Hello AbdulQader,,

Really some institutions trying to do that,, but it's faced the privilege problem,, if there's a low should be control this idea,, and who's the owner of right to certify the these type of nurses,,, in Middle East generally this is the most challenges 

this is my opinion regarding that,,, 

Hot question ....

 exactly Hani .. still the process is unclear and many areas of doubt 

Yes - I think lack of, or inconsistent credentialling is an issue with many advanced practice roles.  While these have developed independently in many countries, the use of similar terminology still implies a degree of comparability that may not be realistic.  In NZ, we have a single advanced practice role that is credentialled, that of the Nurse Practitioner.  This role has an additional registration authorised over that for the Registered Nurse.  We also have clinical nurse specialist roles, but these are not credentials, and vary considerably in terms of content and expectations across the country.  We are currently looking at the introduction of an additional endorsement on practicing certificates to enable RNs to undertake nurse prescribing, and we have a range of nurse led services.  So in answer to your question, some roles are quite clearly defined, while others remain unclear.  There is a degree of political support to continue developing advanced roles, but as you indicate, this is often a result of physician shortage and unmet health needs. 

Exactly Dr. Sandra ..  inconsistent credentialing is a major challenge for their role 

There is one clear pathway for Advanced Nurse/Midwife Practice in Ireland leading to registration with the Nursing and Midwifery Board of Ireland as a Registered Advanced Nurse/Midwife Practitioner (RANP/RAMP). There are 4 core concepts to the role that we all engage with - Autonomy in clinical practice, expert practice, professional and clinical leadership and research. Each post is developed in response to a patient need and healthcare service requirement. With the rapidly growing ageing population and need to promote healthy active ageing within this client group my post as  a RANP Care of the Older Adult Community was developed. I believe my role is valued by my colleagues, my organisation,  the wider community team I provide support to and the patients and families in my care. Further information on the pathway to advance practice in Ireland is available from the  Nursing and Midwifery Board of Ireland website www.nmbi.ie 

HI,

I think that although advanced practice nurses have their position in health care, many do not meet the qualifications to meet the needs of health care. Nurse practitioners are not screened for their advanced experience, but are actively recruited out of BSN programs with little or no clinical practice. The result are nurses who are making nursing and sometimes nursing diagnoses that are harmful to the patient. Or they are not diagnosing patients correctily.

Hello AbdulQader:

If indeed our curriculum by competencies, this helps to improve visibility, prestige, and job autonomy in Nursing.

Nursing developing intensively and extensively evolves resulting by incorporating skills, here where the role of the university is of great importance.

There are many challenges in demonstrating the value of the nurse specialist or advanced practice role and indeed the need to have more standardisation about what quality/competencies they need and how they are evaluated/accredited.  However, I think this is a big discussion that if complex.  Firstly many nursing roles have had to evolve and organisations do not invest in training/development and paying for a high quality nurse expertise.   Secondly the medical profession need to recognise that in many cases development varies according to the managements view about what the medical team need and ask for instead of focussing on what adds value and improves patient care.   There has been quite a lot of work on this in rheumatology specialist nursing within the UK - and you should explore this.  The trouble is many Government will not invest in achieving high quality standardised nurses roles and is always looking to replace these roles with lower paid and less qualified nurses.  This is a problem nursing needs to address - we need to get our house in order and demonstrate the support/expertise. For example in UK nurses run nurse led clinics, additional qualifications can enable nurses to be prescribers and undertake joint injections etc - but this is only of value if it enhances the patients experience journey and optimises effectiveness in the service. Some of these roles are not always welcomed by medical colleagues in less developed areas because they are seen as a threat.   

There is much debate going on within Europe about cross border competencies of different Health Professionals and we need much more clarity but each country has a different level for pre-registration training and qualifications which make it difficult.   So each country must invest, identify how such roles improve patient outcomes and are safe, but equally nurses in many areas have to raise their level of training/qualification and autonomy in delivering high quality care. 

Article The nurse specialist role in Hong Kong: perceptions of nurse...

Not clearly defined curriculum for training. The different competency level amongst qualified nurses from various institutions makes clarification of their roles difficult. 

Not clearly defined curriculum for training. The different competency level amongst qualified nurses from various institutions makes clarification of their roles difficult. 

For this topic, see the special issue of "Nursing Leadership" in 2010 (vol 23)