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A landmark event happened in the last few weeks in the international advanced practice nursing (APN) world; however, most of us haven’t heard much about it, as it’s been eclipsed right now, like many things, because of COVID-19. The International Council of Nurses (ICN) based in Geneva, Switzerland, which represents and guides nursing worldwide, has published the first ever Guidelines on Advanced Practice Nursing 2020 that promotes and supports development for APN and firmly establishes the APN roles internationally.
What’s the big deal? While ICN has published APN documents in the past, nothing of this scope and potential magnitude has ever been released. Globally, there is still a lot of confusion regarding APN roles. There is an enormous, very diverse range around the world of what’s considered APN and also what’s required. For example, this disparate cacophony ranges from countries with diploma RN-educated nurses that are considered nursing specialists, and even as nurse practitioners (NPs), all with various scopes of practice — which we in the U.S. would not consider advanced practice — to other countries that only have non-practice-based senior nursing administrators and nursing educators or researchers designated as advanced practice specialists.
More and more, countries and nursing communities around the world are struggling to better understand and develop the APN roles. Recognizing the need for nursing to advance globally and take on a larger role in providing health care, ICN has not only recognized but legitimized the roles of the NP and clinical nurse specialist (CNS) on the world stage. In publishing these guidelines, it has finally set the bar for APN, as well as provided its “blessing” and a road map for global APN development, uptake and utilization.
In a nutshell, the 38-page Guidelines on Advanced Practice Nursing published by ICN in April 2020 designates, for the first time, CNSs and NPs as the two roles primarily comprising APN internationally. The publication goes on to provide guidelines for the description, scope of practice, education and professional standards recommended for each of the two roles with the intent to assist and promote their development internationally. Note that there is an ICN Nurse Anesthesia Guidelines document currently in progress that will also appear as part of the ICN APN series.
AANP Fellow and recent 2020 Lorretta C. Ford Award recipient Dr. Madrean Schober was integrally involved in crafting the guidelines as its lead author, so I’ve tapped her to give us some insight into the process. First, in case you were wondering how she became lead author, Dr. Schober is no stranger to international APN development and has an impressive array of international accomplishments over more than 25 years. She has assisted, consulted and worked as an expert on the APN role in Pakistan, Oman, Ireland, Singapore, Bahrain and Hong Kong, including an ICN Fellowship in six countries. Additionally, she has presented and published extensively, including numerous articles and several books about international APN.
Back to the two-year process of drafting the guidelines, Dr. Schober related that ICN felt it was important to involve all member countries in a consensus, and as such, the authors went to great lengths to ensure that the document was representative and useful for all. There were eight contributing international authors and 36 expert nursing reviewers representing every continent and global region collaborating on the document. As expected, there were many document drafts and revisions. The drafts were reviewed, revised and received input multiple times by the ICN Executive Committee, the ICN Board of Directors and the more than 130 worldwide national nursing organizations of the ICN until receiving final approval. Talk about patience, but it was worth it.
As Dr. Schober related, it is crucial that the nursing community outline its own guidelines for advanced practice rather than governments and other professions stipulating them, as has happened too often in the past. This will be a game changer, and we hope to see a huge development or shift in development of both the NP and the CNS roles around the world. ICN maintains links with the World Health Organization (WHO), nongovernmental funders, regulatory bodies and government agencies. Although, here in the U.S., we don’t hear much about ICN, globally when ICN talks, the rest of the world pays attention. Let’s hope so!
"Our hope is that through the development of these guidelines, some of the barriers and walls that have hindered the nursing profession can be torn down. These guidelines will hopefully support the profession, enable a clearer understanding and assist in the continual evolution of APN. People around the world have the right to quality, safe and affordable health care. Advanced Practice Nurses are one of the solutions to making this happen." — Annette Kennedy, ICN President, and Howard Catton, ICN Chief Executive Officer.