title: Factors enabling advanced practice nursing role integration in Canada.
abstract: Although advanced practice nurses (APNs) have existed in Canada for over 40 years and there is abundant evidence of their safety and effectiveness, their full integration into our healthcare system has not been fully realized. For this paper, we drew on pertinent sections of a scoping review of the Canadian literature from 1990 onward and interviews or focus groups with 81 key informants conducted for a decision support synthesis on advanced practice nursing to identify the factors that enable role development and implementation across the three types of APNs: clinical nurse specialists, primary healthcare nurse practitioners and acute care nurse practitioners. For development of advanced practice nursing roles, many of the enabling factors occur at the federal/provincial/territorial (F/P/T) level. They include utilization of a pan-Canadian approach, provision of high-quality education, and development of appropriate legislative and regulatory mechanisms. Systematic planning to guide role development is needed at both the F/P/T and organizational levels. For implementation of advanced practice nursing roles, some of the enabling factors require action at the F/P/T level. They include recruitment and retention, role funding, intra-professional relations between clinical nurse specialists and nurse practitioners, public awareness, national leadership support and role evaluation. Factors requiring action at the level of the organization include role clarity, healthcare setting support, implementation of all role components and continuing education. Finally, inter-professional relations require action at both the F/P/T and organizational levels. A multidisciplinary roundtable formulated policy and practice recommendations based on the synthesis findings, and these are summarized in this paper.
authors.affiliation: CHSRF/CIHR in Advanced Practice Nursing, Ontario Training Centre in Health Services & Policy Research, McMaster University, Hamilton, ON.
authors.forename: Alba
authors.initials: A
authors.lastname: DiCenso
authors.forename: Denise
authors.initials: D
authors.lastname: Bryant-Lukosius
authors.forename: Ruth
authors.initials: R
authors.lastname: Martin-Misener
authors.forename: Faith
authors.initials: F
authors.lastname: Donald
authors.forename: Julia
authors.initials: J
authors.lastname: Abelson
authors.forename: Ivy
authors.initials: I
authors.lastname: Bourgeault
authors.forename: Kelley
authors.initials: K
authors.lastname: Kilpatrick
authors.forename: Nancy
authors.initials: N
authors.lastname: Carter
authors.forename: Sharon
authors.initials: S
authors.lastname: Kaasalainen
authors.forename: Patricia
authors.initials: P
authors.lastname: Harbman
mesh_terms: D057179:Advanced Practice Nursing / Q000458:organization & administration*; D001364:Awareness; D002170:Canada; D003479:Curriculum; D020000:Decision Support Systems, Clinical; D003695:Delivery of Health Care / Q000458:organization & administration*; D004509:Education, Nursing, Continuing; D017144:Focus Groups; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D009720:Nurse Clinicians / Q000458:organization & administration* / Q000600:supply & distribution; D009722:Nurse Practitioners / Q000458:organization & administration* / Q000600:supply & distribution; D010563:Personnel Turnover; D011320:Primary Health Care / Q000458:organization & administration*; D006113:United Kingdom; D014481:United States; D000078329:Workforce