APPENDICES
36 37
Even though Jamaica has been the leader in NP edu-
cation and practice in the region, the issue of lack of
legislation continues to pose a challenge. In St. Lucia,
NPs are given a separate registration/licence while
other NPs in the region are required to use their regis-
tered nurse/midwife licence to practice. Amendment of
the Nursing and Midwifery Act is underway in Jamaica
and the Bahamas since 2018. The greatest opposition
is from the medical fraternity (personal communication,
H. McGrath, March 2019).
New Zealand
The rst NP in New Zealand was endorsed in 2001.
Title protection was initially established through trade-
marking, but the trademarking concept is no longer in
effect. In 2015, the Nursing Council of New Zealand
(NCNZ) removed the requirement that restricted NPs to
a specic area of practice and introduced a new more
general scope of practice. NPs in New Zealand must
have: 1) a minimum of four years of clinical experience
prior to entry into an educational programme, 2) com-
plete an approved master’s degree programme that
includes advanced practice and prescribing competen-
cies, 3) pass an assessment against NP competencies
by an approved panel, and 4) register with the NCNZ
(Schober & Green 2018).
Oman
The idea of the Advanced Nurse Practitioner (ANP)
in Oman was inspired by a 2000 meeting of repre-
sentative countries of the World Health Organization-
Eastern Mediterranean Region (WHO-EMRO) focused
on advancing nursing capacity and nurse prescribing.
The primary motivation for the ANP in Oman was a
shortfall of physicians especially in PHC settings both
in number and expertise. In addition, emerging health
problems, increased life expectancy and a desire to
move care closer to the population and deeper into the
community caught the attention of the Ministry of Health
(MOH). The MOH and Directorate of Nursing were also
aware that nurses, out of necessity, in small healthcare
centres were providing services in an extended scope
of practice and beyond the level of their generalised
nursing education. Following a series of situational ana-
lyses by short term WHO consultants and development
of a strategic direction by the Directorate of Nursing
based on recommendations by a multidisciplinary task
force, it was decided to proceed with the APN concept
along with on the job training (OJT) for nurses in health
centres already functioning in an advanced clinical
capacity.
The rst ANP, educated in a USA NP master’s degree
programme, began practice in Oman in 2016. Since
that time, additional nurses have completed pro-
grammes abroad and at Sultan Qaboos University. The
ANPs practice in their eld of expertise and/or teach in
the College of Nursing, SQU. The OJT for nurses prac-
ticing beyond their scope of practice was implemented
in 2017 with 25 nurses enrolled from all governorates
of Oman. Based on this success, the trajectory for
these nurses is to support them from their extended
role based on OJT to progress to the specialist role
(Bachelor in Community Health Nursing) and then to
the ANP role with a focus on family health (personal
communication, M. Al-Maqbali, April 2019).
Republic of Ireland
In Ireland, the Advanced Nurse Practitioner (ANP)
emerged as a result of the Commission of Nursing
report, which recommended this development in 1998
(Government of Ireland 2008). The rst ANP post in
Minor Injury Emergency Care was accredited in 2002
(National Council for the Professional Development of
Nursing and Midwifery, 2008a). Since then, the ANP
presence continues to develop. The intention is to
establish a critical mass of approximately 700 ANPs by
2021, which goes towards the target of 2% of ANPs
within the nursing workforce (Ofce of the Chief Nurse,
Department of Health 2017). To facilitate this develop-
ment, the Nursing and Midwifery Board of Ireland (NMBI)
published National Standards and Requirements for the
Education of ANPs at master’s level at the end of 2017.
Standards and Requirements for prescriptive authority
had already been in place (NMBI 2015a and 2015b).
ANP core competencies in Ireland include: (1) auton-
omy in clinical practice, (2) expert practice, (3) pro-
fessional and clinical leadership, and (4) research
(National Council for the Professional Development
of Nursing and Midwifery 2008b). The title Registered
Advanced Nurse Practitioner (RANP) is protected
through the NMBI.
United Kingdom (UK) (England, Northern Ireland,
Scotland, Wales)
The rst nurses graduated from the Royal College of
Nursing (RCN) Nurse Practitioner programme in 1992
(RCN 2008). The rst 15 students led the way for NPs
who now practice throughout the UK. During the early
formative years as RCN developed an accreditation
system for educational institutions, the rst UK educa-
tional competencies emerged (Barton & Allan 2015).
Those competencies were based on consultancy skills,
disease screening, physical examination, chronic dis-
ease management, minor injury management, health
education and counseling. The RCN competency
framework (2008) provided criteria for new courses with
these baseline competencies establishing a standard
for ANP practice outcomes (Barton & Allan 2015).
Following devolution, the four countries of the UK
(England, Northern Ireland, Scotland, Wales) devel-
oped their own approaches to health and social care
and therefore also to associated workforce policy
regarding Advanced Practice Nursing. As a result, the
NP developed in different ways and educational prepar-
ation ranges from a generic approach to a growing ten-
dency to establish preparation at the master’s degree
level. Despite enthusiasm for the role, regulation for
ANP has not been established in the UK.
There is a move to a wider perspective of Advanced
Clinical Practice (ACP) emerging in the UK since 2017
(HEE, 2017). Identifying with ACP incorporates a wide
range of non-medical healthcare professionals within
the multiprofessional ACP category extending to allied
health professionals. Therefore, use of ‘advanced’ titles
vary within and across institutions. England has taken
this further to include pharmacists and social workers.
In Scotland, there are separate nursing and paramedic
work streams and work has started to widen to other
allied health professionals. The focus in Northern
Ireland is currently nursing but discussions have started
regarding expanding this to allied health professionals
(personal communication, K. Maclaine, 8 March 2019).