Project to regulate APN in Switzerland

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1 Project to regulate APN in Switzerland Prof. Dr. Maya Zumstein-Shaha on behalf of Regulation ANP-CH, August 27, 2018, at the 10th ICN NP/APN Conference in Rotterdam

2 Contenu Nursing and Nursing Education in Switzerland Bachelor Degree Advanced Practice Nursing Regulation Project Next Steps

3 Nursing and Nursing Education in Switzerland (1) Increase in professionalisation, Harmonization of nursing education within the European Union, For Switzerland as part of the Bilateral Treaties: Harmonisation with the system of education of the EU (Bologna directives), and Adoption of the EU Directive for the Recognition of diplomas (2005/36 EC) (European Union, 2005). Need for new roles (Schäfer, Scherrer, Careum F & E, Burla, 2013; Ulrich et al., 2010; Spirig et al., 2010), Shortage of (highly) qualified health professionals, Increase in job and employment attraction due to enhanced career possibilities (Mächler, 2014; Schweizer Berufsverband der Pflegefachfrauen und Pflegefachmänner SBK, 2011).

4 Nursing and Nursing Education in Switzerland (2) Professional education on a tertiary level at universities of applied sciences and/or higher professional colleges in all linguistic areas, Studies in combination with clinical practice, Professional education is grounded in the Swiss general mission of the dual education system. Several ways are determined that may lead to obtaining professional education on tertiary level, Admission to tertiary education always necessitates a higher school certificate, Professional education is credentialed by the State Secretariat for Education, Research and Innovation (SERI), Swiss Nurses Association (SBK-ASI) constitutes the professional body for all nurses in Switzerland,

5 Swiss Education System in Health Care OdASanté (2017)

6 Nursing and Nursing Education in Switzerland (3) Tertiary level education in nursing exists since 2002 in Switzerland, At the same time, the regulation of professional education of nonmedical professions was transferred to the Swiss Confederation, Currently, education for these professions are provided by: Universities of applied sciences and higher professional colleges, General duration: 3 years, Denomination: nurse, Differences in the educational programs between the universities of applied sciences and higher professional colleges are: Admission criteria, Differing final competence profiles, Special situation in Switzerland concerning diplomas obtained prior to the reconstruction of the professional education system, Recognition of the previously obtained diploma can be granted, provided specific criteria are met.

7 Nursing and Nursing Education in Switzerland (4) In 2015, the Federal Counsellor initiated the Law for Health Professions (LP San GesBG). Purpose: Improvement of quality in all non-medical health professions, which are taught at tertiary level, by determining requirement for education and professional practice, Non-medical health professions: nursing, midwifery, physiotherapy, occupational therapy, nutrition, optometry and osteopathy, Content: Determining the relevant professional groups, Regulation of general and profession-specific learning outcomes, Authorisation for professional practice within the specific scope of practice (Swiss Confederation, 2016).

8 Nursing and Nursing Education in Switzerland (5) First time that nursing is accredited with a specialised scope of practice within which nurses may assess, treat and evaluate themselves without physicians orders. However, the law only regulates the Bachelor level in nursing and other health professions except optometry and osteopathy. The Masters level for nursing and other health professions was not included due to fears of over-academisation and cost-increase, Therefore, the project for regulation the Masters level was started. Current state of the law: Law passed, Implementation planned for 2020, Development of ordinances,

9 Nursing and Nursing Education in Switzerland (6) The definition of nursing as proposed by the ICN (2010) also constitutes the Swiss definition of nursing. Nursing encompasses autonomous and collaborative care of individuals of all ages, families of civil unions, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. (Comité international des infirmières/infirmiers, 2010; Association suisse des infirmières et infirmiers ASI-SBK, 2011: 6).

