Advancing Nursing Practice: The Emergence of the Role of Advanced Practice Nurse in Saudi Arabia

BACKGROUND

The roots of advanced practice nursing (APN) can be traced back to the 1890s, but the nurse practitioner (NP) emerged in Western countries during the 1960s in response to the unmet healthcare needs of populations in rural areas. These early NPs utilized the medical model of care to assess, diagnose and treat. Nursing has since grown as a profession, with its own unique and distinguishable, holistic, science-based knowledge, which is complementary within the multidisciplinary team. Today, APNs demonstrate nursing expertise in clinical practice, education, research and leadership, and are no longer perceived as "physician replacements" or assistants. Saudi Arabia has yet to define, legislate or regulate APN.

AIMS

This article aims to disseminate information from a Saudi APN thought leadership meeting, to chron.icle the history of APN within Saudi Arabia, while identifying strategies for moving forward.

CONCLUSION

It is important to build an APN model based on Saudi healthcare culture and patient popu.lation needs, while recognizing global historical underpinnings. Ensuring that nursing continues to distinguish itself from other healthcare professions, while securing a seat at the multidisciplinary healthcare table will be instrumental in advancing the practice of nursing.

New Hampshire Nurse Practitioners Take the Lead in Forming an Accountable Care Organization

In 2012, New Hampshire nurse practitioners (NPs), along with Anthem Blue Cross/Blue Shield, formed the first Patient Centered Shared Savings Program in the nation, composed of patients managed by nurse practitioners employed within NP-owned and operated clinics. In this accountable care organization (ACO), NP-attributed patients were grouped into one risk pool. Data from the ACO and the NP risk pool, now in its third year, have produced compelling statistics. Nurse practitioners participating in this program have met or exceeded the minimum scores for 29 quality metrics along with a demonstrated cost-savings in the first 2 years of the program. Hospitalization rates for NP-managed patients are among the lowest in the state. Cost of care for NP-managed patients is $66.85 less per member per month than the participating physician-managed patients. Data from this ACO provide evidence that NPs provide cost-effective, quality health care and are integral to the formation and sustainability of any ACO.

Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential

OBJECTIVES

Many countries are facing provider shortages and imbalances in primary care or are projecting shortfalls for the future, triggered by the rise in chronic diseases and multimorbidity. In order to assess the potential of nurse practitioners (NPs) in expanding access, we analysed the size, annual growth (2005-2015) and the extent of advanced practice of NPs in 6 Organisation for Economic Cooperation and Development (OECD) countries.

DESIGN

Cross-country data analysis of national nursing registries, regulatory bodies, statistical offices data as well as OECD health workforce and population data, plus literature scoping review.

SETTING/PARTICIPANTS

NP and physician workforces in 6 OECD countries (Australia, Canada, Ireland, the Netherlands, New Zealand and USA).

PRIMARY AND SECONDARY OUTCOME MEASURES

The main outcomes were the absolute and relative number of NPs per 100 000 population compared with the nursing and physician workforces, the compound annual growth rates, annual and median percentage changes from 2005 to 2015 and a synthesis of the literature on the extent of advanced clinical practice measured by physician substitution effect.

RESULTS

The USA showed the highest absolute number of NPs and rate per population (40.5 per 100 000 population), followed by the Netherlands (12.6), Canada (9.8), Australia (4.4), and Ireland and New Zealand (3.1, respectively). Annual growth rates were high in all countries, ranging from annual compound rates of 6.1% in the USA to 27.8% in the Netherlands. Growth rates were between three and nine times higher compared with physicians. Finally, the empirical studies emanating from the literature scoping review suggested that NPs are able to provide 67-93% of all primary care services, yet, based on limited evidence.

CONCLUSIONS

NPs are a rapidly growing workforce with high levels of advanced practice potential in primary care. Workforce monitoring based on accurate data is critical to inform educational capacity and workforce planning.

