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Several subgroups of the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN) have periodically analyzed APN (nurse practitioner and clinical nurse specialist) development around the world. The primary objective of this study was to describe the global status of APN practice regarding scope of practice, education, regulation, and practice climate. An additional objective was to look for gaps in these same areas of role development in order to recommend future initiatives. An online survey was developed by the research team, and included questions on APN practice roles, education, regulation/credentialing, and practice climate. The study was launched in August 2018 at the 10 Annual ICN NP/APNN Conference in Rotterdam, Netherlands. Links to the survey were provided there and via multiple platforms over the next year. Survey results from 325 respondents, representing 26 countries, were analyzed through descriptive techniques. Although progress was reported, particularly in education, results indicated the APN profession around the world continues to struggle over titling, title protection, regulation development, credentialing, and barriers to practice. APNs have the potential to help the world reach the Sustainable Development Goal of universal health coverage. Several recommendations are provided to help ensure APNs achieve these goals.

Advanced practice nursing roles are developing globally, and opportunities for advanced practice nursing are expanding worldwide due to the need for expert nursing care at an advanced level of practice. Yet it is well recognized that barriers exist with respect to APRNs being able to practice to the full extent of their education and training. Addressing barriers to APRN practice worldwide and ensuring that APRNs are able to practice to the full extent of their education and training can help to promote optimal role fulfillment as well as assessment of the impact of the APRN role.

The aim of this pilot study was to test the feasibility of a clinical trial to evaluate the impact of an advanced practice nurse (APN) intervention on blood pressure (BP) control versus usual care in hypertension management, and to provide initial trends. This pilot study was designed as a prospective, open‐label, randomized 1:1, controlled, and monocentric superiority trial, conducted in a French‐labeled European Society of Hypertension excellence center. The APN intervention consisted of an in‐depth therapeutic education and an assessment of therapeutic strategies with adjustments if needed. The study sample included 437 participants (n = 229 in the experimental group; n = 208 in the “usual care” group). Considering the selection bias identified for baseline systolic BP, statistical analyses were adjusted on this parameter. The APN intervention significantly reduced adjusted systolic BP in the experimental group compared with the “usual care” group (−2.72 mm Hg, p = 0.04) and showed a trend toward a decrease in adjusted diastolic BP (−1.85 mm Hg, p = 0.07) and improved BP control with the APN intervention (−8.5%, p = 0.08). The experimental group was significantly more likely to adhere to the HBPM protocol compared with the control group (OR = 1.82, 95% CI [1.22–2.71], p = 0.003). This pilot study confirmed the feasibility of the clinical trial and offered the first data about APNs in hypertension management in France. Initial significant or borderline significant results are encouraging and suggest the benefit of an APN intervention on BP control in hypertension management. Further studies are needed to confirm these results. Trial registration: This clinical trial was registered on ClinicalTrials platform (NCT06227884).

Purpose: To describe international trends on the developing role of the nurse practitioner‐advanced practice nurse (NP‐APN), including nomenclature, levels and types of NP‐APN education, practice settings, scope of practice, regulatory policies, and political environment. Design: A cross‐sectional, descriptive Web‐based survey sent in February and March 2008 to a total of 174 key informants and active members of the International Nurse Practitioner‐Advanced Practice Nursing Network of the International Council of Nurses. Methods: An international Web‐based survey preceded by a pilot survey. Findings: Ninety‐one nurses from 32 countries responded. Thirteen titles were identified on nomenclature for the NP‐APN in different countries. NP‐APN education was available in 71% of the 31 countries responding to this item, with 50% identifying the master's degree as the most prevalent credential. Twenty‐three countries had formal recognition of the NP‐APN role. Of these, 48% had licensure maintenance or renewal requirements for the NP‐APN, with most requiring continuing education or clinical practice. The greatest support for the NP‐APN role came from domestic nursing organizations (92%), individual nurses (70%), and the government (68%), while opposition came primarily from domestic physician organizations (83%) and individual physicians (67%). Conclusions: Interest in the NP‐APN role has been gaining ground worldwide. This study presents a snapshot of education, practice, and regulation for NP‐APNs as they develop their unique role in delivering health care in various countries. Areas that may require more support are highlighted. Clinical Relevance: The NP‐APN role in healthcare systems is expanding and will benefit from international networking and support.

