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November 2023
ICN NP/APN Network Bulletin November 2023
Editor: Colette Henderson RN, NISP, RNT, MSc, BSc (Hons) NP, FHEA
Welcome to the November Network Bulletin
A very warm welcome to the ICN NP/APN November 2023 Network bulletin.
In this month’s edition we report back from an amazing ICN Congress in Montreal in July! The Network was delighted to raise the profile of Advanced Nurse Practice globally, with many thought-provoking discussions with global colleagues.
Inside this bulletin you will find details about the next ICN NP/APN Network conference in Aberdeen, Scotland in 2024 on page 3, where we have shared some of the details about the progress of this conference development. The Network is pleased to congratulate some of our members on achieving a Legacy Award from the Executive Committee of the Fellows of the American Association of Nurse Practitioners (FAANP) (page 4) and international advanced practice features on pages 5-12. We have details of advanced practice nurse developments from China, Rwanda and Finland.
We look forward to seeing many colleagues and friends at the ICN NP/APN network conference in September 2024! We hope you enjoy reading this bulletin! Please consider contributing to the bulletin and raising the profile of the work you are doing. If you are interested in contributing, please contact the editor: Colette Henderson
Table of Contents
Welcome to the November Network Bulletin 1
ICN Congress Montreal 2023 2
Save the date! 3
Congratulations from the Network 4
The gap between education and practice: the experience of Nurse Practitioners in China 5
Implementation strategies for safer administration of look alike, sound alike medication at the University Teaching Hospital of Kigali, Rwanda 7
Finland - Promoting advanced practice nursing through national collaboration 9
Research Study
ICN Congress Montreal 2023
ICN Congress 2023 Nurses together: a force for global health
The NP/APN network shared a booth with the ICN and held several discussions during congress. The sessions of particular interest to advanced practice nurses, included Policy Cafés, one on 2 July on Certification of Specialized Practice for APNs, and another two Policy Cafes on 5 July: ‘APN Guidelines for Nurse Anesthetists’ and ‘Pool of Nursing Experts Policy Café’ where CGNC certified Global Nurse Consultants including our Chair Dr Daniela Lehwaldt shared notes on Leadership and global practices. A Symposium on 3 July related to APN Research, Leadership and the UN SDGs in Action; and a Symposium on 4 July on the Certification of APNs.
Image 1: Members of the ICN NP/APN network at the ICN booth - ICN Congress Montreal 2023
Save the date!
We hope to see many colleagues at the ICN NP/APN Network Conference Congress in Aberdeen, 9-12 September 2024. Visit the website to find out more about this event: NP/APNN 2024
Work is underway to develop the ICN NP/APN Network conference and full details about the developments including the programme and details about abstract submission can be found on the website. We look forward to welcoming you to Scotland!
Congratulations from the Network
A few of our alumni (Lorna and Joyce) will be recognized at the AANP National conference in June with the Legacy Award.
The Executive Committee of the Fellows of the American Association of Nurse Practitioners (FAANP) is pleased to announce the recipients of the 2023 Legacy Award. The FAANP Legacy Award honours, recognizes and memorializes a member of FAANP whose lifelong career has had a profound and enduring impact on the profession and the NP role, articulating a dream that others share and follow. The vision, innovation, courage, persistence, and inspiration of the honorees are essential components of the legacy. The 2023 FAANP Legacy Awardees are:
Joyce Pulcini, PhD, PNP-BC, FAANP, FAAN
Dr Pulcini is a professor emerita at George Washington University. She is an expert in primary care practice and advanced practice nursing policy nationally and internationally and has directed NP programmes at several universities. Her research focuses on the evolving nursing roles and education of nurse practitioners nationally and internationally and removal of barriers to NP practice. Dr Pulcini is the 2019 Towers Pinnacle Award recipient. Her scholarship includes more than 80 peer reviews publications, including her 2020 book with Dr Susan Hassmiller, entitled Advanced Practice Nursing Leadership: A Global Perspective.
Lorna Schumann, PhD, FNP-C, ACNP-BC, ENP-C, ACNS-BC, FAANP, FAAN
Dr Schumann is a recognized clinical expert in family practice and acute care. Her clinical expertise is varied and includes inpatient and outpatient work covering the full array of clinical conditions. She currently works in a homeless clinic. Dr Schumann is also involved in the education of nurses and nurse practitioners in countries without adequate health resources. She has worked in Crimea, Ukraine, Egypt, Liberia, Burundi, Ecuador, Honduras, Guatemala, India, Thailand, and Vietnam and is enthusiastic about helping people in countries that lack resources for health care and health education.
