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Objectives: Advanced practice nursing roles in cancer care are diverse and exist across the cancer care continuum. However, the titles used and the scope of practice differ across countries. This diversity is likely to be misleading to patients and influence nurses' contribution to health care. An understanding of the current state of advanced practice nursing roles in cancer care internationally is needed to inform opportunities for future role development and enhance cancer nursing career pathways., Methods: This scoping review included a systematic search of four databases: MEDLINE, CINAHL, PsycINFO, and Academic Search Complete. Independent screening for papers meeting the review's inclusion criteria was undertaken using online screening software. Data extraction, coding, and mapping were undertaken in NVivo 12., Results: Of the 13,409 records identified, 108 met the review's inclusion criteria. A variety of roles in cancer care settings were described. The United States and the United Kingdom had the most titles for advanced practice nursing roles. Tumor-specific roles were described and integrated into different phases of the cancer care continuum. Trends in continuing professional development for advanced practice nurses in cancer care included the rise in Fellowship programs in the United States and practice-based education in the United Kingdom., Conclusions: The differences in advanced practice nursing roles in cancer care allow regional and institutional variation to meet the needs of patient populations and health care system demands. However, a lack of clarity surrounding titles and roles results in confusion and underutilization of these nurses' highly specialized skill sets., Implications for Nursing Practice: Incongruence in titles and scope of practice internationally will ultimately result in a merging of roles. There is a need for international agreement on education requirements for advanced practice nursing roles to promote career pathways., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Advanced practice nursing in cancer care is a research priority of the European Oncology Nursing Society (EONS). Five authors are members of the EONS research working group (Maura Dowling, Eva Pape, Paz Fernández-Ortega, Cherith Semple, Amanda Drury). Maura Dowling, Eva Paper, and Denise Bryant-Lukosius were Guest Editors for the “Advanced Oncology Nursing Roles” Special issue of Seminars in Oncology Nursing. As authors of this article, they did not participate in any editorial process or decision-making, which was handled by another editor., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aim: Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID-19., Background: COVID-19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contributions to innovations has not been synthesized. Evidence is needed to inform policies, practices, and research about the optimal use of advanced practice nurses., Methods: A scoping review was conducted and reported using the PRISMA-ScR checklist. Electronic databases were searched for peer-reviewed articles published between January 2020 and December 2021. Papers were included that focused on innovations emerging in response to COVID-19 and involved advanced practice nurses., Results: Fifty-one articles were included. Four themes were identified including telehealth, supporting and transforming care, multifaceted approaches, and provider education. Half of the articles used brief and mostly noncomparative approaches to evaluate innovations., Conclusion: This is the first synthesis of international evidence examining the contributions of advanced practice nurses during the pandemic. Advanced practice nurses provided leadership for the innovation needed to rapidly respond to healthcare needs resulting from COVID-19. Innovations challenged legislative restrictions on practice, enabled implementation of telehealth and new models of care, and promoted evidence-informed and patient-centered care., Implications for Practice: Advanced practice nurses led, designed, implemented, and evaluated innovations in response to COVID-19. They facilitated the use of telehealth, supported or transformed models of care, and enabled health providers through education, mentorship, and mental health support., Implication for Policy: Advanced practice nurses are a critical resource for innovation and health system improvement. Permanent removal of legislative and regulatory barriers to their full scope of practice is needed., (© 2023 International Council of Nurses.)

