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How Advanced Practice Nurses Are Delivering High-Quality Care Abroad

International AP Ns Advancing Care Abroad 1

Join the community and communicate with your colleagues to help promote patient-centered care across the globe.

In recent years, the role of the advanced practice nurse (APN) has expanded to include providing care to multicultural populations, both in the United States and abroad. It is an exciting time — rife with both challenges and opportunities — as these providers work to improve health care all over the world.

The American Association of Nurse Practitioners® (AANP) is committed to assisting nurse practitioners (NPs) and other APNs from countries where the role is emerging through community engagement and professional funding support. Read the following stories from International APN Ambassador Program recipients to learn about the efforts made to improve care in foreign countries where the NP role has been established, APN care is blossoming or the APN role is just now emerging.

Establishing the APN Role in Slovenia

2022 International APN Ambassador Program recipient Patricija Lunežnik, RN, MS, is a masters-prepared registered nurse (RN) and first-year Ph.D. student at the University of Maribor Faculty of Health sciences. Together with her colleagues, she is researching the APN role in chronic disease management — a field that is just beginning to emerge in Slovenia. By writing guidelines to support the implementation of the APN role within family practices, Lunežnik hopes to help spur the development of the APN role in her country.

At the 2022 AANP National Conference, Lunežnik spoke to AANP about what it meant to be surrounded by so many advanced practitioners. “It’s a great opportunity to explore how advanced practice nursing looks in practice, because back at home we are still developing this role. We have just implemented the first postgraduate master's program for advanced nursing practice, but we don't have the legislation to implement this role yet. So, this is a great opportunity to network and experience advanced practice nursing in the U.S.”

What does the future hold for APN care in Slovenia? Lunežnik shared that she’s “quite ambitious about the future of nursing in Slovenia. Back home, we must spread the word about the APN role, because it's still not recognized yet, and I think since I'm at the beginning of my nursing career that's a mission that I can accomplish during my working years.” Though ambitious, Lunežnik believes the APN role is key to filling health care shortages in Slovenia. We have huge gaps in care, especially in primary care. With the APN role, we can really focus on patient-centered health care so that our communities are treated holistically. I think this is the right way to go.”

Advancing APN Care in Singapore

“In Singapore, we do not call ourselves NPs, but APNs,” stated Wentao Zhou, APN, PhD, Adv Dip Neuroscience, Grad Dip High Edu. “I have a dual role: I teach at the National University of Singapore, and I also practice at the National Neuroscience Institute, where I serve as a specialized neuroscience APN.” Zhou is an associate professor and program director for the Master of Nursing program at Alice Lee Centre for Nursing Studies at the National University of Singapore — the only accredited master’s degree program for APNs in Singapore.

Last year, Zhou discussed the culture shock of her national conference experience. “I went to the Exhibit Hall and realized there were a lot of pharmaceutical and medical equipment companies there. I was surprised to see that NPs have the independent right to reach out to these people and learn about the latest medication and technology to enhance their practice and benefit their patients.” This is in stark contrast with the APN role in her home country. “In Singapore, we don’t really have an opportunity to reach out to all those external parties.”

Despite these differences, APNs in Singapore still provide advanced, patient-centered care. Zhou clarified, “It's not just doing RN duty, but going beyond. Our role weighs heavily on responsibility, accountability, clinical decision-making and critical thinking. We are clinical leaders, so we are role models to our nurses. This part is definitely the same.” This translates to patient advocacy, as well. “We naturally advocate for the patient. But when we advocate, we put ourselves in a vulnerable place, because we have to handle different stakeholders' expectations. We must stand strong for what we know. I believe we need to have a good relationship with our patients and know their needs. By knowing that, we know how we can appropriately advocate for our patient, reach out to the targeted stakeholder and put our opinion on the table.”

Bringing NP Care to the First Nation People of Australia

“The history of NPs started only two decades ago in Australia, whereas [in the U.S.] it's been established since the 1960s,” said Godfrey Cosma Martis Ajgaonkar, BN, MN, MNNP, a cardiology NP at Logan Hospital in Queensland, Australia. His love for making a difference in people's lives led him to become a nurse, while his desire for advanced knowledge led him to become an NP. Sharing his story at the 2023 AANP National Conference, Martis stated, “The barriers are very similar to what the U.S. has, but you have to consider the difference 60 years of recognition in the U.S. versus two decades of recognition makes. We still have a long way to go to make people know what an NP is.”

“I've worked in rural remote communities of Australia. When I'm saying remote, we are very remote. The health care providers that go there often stay for a short term and then they're gone.” As an NP in cardiology who has worked across tertiary, rural and remote hospital settings, Martis’ favorite workplace has been the outback — or as Australians call it, "the Bush.” “These health professionals have a hard time connecting with the First Nation people of Australia because they come work three, four or six weeks, and then they're gone. They never have that time to connect, to know the challenges, to know the barriers, to understand the cultural aspects of what Bush medicine is and what we can provide as health care professionals.”

NPs like Martis often go the extra mile in Australia — working in remote communities with minimal resources to deliver culturally safe care to First Nation people. “I've had that pleasure coming, going and working there as an NP and seeing firsthand the challenges of delivering care and making better outcomes in remote communities of Australia.” During his first trek to care for First Nation patients, Martis quickly learned the key to caring for this population. I was there to deliver cardiac care. But I quickly learned that, even though they've come into a heart failure clinic, their major concern may just be a skin sore. It's a heart failure clinic, but that doesn't matter — they want you to look at that sore. I found that if you look at their priority first, they connect to you. I think that's where NP care differs: we put patients first, we listen, we deliver the care and we take time. That's the connection we build.”

Take Part in the Global Discussion of Health Care

The AANP International Community is a dynamic platform designed to provide an international exchange of ideas and insight as we all grow together providing care to diverse, underserved populations.

Join this growing community and engage with other like-minded NPs with an interest in international advanced practice issues. Take part in interactive discussion and debate; gain support and explore Q&As; and always be on top of the latest available news, education and information.

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