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Factors enabling advanced practice nursing role integration in Canada.
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:211-38
Publication Type
Alba DiCenso
Denise Bryant-Lukosius
Ruth Martin-Misener
Faith Donald
Julia Abelson
Ivy Bourgeault
Kelley Kilpatrick
Nancy Carter
Sharon Kaasalainen
Patricia Harbman
Author Affiliation
CHSRF/CIHR in Advanced Practice Nursing, Ontario Training Centre in Health Services & Policy Research, McMaster University, Hamilton, ON.
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:211-38
Publication Type
Advanced Practice Nursing - manpower - organization & administration
Decision Support Systems, Clinical
Delivery of Health Care - manpower - organization & administration
Education, Nursing, Continuing
Focus Groups
Great Britain
Health Care Surveys
Health Policy
Interprofessional Relations
Nurse Clinicians - organization & administration - supply & distribution
Nurse Practitioners - organization & administration - supply & distribution
Personnel Turnover
Primary Health Care - organization & administration
United States
Although advanced practice nurses (APNs) have existed in Canada for over 40 years and there is abundant evidence of their safety and effectiveness, their full integration into our healthcare system has not been fully realized. For this paper, we drew on pertinent sections of a scoping review of the Canadian literature from 1990 onward and interviews or focus groups with 81 key informants conducted for a decision support synthesis on advanced practice nursing to identify the factors that enable role development and implementation across the three types of APNs: clinical nurse specialists, primary healthcare nurse practitioners and acute care nurse practitioners. For development of advanced practice nursing roles, many of the enabling factors occur at the federal/provincial/territorial (F/P/T) level. They include utilization of a pan-Canadian approach, provision of high-quality education, and development of appropriate legislative and regulatory mechanisms. Systematic planning to guide role development is needed at both the F/P/T and organizational levels. For implementation of advanced practice nursing roles, some of the enabling factors require action at the F/P/T level. They include recruitment and retention, role funding, intra-professional relations between clinical nurse specialists and nurse practitioners, public awareness, national leadership support and role evaluation. Factors requiring action at the level of the organization include role clarity, healthcare setting support, implementation of all role components and continuing education. Finally, inter-professional relations require action at both the F/P/T and organizational levels. A multidisciplinary roundtable formulated policy and practice recommendations based on the synthesis findings, and these are summarized in this paper.
PubMed ID
21478695 View in PubMed
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