Advanced Nurse Practice: Present and Future: Where to now?

Abstract Background: Significant variations exist in how countries define the Advanced Nurse/Midwife Practice (ANP/AMP) role which has led to countries not yet recognising or partially recognising the role and its associated competencies. Even though the ANP/AMP role encompasses the assessment, diagnosis and treatment of a range of conditions by undertaking advanced decision making clinical skills and competencies the role remains undervalued in many countries. Aim: To identify the roles and competencies currently being undertaken by ANP/AMPs and the outcomes being achieved that highlight the complex nature of the roles and some of the successes in relation to patient care that are being achieved. Method: An evidence review was undertaken, in 2023, to identify what is known about the subject. A total of 65 manuscripts were retrieved through EBSCO host, Pub Med Central, Google Scholar, Medline and CINAHL. Themes were identified, defined, named, reviewed, analysed and coordinated. Findings: Where the role is recognised many advantages accrue to the patient, nurse, healthcare and society. This is especially true in the areas of emergency, cardiac, respiratory, trauma care, recovery from surgery, pain relief and neonatal amongst others. However, the contribution of ANP/AMPs remains under-recognised is some areas. Conclusions: ANP/AMPs realise and articulate the value and diversity that they bring to health systems. However, internationally, they have been under-utilised generally, creating barriers to achieving universal health coverage and the Sustainable Development Goals. Over-crowded clinical learning environments may contribute to this lack of role recognition. Recognition of the role and the sustainable innovations being achieved would be enhanced and further developed through advanced practitioners themselves promoting their roles, complexity and outcomes by research and publications. Identification of stakeholder collaboration, which is taking place needs highlighting, as do the systemic processes that enable and constrain the ANP/ AMP role and affect the role’s potential contribution to the healthcare system. Recommendations: Advanced Practitioners need to increase the quantity and quality of their research in journal manuscripts that highlight the extraordinary growth of the role and of their impact. ANP/AMPs need to more actively articulate the value and diversity that they bring to health systems to strengthen their contribution to them and to global health sustainability.