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Nurses in Advanced Roles: A Description and Evaluation of Experiences in 12 Developed Countries

Author

Listed:
  • Marie-Laure Delamaire
  • Gaétan Lafortune

    (OECD)

Abstract

Many countries are seeking to improve health care delivery by reviewing the roles of health professionals, including nurses. Developing new and more advanced roles for nurses could improve access to care in the face of a limited or diminishing supply of doctors. It might also contain costs by delegating tasks away from more expensive doctors. This paper reviews the development of advanced practice nurses in 12 countries (Australia, Belgium, Canada, Cyprus, Czech Republic, Finland, France, Ireland, Japan, Poland, United Kingdom and United States), with a particular focus on their roles in primary care. It also reviews the evaluations of impacts on patient care and cost. The development of new nursing roles varies greatly. The United States and Canada established “nurse practitioners” in the mid-1960s. The United Kingdom and Finland also have a long experience in using different forms of collaboration between doctors and nurses. Although development in Australia and Ireland is more recent, these two countries have been very active in establishing higher education programmes and posts for advanced practice nurses in recent years. In other countries, the formal recognition of advanced practice nurses is still in its infancy, although unofficial advanced practices may already exist in reality. Evaluations show that using advanced practice nurses can improve access to services and reduce waiting times. Advanced practice nurses are able to deliver the same quality of care as doctors for a range of patients, including those with minor illnesses and those requiring routine follow-up. Most evaluations find a high patient satisfaction rate, mainly because nurses tend to spend more time with patients, and provide information and counselling. Some evaluations have tried to estimate the impact of advanced practice nursing on cost. When new roles involve substitution of tasks, the impact is either cost reducing or cost neutral. The savings on nurses’ salaries – as opposed to doctors – can be offset by longer consultation times, higher patient referrals, and sometimes the ordering of more tests. When new roles involve supplementary tasks, some studies report that the impact is cost increasing.

Suggested Citation

  • Marie-Laure Delamaire & Gaétan Lafortune, 2010. "Nurses in Advanced Roles: A Description and Evaluation of Experiences in 12 Developed Countries," OECD Health Working Papers 54, OECD Publishing.
  • Handle: RePEc:oec:elsaad:54-en
    DOI: 10.1787/5kmbrcfms5g7-en
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    Citations

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    Cited by:

