Moving Towards Universal Health Coverage: Advanced Practice Nursing Competencies in Latin American and Caribbean Countries

Purpose:

In response to the United Nations' call for increased human resources for health to achieve Universal Health Coverage (UHC), the nursing profession needs to educate more nurses with expanded scopes of practice in primary care.  As frontline providers, nurses will have greater impact on health outcomes and reducing global disparities with advanced practice nurses ready to serve communities' needs at a higher level. 

In 2013, the Pan American Health Organization / World Health Organization (PAHO/WHO) issued a resolution, Human Resources for Health: Increasing access to qualified health care workers in primary health care-based health systems (CD52.R13). A major component of the resolution is to build health professional capacity in primary health care, to establish new models of care and to enrich and maximize the scope of practice according to competencies.  The PAHO/WHO Collaborating Center for Advanced Practice Nursing at Columbia University School of Nursing has undertaken a 2 phase project to address this. The first phase is to establish Advance Practice Nursing (APN) Core Competencies in Latin America and Caribbean (LAC) countries. The second phase is to use these competencies as the blueprint to build a prototypical competency-based curriculum for use in LAC, opening the door for APNs to be frontline providers with expanded knowledge and skills.  

Methods:

In order to identify a set of potential APN competencies, a preliminary document of derived APN competencies was developed which served as the basis for a survey that was designed to collect data to establish consensus.  A comprehensive review of established and published APN competencies was conducted. Using PubMed and web searching, the research team collated the documents that purport to identify APN competencies.  The set of derived competencies were conceptualized into four domains: 1) clinical care, 2) interprofessional and patient-centered communication, 3) context of care and 4) using evidence for practice.   An exploratory survey was created that incorporated the derived APN competencies and was targeted to delineate APN practice and competencies for primary care in LAC.  The survey will be sent to nurse educators and leaders in nursing services to establish consensus of APN competencies in LACs. Using the snowball sampling technique, respondents will be asked to forward the survey to their professional networks.

Results:

The result will identify the core APN competencies for LAC as the foundation for development of APNs' capacity in primary care in LAC.  The final document will be disseminated through publications and webinars.  Ministries of health, educational institutions, and regulatory councils will use the competencies as a framework to build context-specific APN competencies and to tailor context-specific curricula as scopes of practice are expanded. 

Conclusion:

Using the Consensus APN Core Competencies in LAC, a model curriculum will be developed that will highlight suggested content that relates to the competencies. By augmenting the competencies to include content areas to support the curriculum, innovative curricula will emerge that fits into the context of the individual country.  It also provides a template for application for other regions of the world.