1. Kaplan, Louise PhD, ARNP, FNP-BC, FAANP, FAAN

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The International Council of Nurses established the Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN) in 2000 at the 8th International Conference of Nurse Practitioners in San Diego, California. The Network resulted from years of planning by representatives of the American Association of Nurse Practitioners, the Royal Colleges of Nursing in the United Kingdom and Australia, the International Council of Nursing, and advanced practice nurses from other countries.1 The Network has subsequently sponsored an NP/APNN conference biennially. The 10th conference, held in Rotterdam, the Netherlands from August 26 to 29, 2018, was attended by over 1,600 individuals from 67 countries.


The conference showcased multiple keynote addresses and over 450 concurrent sessions. Keynote speakers included nurses, NPs, and policy makers from around the world. These speakers discussed a wide range of topics, including the emergence of the advanced practice role in Latin America, the centrality of nursing's role in addressing global health challenges, the advanced practice role in mental health, regulation of NP and advanced practice registered nurse (APRN) roles, and collaboration among physicians, nurses, and NPs.


Concurrent sessions were organized according to 11 thematic areas, including changing healthcare and the role of the NP and APRN, international developments and collaboration, evidence-based clinical practice and scientific research, innovation, and education. In addition to poster sessions, the Dutch Innovation Plaza, supported by the Dutch Ministry of Health, showcased innovations primarily related to electronic technologies that could be used in practice. Conference organizers offered an opportunity to visit clinics that provide care for those with mental health and addiction issues, a university medical center, a long-term-care facility, and a hospital that profiled its use of NPs in the hospital setting.


International NPs facing similar issues

Many of the regulatory sessions identified the challenges NPs and APRNs confront in developing their roles in other countries and were reminiscent of the challenges NPs faced in the US. For example, many countries allow RNs to prescribe under certain conditions. Comments during a session about the NP role in Australia identified RN prescribing, which requires a collaborative agreement, as a pathway to NP prescribing which would not require a collaborative agreement.


In many countries such as the Netherlands, the NP role is predominantly hospital based, and the title used is often confusing. For example, NP is not a protected title in the Netherlands, and there is no legal authority for performing certain procedures. Certified nurse specialist is a protected title, and a registered certified nurse specialist may perform specified procedures as well as diagnose and prescribe medication.2


Underresourced countries often use RNs in advanced practice capacities. In Tanzania, half of RNs are educated at a certificate level, 42% received a diploma in nursing, and 7% have a baccalaureate or advanced practice education. Forty-four percent of Tanzanian RNs prescribe at a health facility or for neighbors and friends with urinary tract infection, which is the most common problem for prescribing. Of the 84% who perform minor procedures, 85% suture, 50% perform incision and drainage, and 13% perform circumcision.3


The NP role in the Kingdom of Eswatini

I participated in a symposium to present the landscape assessment my colleague and I conducted, as we sought to assess the readiness of the Kingdom of Eswatini for the introduction of the family NP (FNP) role. We identified barriers and facilitators to the introduction of the FNP role. Barriers included poor infrastructure and limited resources, the lack of NP role models, technology issues for students and practitioners, and the recollection of a certificate-level FNP role, which was not an advanced practice role.


Facilitators included the approval of a scope of practice for the NP by the Eswatini Nursing Council (Swaziland Nursing Council), receptivity and support of community members and Ministry of Health officials, and a high level of interest in the role by nurses, 26 of whom enrolled in the first year of the master's degree program.4


Networking was a major component of the conference, with nurses individually and collectively engaging in dialogue. The conference also allowed for concurrent meetings, such as the one held by the Anglophone Africa Advanced Practice Nurse Coalition. This group is developing a project to seek support from the World Health Organization's regional office for Africa to support development of the advanced practice nurse (APN) role on the continent. The project would supplement the efforts already occurring in African countries by working to make development of the APN role a policy and workforce planning priority.5


Increased global presence of the NP role

The conference was inspiring and served to advance the NP role globally. The network's leadership and the conference organizing committee worked hard to make this an outstanding event, and they deserve recognition for their efforts. I attended the 5th NP/APNN conference in Toronto, Canada in 2008, which was about one-fourth the size of this one. The increased interest in the 2018 conference mirrors the increased global presence of the NP role. The ICN NP/APNN is a valuable resource for practicing NPs, educators, researchers, and policy makers. It promotes development of sustainable efforts and partnerships to promote the NP role to ultimately improve the health of individuals around the globe. Mark your calendar for the next meeting in Halifax, Canada, scheduled for August 30 to September 2, 2020.




1. ICN Nurse Practitioner/Advanced Practice Nursing Network. Network history - 1992 to 2018. 2018. [Context Link]


2. Vogel B, Dekker M. The establishment of the certified nurse specialist in the Dutch legal system: the legal status of nurse practitioners in the Netherlands. Presentation to the 10th ICN NP/APN Conference. Rotterdam, the Netherlands; 2018. [Context Link]


3. Mtuya CC, Blood-Siegfried J. Development of the NP role in Tanzania. Presentation to the 10th ICN NP/APN Conference. Rotterdam, the Netherlands; 2018. [Context Link]


4. Dlamini C, Kaplan L. Developing and introducing the family nurse practitioner role in Eswatini. Presentation to the 10th ICN NP/APN Conference. Rotterdam, the Netherlands; 2018. [Context Link]


5. Anglophone Africa APN Coalition Meeting Minutes. Rotterdam, the Netherlands; 2018. [Context Link]