Advanced practice nurse roles in Europe: Implementation challenges, progress and lessons learnt

John Unsworth*, Karen Greene, Parveen Ali, Gro Lillebø, Doina Carmen Mazilu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Background: Advanced Practice Nursing (APN) roles offer improved access to care, and increased quality and more timely care. Despite the advantages of APN roles, there is a disparity between European countries when it comes to implementing APN roles.
Aim: To explore the implementation of advanced practice nursing roles in a range of European countries and to explore what factors facilitate or hinder the implementation of these roles.

Methods: A case study evaluation of the process of implementing APN roles. The sample included four countries where APN roles were well-developed (Ireland, Spain, Norway, and the United Kingdom) and four where APN roles were implemented (Estonia, Slovenia, Cyprus, and Romania). Interviews were conducted with key informants (n = 28) from government departments, regulatory bodies, Nursing Associations, and Universities. The COREQ Consolidated criteria for reporting qualitative research has been used throughout.

Limitations: The small number of countries when considering the size of the region and key informants representing the view of only 3-4 people in each country.

Results: Four themes were identified including the rationale for the development of the roles, influence, the evolutionary nature of role development, and evidence. The data also revealed a mismatch between the perceptions of how the roles develop among the different countries in the early stages of implementation.

Conclusion: Successful role implementation is dependent upon a tripartite approach between managers, practitioners, and educators. An evolutionary approach to role development was used. Regulation and policy come later on in the process of implementation.

Implications for nursing policy: APN policy should be based on patient need rather than on the workforce or professional imperatives. The process of implementation can take 15-20 years in total. Recognising the importance of the relationships between service managers and educators is key to the early development of these roles.
Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalInternational Nursing Review
Early online date12 Sept 2022
Publication statusE-pub ahead of print - 12 Sept 2022


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