This article analyzes advanced practice nursing roles through a literature review and a pilot stakeholder survey in relation to five strategic areas: (1) definitions and scope of practice; (2) education, credentialing and regulation; (3) new roles in healthcare; (4) costs and benefits in health reform; and (5) implementation and relationships. The Canadian health services environment is best served by a multifaceted APN role, defined by a nursing paradigm that invokes collaborative relationships with physicians, and education and credentialing that is based on national standardization.
Get full access to this article
View all access options for this article.
References
1.
KochLWPazakiSHCampbellJD. The first 20 years of nurse practitioner literature: An evolution of joint practice issues. Nurse Practitioner1992; 17(2): 62–71.
2.
AlcockDS. The clinical nurse specialist, clinical nurse specialist/nurse practitioner and other titled nurse in Ontario. Canadian Journal of Nursing Administration1996; 9(1): 23–44.
3.
HaddadB. Report on the expanded role nurse project. Canadian Journal of Nursing Administration1992 Nov–Dec; 5(4): 10–17.
4.
MorganPPCohenL. Should nurse practitioners play a larger role in Canada's healthcare system?Canadian Medical Association Journal1992; 146(6): 1020–1025.
5.
Canadian Nurses Association.Out in front —advanced nursing practice. Nursing now: Issues and trends in Canadian nursing [2nd in series]. Ottawa: The Association; January 1997.
6.
BirenbaumR. Nurse practitioners and physicians: Competition or collaboration?Canadian Medical Association Journal1994; 151(1): 76–78.
7.
Nova Scotia Department of Health.Minister's Working Group on Nurse Clinicians. Final report to the minister. September 1996.
8.
Nova Scotia Department of Health.Good medicine: Securing doctors' services for Nova Scotia [white paper]. Halifax: Queen's Press; 1997.
9.
ReedCASelleckCS. The role of midlevel providers in cancer screening. Medical Clinics of North America1996; 80(1): 135–144.
10.
Sparacino PSA.Opportunities for the advanced practice nurse: Encroachment or collaboration?Clinical Nurse Specialist; 8(3): 122.
11.
WalkerPH. Dollars and sense in health reform: Interdisciplinary practice and community nursing centres. Nursing Administration Quarterly1994; 19(1): 1–11.
12.
GilesT. The cost-effective way forward for the management of the patient with heart failure. Cardiology1996; 87Suppl 1: 33–39.
13.
SprossJ. Advanced practice nurses and patient outcomes [editorial]. Clinical Nurse Specialist1995; 9(2): 75.
14.
SpatzDL. Women's health: The role of advanced practice nurses in the 21st century. Nursing Clinics of North America; 31(2): 269–277.
15.
MitchellAPinelliJPattersonCSouthwellD. Utilization of nurse practitioners in Ontario. Executive summary [discussion paper]. Hamilton (ON): McMaster University School of Nursing; September 1993.
16.
BajnokIWrightJ. Revisiting the role of the nurse practitioner in the 1990s: A Canadian perspective. AACN Clinical Issues in Critical Care Nursing1993; 4(4): 609–610.
17.
BoyleD. Documentation and outcomes of advanced nursing practice. Oncology Nursing Forum1995; 22Suppl 8: 11–17.
18.
HylkaSCBeschleJC. Nurse practitioners, cost savings, and improved patient care in the Department of Surgery. Nurse Economist1995; 13(6): 349–354.
19.
ConradLFraserKGregorFLeGrowKMoffattFWStinsonD. A proposal to prepare neonatal nurse practitioners. Submission to the Department of Health, Government of Nova Scotia. Halifax (NS): School of Nursing, Faculty of Health Professions, Dalhousie University; 1996.
20.
Van der HorstMPattersonCA. General medicine expanded role nurse: Role description. Canadian Journal of Nursing Administration1993 Sept-Oct; 6(3): 22–25.
21.
WayDOJonesLM. The family physician-nurse practitioner dyad: Indications and guidelines. Canadian Medical Association Journal1994; 151(1): 29–34.
22.
FlookN. Doctors, nurses, and primary care [editorial]. Canadian Family Physician1995 Sept; 41: 1441.
23.
Georgian Research Society.The attitude of general practitioners towards practice nurses: A pilot study. British Journal of General Practice1991; 41: 19–22.
24.
PearsonLJ. Annual update of how each state stands on legislative issues affecting advanced nursing practice. Nurse Practitioner1995; 20(1): 13–14,16–18,21–22.
25.
Ontario College of Family Physicians.Submission to the Health Professions Regulatory Advisory Council regarding proposed changes of regulations to the scope of nursing practice. Mississauga (ON): The College; May 1995.
26.
LambGS. Two explanations of nurse practitioner interactions and participatory decision making with physicians. Research in Nursing and Health1991; 14: 379–386.
27.
SebasMB. Developing a collaborative practice agreement for the primary care setting. Nurse Practitioner1994; 19(3): 49–51.
28.
GuidoGW. Advanced nursing practice: Legal concerns. AACN Clinical Issues in Critical Care Nursing1995; 6(1): 99–104.
29.
HaberJ. Regulating advanced practices. Perspectives in Psychiatric Care1995; 31(1): 5–7.
30.
LambertVALambertCEJr. Advanced practice nurses: Starting an independent practice. Nursing Forum1996; 31(1): 11–21.
31.
KassirerJP. What role for nurse practitioners in primary care?New England Journal of Medicine1994; 330(3): 204–205.
32.
CronenwettL. Molding the future of advanced practice nursing, Nursing Outlook1995 May/June; 43(3): 112–8.
33.