Objectives: To examine the advanced practice nurse workforce in Swiss cancer care and how their roles are being implemented (eg, role structures, processes) to achieve optimal outcomes for patients and their families, care organizations, and the broader health care system., Methods: A cross-sectional study was conducted. The sample included master-prepared advanced practice nurses in cancer care, who completed an online questionnaire from December 2021 to January 2022. Thirty-nine items assessed structures (eg, role characteristics, utilization), processes (eg, role activities, interventions), and perceived outcomes (eg, for patients, the health care system) of advanced practice nurses in Swiss cancer care. Data from closed questions were analyzed using descriptive statistics. Data from open-ended questions were organized and summarized into categories related to domains of advanced practice nursing and its reported frequency by the advanced practice nurses., Results: The participating advanced practice nurses (n = 53), worked in half of the 26 Swiss cantons. Interventions were identified within nine categories, of which most were targeted to patients and their families (n = 7), followed by health care professionals (n = 2). Perceived positive outcomes were patient symptom management, length of hospital stay, and health care costs. Participants felt less confident in cancer care (eg, autonomous practice) and reported 15 professional development needs (eg, medical interventions, teaching)., Conclusions: This study provides a comprehensive examination of 53 advanced practice nurses, detailing the characteristics of their roles and utilization across various jurisdictions and health care settings. The results highlight the diverse dimensions of advanced practice nursing and its potential to enhance cancer services and outcomes in Switzerland. Opportunities for role development support and expansion are identified., Implications for Nursing Practice: More systematic health human resource planning is needed to expand the deployment of advanced practice nurses across jurisdictions, practice settings, and more diverse patient populations. Role development needs show the desire for specialized educational preparation in cancer care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Aims: The aims of the study were to describe the processes used to introduce advanced practice nursing roles and factors that facilitated or hindered role implementation, examine the time advanced practice nurses (APNs) spend in role activities and how these activities relate to domains of advanced practice nursing and examine how implementation processes influenced APN integration within healthcare teams., Design: A multiple case study was conducted., Methods: Five cases were included, representing the four population areas approved for advanced practice nursing in France. Data were collected from January to March 2021 using observation, interview and document analysis methods. Data were examined using thematic analysis., Results: Participants included APNs (n = 5), nurses/allied health providers (n = 5), physicians (n = 5), managers (n = 4) and decision-makers (n = 4). Stakeholder engagement and leadership provided by decision-makers, managers, physicians and APNs facilitated role implementation. Poor stakeholder role understanding, uncertain role funding, and the COVID-19 pandemic hindered role implementation. APNs spent the most time in clinical activities. Participants perceived the integration of APNs within the healthcare team and their impact on patient care to be positive., Conclusion: Stakeholder engagement and organizational and APN leadership facilitated the implementation of the roles, especially related to team-based patient care. Further efforts are needed to strengthen APN involvement in non-clinical activities and address role barriers., Implications for Nursing and Patient Care: Systematic and system-wide approaches are needed to improve role clarity, role autonomy and health systems integration of APNs. Research should examine patient perspectives about APNs in France., Impact: The results highlight how policies can create favourable conditions for advanced practice nursing role implementation in France. Internationally, this study serves as a reminder to APNs and nurse leaders about the strategies for and importance of implementation evaluation to support the optimal development of advanced practice nursing roles., Reporting Method: The study reporting followed the Consolidated Criteria for Reporting Qualitative Research., Patient or Public Contribution: No Patient or Public Contribution., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

The retention of Canada's advanced practice nurses (APNs), including clinical nurse specialists and nurse practitioners, is a national health human resources issue. APNs are essential within the Canadian healthcare workforce for meeting patient and population health needs, often in underserved communities. A shortage of APNs will exacerbate barriers to access to care for patients across sectors, including primary, acute, long-term and transitional care settings. This paper provides highlights from literature reporting on the state of APN human resources in Canada, including influential barriers and facilitators, and recommendations for retaining these important leaders in the healthcare workforce., (Copyright © 2023 Longwoods Publishing.)

A career ladder for nurses, including several levels of nursing practice and specific roles for advanced practice nurses, was introduced in Hong Kong around the start of the 21st century. To date no studies have distinguished the practices of advanced practice nurses in Hong Kong. This cross-sectional study, conducted between November 2020 and March 2021, aims to identify and differentiate the practice patterns of advanced practice nurses by utilizing the Advanced Practice Role Delineation tool. A total of 191 responses were obtained. Three roles were identified: nurse consultant, advanced practice nurse, and advanced practice nurse in management. Among the five advanced practice nursing domains, nurses were most frequently involved in Education and in Direct Comprehensive Care activities, while least active in Research and in Publication and Professional Leadership. Identifying activities in various nursing roles helps to differentiate their responsibilities and provides new insights for role utilization and support. Although the role characteristics are shaped by country contexts, research evidence on practice patterns may be used to support international discussion and efforts to promote role clarity and effective role introduction and optimization., (© 2022 The Authors. Nursing & Health Sciences published by John Wiley & Sons Australia, Ltd.)

