Post on 28-Apr-2018
XV Colloquio Panamericano de Investigacion en Enfermeria
Symposium on Advanced Nursing Practice Mexico City, October 6, 2016
Denise Bryant-Lukosius, RN PhD Associate Professor, School of Nursing and Co-Director
Canadian Centre for APN Research (CCAPNR) McMaster University, Hamilton, Ontario, Canada
D. Bryant-Lukosius, 2016 1
Share experiences and lessons learned from a Canadian
context and the School of Nursing at McMaster University
about advancing nursing roles in primary health care (PHC)
Describe collaborations between PAHO and WHO
Collaborating Centres to move the APN agenda forward in
PHC in Latin America and the Caribbean (LAC)
D. Bryant-Lukosius, 2016 2
Registered nurse with the expert knowledge base, complex decision-making skills, and clinical competencies for expanded practice
Role characteristics are shaped by the context and/or country where the APN works
•A master’s degree is recommended for entry level
1970s Kergin Report: Need for expanded nurse roles in PHC in Canada
McMaster and other universities start programs to prepare nurses
with expanded roles as early NPs for isolated settings and family
practice
Pilot projects including the Burlington RCT of NPs
1980s Closure of NP education programs, despite research evidence about
their effectiveness
D. Bryant-Lukosius, 2016 5
1990s Primary Health Care Reform is a provincial/national policy priority
Ontario government funds needs assessment about NP roles for PHC
10 university consortium for post-baccalaureate PHC NP education in Ontario
2000s Shift to NP education at the Master’s level despite lack of government support
National NP competencies developed to guide licensing/regulation and curricula
National Chair in APN (Dr. DiCenso) 2001-2011
Built capacity in developing PhD prepared APN faculty and researchers
Conducted decision-maker linked and policy relevant research
Developed evidence-based tools such as the PEPPA Framework to guide the effective use of CNS and NP roles (Bryant-Lukosius & DiCenso, 2004)
D. Bryant-Lukosius, 2016 6
2010 to 2016 2010 Special Edition on APN in the Canadian Journal of Nursing
Leadership (CJNL) profiles research from the APN Chair Program
2011 launch of the Canadian Centre for APN Research (CCAPNR) at McMaster
Expand internationally and focus on Models of Care and Skill Mix as policy priorities, and lead work to optimize RN, NP, and CNS roles in team-based PHC
CCAPNR faculty are editors of 2016 Special Edition on APN in CJNL
Substantive progress in the education, regulation, deployment, and numbers of NPs in PHC, but full health systems integration has yet to be achieved
D. Bryant-Lukosius, 2016 7
Strong nursing leadership at clinical, academic and policy
levels is essential to continually drive the introduction,
effective development and integration of APN roles
◦ Formal policies to support APN role implementation such as
legislation, regulation, competencies and education, lag behind
the informal introduction of the roles
◦ Health systems integration evolves slowly and iteratively over
time
◦ Takes time to overcome existing policies that are barriers to APN
roles (e.g., physician fee for service)
D. Bryant-Lukosius, 2016 8
A systematic approach to introducing APN roles is essential to design the right roles to address population health, nursing practice, and health system needs
D. Bryant-Lukosius, 2016 9
PEPPA has been used in
Canada and over 16 other
countries to successfully
design, implement and evaluate
APN and other advanced health
provider roles (Boyko, Carter &
Bryant-Lukosius, 2016)
Backbone of rural, northern, and remote healthcare
Primary providers for at risk and hard-to-reach populations in urban settings
Increase access to care underserviced communities through NP-led interprofessional teams
D. Bryant-Lukosius, 201610
• To address unmet health needs,
improve the recruitment/retention
of nurses, and improve the quality
of nursing care in high risk areas:
• Maternal and Child Health
• Mental Health and Addictions
• Chronic Disease Management
• Diabetes
D. Bryant-Lukosius, 2016 11
• In 2005, Health Canada introduced CNS roles for 600 First Nations and
Inuit communities across the country (Veldhorst, 2006)
A standardized, coordinated and collaborative approach
to APN education among universities was necessary to
address resource and policy issues and reduce
variability in practice
• Ontario NP Education Consortium
• Established standardized education across10 universities
• Shared the costs and scarce faculty resources
• Developed NP faculty and expertise across the province
• Cohesive lobby group to advocate for policy changes related to NP
education
D. Bryant-Lukosius, 2016 12
Integrated knowledge translation that engages policy makers and
administrators in research increases their awareness,
understanding and uptake of best practices for using APN roles
to impact on priorities for health care improvement
D. Bryant-Lukosius, 2016 13
Pan-Canadian collaboration through the APN Chair Program and CCAPNR has been effective for:
building and sustaining APN faculty for education and research
generating evidence to influence policies and practices
maintaining momentum and profile
establishing a national network of nurse leaders and advocates to address policy issues and role implementation barriers
D. Bryant-Lukosius, 2016 14
The world is a small place.
International collaboration and
partnerships benefits APN
role development in countries
with established roles and
where they are new or just
emerging.
D. Bryant-Lukosius, 2016 15
2015 McMaster summit
2016
University of Michigan hosts meeting on developing APN competencies
McMaster and PAHO host a webinar series on APN role development, education and regulation
PAHO establishes pan-country advisory committee to develop APN role competencies
D. Bryant-Lukosius, 2016 16
Further academic collaboration to align APN roles with policy priorities for UHC and UA to health in Latin America
Illustrates APN outcomes and how the roles can be used to address health care inefficiencies
Cost savings gained through the introduction of APN roles can be used to offset the costs of UHC
D. Bryant-Lukosius, 2016 17
McMaster University has a long history in APN role education, research and development
Much progress has been made to increase access to high quality PHC services in Canada through improved APN role deployment
Continued efforts are required to produce and better use evidence to support full APN role integration
D. Bryant-Lukosius, 201619