title: Introducing Advanced Practice Nurses / Nurse Practitioners in health care systems: a framework for reflection and analysis.
abstract: An increasing number of countries are exploring the option of introducing Advanced Practice Nurses (APN), such as Nurse Practitioners (NP), as part of the health care workforce. This is particular relevant in light of the increase of the elderly and chronically ill. It is crucial that this introduction is preceded by an in depth understanding of the concept of advanced practice nursing as well as an analysis of the context.
  
  
  OBJECTIVE
  Firstly, a conceptual clarification of Advanced Practice Nurses and Nurse Practitioners is provided. Secondly, a framework is introduced that assists in the analysis of the introduction and development of Advanced Practice Nurse roles in a particular health care system. Thirdly, outcomes research on Advanced Practice Nursing is presented.
  
  
  METHODS
  Argumentation developed using data based papers and policy reports on Advanced Practice Nursing.
  
  
  RESULTS
  The proposed framework consists of five drivers: (1) the health care needs of the population, (2) education, (3) workforce, (4) practice patterns and (5) legal and health policy framework. These drivers act synergistically and are dynamic in time and space. Outcomes research shows that nurse practitioners show clinical outcomes similar to or better than those of physicians. Further examples demonstrate favourable outcomes in view of the six Ds of outcome research; death, disease, disability, discomfort, dissatisfaction and dollars, for models of care in which Advanced Practice Nurses play a prominent role.
  
  
  CONCLUSIONS
  Advanced Practice Nurses such as Nurse Practitioners show potential to contribute favourably to guaranteeing optimal health care. Advanced Practice Nurses will wield the greatest influence on health care by focusing on the most pressing health problems in society, especially the care of the chronically ill.
authors.affiliation: Institute of Nursing Science, University of Basel, Basel, Switzerland. sabina.degeest@unibas.ch
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
authors.forename: Philip
authors.initials: P
authors.lastname: Moons
authors.forename: Betty
authors.initials: B
authors.lastname: Callens
authors.forename: Chris
authors.initials: C
authors.lastname: Gut
authors.forename: Lyn
authors.initials: L
authors.lastname: Lindpaintner
authors.forename: Rebecca
authors.initials: R
authors.lastname: Spirig
mesh_terms: D003695:Delivery of Health Care; D006291:Health Policy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D016294:Models, Nursing; D009720:Nurse Clinicians / Q000600:supply & distribution* / Q000639:trends; D009722:Nurse Practitioners / Q000600:supply & distribution* / Q000639:trends; D024802:Nurse's Role; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D000078329:Workforce