Background: Internationally, there is increasing demand for nurse practitioner (NP) and advanced practice nursing (APN) roles; however, high variability exists in how NP/APN roles are defined and understood., Purpose: The aim of this research was to improve our understanding of how the NP/APN is defined globally by: 1) examining role definitions, competencies, and standards of practice for advanced practice nurses internationally; 2) describing from a global perspective the core concepts and common features of NP/APN associated with practice domains; and 3) exploring the utility of text mining and visual analytics in identifying the clustered core concepts common to NP/APN roles organized around the five advanced practice domains of the Strong Advanced Practice Model., Methods: This article describes the findings of a secondary analysis of an international NP/APN competency mapping project, using innovative text mining and visual analysis techniques to reexamine and summarize the NP/APN role in 19 countries from Africa, Australia, Asia, Europe, and North America., Results: Although weak aggrupation/associations suggest that further work is needed to define the domains of advanced practice with associated model development, visual analysis points to the identification of common concepts and linkages between concepts for each practice domain of advanced practice outlined in the Strong Model., Implications for Practice: The secondary text mining and visual analysis presented in this article allows for comparison of core elements between advanced practice role descriptions, standards, and competencies globally to ultimately provide a global perspective on the common features of NP/APN roles and areas where further delineation is required., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2020 American Association of Nurse Practitioners.)

Purpose: To examine the exemplary practice of nurse consultants (NCs) and derive a model to illustrate the highest level of advanced nursing practice., Design: A descriptive study was conducted to examine the practice and outcomes of seven NC roles in varied clinical specialties in Hong Kong. Exemplary practice was examined in relation to competencies for advanced practice nursing in Hong Kong and the United Kingdom., Methods: Data about NC characteristics and their practices were collected using a structured questionnaire and analyzed using descriptive statistics. Health service documents and clinical notes were analyzed using the framework approach., Findings: All NCs demonstrated the competence expected of an advanced practice nurse with impacts on patients, nursing profession, and the organization as identified in the advanced nursing practice framework in Hong Kong. NCs also performed at the highest level of practice delineated by Skills for Health in the United Kingdom. They were involved in diagnostic and therapeutic practice, and identified patient satisfaction and symptom management as key outcomes., Conclusions: This study provides new insight into levels of advanced practice and illustrates the exemplary work of NCs to demonstrate how they have developed and shaped services to bring about positive patient and organizational outcomes. Career laddering that places NCs at the highest level of advanced practice is important for making the best use of nursing expertise to achieve optimal patient and organizational outcomes., Clinical Relevance: This study addresses a knowledge gap to enrich our current understanding of the impact of advanced practice nursing roles by linking NC role practices and competencies to key outcomes., (© 2017 Sigma Theta Tau International.)

SYNOPSIS Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.