The gap between education and practice: the experience of Nurse Practitioners in China
Authors: Rongsong Tang1, Jingpin Wang1, Baohua Li1, Mingzi Li2 Affiliations: 1. Department of Nursing, Peking University Third Hospital, Beijing, China; 2. School of Nursing, Peking University, Beijing, China.
Background
Nurse practitioners (NP) have become an important part of Global Healthcare System and in November 2022 there were more than 355,000 nurse practitioners in the USA. Previous studies showed that an NP presented similar outcomes and was more economical relative to medical doctors. Peking University introduced the first NP master’s degree programme in 2017 in response to the lack of general practitioners (GP) in primary care settings of China. The first NP graduates from this programme have practiced for nearly three years now.
Objectives
To explore the gap between the education and practice of NP’s and identify methods to reduce variance.
Methodology
This is a case report study of the first NP graduates from Peking University.
Findings
The three-year Master level education programme was designed mainly according to the international standards of NP education and the Master level training programme of GP of Peking University, including theoretical courses and clinical practice. Theoretical courses included general courses and NP-related courses. And clinical practice was a 24-month training programme consisting of nursing practice and medical practice with a time ratio of 1:1. The purpose of nursing practice and medical practice is to teach students regular nursing care skills through nursing rotation, the diagnostic and therapeutic skills through residency-like clinical rotations, respectively.
However, up to now in China the diagnosing and prescribing rights are just given to physicians, which means NPs cannot practice as they expected and trained. Therefore, as a matter of fact, NP graduates had to play the roles similar as clinical nurse specialists. Given the insufficient clinical practice experience of the new NP graduates, they received one year training in a specialized nursing practice. After that they started their attempt to build new service modes of NP practice. One NP has been working at a tertiary hospital. She implemented inpatient consultations, conducted whole-hospital blood glucose management and provided diabetes case management at outpatient clinic with the function of assessing patients' diabetes management behaviors and the levels of glycemic control, administering lifestyle interventions, and referral those who needs to endocrinologist. Another NP has been working at a community hospital affiliated to the tertiary hospital, conducting patients’ assessment, patients’ managements, lifestyle intervention and transfer treatment to GP via diabetes case management clinics. Meanwhile, she made health records and followed the patients with chronic diseases living in the community.
Image 1: NP providing case management
Image 2: NP providing inpatient consultation.
Figure 1: The workflow for an NP conducting whole-hospital blood glucose management.
Conclusion and recommendations
The main gap between education and practice of NP in the first master’s degree programme may be that too much emphasis was paid to diagnosis and treatment ability education while in the practice setting the NP role is more like a CNS. The specialized nursing training in the NP programme needs to be strengthened.
The significance of the study specifically for advanced practice nursing
Relevant laws and regulation rules relating to APN practice are crucial not only to practice, but also education. At the infant stage of NP education and practice, clinical needs and practice feasibility should be particularly considered to obey the running laws and regulation rules.
References
America Association of Nurse Practitioners (2022). NP fact sheet. [2023-04-25]. http：//www.aanp.org/about/all-about-nps/np-factsheet.
Liu CF, Hebert PL, Douglas JH, Neely EL, Sulc CA, Reddy A, Sales AE, Wong ES (2020). Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care. Health Serv Res. Apr;55(2):178-189.
Tang RS, Lu Y, Jiang H, Jiang XJ, Zhou N, Li MZ, Shang SM (2020). Current situation and enlightenment of practicing and prescribing rights of practicing nurses [J].Chinese Journal of Nursing, 55(05):796-800.
Implementation strategies for safer administration of look- alike, sound-alike medication at the University Teaching Hospital of Kigali, Rwanda
Author: Valens Musengamana, RN, MScN
Background
Patient safety is a serious global public health concern. The cost of medications error is estimated at 42 billion USD annually worldwide. Adverse drug events appear to be a leading cause of injury in high-, middle- and low-income countries. Confusions involving look-alike/ sound-alike (LASA) drug names continue to threaten patient safety. The aim of the project was to implement strategies to prevent medication errors and promote patient safety at Kigali University Teaching Hospital in the pharmacy department.
Methodology
A checklist was developed in order to evaluate the implementation of LASA policy. The project monitoring was done day to day and the evaluation was performed after 3 months.