The Evolution of the Role of Nurses: The History of Nurse Practitioners in Pediatric Oncology

The role of nursing has been around since the beginning of time as demonstrated historically by caretakers who have attempted to relieve the suffering of children and of the sick within their community. In the late 1940s, the field of pediatric oncology nursing began emerging, and by the early 1970s, there were 2 pediatric nurse practitioner programs specific for pediatric oncology. The practice strategies for this role include not only directing and providing patient care to children with oncologic diseases but also negotiating the healthcare delivery system, monitoring and ensuring the quality of health care practice, offering family-centered care, and demonstrating cultural competency. In essence, the nurse practitioner role is multifaceted, requiring independent and interdependent decision making and direct accountability for clinical judgment in managing the care of children with cancer and their families.

The long road to full prescribing powers

In 1978, the RCN proposed that nurses should have the authority to prescribe dressings and topical treatments. Almost 40 years later, there are 73, 970 nurse prescribers in the UK, more than 10% of the profession. As the RCN celebrates its 100th anniversary, this article looks at the history of nurse prescribing.

50 years of NP excellence

The nurse practitioner (NP) role is marking its 50th anniversary in 2015. This article explores the history and future of the role by talking with NP thought leaders.

Modifying State Laws for Nurse Practitioners and Physician Assistants Can Reduce Cost Of Medical Services

"Bending the cost curve" for health care services in the United States challenges policymakers. A cost analysis was undertaken based on what would occur if more physician assistants (PAs) and nurse practitioners (NPs) per capita were deployed over a 10-year period. The State of Alabama was used as a case study because it is one of a handful of U.S. states with restrictive legislation impacting the scope of practice of PAs and NPs. Changing PA and NP scope of practice legislation in Alabama to match states in the upper quartile of collaborative legislation such as Washington and Arizona would increase the employment and distribution of PAs and NPs. Even modest changes in legislation will result in a net savings of $729 million over the 10-year period. Underutilization of PAs and NPs by restrictive licensure inhibits the cost benefits of increasing the supply of PAs and NPs and reducing the reliance on a stagnant supply of primary care physicians in meeting the needs of its citizens.

Mental health nursing in New Zealand primary health care

International literature and New Zealand health policy is giving increased emphasis to the role of the primary health care sector in responding to mental health issues. These issues include the need for health promotion, improved detection and treatment of mild to moderate mental illness, and provision of mental health care to some of those with severe mental illness who traditionally receive care in secondary services. These developments challenge specialist mental health nurses to develop new roles which extend their practice into primary health care. In some parts of New Zealand this process has been under way for some time in the form of shared care projects. However developments currently are ad hoc. There is room for considerable development of specialist mental health nursing roles, including roles for nurse practitioners in primary mental health care.

Duty hour restrictions: organizational dynamics, systems issues, and the impact on faculty

The potential impact of resident duty hour restrictions on faculty is likely significant; however, the extent of this impact has still not been well documented. We undertook a narrative review of the literature to determine the magnitude of that potential impact and the nature of the evolving discourse related to faculty members as individuals. The literature provides an inconsistent picture of the impact of duty hour restrictions on faculty. While some studies have reported a significant increase in faculty workload, others suggest that the impact of duty hour restrictions has been minimal. Some papers suggest that duty hour restrictions may fundamentally change the nature of resident-teacher interactions and, as a result, will necessitate significant changes to the way education is delivered. Overall, the majority of issues of concern relate to one of the following: volume and composition of work, impact on faculty career choice, evolving perceptions of residents as learners, and the need to find an appropriate balance between learning and the quality and quantity of patient care. In describing these themes we identify some potential solutions and future directions for reconciling duty hour restrictions with faculty perceptions, anxieties, and desired outcomes.

Understanding advanced nursing practice

Articles published in Nursing Times in 2012 presented the role of the advanced nurse practitioner as an extension into the territory of junior doctors in response to pressures in healthcare resources. This article traces the history of advanced practice and suggests that a more appropriate model, post Francis report, should focus on fundamental skills and core nursing values. Rather than attempting to plug a gap created by a shortage of doctors by developing medical skills, nurses should value and promote advanced nursing practice, which is driven by patients' needs for the care that doctors are unable and unskilled to provide.