Advanced PracticeNursinginSwitzerland:Recent developments and regulation

2.SwissAPPSymposiumWinterthur,24.1.2020

ProfDr.RomyMahrerImhof

Responseof changes inhealth care

• Increaseofchronicdiseases• Longevityandincreaseddemands• Changedpatients’expectations• Shortageofworkforce• Careerpathways

Implementationof Advanced PracticeNursing

Buchan&Calman,2004,Skill-mixandpolicychangeinthehealthcareworkforce:Nursesinadvancedroles,OECD

MasterofScienceinNursingprograms

• UniversityofBasel(2000)• UniversityofLausanneandHES-SO(2009)• UniversitiesofAppliedSciencesBern,WinterthurandSt.Gallen(2010)

• UniversityofAppliedScienceKalaidos,Zürich(2010)• UniversityofAppliedSciencesinItalianspeakingpartofSwitzerland(2019)

Pioneers

5

…followed by manyothers…

8

APNinSwitzerland 2013:1.Surveyof MSc

Schwendimann &Koch,2013

Participants:211MSc

136educated inSwitzerland75educated abroad

M=40years (range 23-60)

178women (84%)

Workplaces of APN

0% 10% 20% 30% 40% 50% 60%

HomeCareService

NursingHome

SchoolofHigherEducation

PsychiatricHospital

Freelancer/Association

University

UniversityofAppliedSciences

Hospital

3%

5%

6%

8%

12%

12%

27%

53%

WorkplacesofAPN

PrimaryCare

Stagesof DevelopmentTaskshifting

11

Maier&Aiken(2016)EuropeanJournalof PublicHealth,Taskshifting from physicians to nurses...

Barriers for APNImplementation

• No titleprotection• No role clarity• Unclear /no financial reimbursement• Differenteducation• Unnecessary limitation• Resistanceof stakeholders

Heale &Buckley,2015,Aninternationalperspectiveofadvancedpracticeregulation;Maier&Aiken,2016,Expandclinicalrolesnursestorealigntheglobalhealthworkforcewithpopulationneeds:acommentary

Facilitators for APNImplementation

• Regulationof• Professionaltitle• Scope of practice

• Standardsof education programs• Defined practice competencies• Reimbursement• Presenceof informalpractice

Maier&Aiken,2016,Expandclinicalrolesnursestorealigntheglobalhealthworkforcewithpopulationneeds:acommentary

Regulationof APNTitleprotection,scopeofpractice,registration,prescriptiveauthority

15

Regulation

MaierCB.,2015,Theroleofgovernanceinimplementingtask-shiftingfromphysicianstonursesinadvancedrolesinEurope,U.S.,Canada,NewZealandandAustralia.

Roleofregulation- avoidinformalpractice

• Regulationvialegislation• RegularreviewsoflegislatedScopes-of-Practice(SoP)byexternalreviewgroup(Netherlands);‘Experimentallaw’linkedtoevaluation(Netherlands,California)

• Harmonizationindecentralizedcountrycontext(U.S.)orchangeoflocus:fromstatetofederallevel(Australia)

• Self-regulation• Nursingregulatorybody(e.g.NewZealand,Australia)->canmoreeasilyadaptSoPasskillsandcompetencieschange

• Non-regulatedSoPs• Employer-basedmechanisms,e.g.viacollaborativearrangements(UK),protocols->lessroleclarity,malpracticehandling,responsibilityshiftedtoemployers

RegulationforAdvancedPracticeNurses

• September2016:SwisslawforhealthprofessionalonBSclevel• provisionfortheaccreditationofeducationalprogramsatuniversitylevel• regulationofindependentpractice• registerforallnurses

• SwissNationalParliamentdidnotagreetoincludeaseparateregulationofAPN

• Self-Regulatorybodybasedonframeworkshallbedeveloped

Projekt Reglementierung APN-CH

15.10.20 19

Objectives

Objective1• TheroleprofilesoftheclinicalnursespecialistCNSandthenursepractitionerNParedefinedwithinoneAPNframework(e.g.,Hamric etal.ortheCanadianframework)

Objective2• MainelementsoftheregulationofAPNs(CNSandNPs)areformulated.Objective3• Requirementsforaregulatorybodyanditselementsareformulated.

Firstregistration=Titleprotection

• MScinNursingEducationwithaminimumof90ECTS;APNfocuscurricula(clinicalassessment,advancedpracticeanddecision-makingskills)

• Confirmationofadvancedpracticefromatleast40%

• Supervisedpractice(confirmed50h)withinthefirstyearaftercompletionofeducationaltrack

15.10.20 21

Re-Registrationevery5years

• ConfirmationofCPD:• 8ECTSeducation/courses• Informaleducationsuchasqualitycirclesetc.

• Confirmationofadvancedpracticework:• Atleast40%ofafulltimeequivalentover5years

15.10.20 22

Mostrecentdevelopments

• l'Article 124bisInfirmiers praticiens spécialisés1L’infirmier praticien spécialisé est une personne dont laformation,deniveaumaster,lui permet d’assumer,dans son champ decompétence etdemanièreautonome,lesresponsabilités médicales suivantes :a)prescrire etinterpréter destests diagnostiques ;b)effectuer desactes médicaux ;...c)prescrire desmédicaments etenassurer lesuivi etlesajustements.2L’infirmier praticien spécialisé pratique enprincipe àtitre dépendant,auseind’un établissement sanitaire ou d’une organisation desoins.Ilpeut toutefois également pratiquer àtitre indépendant,dans lecadre d’uneconvention passée avec un médecin autorisé àpratiquer àtitre indépendant3Lerèglement précise leslimites desresponsabilités énumérées àl'alinéa.Ilprécise également leslimites desresponsabilités respectives desprofessionnelsconcernés parl'alinéa.4Lesorganisations professionnelles concernées sont consultées sur lerèglement

Canton Vaud

Regulatingorganizationsince11.11.2019

Form RegisteredAssociation

Organizinginstitutions SBK,IGSwissANP,VFP,SwissNurseLeaders,StiftungLindenhof

Expertcommission electedbyboardofdirectors;developmentrulesofprocedures,applicationapproval

Scientificadvisoryboard stakeholdersofthehealthcaresystemsandeducationalinstitutions

15.10.20 25

Operationalization

• Onlineregistration• E-log• Website• Rulesofprocedure

• Regulatingorganization• Constitutetheboardofdirectors• Constitutetheexpertcommission

Conclusions• Changesinhealthsystems,teams,payers,regulators,patients• Multitudeofpolicyreforms,oftenacceleratedevelopmentatearlystages

• Enablingpolicyenvironment• Regulation:withoutauthorization,nursescannotpracticeinadvancedroleslegallyandofficially

• Paymentpolicies:levelsofreimbursementwithimplicationsoncostsanduptakeinpractice

• Education:revisecurricula,competencies,trainingandCPD

ProfDr RomyMahrerImhof

ProfDr.RomyMahrerImhofNursingScience&CareLtdObertor88400Winterthurromy.mahrer@ns-c.ch