Results
The project was implemented at 88%. The interventions implemented were: 1) update LASA policy with current evidence, 2) creation of a list of confusing LASA medication names using tall man lettering, 3) store LASA medication by using uniform warning labels throughout the respective facility to facilitate identification (blue color labels), 4) create an inter-professional collaboration pathway between units and pharmacy team 5) build capacity regarding medication error prevention at the pharmacy department by putting strategies in place. The project contraints was to obtain enough labels hospital; the procurements process will be used and are beyond the timeline.
Conclusion
This study is on implementation strategies for safer administration of LASA medication. These will prevent patients harm from medication error and will result in service delivery improvement.
What is already known on this topic in advanced practice nursing?
A study at Kigali University Teaching Hospital in 2017 found that 39% and 45% of nurses do not report medical error if they are only the one who discovered the errors.
Proposed solutions for overcoming medication errors are: Reducing interruptions and distractions, storage strategies, typographic intervention, e.g., tall man lettering, barcoding, computerized physician order entry.
What does this project add to advanced practice nursing?
The key activities from the project were to update LASA medication policy with current evidence, elaborate a list of LASA medicationusing tall man lettering, store LASA medication by using uniform warning labels throughout the respective facility to facilitate identification, create an inter-professional collaboration pathway between units and pharmacy team, build capacity regarding medication error prevention at the pharmacy department.
The specific significance of the project to advanced practice nursing
- Implementation strategies for safer administration of look-alike/sound-alike medication at the University Teaching Hospital of Kigali reduced medication errors. The project put in practice the strategies that improved patient safety and decreasing patient harming from LASA medication. Also, the hospital leadership may be aware of the medication errors, and can develop, implement and sustain appropriate policies and strategies to improve patient safety. The clinicians can better identify the potential for errors by staying alert to the specific medications that cause the most confusion in individual practice settings.
- In nursing/midwifery, this quality improvement project contributed to the existing strategies improving patient safety.
Finland – Promoting advanced practice nursing through national collaboration.
Authors: Krista Jokiniemi, RN, PhD, University of Eastern Finland, University Lecturer, chair of the APN expert working group ; Anna Suutarla, RN, PHN, M.Sc. Finnish Nurses Association, Senior Advisor, coordinator of the APN expert working group; Anna Axelin, RN, PhD, University of Turku, Associate Professor; Mervi Flinkman, RN, PhD, The Union of Health and Social Care Professionals in Finland (Tehy), Senior Advisor; Sini Hämäläinen, RN, MHC, LAB University of Applied Sciences, Senior Lecturer; Jaana Kotila, RN,MnSc, Helsinki University Hospital (HUS), eHealth services, Development manager; Tuija Lehtikunnas, RN, PhD, Turku University Hospital, Hospital Director of Nursing; Virpi Sulosaari, Turku University of Applied Sciences, Principal lecturer; Annukka Tuomikoski, RN, PhD Oulu University Hospital, The wellbeing services county of North Ostrobothnia, Director of Nursing Competence
Introduction
In 2023, Finland implemented one of the largest reforms in the social and healthcare system in its history. The changes also brought an opportunity to advance advanced practice nursing integration in the new social and healthcare structure and new job opportunities for healthcare professionals. However, due to slow changes in the career perspectives of nurses and in the healthcare system, the know-how and potential of APNs has not been utilized to the full extent. The growing shortage of nursing professionals forces the government to add more emphasis on clinical career path opportunities for registered nurses.
Background
In Finland, the education for advanced practice nurses (APN) began in universities and universities of applied sciences at the beginning of the 21st century. The first APN posts were established in the university hospitals at the same time. advanced practice nursing (APN) roles are country specific. Therefore, in 2016, the first Finnish Nurses Association APN expert working group was appointed to clarify and describe advanced practice nursing roles in the country-specific context in Finland. Currently two APN roles are recognized: clinical nurse specialist (CNS) and nurse practitioner (NP). In addition, the role of specialist in clinical nursing science exists in one university hospital. The role of nurse informatic (NI) has been established in the healthcare sector. However, there is still no national consensus or regulation on these roles in social and healthcare. In Finland, special authority for limited prescribing for registered nurses is a separate education and a regulated extended role. This role is mainly implemented in primary health care.
In 2016, the first expert group recommended
1. The job descriptions of APNs have to be defined, titles unified, and legislative changes examined.
2. Nursing education must be developed to meet the needed competencies.
3. The number of APNs must meet the health requirements of the Finnish population.
4. The specialist job description must be seen in the salary of the nurse.
5. The effectiveness of APN job descriptions must be evaluated and followed.
Some of the recommendations have progressed but there is still no national consensus or regulation for APN roles and education. Moreover, information on the state of APNs was somewhat scattered and it was seen as important to identify the progress since 2016.