Objective:: to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health., Method:: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health., Results:: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation., Conclusions:: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries., Objetivo:: analisar o papel da enfermagem com prática avançada (EPA) a nível internacional para um relatório do seu desenvolvimento na América Latina e no Caribe, para apoiar a cobertura universal de saúde e o acesso universal à saúde., Método:: análise da bibliografia relacionada com os papéis da EPA, sua implantação no mundo e a eficácia da EPA em relação à cobertura universal de saúde e acesso à saúde., Resultados:: dada a evidência da sua eficácia em muitos países, as funções da EPA são ideais como parte de uma estratégia de recursos humanos de atenção primária de saúde na América Latina para melhorar a cobertura universal de saúde e o acesso à saúde. Brasil, Chile, Colômbia e México estão bem posicionados para construir esta força de trabalho. Barreiras à implementação destas funções incluem: a falta de clareza do seu papel, a legislação/regulamentação, educação, financiamento, e a resistência médica. Uma liderança forte de enfermagem é necessária para alinhar o papel da EPA com as prioridades políticas e trabalhar em colaboração com os profissionais de atenção primária e os decisores políticos para a implementação bem sucedida das suas funções., Conclusões:: dada a diversidade de contextos dos diferentes países, é importante avaliar sistematicamente as necessidades de saúde do país e da população para introduzir a combinação mais adequada e complementar dos papéis da EPA e formatar sua aplicação. A introdução bem sucedida do papel da EPA na América Latina e no Caribe poderia fornecer um roteiro para funções semelhantes noutros países de baixa/média renda., Objetivo:: examinar el rol de la enfermería con práctica avanzada (EPA) a nivel internacional para informar de su desarrollo en América Latina y el Caribe, en apoyo a la cobertura de salud universal y el acceso universal a la salud., Método:: se analizó la literatura relacionada con los roles de la EPA, su despliegue en el mundo y la eficacia de EPA en relación con la cobertura de salud universal y el acceso a la salud., Resultados:: dada la evidencia de su eficacia en muchos países, las funciones de la EPA son ideales como parte de una estrategia de recursos humanos de atención primaria de salud en América Latina para mejorar la cobertura de salud universal y el acceso a la salud. Brasil, Chile, Colombia y México están bien posicionados para construir esta fuerza de trabajo. Las barreras a la implementación de estas funciones incluyen: la falta de claridad de su rol, la legislación/regulación, educación, financiamiento, y la resistencia de los médicos. Se necesita un liderazgo fuerte de enfermería para alinear los roles de la EPA con las políticas prioritarias, y trabajar en colaboración con los profesionales de atención primaria y los responsables de las políticas para la implementación exitosa de sus funciones., Conclusiones:: teniendo en cuenta la diversidad de los contextos en diferentes naciones, es importante evaluar sistemáticamente las necesidades de salud del país y de la población para introducir la combinación más adecuada y complementaria de los papeles de la EPA y dar un formato a su aplicación. La introducción con éxito del papel de la EPA en América Latina y el Caribe podría proporcionar una hoja de ruta para funciones similares en otros países de bajos/medios ingresos.

Background: Health system researchers must ensure that the products of their work meet the needs of various stakeholder groups (e.g., patients, practitioners, and policy makers). Evidence-based frameworks can support the uptake and spread of research evidence; however, their existence as knowledge translation tools does not ensure their uptake and it is difficult to ascertain their spread into research, practice, and policy using existing methods., Purpose: The purpose of this article is to report results of a study on the spread and uptake of an evidence-based framework (i.e., the participatory, evidence-based, patient-focused process for advanced practice nursing [PEPPA] framework) into research, practice, and policies relevant to the introduction and evaluation of advanced practice nursing roles. We also reflect on the utility of using a modified citation methodology to evaluate knowledge translation efforts., Methods: We searched four databases for literature published between 2004 and 2014 citing the original paper in which the PEPPA framework was published, and carried out an Internet search for grey literature using keywords. Relevant data were extracted from sources and organized using NVivo software. We analysed results descriptively., Results: Our search yielded 164 unique sources of which 69.5% were from published literature and the majority (83.4%) of these were published in nursing journals. Most frequently (71.5%), the framework was used by researchers and students in research studies. A smaller number of citations (11.3%) reflected use of the PEPPA framework in practice settings with a focus on role development, implementation, evaluation, or a combination of these., Linking Evidence to Action: This study demonstrates that the PEPPA framework has been used to varying degrees as intended, and provides guidance on how to evaluate the spread and uptake of research outputs (e.g., theoretical frameworks). Further research is needed about ways to determine whether evidence-informed research tools such as frameworks have been taken up successfully into practice and policy contexts., (© 2016 Sigma Theta Tau International.)