DaviesBHughesAM. Clariflcation of advanced nursing practice: Characteristics and competencies. Clinical Nurse Specialist1995; 9(3): 156–60, 166.
34.
PattersonCHaddadB. The advanced nurse practitioner: Common attributes. Canadian Journal of Nursing Administration1992 Nov–Dec; 5(4): 18–22.
35.
MitchellGSantopintoM. The expanded role nurse: A dissenting viewpoint. Canadian Journal of Nursing Administration1988 Dec; 1(4): 8–10,14.
36.
HawkinsJWHolcombeJK. Titling for advanced practice nurses. Oncology Nursing Forum1995,22Suppl 8: 5–9.
37.
ElliottPA. The development of advanced nursing practice: 1. British Journal of Nursing1995; 4(11): 633–636.
38.
GiovannettiPStuartMTenoveSvan den BergR. Report of the CAUSN Working Committee on Advanced Nursing Practice 1996 (revised). Ottawa:CAUSN.
39.
MirrMP. Advanced clinical practice: A reconceptualized role. AACN Clinical Issues in Critical Care Nursing1993; 4(4): 599–602.
40.
RayGL. Advanced practice nursing: The winds of change [commentary]. Journal of Nursing Administration; 25(11): 5–6.
41.
BrownR. Education for specialist and advanced practice. British Journal of Nursing1995; 4(5): 266–268.
42.
GirotEA. Preparing the practitioner for advanced academic study: The development of critical thinking. Journal of Advanced Nursing1995; 21(2): 387–394.
43.
NiebuhrBS. Credentialing of critical care nurses. AACN Clinical Issues in Critical Care Nursing1993; 4(4): 611–616.
44.
FaginCM. Improving nursing practice, education and research. Journal of Nursing Administration1996; 26(3): 30–37.
45.
Standards for educational programs: Preparing students as acute care nurse practitioners.Proceedings of the preparing nurses for advanced practice in acute care consensus conference. AACN Clinical Issues in Critical Care Nursing1993; 4(4): 593–598.
46.
RaschREFraumanAC. Advanced practice in nursing: Conceptual issues. Journal of Professional Nursing1996; 12(3): 141–146.
47.
Ontario Ministry of Health.Nurse practitioners in Ontario: (a) position paper; (b) a new beginning. Toronto: The Ministry; February 1994.
48.
DeaneKA. CNS and NP: Should the roles be merged?Canadian Nurse1997 June:24–9.
49.
ShahHSSullivanDTLattanzioJBruttomessoKM. Preparing acute care nurse practitioners at the University of Connecticut. AACN Clinical Issues in Critical Care Nursing1993; 4(4): 625–629.
50.
HohmanMVanderWoude D. Regulation of advanced nursing practice: One state's approach. AACN Clinical Issues in Critical Care Nursing1993; 4(4): 617–623.
51.
GrecoKE. Regulation of advanced nursing practice. Part one — Second licensure. Oncology Nursing Forum1995; 22Suppl 8: 35–38.
52.
Spencer-CisekPSveningsonL. Regulation of advanced nursing practice. Part two — Certification. Oncology Nursing Forum1995; 22Suppl 8: 39–42.
53.
Medical Act, Chapter 10 of the Acts of 1995–96. An Act Respecting the Practice of Medicine1996; Halifax (NS):Queen's Printer.
54.
SafrietBJ. Impediments to progress in healthcare workforce policy: License and practice laws. Inquiry1994 Fall; 31: 310–317.
55.
MahoneyDF. An economic analysis of the nurse practitioner role. Nurse Practitioner1988; 13(3): 44–52.
56.
MooreSM. Promoting advanced practice nursing. AACN Clinical Issues in Critical Care Nursing1993; 4(4): 603–608.
57.
DiCensoA. The neonatal nurse practitioner. Current Opinion in Pediatrics1998,10: 151–155.
58.
LorensenMJonesDEHamiltonGA. Advanced practice nursing in the Nordic countries. Journal of Clinical Nursing1998; 7: 257–264.
59.
SackettDLSpitzerWOGentMRobertsRS. The Burlington randomized trial of the nurse practitioner: Health outcomes of patients. Annals of Internal Medicine1974; 80(2): 137–42.
60.
ChambersLWWestAE. The St. John's randomized trial of the family practice nurse: Health outcomes of patients. International Journal of Epidemiology1978; 7(2): 153–61.
61.
BrownSAGrimesDE. A meta-analysis of nurse practitioners and nurse midwives in primary care. Nursing Research1995; 44(6): 332–9.
62.
HamricABWorleyDLindebakSJaubertS. Outcomes associated with advanced nursing practice prescriptive authority. Journal of the American Academy of Nursing Practice1998; 10(3): 113–8.
63.
GrimesDEGarciaMK. Advanced nursing and work site primary care: Challenges for outcomes evaluation. Advanced Practice Nursing Quarterly1997; 3(2): 19–28.
64.
WelchH. Nurse midwives as primary care providers for women. Clinical Nurse Specialist1996; 10(3): 121–124.
65.
HopkinsASolomonJAbelsonJ. Shifting boundaries in professional care. Journal of the Royal Society of Medicine1995 July; 89: 364–71.
66.
WojnerAW. Outcomes management: An interdisciplinary search for best practice. AACN Clinical Issues in Critical Care Nursing1996; 7(1): 133–145.
67.
MacFarlaneD. Citizen partidpation in the reform of healthcare policy: A case example. Healthcare Management Forum1996; 9(2): 31–35.
68.
Medical Society of Nova Scotia GP Alternative Remuneration Working Group Report [position paper]. Dartmouth (NS): Medical Society of Nova Scotia; 1995.