Methods
A new APN expert group for the Finnish Nursing Association was established in 2021.
The members of the 2nd APN expert group represented nursing practice, education, research, nursing leadership, and trade union. The collaborative work included a scoping review of scientific literature to capture the current state of APN research in Finland, focus group interviews (N=31) on APNs´, nurse leaders´, and educators' perspectives on the current state of APN, and the development of fact sheets on the APN roles for communication actions and recommendations for future role development. In addition, the expert group participated in the Nursing Research Foundation Sr (NRF) development process of updating the Action Model of Expertise for Evidence-Based Health Care (EBHC).
Results
The scoping review of the literature revealed moderate research (n=19) on the APN roles within Finland. One of the challenges is that the titles used in the APN roles vary. Based on the interviews, the role of APNs varies according to the organization’s capability and resources to utilize the full potential of the APN role. In best case, the role was well-established and independent and thus improved the quality of patient care. However, APNs were often used as a substitute for nursing staff which in turn limited the full use of their expertise or their role was not acknowledged within the organization. The updated Action Model of Expertise, including five different types of experts and their core competencies, was introduced as a means of facilitating EBHC in Finland.
In addition, the expert group made the following recommendations:
- 1. APN roles and education should be established by a national advisory board.
Initiatives relating to the regulation of tasks, skills recognition, and the harmonization of qualifications should be coordinated at the national level. During the 2023-2027 government term, a nursing division of the Advisory Board of Health Care Professionals, established by the Ministry of Social Affairs and Health, should be set up. We recommend that this section, in its upcoming period of operation, review and make recommendations on APN roles that require a Master´s level degree (University of Applied Sciences/University). A national model and systematic implementation and monitoring will contribute to the optimal allocation of resources.
- 2. There needs to be close collaboration between the educational system and working life
Collaboration and networks between the education system and working life should be strengthened for developing APN roles. Collaboration must be implemented across the board, from the highest national level to individual organizations. This will ensure that the education system produces the skills needed by working life, including in terms of continuous education. Close collaboration between the education system and working life must reflect the health needs of the population and take account of future challenges, such as population aging.
3. Wellbeing Services Counties should systematically use and increase APN job roles
There is a need to increase the number of APN roles in Wellbeing Services Counties, both at primary and specialized levels and in services for the elderly, both in service housing with 24-hour assistance, and in-home care. Making full and optimal use of the skills of advanced practice nurses is important for prevention, access to care, health promotion ensuring evidence-based care, and developing technology and digitalization. APN roles are an essential part of nurses' clinical career paths, the development of nursing and clinical support structures, thus playing an important role in the sector’s professionals' retention and attractiveness as an employer.
- 4. APNs should be involved in development working groups on health and social services.
- APNs have expertise in wellbeing, health, nursing development and research, and evidence-based practice. This expertise should be used in nursing and multi-professional development teams to develop the functions of the social care system and crisis preparedness.
- 5. Organizations need to produce and analyze data for evaluating the effectiveness of APNs
More information is needed on the effectiveness and cost-effectiveness of APNs in different areas of nursing. Uniform nurse-sensitive indicators should also be introduced in the area of advanced practice nursing. Consistent data on effectiveness produced by organizations will enable the study of tasks and support future decision-making and the development of task profiles and training.
Conclusion
Harmonization of APN roles is needed as it promotes the understanding and utilization of full APN potential. The social and healthcare system in Finland is under transformation and it is restructured to meet the changing population needs. It is a critical time to continue the systematic implementation as well as influencing and policy work of APN roles to secure patients’ access to high-quality social and healthcare services and retention of expert workforce.