Purpose: To address the gap in evidence-based information required to support the development of advanced practice nursing (APN) roles in Switzerland, stakeholders identified the need for guidance to generate strategic evaluation data. This article describes an evaluation framework developed to inform decisions about the effective utilization of APN roles across the country., Approach: A participatory approach was used by an international group of stakeholders. Published literature and an evidenced-based framework for introducing APN roles were analyzed and applied to define the purpose, target audiences, and essential elements of the evaluation framework. Through subsequent meetings and review by an expert panel, the framework was developed and refined., Findings: A framework to evaluate different types of APN roles as they evolve to meet dynamic population health, practice setting, and health system needs was created. It includes a matrix of key concepts to guide evaluations across three stages of APN role development: introduction, implementation, and long-term sustainability. For each stage, evaluation objectives and questions examining APN role structures, processes, and outcomes from different perspectives (e.g., patients, providers, managers, policy-makers) were identified., Conclusions: A practical, robust framework based on well-established evaluation concepts and current understanding of APN roles can be used to conduct systematic evaluations., Clinical Relevance: The evaluation framework is sufficiently generic to allow application in developed countries globally, both for evaluation as well as research purposes., (© 2016 Sigma Theta Tau International.)

This 2016 special edition on advanced practice nursing (APN) roles in Canada builds on earlier role progress reported in the first special edition in 2010. Advancements in role development and innovative models that utilize APN roles are highlighted. The need for further efforts to support health systems integration of APN roles related to funding, research and decision-maker understanding of the roles, and to learn from international experience in APN role implementation are described.

The transfer of health-related research knowledge between producers and users is a complex, dynamic and iterative process. There has been little research describing the preferred knowledge transfer strategies used by different stakeholder groups, including healthcare providers, policymakers and administrators. The purpose of the survey was to gain an understanding of the content and preferred dissemination strategies of knowledge users of briefing notes about the effectiveness of advanced practice nursing (APN) roles in Canada. An on-line cross-sectional survey was conducted from December 2011 to January 2012. Purposeful sampling was used to identify the target audience. The questionnaire included six items. The response rate was 44% (n=75/170). Participants identified that the briefing note should concisely summarize definitions for APN roles and information about the safety, effectiveness, cost savings and effective role implementation strategies. Multiple approaches were favoured to disseminate the information. Preferred dissemination strategies included personalized emails, meeting with briefing note recipients, engaging nurse practitioners and clinical nurse specialists in organizations where APN roles have been successfully implemented, engaging the media and using social media. The use of briefing notes has shown promise. More research is needed to evaluate the effectiveness of tailored briefing notes., (Copyright © 2015 Longwoods Publishing.)

The objective of this decision support synthesis was to identify and review published and grey literature and to conduct stakeholder interviews to (1) describe the distinguishing characteristics of clinical nurse specialist (CNS) and nurse practitioner (NP) role definitions and competencies relevant to Canadian contexts, (2) identify the key barriers and facilitators for the effective development and utilization of CNS and NP roles and (3) inform the development of evidence-based recommendations for the individual, organizational and system supports required to better integrate CNS and NP roles into the Canadian healthcare system and advance the delivery of nursing and patient care services in Canada. Four types of advanced practice nurses (APNs) were the focus: CNSs, primary healthcare nurse practitioners (PHCNPs), acute care nurse practitioners (ACNPs) and a blended CNS/NP role. We worked with a multidisciplinary, multijurisdictional advisory board that helped identify documents and key informant interviewees, develop interview questions and formulate implications from our findings. We included 468 published and unpublished English- and French-language papers in a scoping review of the literature. We conducted interviews in English and French with 62 Canadian and international key informants (APNs, healthcare administrators, policy makers, nursing regulators, educators, physicians and other team members). We conducted four focus groups with a total of 19 APNs, educators, administrators and policy makers. A multidisciplinary roundtable convened by the Canadian Health Services Research Foundation formulated evidence-informed policy and practice recommendations based on the synthesis findings. This paper forms the foundation for this special issue, which contains 10 papers summarizing different dimensions of our synthesis. Here, we summarize the synthesis methods and the recommendations formulated at the roundtable.