Background . According to projections based on current trends, it can be anticipated that from 2024 onward, approximately 70% of all cancer cases will be diagnosed in individuals 65 years and older. Given this complex intersection between population ageing and cancer incidence, it is of great importance to address this issue from a comprehensive care perspective. Here comes the importance of advanced practice nurse into play. However, this figure is still not sufficiently valued in many countries. Its roles are also not clearly defined at the international level. For this reason, a systematic review of the scientific literature was carried out to analyze the impact of advanced practice nurse on the quality of life of older adults with cancer. Methods . Searches were carried out in PubMed, Web of Science (WoS), Scopus, CINAHL, LILACS, and ScienceDirect databases. They were limited to studies conducted in the last 7 years. Only open‐access articles were selected. To analyze the chosen articles and assess their quality, the criteria of the PRISMA and CASPe statements were applied. All authors participated in both the selection of the articles and their analysis. Results . Of the initial 58 articles selected, a total of 10 articles were finally included, as they met the eligibility criteria established after further analysis. The results show a positive relationship between the advanced practice nurse intervention and quality of life in older adults with cancer. Conclusions . Advanced practice nurse (APN) plays a key role in the care of older adults with cancer, significantly improving their quality of life and contributing to the comprehensive care of these patients. The findings evidenced in this work support the integration of APNs in cancer care teams to improve patient experience and overall well‐being.

Advanced practice nursing (APN) and advanced practice midwifery (APM) in Kenya are critical in healthcare system strengthening by expanding access to quality care, particularly in underserved regions. Globally, the International Council of Nurses (ICN) defines APN as a level of nursing practice that requires a minimum of a master's degree, along with advanced clinical training and competency. Similarly, APM involves midwives with advanced training to provide specialized maternal and neonatal care. In Kenya, the APN and APM concepts were launched in 2020 and are still nascent, and their practice is determined by the context as provided by the country credentialing the practice. Despite the strides made in developing the advanced roles, there is an eminent gap in understanding stakeholders' perceptions of the roles, scope of practice, and regulation. To explore stakeholders' perceptions of the roles and regulations of APN and APM in Kenya. An exploratory qualitative study was undertaken as part of a larger formative research conducted between January 2022 and November 2023, utilizing a multimethod design that included a gap analysis of the scopes of practice for APN and APM in Kenya. Data collection was conducted among purposively sampled participants using a total of 7 focus group discussions (FGDs), with three of them conducted among 14 APN and APM students and 4 FGDs among 16 members of the Kenyan-based nursing and midwifery associations. Seven key informant interviews (KIIs) were also held with 2 medical doctors (OBGYN), two faculty, and 3 students (practicing APN). A thematic analysis approach was employed, and reporting was done according to the Standards for Reporting Qualitative Research. Participant's perspectives were reflected in 5 themes: definition of APN/APM and scope; entry qualifications into APN/APM practice; roles of APN/APM; barriers to enacting APN/APM roles; the national policy and regulatory landscape for advanced practice roles. There were varied viewpoints on how APNs/APMs are defined in the Kenyan context. Similarly, views on the entry level qualifications into APN/APM were diverse. Many participants emphasized the importance of licensure, autonomy of practice, ability to manage patients independently, training, and competency. Well-defined policies and regulations can create an enabling environment for practice.