References
International Council of Nurses. (2020) Guidelines on Advanced Practice Nursing. Available at https://www.icn.ch/system/files/documents/2020-04/ICN_APN%20Report_EN_WEB.pdf
Jokiniemi, K., Suutarla, A., Axelin, A., Flinkman, M., Hämäläinen, S., Kotila, J., Lehtikunnas, T., Palomaa, M., Sulosaari, V. & Tuomikoski, A. (2023) Laajavastuinen hoitotyö - sairaanhoitajan uramalli lähellä ihmistä. Finnish Nurses Association. Available at: https://sairaanhoitajat.fi/wp-content/uploads/2023/04/APN-raportti-2023_final.pdf
Kotila, J., Axelin, A., Fagerström, L., Flinkman M., Heikkinen, K., Jokiniemi, K., Korhonen, A., Meretoja, R. & Suutarla, A. (2016) New roles for nurses – quality to future social welfare and health care services. Finnish Nurses Association. Available at: https://sairaanhoitajat.fi/wp-content/uploads/2020/01/new-roles-for-nurses.pdf Useful resources
Report of the first APN expert group (2016): https://sairaanhoitajat.fi/wp-content/uploads/2020/01/new-roles-for-nurses.pdf
Report of the second APN expert group (2023, in Finnish) to be published in English: https://sairaanhoitajat.fi/wp-content/uploads/2023/04/APN-raportti-2023_final.pdf
Video clips on APN work in Finland: https://www.youtube.com/watch?v=Z6n2MsEx-DQ&t=7s
Nursing Research Foundation (NRF) Action Model of Expertise for Evidence-Based Health Care (EBHC): https://www.hotus.fi/wp-content/uploads/2023/04/finame-en-final.pdf
Research Study *** PARTICIPANTS NEEDED! ***
We are offering 6 x 1-hour supervision sessions of Resilience Based Clinical Supervision (RBCS) for Advanced Practice Nurses and Nurse Practitioners and would like YOU to participate!
What is RBCS? RBCS is a supportive forum that will increase your ability to respond positively to the emotional and physiological demands of your role. It was developed by the Foundation of Nursing Studies in the United Kingdom and has been successfully utilized for student nurses, nurses and Advanced Practice Nurses.
Why RCBS for APNs/NPs? Members of the ICN NP/APN Network undertook a longitudinal study investigating APNs’ emotional and spiritual wellbeing during COVID-19. They found that the wellbeing and resilience of APNs and NPs were severely impacted and continued to be 18 months into the pandemic. In response to this, the researchers offered a RBCS pilot study last year which evaluated as an excellent response to support APNs and NPs. In response to the pilot, the ICN NP/APN Network is offering its members the opportunity to take part in a global RBCS group from January 2024.
What will I be asked to do? Starting in January, you will participate in 6x1-hour virtual supervision sessions over five months. These will be facilitated by trained RCBS supervisors who are also APNs. Before the first session and after the last session you will be asked to complete a short online survey about your wellbeing and resilience. You will also be asked to provide a short evaluation of the programme after its completion. You are free to withdraw from the research at any time before data collection without giving any explanation.
What will you do with the survey I complete? We will analyze your surveys and evaluations to learn more about the role of RCBS in APN and NP wellbeing. We hope to publish these results. Th results will not be linked back to you in any way. This research has been reviewed and approved by the University of Huddersfield’s School Research Ethics and Integrity Committee (SREIC).
I’m interested! Who do I contact? Please email Sabina Staempfli at sabina.staempfli@ubc.ca if you are interested in participating in this study. We look forward to hearing from you!
May 2023 |
ICN NP/APN Network Bulletin May 2023
Editor: Colette Henderson RN, NISP, RNT, MSc, BSc (Hons) NP, FHEA
Welcome to the May Network Bulletin
A very warm welcome to the ICN NPAPN May 2023 Network bulletin.
In this month’s edition we will share details of work that is continuing within the Network, and we will take a closer look at our international collaborations. Thanks to Dr Misuzu Nakamura, our colleague in the communication subgroup for sharing this image of the cherry blossom in Japan.
Inside this bulletin you will find details about the first ever Network webinar which will start in September 2023, further details about this on page 2 of this bulletin. We will be looking at a Fulbright Scholar’s experience, an international education collaboration and spotlighting one of the communications subgroup member’s role as a Neuroscience Stroke Program Manager as well as the launch of a new international journal.
We look forward to seeing many colleagues and friends at the ICN Congress in July 2023.
We hope you enjoy reading this bulletin! If you are interested in contributing to the bulletin, please contact the editor: Colette Henderson
Table of Contents
TOC \h \u \z Welcome to the November Network Bulletin 1ICN NP/APN Network Launch Webinar Series in September 2023 2
Save the Date! 3
Fulbright Visiting Scholar Experience 4
International Advanced Practice Educational Partnerships: The Netherlands, Scotland, Wales and USA 6
Spotlight on Neuroscience/Stroke Program Manager Role 8
Raising the Profile- Nurse Practitioners and Advanced Practice Nursing
Initiatives 10
New International Advanced Practice Journal 11
ICN NP/APN Network Launch Webinar Series in September 2023
By Ms Joshi Dookhy, RANP
The ICN NP/APN Network is delighted to announce the launch of a series of free webinars, directed to our members in September 2023.