Although advanced practice nurses (APNs) have existed in Canada for over 40 years and there is abundant evidence of their safety and effectiveness, their full integration into our healthcare system has not been fully realized. For this paper, we drew on pertinent sections of a scoping review of the Canadian literature from 1990 onward and interviews or focus groups with 81 key informants conducted for a decision support synthesis on advanced practice nursing to identify the factors that enable role development and implementation across the three types of APNs: clinical nurse specialists, primary healthcare nurse practitioners and acute care nurse practitioners. For development of advanced practice nursing roles, many of the enabling factors occur at the federal/provincial/territorial (F/P/T) level. They include utilization of a pan-Canadian approach, provision of high-quality education, and development of appropriate legislative and regulatory mechanisms. Systematic planning to guide role development is needed at both the F/P/T and organizational levels. For implementation of advanced practice nursing roles, some of the enabling factors require action at the F/P/T level. They include recruitment and retention, role funding, intra-professional relations between clinical nurse specialists and nurse practitioners, public awareness, national leadership support and role evaluation. Factors requiring action at the level of the organization include role clarity, healthcare setting support, implementation of all role components and continuing education. Finally, inter-professional relations require action at both the F/P/T and organizational levels. A multidisciplinary roundtable formulated policy and practice recommendations based on the synthesis findings, and these are summarized in this paper.

The acute care nurse practitioner (ACNP) role was developed in Canada in the late 1980s to offset rapidly increasing physician workloads in acute care settings and to address the lack of continuity of care for seriously ill patients and increased complexity of care delivery. These challenges provided an opportunity to develop an advanced practice nursing role to care for critically ill patients with the intent of improving continuity of care and patient outcomes. For this paper, we drew on the ACNP-related findings of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing. The synthesis revealed that ACNPs are working in a range of clinical settings. While ACNPs are trained at the master's level, there is a gap in specialty education for ACNPs. Important barriers to the full integration of ACNP roles into the Canadian healthcare system include lack of full utilization of role components, limitations to scope of practice, inconsistent team acceptance and funding issues. Facilitators to ACNP role implementation include clear communication about the role, with messages tailored to the specific information needs of various stakeholder groups; supportive leadership of healthcare managers; and stable and predictable funding. The status of ACNP roles continues to evolve across Canada. Ongoing leadership and continuing research are required to enhance the integration of these roles into our healthcare system.

In Canada, education programs for the clinical nurse specialist (CNS) and nurse practitioner (NP) roles began 40 years ago. NP programs are offered in almost all provinces. Education for the CNS role has occurred through graduate nursing programs generically defined as providing preparation for advanced nursing practice. For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe the following: (1) history of advanced practice nursing education in Canada, (2) current status of advanced practice nursing education in Canada, (3) curriculum issues, (4) interprofessional education, (5) resources for education and (6) continuing education. Although national frameworks defining advanced nursing practice and NP competencies provide some direction for education programs, Canada does not have countrywide standards of education for either the NP or CNS role. Inconsistency in the educational requirements for primary healthcare NPs continues to cause significant problems and interferes with inter-jurisdictional licensing portability. For both CNSs and NPs, there can be a mismatch between a generalized education and specialized practice. The value of interprofessional education in facilitating effective teamwork is emphasized. Recommendations for future directions for advanced practice nursing education are offered.

The clinical nurse specialist (CNS) provides an important clinical leadership role for the nursing profession and broader healthcare system; yet the prominence and deployment of this role have fluctuated in Canada over the past 40 years. This paper draws on the results of a decision support synthesis examining advanced practice nursing roles in Canada. The synthesis included a scoping review of the Canadian and international literature and in-depth interviews with key informants including CNSs, nurse practitioners, other health providers, educators, healthcare administrators, nursing regulators and government policy makers. Key challenges to the full integration of CNSs in the Canadian healthcare system include the paucity of Canadian research to inform CNS role implementation, absence of a common vision for the CNS role in Canada, lack of a CNS credentialing mechanism and limited access to CNS-specific graduate education. Recommendations for maximizing the potential and long-term sustainability of the CNS role to achieve important patient, provider and health system outcomes in Canada are provided.

