Dear editor,
Health care systems globally are facing challenges of meeting the growing demand for
primary care services due to a shortage of primary care physicians. Policy makers
and administrators are searching for solutions to increase the primary care capacity.
While people of all ages receive emergency and critical care services across the world,
the elderly population continues to exhaust a greater proportion of these services.
The aging population and high prevalence of chronic illness have led to an increase
in the demand for primary care that the current supply of primary health care providers
may be unable to meet. With the impending rise in demand for health services, an effective
utilization of the workforce is paramount to ensure high-quality yet cost-effective
health service delivery. Efforts are underway for measures to enhance productivity
through increasing the capacity of the workforce.
The effective utilization of nurse practitioners (NPs) has been proposed as a solution.
The global annual growth of the NP workforce has been estimated to be between three
to nine times greater compared with physicians. The nomenclature varies internationally.
The “NP” title is used in Australia, Belgium, Canada, Sweden, the United Kingdom,
and the United States, whereas the advanced practice nurses “APN” title is used in
Switzerland, Singapore, and South Korea.[2] Nonetheless, NPs and APNs (NP/APNs) are registered nurses (RNs) “who acquired the
expert knowledge base, complex decision-making skills, and clinical competencies for
expanded practice” and enter the workforce with a master's degree.[3] The transition from RN to NP is a significant career role transition. It is often
difficult and can be stressful across various settings. During this time, there is
a shift from an experienced, often expert status in the RN role to an inexperienced,
novice status in the NP role. During NP role transition, there are different personal
and environmental factors that are thought to promote the transition, and two of these
factors include experience and receiving a formal orientation. Experience is believed
to be important for skill acquisition and developing competency in nursing practice.
Prior RN experience is reported to provide a foundation and help facilitate the transition
to the NP role, and NPs with less RN experience are thought to require more time to
transition into the new role. Alternatively, the relationship between prior RN experience
and NP role transition may not be solely explained by the amount of RN experience
but also the type of RN experience gained.
This advanced practice role was first introduced in the 1960s as a solution to the
lack of primary care physicians, to meet the primary care needs of the rural and underserved
populations. Primary care has first contact with patients and, subsequently, provides
continuity of care within the health care system through the coordination of care
according to patients' needs. To fulfill primary care needs, NP/APNs in this setting
are trained generalists who have a breadth of knowledge to render a wide scope of
care.
NP role has extended to other health care settings such as the acute care. Emergency
and primary care advanced nursing practice do share similarities in that they serve
as first-contact access to health care, but the acuity of the patient manifestations
delineates the two. Unlike in primary care NP/APNs, emergency NP/APNs are trained
to manage patients with acute life- or limb-threatening conditions.[1] This expanded practice allows nurses to assume some medical tasks typically performed
by physicians, aiming at not only increasing the access to health care and service
efficiency but also eventually mitigating the cost of health services.
Although NP services in the emergency setting did reduce waiting time and provide
care comparable to that of a midgrade physician, the cost of NP services is at times
higher than that of resident physicians. On the other hand, the use of NPs has shown
to reduce the cost of emergency and intensive care services. Consequently, the cost-effectiveness
of advanced nursing practice in the emergency and critical care settings has remained
inconclusive.
The history of Japanese NPs started in the year 2010, when the Government decided
to create the NP system. In 2012, the training system was started with masters course,
with majors in health sciences. Since 2014, the main law for NP system was changed,
which came into effect from the following year.
Japanese NPs work under directions of physicians, prescribe medicines under directions,
should have more than 5 years' experience as a RN, and its role is still expanding.
In contrast, the western NPs have an independent relation with the physician depending
on the state of work, can prescribe medicines, and have a wide range of work involved.
If NP/APNs can indeed provide competent and safe care in adverse settings, greater
access to emergency and critical care services will be available, thereby strengthening
the workforce to fulfill the escalating health care demands not only in developed
nations, but also in places where there is a huge shortage of qualified doctors.