Commenting on this launch, Dr Emily Lockwood, Alumni, and former lead for the webinar development and working group said,
“I am delighted to lead the ICN NP/APN webinars, a cost-neutral development to reach out to a larger audience of ICN NP/APNs and share knowledge transformation to position ourselves as leaders in patient-focused and organizational-focused leadership. Strength is always in numbers and this global development will bring ICN NP/APN leaders and clinical experts from all over the world together to impart knowledge and leverage the voice of ICN NP/APNs”.
The existence of advanced practice nursing roles is becoming more prevalent across different specialties globally due to low physician density, economic and climate challenges, and the health challenges that accompany growing populations. Greater professional nursing leadership and autonomy are essential components to achieve the highest quality possible care.
The topic for the first webinar is ‘Clinical Leadership’ where the importance of the clinical leadership role and improving connections with policy and organizational culture will be discussed. Key speakers will include Dr Michelle Acorn (ICN Chief Nurse), Dr Daniela Lehwaldt & Josette Roussel (Chair & Deputy Chair ICN NP/APN Network), Dr Madrean Schober, ICN NP/APN Alumni and Professor Mark White, President of Sigma.
It is anticipated a second webinar will take place during NP/APN Week which this year is 12-18 November. The topic for the second webinar will be ‘Clinical Autonomy’. Further details will follow about this webinar, please keep an eye on the network social media account ICNGlobalAPN Twitter and ICNGlobalAPN Facebook.
The webinars will be live Zoom sessions lasting approximately 1 hour with 15 minutes built in for a Q & A session. Details for registering for the webinars will be made available via Eventbrite in due course. Please note that those wishing to attend the webinars will need to join the ICN NP/APN Network. Click here to join free of charge!
Save the Date!
We hope to see many colleagues at the ICN Congress in Montreal, 1-5 July 2023. Visit the website to find out more about this event: https://icncongress2023.org/
The ICN NP/APN Network will share a booth with ICN and hold several discussions during the congress. There are several sessions of particular interest to advanced practice nurses, including Policy Cafés, one on 2 July on Certification of Specialized Practice for APNs,and another two Policy Cafes on 5 July; one on APN Guidelines for Nurse Anesthetists and the other one entitled ‘Pool of Nursing Experts Policy Café’ where CGNC certified Global Nurse Consultants including our Chair Dr Daniela Lehwaldt will share notes on Leadership and global practices. A Symposium on 3 July relates to APN Research, Leadership and the UN SDGs in Action; and a Symposium on 4 July on the Speciality Certification of APNs.
Fulbright Visiting Scholar Experience
By Dr Bonisile Nsibandze
Dr Bonisile Nsibandze was awarded a Fulbright African Scholar Award in 2022. She is a state registered nurse and family nurse practitioner who is currently working at the University of Eswatini, Faculty of Health Sciences as a lecturer, researcher and community service provider. She is the Programme Coordinator for the Master of Nursing Science in Family Nurse Practice within the Department of General Nursing Sciences.
The overall aim of this Fulbright award was to facilitate exchange of knowledge, skills, ideas, and best practices for teaching Family Nurse Practice (FNP). The Eswatini healthcare delivery system is in need of more FNPs particularly in primary health care settings in order for the country to achieve Universal Health Coverage. Hence, high-quality training of FNPs as advanced practice nurses is fundamentally important to ensure access to health care and positive patient outcomes.
Dr Nsibandze’s report details the activities that she undertook during her attachment at the Robert and Donna Manning School of Nursing and Health Sciences, University of Massachusetts in Boston from January to May 2022. The activities were designed to meet the three pillars of university faculty: teaching, practice and community service.
- 1. Teaching
I co-taught three Spring semester graduate courses in the nurse practitioner track:
· Advanced Health Promotion - didactic: This course focuses on health promotion and maintenance throughout the life continuum. I co-taught this course with Prof Elizabeth Russet, and I had an amazing time in this class. The health promotion course is not featured in the FNP Master’s Curriculum in the University of Eswatini, however course content is offered in other relevant courses.
- · Advanced Health Promotion – seminar. The purpose of this course is to teach, guide and support students through their clinical attachment. Students presented on their clinical experiences, discussed clinical cases from minor to complex health issues, evidence-based practice and emerging health issues. Clinical support for FNP students, in smaller groups, remains critical in the development of clinical reasoning skills. The co-faculty for this course was Prof Teresa Roberts.
- · Care of the Older Adult – didactic and clinical: this is the last primary health care clinical course for the Adult and Gerontology Nurse Practitioner program which is offered in an asynchronized mode. The clinical reasoning process, diagnostics and review of treatment protocols and guidelines for the adult and elderly patient formed the main focus of this course. The co-faculty for this course was Prof Tamika Dowling.