10 Nursing and Nursing Education in Switzerland (7) The Bachelor degree in Nursing constitutes a professional qualification that allows for working as a registered nurse, Currently: 15 general and profession-specific learning outcomes: Provision of care including assessment, treatment and evaluation, Caring for patients and their families, Evidence-based practice, Generation and application of new knowledge, Working within an interdisciplinary team, Considering ethical issues, Communicating adequately and competently with care receivers and providers, Working in rapidly changing and challenging situations,

11 Master of Science in Nursing (1) Several providers with various aims: University of Basle, Institute of Nursing Science: APN Research track Diploma of Advanced Studies in ANP Plus (after the MSc) University of Lausanne, Institut universitaire de formation et de recherche en soins APN NP track (new) Universities of Applied Sciences Berne, Winterthur and St. Gall, Divisions of Nursing, Clinical Nurse Specialist APN Private University of Applied Sciences Kalaidos, Zürich, Clinical Excellence

12 Master of Science in Nursing Learning Outcomes Master of Science in Nursing graduates across Switzerland are expected to be clinical experts who: analyse and intervene in complex and problematic clinical situations, Provide effective evidence-based care, Contribute to or engage in the development of new solutions, concepts, Contribute to or engage in the development of research questions, Contribute to or engage in the promotion of the health care system grounded in their professional knowledge ( profile_and_prospects.html). Doctorates in nursing science are offered at the two university institutes, namely Basle and Lausanne.

13 Advanced Nursing Practice in Switzerland (1) Demographic changes, Advancement in medicine and other health-related scientific disciplines, Increase in numbers of persons with chronic diseases and multimorbidity, Growth in dementia and similar pathologies, Growth in obesity and metabolic diseases, Weak reduction in cardiovascular and cancer-related diseases (Federal Statistics Office, 2017), Increase of demands for autonomy and self-management of patients and their families resulting from the changes in the health care system (Richards, 2012), Higher demand for adherence to medications and other treatments, Higher risk of impaired safety in care and treatments (Schrappe, 2015; Schwendimann, Zimmermann, Kung, et al., 2012).

14 Advanced Nursing Practice in Switzerland (2) Increase in fragmentation of the health care system, Continually higher cost constituting an impairment to efficiency, Even more pronounced shortage of highly qualified and skilled professionals, Counter-measures include: Implementation of clinical pathways to reduce fragmentation, Clinical Care Pathways, New structures for financing and accounting to improve costrelated issues, Diagnosis-related groups (DRG) (Deneckere, Euwema, Van Herck, et al., 2012; Kleinknecht, Frei, Spichiger, et al., 2011; Laaser, Rottger-Liepmann, Breckenkamp, et al., 2000; Schweizer Berufsverband der Pflegefachfrauen und Pflegefachmänner SBK, 2011).

15 Advanced Nursing Practice in Switzerland (3) Challenges for patients and their families include the need for: more tailored, adequate and relevant information, comprehensive and comprehensible information, systematic provision of information, specific preparation and learning of skills, guidance to improve moving through the health care system, And psychosocial support tailored to the situation, Support and education of the family (Lamiani & Furey, 2009; Lorig, 2001).

16 Advanced Nursing Practice in Switzerland (4) Advanced Nursing Practice (ANP) constitutes an answer to these challenges, Particularly, the advantage of ANP is perceived related to patients with chronic diseases or multimorbidity (Hamric et al., 2014), ANP is a concept developed by Hamric et al. (2014), ANP denotes a nurse: with extended practice, with an academic education such as Masters or doctoral degree, who specialises in one particular domain of nursing, whose professional activity focusses on patients and their families.

17 Advanced Nursing Practice in Switzerland (5) The definition used for Advanced Practice Nurses in Switzerland is based on the definition by Hamric et al. (2014): An Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base due to her academic education, expert knowledge as well as complex decision-making skills to be used in complex situations, and clinical competencies for expanded practice. Advanced Practice Nurses are able to take over enhanced roles in diverse settings and to fulfil these roles autonomously within their scope of practice and as part of the interprofessional team. The key competencies of Advanced Practice Nurses include direct clinical practice, expert coaching, consultation, ethical decision making, interdisciplinary collaboration, clinical and specialized leadership as well as research skills (

18 Advanced Nursing Practice According to Hamric et al. (2014)

19 Kick-Off: October 19, 2017

20 Project to Regulate Advanced Nursing Practice in Switzerland (1) For the Federal Law for non-medical health professions a network of stakeholders in nursing education and practice had been instituted, During the elaboration of this law, the need was identified to promote the Masters level education and to have it integrated. Hence, a task force was created including representatives from Masters degree education in nursing in Switzerland as well as relevant professional associations promoting advanced nursing practice. Coordination of this task force: Swiss Nurses Association, However, the Masters level education failed to be integrated into the new law. Strong motivation to pursue regulation of advanced nursing practice, Diverse interpretations of advanced roles had cropped up.