    1. Maier, Claudia B. & Batenburg, Ronald & Birch, Stephen & Zander, Britta & Elliott, Robert & Busse, Reinhard, 2018. "Health workforce planning: which countries include nurse practitioners and physician assistants and to what effect?," Health Policy, Elsevier, vol. 122(10), pages 1085-1092.
    2. Faith Donald & Kelley Kilpatrick & Kim Reid & Nancy Carter & Ruth Martin-Misener & Denise Bryant-Lukosius & Patricia Harbman & Sharon Kaasalainen & Deborah A. Marshall & Renee Charbonneau-Smith & Erin, 2014. "A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence?," Nursing Research and Practice, Hindawi, vol. 2014, pages 1-28, September.
    3. Silje Havrevold Henni & Marit Kirkevold & Konstantinos Antypas & Christina Foss, 2019. "The integration of new nurse practitioners into care of older adults: A survey study," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(15-16), pages 2911-2923, August.
    4. Julia van Kraaij & Catharina van Oostveen & Hester Vermeulen & Maud Heinen & Anita Huis & Marian Adriaansen & Jeroen Peters, 2020. "Nurse practitioners’ perceptions of their ability to enact leadership in hospital care," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(3-4), pages 447-458, February.
    5. Köppen, Julia & Maier, Claudia B. & Busse, Reinhard, 2018. "What are the motivating and hindering factors for health professionals to undertake new roles in hospitals? A study among physicians, nurses and managers looking at breast cancer and acute myocardial ," Health Policy, Elsevier, vol. 122(10), pages 1118-1125.
    6. Sharon Barak & Tzlil Rabinovitz & Achinoam Ben Akiva-Maliniak & Rony Schenker & Lian Meiry & Riki Tesler, 2022. "An Individually Tailored Program to Increase Healthy Lifestyle Behaviors among the Elderly," IJERPH, MDPI, vol. 19(17), pages 1-12, September.
    7. Gerard M Fealy & Daniela Rohde & Mary Casey & Anne‐Marie Brady & Josephine Hegarty & Catriona Kennedy & Martin McNamara & Pauline O'Reilly & Geraldine Prizeman, 2015. "Facilitators and barriers in expanding scope of practice: findings from a national survey of Irish nurses and midwives," Journal of Clinical Nursing, John Wiley & Sons, vol. 24(23-24), pages 3615-3626, December.
    8. Catrin Evans & Ruth Pearce & Sarah Greaves & Holly Blake, 2020. "Advanced Clinical Practitioners in Primary Care in the UK: A Qualitative Study of Workforce Transformation," IJERPH, MDPI, vol. 17(12), pages 1-19, June.
    9. Yukari Hara & Kyoko Asakura & Takashi Asakura, 2020. "The Impact of Changes in Professional Autonomy and Occupational Commitment on Nurses’ Intention to Leave: A Two-Wave Longitudinal Study in Japan," IJERPH, MDPI, vol. 17(17), pages 1-14, August.
    10. Dorota Kilańska & Anna Lipert & Marika Guzek & Per Engelseth & Michał Marczak & Kamila Sienkiewicz & Remigiusz Kozłowski, 2021. "Increased Accessibility to Primary Healthcare Due to Nurse Prescribing of Medicines," IJERPH, MDPI, vol. 19(1), pages 1-22, December.
    11. Marlene Carvalho & Filomena Gaspar & Teresa Potra & Pedro Lucas, 2022. "Translation, Adaptation, and Validation of the Self-Efficacy Scale for Clinical Nurse Leaders for the Portuguese Culture," IJERPH, MDPI, vol. 19(14), pages 1-12, July.
    12. Ruth Martin‐Misener & Faith Donald & Abigail Wickson‐Griffiths & Noori Akhtar‐Danesh & Jenny Ploeg & Kevin Brazil & Sharon Kaasalainen & Carrie McAiney & Nancy Carter & Lori Schindel Martin & Esther S, 2015. "A mixed methods study of the work patterns of full‐time nurse practitioners in nursing homes," Journal of Clinical Nursing, John Wiley & Sons, vol. 24(9-10), pages 1327-1337, May.
    13. Catriona Kennedy & Patricia Brooks Young & Jacqueline Nicol & Karen Campbell & Carol Gray Brunton, 2015. "Fluid role boundaries: exploring the contribution of the advanced nurse practitioner to multi‐professional palliative care," Journal of Clinical Nursing, John Wiley & Sons, vol. 24(21-22), pages 3296-3305, November.
    14. Isabelle Brault & Kelley Kilpatrick & Danielle D’Amour & Damien Contandriopoulos & Véronique Chouinard & Carl-Ardy Dubois & Mélanie Perroux & Marie-Dominique Beaulieu, 2014. "Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study," Nursing Research and Practice, Hindawi, vol. 2014, pages 1-9, December.
    15. Mary Ryder & Elisabeth Jacob & Joyce Hendricks, 2019. "An inductive qualitative approach to explore Nurse Practitioners views on leadership and research: An international perspective," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(13-14), pages 2644-2658, July.
    16. Kelley Kilpatrick & Mira Jabbour & Chantal Fortin, 2016. "Processes in healthcare teams that include nurse practitioners: what do patients and families perceive to be effective?," Journal of Clinical Nursing, John Wiley & Sons, vol. 25(5-6), pages 619-630, March.
    17. Ruggeri, Matteo & Drago, Carlo & Moramarco, Vincenzo & Coretti, Silvia & Köppen, Julia & Islam, Muhammad Kamrul & Gibson, Jonathan & Busse, Reinhard & van Exel, Job & Sutton, Matthew & Askildsen, Jan , 2018. "New professional roles and patient satisfaction: Evidence from a European survey along three clinical pathways," Health Policy, Elsevier, vol. 122(10), pages 1078-1084.
    18. Gerard M Fealy & Mary Casey & Denise F O'Leary & Martin S McNamara & Denise O'Brien & Laserina O'Connor & Rita Smith & Diarmuid Stokes, 2018. "Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(19-20), pages 3797-3809, October.
    19. Agnes Higgins & Rebecca Murphy & Carmel Downes & Jarlath Varley & Cecily Begley & Naomi Elliott, 2020. "Factors influencing the implementation of Epilepsy Specialist Nurse role: Using the Consolidation Framework for Implementation Research," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(7-8), pages 1352-1364, April.
    20. János Sándor & Anita Pálinkás & Ferenc Vincze & Valéria Sipos & Nóra Kovács & Tibor Jenei & Zsófia Falusi & László Pál & László Kőrösi & Magor Papp & Róza Ádány, 2018. "Association between the General Practitioner Workforce Crisis and Premature Mortality in Hungary: Cross-Sectional Evaluation of Health Insurance Data from 2006 to 2014," IJERPH, MDPI, vol. 15(7), pages 1-12, July.
    21. Maier, Claudia B., 2015. "The role of governance in implementing task-shifting from physicians to nurses in advanced roles in Europe, U.S., Canada, New Zealand and Australia," Health Policy, Elsevier, vol. 119(12), pages 1627-1635.
    22. Temido, Marta & Dussault, Gilles, 2015. "How can a country learn from the experience of another? Expanding nurses’ scope of practice in Portugal: Lessons from England," Health Policy, Elsevier, vol. 119(4), pages 475-487.

    More about this item

    Keywords

    advanced roles; clinical nurse specialists; nurse practitioners; nurses; OECD countries; primary care; skills;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J2 - Labor and Demographic Economics - - Demand and Supply of Labor

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