Advanced Nursing Practice in Thailand:

An Initiative or Old Wine in the New Bottle!

Assistant Professor Nanthaphan Chinlumprasert, Ph.D., R.N.

Faculty of Nursing Science,

Assumption University of Thailand

The Development of APN in Thailand

1974 1988 1994 2000Present

NP

Existed

NP

ExistedCCS granted

“Nursing Expertise”

CCS granted “Nursing

Expertise”

NNCT approved

CNS in 5 areas

NNCT approved

CNS in 5 areas

NHSRNHSR

PCUPCU

APN

NP

Advanced Practice Nurse (APN)

1. Nurse - Anesthetist

2. Nurse - Midwife

*3. Clinical Nurse Specialist

*4. Nurse Practitioner

Nurse Practitioner (NP)

In 1974 : NP first established to serve people in the remote area and to ease the Physician shortage

: 4-month-training

: Work as physician extender

: No autonomy Legitimate limitation

Not well accepted by NNCT

Nursing Experts (NE)

In 1988 : The Commission of Civil Servant (CCS) has granted the career ladder for promoting experienced nurses to become Nursing Experts

: Academic report and experiences were used to consider the promotion

: Nursing service system has no distinctive organizational line and scope of practice for Nursing Expert position

: No continuous support by Nursing Organization

Clinical Nurse Specialist (CNS)

In 1994 : The National Nursing Council of Thailand (NNCT) has approved CNS in 5 areas

1) Community Nursing

Family Nursing

Occupational Health Nursing

School Health Nursing

2) Mental Health & Psychiatric Nursing

3) Pediatric Nursing

4) Maternal & Child Nursing

5) Medical – Surgical Nursing

CNSCNS

Master degree in nursing specialty

Certification of CNS granted by NNCT

2000 Present : National Health System Reform (NHSR)

National Health System:

Is the entire system of the national health that interrelated or interconnected as the holism. It effects to the health of all population including other factors such as individual, environment, economic, social, physical, biological, and the factor of health care system.

Principle of NHSR

Holistic Participatory Public Policy for Health Equity * Efficiency * Quality * Consumer responsiveness and

protection

National Health System

Health Service System

Nursing Service System

Health Service System

University/Regional Hospital

Provincial/General Hospital

Health Center, PCU, Com. Hospital

Village, CPHCSelf Care, Self Reliance

Tertiary

Secondary Care

Primary Care

Primary Health Care

Equity

Efficiency

Quality

National Health Insurance Policy

Universal Coverage

Primary Care Focus

APN

NursesNP

CNS-Com. NsgPrimary Care Unit

Other APNS

Secondary level

Tertiary levelNurses

CNS

Requirement for APN Certification

1. Master degree in nursing specialty

2. Three years working experiences in the specific area of expertise

3. The curriculum must be approved by NNCT

The number of APN in Thailand

APN Thailand (2003)

CNS-MCH

CNS-Ped.

CNS-Med.

CNS-Surg.

CNS-Psy.

CNS-Community

1

8

9

10

12

9

Total 49

The ratio of APN to nursing population

Thailand (2003) U.S. (1996)

Total Nurses Population

APN

120,000

49

2.55 million

161,700 persons

APN : Nsg Pop 1:2,449 1:16

Educational requirement for Master degree in Nursing to meet APN requirement

Plan A Total credit hours 42 Cr.

1. General Core Courses 15 Cr. Master core courses 8 Cr. APN core courses 7 Cr.

2. Specific Courses 12 Cr.

Theory courses 6 Cr.

Practicum courses 6 Cr.

3. Elective Courses 3 Cr.

4. Thesis 12 Cr.

1. General Core Courses 15 Cr.

2. Specific Courses 18 Cr.

Theory courses 6 Cr.

Practicum courses 9 Cr.

Seminar 3 Cr.

Plan B Total credit hours 42 Cr.

3. Elective Courses 3-6 Cr.

4. Independent Study 3-6 Cr.

Advanced Nursing Practice initiative requires:

Goal & Strategy : Participative management, Public/Private sectors involvement

Professional leadership

Initiation/creativity

Vision

Good governance

Social & Political Movement

: Lobbying, Negotiating power

Evidence-based policy making

: Research utilization

Research: Public demands

Market driven trend

Customer satisfaction

Cost effectiveness

Job analysis & Evaluation

APN-NP positioning

Reimbursement/Incentives

What did NNCT accomplish?

Enactment Nursing and Midwifery Acts B.E. 2528/2540

Advanced educational degree Certified NP,

CNS in Master level

Set up standard criterion core competency and qualification of APN

Standardize primary medical care as a competency in generic nursing program (BNS)

Research

A study of characteristics of nursing services in Thailand

A need survey of Thai people on health care delivery and nursing services

A study of nurses’ role in hospitals of the Northern Thailand

A study of service efficiency of nursing/midwifery private clinics in Thailand

Continuing education policy & enforcement

Exercising power & controlling Unity & Quality Assurance

Challenging trend : What should nurse leader do?

Empowerment

Actual evidence-based decision making and policy setting

APN-NP positioning in NHSR/NHIS

UnityQuality AssurancePursue APN

Public relation / Social movement ↑ Nursing Image⊕

Political movement

Useful research/study goals attainment

The nursing profession

movement can no longer be

governed and managed by only

opinions and casual intuition of

nursing leaders

Continually relevant research

will provide definite answers

for the challenging question …

Is APN an initiative or old

wine in the new bottle?