A. Background
The nursing profession has evolved with the advancements in technology, evidence-based research and new care options, and the increasing and changing health needs of the patients and citizens of Europe require nursing to take the leadership on advanced practice roles to support safe and effective health service delivery.
To meet this demand nurses have advanced their education and practice to deliver innovation and lead change. Interprofessional care is becoming more important with a strong focus on professional collaboration, which opens opportunities for nurses to advance and contribute their expert knowledge and practice to improve safe and effective care. It is important for nurses to achieve higher levels of education and training to support the development of new and advanced nursing roles with greater professional autonomy.
It is evident that the role of nurses is advancing rapidly and needs to be guided within a framework to evolve the new scope of advanced practice based on evidence and lessons learnt from similar contexts. Advanced nursing roles will positively contribute to the ambition of the European Pillar of Social Rights.
B. Some key developments
1. EFN Working Group on Advanced Practice Nursing
Believing on the importance of the Advanced Practice Nursing (APN) for the delivery of positive health outcomes, the EFN has been committed to ensuring the nursing profession evolves effectively in response to patient needs and care demands. Examples of this include the EFN Workforce Matrix 3+1, and the EFN Working Group on APN dedicated to advance practice developments, created in 2018, and constituted by EFN members representatives from the following countries NNAs: Austria, Belgium, Croatia, Cyprus, Estonia, Finland, Italy, Luxemburg, Norway, Portugal, Spain, Sweden, Switzerland, and United Kingdom (Chair).
2. Evidence-based data
Evidence-based data and an EFN Policy Statement on APN was seen as essential for the EFN members to advance the developments at national level and to guide the EFN in lobbying the EU institutions. As such, in 2021, the EFN Working Group undertook a mapping exercise of current Advanced Practice Nursing (APN) frameworks across Europe, collecting data from the 35 EFN Members countries, that is now being analysed and should soon be published as a meta-analysis, and which identified a significant level of variation in how those countries that reported having an APN framework defining what an APN means and how it is regulated at education and practice level.
The EFN Members fed back on 60 items, concerning key features of advanced practice nursing, with a view to mapping existing developments and understanding state of the art. The aim was to update and consolidate the EFN Members’ work on advanced practice nursing over the years, intending to assess progress to date and identify avenues for future efforts to focus on developing standardisation of advanced nursing practice across Europe. The report uncovered a high level of variation in how implementation has taken place across the 20 EFN member countries which reported having an established APN framework. This goes from the definition adopted by the country to the level of training required to qualify and practice as an Advanced Practice Nurse. For instance, only 14 of the 20 countries with an established APN framework adhere to the definition provided by the International Council of Nurses, with the rest either adopting the EFN ‘Workforce Matrix 3+1’ definition or developing their own definitions of APN. Furthermore, only 11 countries out of the 20 EFN members with an APN framework reported the existence of a law establishing minimum educational requirements to qualify as an advanced practice nurse. These requirements, however, vary significantly amongst countries. For instance, in some countries, the minimum requirement is a master’s degree whereas in others the requirement is a postgraduate certificate or a diploma, which are both below a master’s degree level. The same level of variation was observed for educational pre-requisites needed to begin APN education and as well as for number of ECTS credits required to progress from a general nursing degree to APN. Some countries reported that the level of education needed to qualify as a Nurse Practitioner, or a Clinical Nurse Specialist is consistent with advanced practice nursing level.
The Working Group is further investigating the design models of APN that work in different contexts and the potential impact of a standardised regulatory framework on current qualified advanced practice nurses across Europe.
3. Revised EFN Workforce Matrix 3+1, especially the development of APN in the EU and Europe (June 2023)
Based on the survey and analysis of the Data collected by the EFN Working Group APN, led by Wendy Preston (RCN), the EFN Members endorsed the APN core competencies and the APN Country specific principles at the April 2023 EFN General Assembly, in Croatia. The Updated EFN Workforce Matrix 3+1 category on APN can he found here.
4. EFN Policy Statement on APN
As stated in EFN Workforce Matrix 3+1, APN has a key role to play in building the resilience of the health and care system in the EU and Europe. As such, in the EFN Policy Statement on Advanced Practice Nurse, approved by the April 2022 EFN General Assembly (Read it here), the EFN is calling upon the EU Institutions and other health stakeholders to join efforts and make rapid progress in developing advanced practice nursing in the EU and Europe by:
- Promoting evidence-based nursing, patient safety, universal health coverage (UHC), sustainable development goals (SDGs), high quality care, nurse retention and recruitment by fostering APN roles in EU area;
- Facilitating member states to develop nationally agreed-upon, as a minimum, master’s level standards for preparation programmes for advanced practice nursing;
- Facilitating member states to establish formal recognition and licensing (protected title) of APN nurses at the national level; and
- Exploring the potential for a European framework for advanced practice nursing, that can be used at national level to enable regulation, mobility, national and international comparison, cooperation in research and development and sharing of expertise.
With Europe fighting its way out of the COVID-19 pandemic, it is important to remember that making timely progress in the development of advanced practice nursing will rely on genuine collaboration between policymakers, educators, employers, and frontline nurses to ensure that any initiatives are fit for purpose. Engaging frontline staff and advanced practice nurses will be fundamental to the journey forward.
5. EFN article on “Advanced practice nursing in long-term care”
Skills empowerment is key for nurses, especially linked to the APN in long-term care. Investing in advanced roles for nurses, with special regard to the APN and nurse prescribers, will positively increasing access to healthcare services for EU citizens. An advanced role with the appropriate skills-mix, will future proof the design of an effective, responsive, dynamic and sustainable frontline workforce composition, as set out in the EFN Workforce Matrix 3+1. Based on the survey findings, the EFN wrote an article entitled “Advanced practice nursing in long-term care”, providing insights into the EU’s advanced practice nursing in long-term care. Read it here.
6. EFN Short-Medium-Long Term APN Strategy/Work Plan
Taking their work further, the EFN WG on APN, presented at the EFN October 2022 General Assembly, in Slovenia, a Short-Medium-Long Term APN Strategy/Work Plan, looking respectively at educational, workforce and quality & safety aspects, that the EFN members discussed and approved medium/long-term strategy. (Not available to the public)
7. Roadmap on APN
The next step in this APN development process is to have a roadmap toward developing APNs, likely to be of special value to those countries wishing to establish or further develop APNs. The EFN Working Group on APN has now prepared a first draft Roadmap, including some examples on culture, practice and legislation change, that will be discussed by the EFN members at the EFN October General Assembly, taking place in Spain.