- 2. Graduate Program Operations
I was a member of multiple committees responsible for guiding, directing and planning graduate programs in the College of Nursing. The committees had a weekly meeting schedule both in-person and virtually.
· The Masters Curriculum Working Group is responsible for course level trouble-shooting, reviewing course alignment and determining course sequencing through the postgraduate nursing programs.
- · The Graduate Faculty Meetings includes all faculty teaching in the graduate program. The aim is to receive reports on graduate activitiess, harmonize course offerings, plan students’ clinical placements and review preceptor qualifications and appropriateness.
- · The Graduate Operations Meeting focus on Master’s program and Post Master’s program trouble shooting.
- 3. Teaching in the Centre for Clinical Education and Research (CCER)
The simulation lab is core for clinical education in the College of Nursing. A combination of high- to low-fidelity scenarios are used to create real-life clinical situations that will require nursing students to engage in critical thinking and provide comprehensive nursing care to the patient. Co-faculty members included Ms. Rosemary Samia and the CCER teaching team.
4. Clinical practice at Beth Israel Deaconess Medical Centre (BIDMC)
Access to the clinical practice site was arranged to promote exposure and understanding of the health care delivery system in the United States. Clinic visits were arranged for one day a week from April to May 2022. The patient complement included patients from all age groups with diverse common and chronic diseases and those seeking annual physicals. My preceptor in this healthcare setting was Dr Maura M. Brain from whom I learned so much even though our time together was limited.
5. Conferences and enrichment seminars
The Fulbright Scholar Programme arranged a number of enrichment seminars throughout the attachment period. A majority of these seminars were aimed at dissemination of research data through presentations and manuscript preparation and publishing. Some of the conferences and seminars I participated in included virtual Fulbright Enrichment Seminars covering topics such as manuscript publishing and peer review workshops, understanding Massachusetts’ political system, understanding the American College System and mitigating the effects of climate change. I presented a paper titled ‘Strategies to facilitate HIV self-management by female adolescents living with HIV in Manzini, Eswatini’ during a Research Day hosted by the Manning College of Nursing and Health Sciences, University of Massachusetts, Boston.
6. Community service
Community service engagements provided time for meeting new people, establishing new connections and learning more about the USA. The following are some examples of community service engagements I participated in:
· 19 February 2022: Community Park and harbor side clean-up of Lo Presti Park in East Boston
- · February to May 2022: served as a member for a new Neighborhood Birth Centre in Boston. I learned about the concept of ‘doula’ – which we do not have in Eswatini. An interesting part of this was conducting field visits to established birth centers within the New England region. I got to understand the midwifery practice associated with Birth Centres, the establishment of hospital affiliations and the business side of it.
- 7. Summary and lessons learned
Learning occurred and good practice points were noted. Below, I list a few critical points that I learned and I think are relevant and would be beneficial when applied to the Master of Nursing Science programmes including the FNP programme at the University of Eswatini.
- · Graduate programs in nursing require a full and collaborative staff complement which include lecturers, clinical instructors and preceptors to ensure quality of the graduate product.
- · Program planning, appropriate course sequencing and academic advising remain critical for the semester-to-semester progression of students through the graduate program.
- · Course evaluations and exit surveys for graduating students are a valid source of data that can be analysed to improve course offerings as well as inform program structure.
- · Continuous clinical support, guidance and mentoring of nursing students ensures a competent and confident product.
- · Maintenance of a healthy, collaborative and consultative relationship between the nursing school, clinical area and licensing/regulatory body is important.
International advanced practice educational partnerships: The Netherlands, Scotland, Wales and USA
By Lillian Maas, Wim Breeman, Karin Nobbe-de Graaf, Carolien van Dijk, Colette Henderson, Jonathan Thomas, Dr Carole Mackavey, Dr Mary Benbenek, Dr Tammy Stout, Dr Sabrenda Littles
Rotterdam University in the Netherlands has a two-year Master’s Advanced Nursing Practice programme that is government supported. One of the key requirements of the programme is that students gain an understanding of advanced practice internationally. To achieve this, Rotterdam University has collaborated with Swansea University (Wales) the University of Texas (USA), Texas Women’s University (USA), the University of Minnesota (USA) and the University of Dundee (Scotland) to develop international student placements.
The collaboration includes a series of educational online workshops that take place at varying points throughout the year. These workshops are designed to promote collaboration and support introductions to practitioners that the Rotterdam students will meet during their in-country placements. Educational sessions have included presentations from both faculty and students covering topics relevant to advanced practice nursing education and country specific public health concerns.
