Advanced Nursing Practice Regulation A Global Perspective A Global Perspective Fadwa A Affara International Nurse Consultant

What is Regulation?

Educational programmes and institutions (approval, accreditation) Educational programmes and institutions (approval, accreditation) Practitioners (registration, licensure, certification Practitioners (registration, licensure, certification Practice (scope of practice) Practice (scope of practice) Health care agencies (accreditation, approval) Health care agencies (accreditation, approval) Regulation influences:

All of those legitimate and appropriate means – governmental, professional and individual – where by order, identity, consistency and control are brought to a profession and its practice. Styles & Affara for ICN Professional Regulation Defined

Define the profession and its members. What is advanced nursing practice and who is the advanced practice nurse? Define the profession and its members. What is advanced nursing practice and who is the advanced practice nurse? Determine the scope of practice. What can an advanced practice nurse do? Determine the scope of practice. What can an advanced practice nurse do? Set standards of education and for ethical, competent practice. What level of performance will be expected of the advanced practice nurse? Set standards of education and for ethical, competent practice. What level of performance will be expected of the advanced practice nurse? Establish some system of accountability. What will the advanced practice nurse be answerable for, and to whom? Establish some system of accountability. What will the advanced practice nurse be answerable for, and to whom? Outcomes of Regulation

What Regulatory System?

… the overriding purpose of statutory regulation of nursing is that of service to and protection of the public. … Benefits to the profession and individual practitioners are secondary, and although they may be significant, do not in themselves provide good reason for statutory regulation. Styles & Affara for ICN. 1997

Types of Systems 1. Regulation by the Government where regulation is carried out under direct government oversight. Its focus tends to be on registering and licensing nurses. 1. Regulation by the Government where regulation is carried out under direct government oversight. Its focus tends to be on registering and licensing nurses. 2. The professional model where regulatory functions and authority are devolved to statutory bodies with major representation from nursing, or to the professional association.

Advanced Nursing Practice Regulation

… ill-defined and diverse ; educational requirements and legal definitions of nursing generally inadequate for the complexity and expansion of the nursing role as it is emerging in response to health care needs. Styles, 1986

Proliferation of titles Proliferation of titles No clearly identifiable processes specific to skills, knowledge acquisition, special competencies of advanced nursing practice obviously associated with title selection No clearly identifiable processes specific to skills, knowledge acquisition, special competencies of advanced nursing practice obviously associated with title selection Titling

Level of authority Level of authority Reluctance to move beyond the generalist nurse to standards underpinning the more complex knowledge and skill sets of APNs Reluctance to move beyond the generalist nurse to standards underpinning the more complex knowledge and skill sets of APNs Scope of practice

From certificates for post-basic courses to formal university programmes and obtaining a masters degree From certificates for post-basic courses to formal university programmes and obtaining a masters degree ICN official recommends educational preparation at a masters level. ICN official recommends educational preparation at a masters level. Educational Requirements

Types and rigor of the credentialing mechanisms Perceived potential and level of risk -- likely severity of harm to the consumer. Perceived potential and level of risk -- likely severity of harm to the consumer. Depth of specialised and advanced knowledge required. Depth of specialised and advanced knowledge required. Skills and abilities needed for practice. Skills and abilities needed for practice. Degree of autonomy allowed by the role. Degree of autonomy allowed by the role. Breadth of scope of practice. Breadth of scope of practice. National Council of State Boards of Nursing, 2002 Factors to consider

Regulatory Mechanisms Licensure Licensure Certification Certification Registration Registration Recognition Recognition Accreditation Accreditation Types and rigor of the credentialing mechanisms

Examination Examination Portfolio review Portfolio review Application desk audit, interview or assessment by an expert panel Application desk audit, interview or assessment by an expert panel Practice and continuing education requirement Practice and continuing education requirement Validating initial and continuing competence

…. crazy quilt or hodgepodge of role descriptions, titles, scopes of practice related to the specifics of the extended role skill set and educational and registration requirements. (Key Informant, 2005)

Goal of ICN International Nurse Practitioner /Advanced Practice Nursing Network (INP/NPNN) … become an international resource for nurses practising in nursing practitioner (NP) or advanced practice nursing (APN) roles, and interested others (e.g. policymakers, educators, regulators, health planners).

Self-regulation (self governance) Self-regulation (self governance) Public involvement in professional self- regulation Public involvement in professional self- regulation Mechanisms for international communication Mechanisms for international communication Collaboration and coordinating Collaboration and coordinating Increased congruence and coherence among regulatory systems Increased congruence and coherence among regulatory systems ICN & WHO st Century Professional Regulation

Agreeing on acceptable and feasible criteria for mutual recognition Agreeing on acceptable and feasible criteria for mutual recognition Portability of qualifications Portability of qualifications Providing evidence about competence, qualifications and the fitness of nurses Providing evidence about competence, qualifications and the fitness of nurses International Regulatory Challenges