2. Advanced Nursing Practice in Thailand: An Initiative or Old Wine in the New Bottle! Assistant Professor Nanthaphan Chinlumprasert, Ph.D., R.N. Faculty of Nursing Science, Assumption University of Thailand

3. The Development of APN in Thailand 1974198819942000 Present NP Existed CCS granted “Nursing Expertise” NNCT approved CNS in 5 areas NHSR PCU APN NP

4. Advanced Practice Nurse (APN) 1. Nurse - Anesthetist 2. Nurse - Midwife *3. Clinical Nurse Specialist *4. Nurse Practitioner

5. Nurse Practitioner (NP) In 1974 : NP first established to serve people in the remote area and to ease the Physician shortage : 4-month-training : Work as physician extender : No autonomy Legitimate limitation Not well accepted by NNCT

6. Nursing Experts (NE) In 1988 : The Commission of Civil Servant (CCS) has granted the career ladder for promoting experienced nurses to become Nursing Experts : Academic report and experiences were used to consider the promotion

7. : Nursing service system has no distinctive organizational line and scope of practice for Nursing Expert position : No continuous support by Nursing Organization

8. Clinical Nurse Specialist (CNS) In 1994 : The National Nursing Council of Thailand (NNCT) has approved CNS in 5 areas 1) Community Nursing Family Nursing Occupational Health Nursing School Health Nursing

9. 2) Mental Health & Psychiatric Nursing 3) Pediatric Nursing 4) Maternal & Child Nursing 5) Medical – Surgical Nursing

10. CNS Master degree in nursing specialty Certification of CNS granted by NNCT

11. 2000  Present : National Health System Reform (NHSR)

12. National Health System: Is the entire system of the national health that interrelated or interconnected as the holism. It effects to the health of all population including other factors such as individual, environment, economic, social, physical, biological, and the factor of health care system.

13. Principle of NHSR  Holistic  Participatory  Public Policy for Health  Equity *  Efficiency *  Quality *  Consumer responsiveness and protection

14. National Health System Health Service System Nursing Service System

15. Health Service System University/Regional Hospital Provincial/General Hospital Health Center, PCU, Com. Hospital Village, CPHC Self Care, Self Reliance Tertiary Secondary Care Primary Care Primary Health Care

16. Equity Efficiency Quality National Health Insurance Policy Universal Coverage Primary Care Focus

17. APN Nurses NP CNS-Com. Nsg Primary Care Unit Other APNS Secondary level Tertiary level Nurses CNS

18. Requirement for APN Certification 1. Master degree in nursing specialty 2. Three years working experiences in the specific area of expertise 3. The curriculum must be approved by NNCT

19. The number of APN in Thailand APNThailand (2003) CNS-MCH CNS-Ped. CNS-Med. CNS-Surg. CNS-Psy. CNS-Community 1 8 9 10 12 9 Total49

20. The ratio of APN to nursing population Thailand (2003)U.S. (1996) Total Nurses Population APN 120,000 49 2.55 million 161,700 persons APN : Nsg Pop1:2,4491:16

21. Educational requirement for Master degree in Nursing to meet APN requirement Plan A Total credit hours 42 Cr. 1. General Core Courses 15 Cr. Master core courses 8 Cr. APN core courses 7 Cr.

22. 2. Specific Courses 12 Cr. Theory courses 6 Cr. Practicum courses 6 Cr.

23. 3. Elective Courses3 Cr. 4. Thesis 12 Cr.

24. 1. General Core Courses 15 Cr. 2. Specific Courses 18 Cr. Theory courses 6 Cr. Practicum courses 9 Cr. Seminar 3 Cr. Plan B Total credit hours 42 Cr.

25. 3. Elective Courses3-6 Cr. 4. Independent Study 3-6 Cr.

26. Advanced Nursing Practice initiative requires: Goal & Strategy : Participative management, Public/Private sectors involvement Professional leadership Initiation/creativity Vision Good governance

27. Social & Political Movement : Lobbying, Negotiating power Evidence-based policy making : Research utilization

28. Research: Public demands Market driven trend Customer satisfaction Cost effectiveness Job analysis & Evaluation APN-NP positioning Reimbursement/Incentives

29. What did NNCT accomplish?  Enactment  Nursing and Midwifery Acts B.E. 2528/2540  Advanced educational degree  Certified NP, CNS in Master level  Set up standard criterion core competency and qualification of APN  Standardize primary medical care as a competency in generic nursing program (BNS)

30.  Research A study of characteristics of nursing services in Thailand A need survey of Thai people on health care delivery and nursing services A study of nurses’ role in hospitals of the Northern Thailand A study of service efficiency of nursing/midwifery private clinics in Thailand

31.  Continuing education policy & enforcement  Exercising power & controlling  Unity & Quality Assurance

32. Challenging trend : What should nurse leader do?  Empowerment  Actual evidence-based decision making and policy setting  APN-NP positioning in NHSR/NHIS Unity Quality Assurance Pursue APN

33.  Public relation / Social movement  ↑ Nursing Image ⊕  Political movement  Useful research/study  goals attainment

34. The nursing profession movement can no longer be governed and managed by only opinions and casual intuition of nursing leaders

35. Continually relevant research will provide definite answers for the challenging question … Is APN an initiative or old wine in the new bottle?