The aim of the partnership is to support development of critical thinking, cultural competence and understandings of global healthcare systems. Some of the key outcomes from this global partnership have been the development of collaborative and supportive networks that have led to joint work on scholarly activity such as conference presentations and journal articles.
For more information about this partnership please contact; Lillian Maas or Colette Henderson
Images from the November 2022 placement visits:
University of Minnesota
Texas Medical Center
Texas Woman’s University
University of Dundee
Spotlight on Neuroscience/Stroke Program Manager role
By Dr Varsha Singh
My current role is Neuroscience /Stroke Program Manager at St. Joseph’s University Medical Center, which is a Comprehensive Stroke Center in New Jersey, USA, I am privileged to be working in a very niche environment where nurse practitioners (NPs) are subject matter experts (SME) as well as educators almost every day. The Neuroscience /Stroke Program has so many unique applications and I thoroughly enjoy the work I do as a Neuroscience/Stroke Specialist Advanced Practice Nurse. I serve on the New Jersey State Stroke Care Advisory Panel under the leadership of our Health Commissioner.
I oversee a team of nine Neuroscience NPs. They function in their two specific roles of neurology or neurosurgery and collaborate with neurologists or neurosurgeons. Neurology NPs manage stroke codes and consult patients with neuromuscular disorders or epilepsy. Stroke management requires time sensitive treatments by specially trained clinicians.
Neurosurgery NPs primarily focus on all hemorrhagic strokes, subarachnoid hemorrhages and all patients who undergo neurosurgical procedures. They consult trauma cases where patients suffer head or spine injuries, and they attend daily rounds to ensure continuing communication with neurosurgeons to provide safe and care. Neuroscience NPs are assigned the following duties:
- · First responder to stroke codes
- · Perform comprehensive neuroassessment to determine the extent of stroke
- · Perform stroke specific assessment scores
- · Review CT Head, MRI, CT Perfusion studies and communicate with the neurologists and radiologists
- · Review results with emergency room physicians and discuss treatment pathway’s supported and directed by the neurologist.
- · Guide nurses on dosage and mixing of thrombolytic therapy
- · Guide nurses on immediate transfer of patients’ for neuro intervention
- · Place all the orders as per the stroke protocol
- · Discuss acute as well as post-acute management of stroke patients with an interdisciplinary team
- · Follow up patients who have a neurological diagnosis
- · Review quality metrics and report any variances related to stroke core measures such as dysphagia screening, VTE prophylaxis, administration of antithrombotic, statins, and anticoagulants.
Stroke Program Manager
My unique role allows me to participate clinically as well as administratively. My prime responsibility revolves around the quality compliance and data management associated with stroke care. The stroke data is primarily about the timeliness: did we deliver the care within the required time? All stroke management interventions are time bound and are subject to penalty if there is a delay.
I find my day-to-day work is so unique and has such diverse application that every day is full of new opportunities to learn. I diligently share my findings and knowledge with my team members and believe that mentoring my team of Neuroscience NPs will eventually reflect in terms of better patient outcomes and make the program stronger.
Our stroke data is concurrently reviewed and shared with the state-based Stroke Registry as well as with the accrediting agency.
As stroke treatment guidelines continue to evolve, there is always a need for continuing education. One of my responsibilities is to engage clinical staff with ongoing education and updates about new guidelines.
I absolutely love my role as a Neuroscience Nurse Practitioner and Stroke Program Manager. The NP team are highly invested in this program and some of them have national certification as stroke nurses. I believe in supporting and mentoring staff so that they can advance in their careers. My dream is to enhance our abilities to maximize our potential, so that our neuroscience team is considered as a great example of neuroscience programs.
Varsha is second from the right.
Raising the profile: nurse practitioners and advanced practice nursing initiatives
These papers reflect the ongoing work of the network to raise the profile of Advanced Practice Nursing globally.
The Role of Nurse Practitioners in Jamaica: by ICN NP/APN Network Core Steering Group member, Heather McGrath
Advanced practice nursing initiatives in Africa: moving towards the nurse practitioner role: Experiences from the field by Network colleagues from the Core Steering Group and Global Academy of Research and Enterprise. This paper discusses the development and progression of the advanced practice nurse practitioner role in Africa.
New international advanced practice journal
A new quarterly journal that focuses on advanced practitioners across a range of healthcare-related specialties. The International Journal for Advancing Practice is the first journal of its kind to address the needs, focus and range of advanced practitioners on a truly international scale. Search for the journal at here to read more and submit research!