The World Health Organization (WHO) called for the expansion of all nursing roles, including advanced practice nurses (APNs), nurse practitioners (NPs) and clinical nurse specialists (CNSs). A clearer understanding of the impact of these roles will inform global priorities for advanced practice nursing education, research, and policy. To identify gaps in advanced practice nursing research globally. A review of systematic reviews was conducted. We searched CINAHL, Embase, Global Health, Healthstar, PubMed, Medline, Cochrane Library, DARE, Joanna Briggs Institute EBP, and Web of Science from January 2011 onwards, with no restrictions on jurisdiction or language. Grey literature and hand searches of reference lists were undertaken. Review quality was assessed using the Critical Appraisal Skills Program (CASP). Study selection, data extraction and CASP assessments were done independently by two reviewers. We extracted study characteristics, country and outcome data. Data were summarized using narrative synthesis. We screened 5840 articles and retained 117 systematic reviews, representing 38 countries. Most CASP criteria were met. However, study selection by two reviewers was done inconsistently and language and geographical restrictions were applied. We found highly consistent evidence that APN, NP and CNS care was equal or superior to the comparator (e.g., physicians) for 29 indicator categories across a wide range of clinical settings, patient populations and acuity levels. Mixed findings were noted for quality of life, consultations, costs, emergency room visits, and health care service delivery where some studies favoured the control groups. No indicator consistently favoured the control group. There is emerging research related to Artificial Intelligence (AI). There is a large body of advanced practice nursing research globally, but several WHO regions are underrepresented. Identified research gaps include AI, interprofessional team functioning, workload, and patients and families as partners in healthcare. CRD42021278532.

Aim. To explore the perception of executive nurse leaders regarding the implementation of advanced practice nursing in Saudi Arabia. Design. An exploratory, descriptive, and qualitative design was used. Methods. Purposive sampling was used to recruit chief nurse officers and executive nurse directors from government, private, and military health systems in tertiary, secondary, and primary settings. Data were collected from July to November 2022 using virtual semistructured interviews, which were recorded and transcribed. Thematic analysis was conducted manually. Results. Eleven participants were included in the study. The following themes were identified: unique characteristics of advanced practice nursing, impacts of advanced practice nursing in nursing profession, challenges to utilize the advanced practice nursing roles, opportunities to foster the proper implementation of advanced practice nursing, and recommendations to move forward with fitting advanced practice nursing in Saudi health system. Participants characterized advanced practice nursing as specialized, advanced, and autonomous and reported that it increases access to care, provides efficient and cost-effective care, and expands nursing career pathways. The lack of job description, fragmentation of implementation efforts, lack of training programs, and resistance from physicians, nurses, and patients hinder its implementation. The Saudi Vision 2030, gaps in health care, the growing population, and the familiarity of the healthcare system with advanced practice nursing were viewed as opportunities. The following subthemes emerged under recommendations: establish, train, and implement. Conclusion. Executive nurse leaders perceived advanced practice nursing as a promising initiative to improve healthcare delivery and the nursing profession. Several opportunities make “now” the right time to implement it.

Management of critically ill patients is changing due a rise in population age, comorbidity and complexity. To accommodate these changes, the demand is increasing for advanced practice nurses. More knowledge is needed regarding the role of advanced practice critical care nurses in European countries. The aim of the study was to review the literature describing skills and competencies required for advanced practice critical care nursing in Europe and to investigate related policy. We performed a scoping review including papers published in 1992–2019 targeting policy and the intersection of advanced practice nursing (level of practice), critical care nursing (specialty area) and Europe (geographical origin). Main sources of evidence were PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, SweMed+, Scopus, ERIC and Social Sciences Citation Index. We also searched grey literature, webpages, reference lists and performed hand-search. The search identified 11,478 papers/references of which 42 were included. Four levels of practice were identified with unclear boundaries: professional nurse, specialized nurse, advanced practice nurse and advanced critical care practitioner (nurse or other). Most skills and competencies described in the literature were generic to advanced practice and only few were area specific to critical care. Advanced practice critical care nurses were often unable to fulfil their role because education, supportive policy and legislation were lacking. This scoping review informs the policy makers and the INACTIC study of existing advanced practice in critical care nursing in Europe. The advanced role in critical care nursing is characterized by inconsistency regarding policy, education, titles, roles, scope of practice, skills and competencies. Levels of practice and areas of specialization need to be clarified. Most skills and competencies identified were generic for advanced practice nursing and many were generic for any profession. Task-shifting from physician to nurse needs to be more clearly defined and patient outcomes described. Given the scarcity of papers in our target area, we believe it might be too early to conduct a systematic review at this time.