A framework for the introduction and evaluation of APN roles emphasizes the importance of a systematic approach to role development based on the assessment of patient health needs. This study determined the health-related quality of life (HRQL) of patients with prostate cancer. The most frequent and severe patient health problems and their perceptions of priority health problems were identified and compared across five patient groups as a strategy to inform the supportive care role of the advanced oncology nurse for patients with advanced prostate cancer. The study found that the majority of men with early stage and advanced hormone sensitive prostate cancer can expect to enjoy good quality of life for several years following diagnosis. These two patient groups have common priority needs for improving their health related to sexual function, urinary frequency, urinary incontinence, and physical activity. Both groups may benefit from an advanced practice nursing (APN) role that can provide episodic supportive care for health problems occurring at different treatment stages. Conversely, it was found that men with advanced hormone refractory prostate cancer experience significantly poorer HRQL and have multiple severe health problems. These patients also have different priority needs including problems related to pain, fatigue, and decreased physical activity. Because of this, the focus of supportive care programs and interventions in advanced prostate cancer will differ for those with hormone refractory disease. They may benefit more from an APN role that can provide ongoing rather than episodic supportive care to assess and manage the multiple, new, and worsening health problems associated with progressive disease.

Advanced practice nursing has evolved over the years to become recognized today as an important and growing trend among healthcare systems worldwide. To understand the development and current status of advanced practice nursing within a Canadian context, it is important to explore its historical roots and influences. The purpose of this paper is to provide a historical overview of the major influences on the development of advanced practice nursing roles that exist in Canada today, those roles being the nurse practitioner and the clinical nurse specialist. Using a scoping review and qualitative interviews, data were summarized according to three distinct time periods related to the development of advanced practice nursing. They are the early beginnings; the first formal wave, between the mid 1960s and mid 1980s; and the second wave, beginning in the late 1980s and continuing to the present. This paper highlights how advanced practice nursing roles have evolved over the years to meet emerging needs within the Canadian healthcare system. A number of influential factors have both facilitated and hindered the development of the roles, despite strong evidence to support their effectiveness. Given the progress over the past few decades, the future of advanced practice nursing within the Canadian healthcare system is promising.

Title confusion and lack of role clarity pose barriers to the integration of advanced practice nursing roles (i.e., clinical nurse specialist [CNS] and nurse practitioner [NP]). Lack of awareness and understanding about NP and CNS roles among the healthcare team and the public contributes to ambiguous role expectations, confusion about NP and CNS scopes of practice and turf protection. This paper draws on the results of a scoping review of the literature and qualitative key informant interviews conducted for a decision support synthesis commissioned by the Canadian Health Services Research Foundation and the Office of Nursing Policy in Health Canada. The goal of this synthesis was to develop a better understanding of advanced practice nursing roles and the factors that influence their effective development and integration in the Canadian healthcare system. Specific recommendations from interview participants and the literature to enhance title and role clarity included the use of consistent titles for NP and CNS roles; the creation of a vision statement to articulate the role of CNSs and NPs across settings; the use of a systematic planning process to guide role development and implementation; the development of a communication strategy to educate healthcare professionals, the public and employers about the roles; attention to inter-professional team dynamics when introducing these new roles; and addressing inter-professionalism in all health professional education program curricula.

Supportive nursing leadership is important for the successful introduction and implementation of advanced practice nursing roles in Canadian healthcare settings. For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe and explore organizational leadership in planning and implementing advanced practice nursing roles. Leadership strategies that optimize successful role integration include initiating systematic planning to develop the roles based on patient and community needs, engaging stakeholders, using established Canadian role implementation toolkits, ensuring utilization of all dimensions of the role, communicating clear messages to increase awareness about the roles in the organization, creating networks and facilitating mentorship for those in the role, and negotiating role expectations with physicians and other members of the healthcare team. Leaders face challenges in creating and securing sustainable funding for the roles and providing adequate infrastructure support.