21 Project to Regulate Advanced Nursing Practice in Switzerland (2) Main objective: Regulation of the roles of Advanced Practice Nurses APNs, including both profiles clinical nurse specialists (CNS) and nurse practitioners (NP) in order to contribute to high quality health care for all residents of Switzerland in the future. For the definition of the scopes of practice interprofessional discussion with other providers is considered essential. Coordination by the Swiss Nurses Association Steering group and project work group include key representatives of Masters level education in nursing in Switzerland, clinical practice, hospitals, and representatives of professional associations promoting advanced nursing practice in Switzerland.

22 Project to Regulate Advanced Nursing Practice in Switzerland (3) It was decided that Advanced Nursing Practice included two roles: Clinical nurse specialists Nurse Practitioners

23 Project to Regulate Advanced Nursing Practice in Switzerland (4) Aim 1: The role profiles of the clinical nurse specialist CNS and the nurse practitioner NP are defined within one APN framework (e.g., Hamric et al. or the Canadian framework). The scope of practice, based on patient needs, is discussed with the other main providers in the same field. Aim 2: Main elements of the regulation of APNs (CNS and NPs) are formulated. They may include the following fields: Education Work experience Professional practice Continuous professional development CPD Title protection Course accreditation Possible federal examination Pathway for specialist nurses

24 Project to Regulate Advanced Nursing Practice in Switzerland (5) Aim 3: Requirements for a regulatory body and its elements are formulated. Such a regulating body is in place, and may include the following fields: Aim 4: A responsible organ An expert commission An implementing structure A sustainable financing model The connection and harmonisation with health system developments and political environment is made by monitoring, communication and stakeholder involvement.

25 Project to Regulate Advanced Nursing Practice in Switzerland (6) Work in subgroups, Regular meetings with thorough monitoring of the current situation in Switzerland, Subgroup 1: is concerned with developing a potential structure for such a credentialing organisation, Subgroup 2: is concerned with developing criteria for ANP credentialing, Consultation of relevant literature, Consultation of experts through theoretical inputs, Presentation at various conferences across Europe,

Project to Regulate Advanced Nursing Practice in Switzerland (7) Law on health

Nurses have an autonomous practice, Within this practice, nurses are allowed to

November 7, 2017, to the Federal Chancellor s Office Nurses to be recognised to

are allowed to assess, diagnose, prescribe, treat and evaluate on a national

26 Project to Regulate Advanced Nursing Practice in Switzerland (7) Law on health professionals for the Canton of Vaud (French Part) passed in December 2017 Nurses have an autonomous practice, Within this practice, nurses are allowed to assess, diagnose, prescribe, treat and evaluate, Initiative submitted on November 7, 2017, to the Federal Chancellor s Office Nurses to be recognised to having an autonomous practice on a national level, Within this practice, nurses are allowed to assess, diagnose, prescribe, treat and evaluate on a national level, Within 8 months: signatures collected!

27 Next Steps Steering group meeting in September, Presentation of proposed structure, Presentation of proposed criteria for credentialing ANP, Determination of next goals such as determining the scope of practice,

