special issue covers six APN aspects: (1) leadership, (2) education and mentoring, (3) jobs and roles, (4) service delivery and safety across sectors, (5) health workforce investments and value for money, and (6) APNs responding to COVID and disasters. Your comprehension will be broadened and enrichened from the insights and perspectives shared related to education collaborations, the evolution of APN scope of practice in acute care, implementation of APNs, healthcare professionals’ and managers' views of the APN role, a leadership framework in the context of system change, a scoping review of APN response and innovations during the COVID-19 pandemic, APN leadership towards COVID-19 recovery, advancing the nursing profession through implementing the NP role, APN clinical decision-making processes, deployment of APNs, scopes of practice of advanced practice nursing and midwifery, APN psychotherapy, APN roles in sustaining nurses’ resilience, and CNS roles in nutrition to give you a diverse taste among the dozens of articles included in this special publication.

It is crucial that APNs are empowered, actively contribute to policy dialogue and are respected in governance environments. Influencing and persuading advancing support, commitments and actions, including investments in APNs and generating and dissemniating evidence-informed data-driven best practices as respected thought leaders, clinicians, system navigators, educators, collaborators and quality improvers are vital (Acorn, 2021a, 2023a).

Three foundational ICN APN resources exist: (1) Guidelines on Advanced Practice Nursing (2) Guidelines on Nurse Anesthetists and (3) Nurse Prescribing to provide global information and guidance (ICN, 2020, 2021a, 2021b). The implications for APN health and nursing policy are ripe. High-priority actions should wrap around (1) advancing APN role recognition and enabling positive practice environments as a health workforce solution synergizing nursing retention and recruitment, (2) investments to fund and sustain integrated APN health system roles to optimize access and UHC, and (3) improve APN data capture to drive dialogue and decision-making.

The policy and political perspectives, contexts and conditions including both the need and demand for utilizing APNs are rich and ample in clinical service delivery, leading and supporting care teams, educating precepting and mentoring APNs, capturing data and outcomes measures of APN and team contributions, inclusion into the National Health Workforce Accounts, and embedding all the domains of advanced practice into the International Classification of Nursing Practice are essential.

The World Health Organization's (WHO) first State of the World's Nursing (SOWN) report (WHO, 2020) was conducted in the pre-COVID state. The next WHO SOWN report targeted for 2025 will capture important pandemic and ageing workforce effects. The Global Strategic Directions for Nursing and Midwifery (GSDNM) (WHO, 2021) adopted at the World Health Assembly (WHA) by member states is entering its final year for accelerating implementation and progress in 2024 in order to influence further policy priorities for 2025–2029. The WHA and TRIAD 2024 are gearing up. Opportunities for deliberations and interventions between WHO, ICN and the International Confederation of Midwives (ICM) can capture APN solutions as strategic workforce levers. Scaling up and out efforts for comprehensive APN education, regulation and labour market analysis are key country and regional opportunities (Acorn, 2023b; World Bank, 2021). Local, regional and national nursing QUADS summit opportunities ensuring representation from the four pillars which include educators, regulators, Government Chief Nursing and Midwifery Officers, employers, unions, and professional associations for APN momentum to address nursing and midwifery education and curriculum, scope of practice, regulation, and governance would be advantageous.

Future research focusing on APN health workforce solutions to advance UHC and nursing retention could further inform APN data analytics and return on investments. APN role definition, education, regulation, credentialing, certification, scope of practice, working conditions, remuneration, funding models and integration vary worldwide (Acorn, 2023a, 2023b). Clarity and alignment can strengthen future workforce harmonization, innovation, models of care and data. National, regional and global clarity and consistency can inform the design, delivery and leadership for health, education and socioeconomic systems. Healthcare demands related to pandemics, ageing population, noncommunicable diseases, natural disasters, humanitarian crisis and climate change have exposed glaring health needs, taxed and under- resources workforces for service delivery and educational institutions' capacity locally and globally (Acorn, 2021a).

We look forward to being reunited with many of you at the 13th ICN APN/NP Network conference in Aberdeen, Scotland, on September 9–12, 2024. The ICN APN/NP network looks forward to seeing you along with the North of Scotland Advanced Practice Academy hosted at Robert Gordon University. This event will enable exchanging expertise experience for supporting nurses and countries who are in the process of developing, implementing, integrating and sustaining advanced practice roles.