29 Literature (1) Deneckere, S., Euwema, M., Van Herck, P., Lodewijckx, C., Panella, M., Sermeus, W., & Vanhaecht, K. (2012). Care pathways lead to better teamwork: results of a systematic review. Soc Sci Med, 75(2), doi: /j.socscimed Federal Statistical Office (BFS). (2017). Gesundheit ( ). Retrieved from Neuchâtel: file:///c:/users/maya/documents/taskforce%20anp/icn%20rotterdam%202017/gesundheit_taschenstatistik_bfs_2017.pdf Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2014). Advanced practice nursing : an integrative approach (5th edition. ed.). St. Louis, MO: Elsevier Saunders. Hopkins, R. B., Garg, A. X., Levin, A., Molzahn, A., Rigatto, C., Singer, J.,... Goeree, R. (2011). Cost-effectiveness analysis of a randomized trial comparing care models for chronic kidney disease. Clin J Am Soc Nephrol, 6(6), doi: /cjn Kleinknecht, M., Frei, I. A., Spichiger, E., Muller, M., Martin, J. S., Straudacher, D., & Spirig, R. (2011). [Palliative care research. Data before and after DRG introduction]. Krankenpfl Soins Infirm, 104(2), 16-18, Laaser, U., Rottger-Liepmann, B., Breckenkamp, J., & Bublitz, K. (2000). [The effect of diagnosis-related groups on hospital care]. Pflege, 13(1), Lamiani, G., & Furey, A. (2009). Teaching nurses how to teach: an evaluation of a workshop on patient education. Patient Educ Couns, 75(2), doi: /j.pec Lorig, K. R. (2001). Patient education: a practical approach (3rd ed.). Thousand Oaks, Calif.: Sage Publications. Mächler, K. (2014). Ein Karrieremodell für di Pflege in der Schweiz. Kapitel 14. In R. Tewes & A. Stockinger (Eds.), Personalentwicklung in Pflege- und Gesundheitseinrichtungen Erfolgreiche Konzepte und Praxisbeispiele aus dem In-und Ausland. Berlin: Springer. Schäfer, M., Scherrer, A., & Burla, L. (2013). Bildungsabschlüsse im Bereich Pflege und Betreuung. Systematische Übersichtsarbeit (Obsan Dossier 24) ( ). Retrieved from Neuchâtel: Schrappe, M. (2015). [Patient safety: a topic of the future, the future of the topic]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 58(1), 4-9. doi: /s Schweizer Berufsverband der Pflegefachfrauen und Pflegefachmänner. (2011). Professionelle Pflege Schweiz. Perspektive Positionspapier des Schweizer Berufsverbands der Pflegefachfrauen und Pflegefachmänner SBK. Retrieved from Bern: Schwendimann, R., Zimmermann, N., Kung, K., Ausserhofer, D., & Sexton, B. (2012). Variation in safety culture dimensions within and between US and Swiss Hospital Units: an exploratory study. BMJ Qual Saf. doi: /bmjqs Spirig, R., Eze, G., Wehrli, M., Rageth, E. S., Zogg, K., Frei, I. A., & Rosery, S. (2010). [Career model for nurses. From the specialist to the expert]. Krankenpfl Soins Infirm, 103(1), Federal law on non-medical health professions (health professions' law, GesBG), C.F.R. (2016). Ulrich, A., Hellstern, P., Kressig, R. W., Eze, G., & Spirig, R. (2010). [Advanced Nursing Practice in daily nursing care: practice development of an acute geriatric Advanced Nursing Practice team]. Pflege, 23(6), doi: / /a000079

30 Bachelor Degree Learning Outcomes (1) Providing effective care that focusing on the patients well-being and health, Evaluating situations in daily professional care systematically and systemically with a focus on effectiveness, Planning and implementing nursing interventions and reflect on them systematically, Integrating evidence-based practice and scientific knowledge, professional experience as well as patients and families preferences into care, Working autonomously within an interdisciplinary team, Thinking and acting professionally specific to nursing care and across disciplines/professions, Constructing trusting relationship with patients, Communicate purposefully and tailored toward the recipients,

31 Bachelor Degree Learning Outcomes (2) Guiding and consulting patients, families and other health professionals, Acting according to high moral standards in hectic or potentially contentious/conflicting situations Developing and implementing methods for problem-solving autonomously or in a group of persons, Mastering highly complex nursing situations taking interdisciplinary resources into account, Acting/reacting proactively in complex nursing situations, Applying research results, implementing these systematically into practice and developing nursing services further, Assisting in research projects as a qualified collaborator (

32 Advanced Nursing Practice in Switzerland (7) Advanced Practice Nurses make a difference in patient outcomes due to: Application of evidence-based practice in clinical practice, Systematic evaluation of clinical practice, Analytic, critical and reflective thinking, Consideration of ethical issues when making decisions in clinical practice, Possession of professional leadership skills, possession of mentoring and coaching skills, Possession of research skills, and Active contribution to changing clinical practice. Improved patient outcomes include (but not exhaustively): Improved continuity of care, less errors, better information transmission, reference persons, maintaining or improving quality of life, supporting patients and their families, and more person-centred care (Hamric, et al., 2014; Hopkins, Garg, Levin, et al., 2011; Ulrich et al., 2010; Spirig et al., 2010).

Development of National Master Competencies for Regulating Advanced Practice Nursing

Development of National Master Competencies for Regulating Advanced Practice Nursing Prof. Dr. Maya Zumstein-Shaha, ICN-ANP Conference Rotterdam, August 26-29, 2018 Bern Gesundheit University of Applied