A CALL FOR THE DEVELOPMENT OF ADVANCED PRACTICE NURSING (APN) IN THE PHILIPPINES

by Jasper L. Tolarba, DNP (c), MSN, MA, CCRN

Robyn DeAngelis

LEGAL BACKGROUND
Nursing Practice Act of 1991 (Republic Act 7164); and then Nursing Practice Act of 2002 (Republic Act 9173)

Current legislative moves to amend Republic Act 9173 • Senate Bill 2988 introduced by Sen. Ralph Recto on October 2011 • House Bill 4567 introduced by Rep. Carlos Padilla on May 2011 - to give nurses further protection and their welfare enhanced (i.e. increase of salary) - provide additional educational requirements for different levels of the nursing practice (i.e. creation of the Advanced Practice Nursing or APN)

APN HISTORY AND BACKGROUND
• Started in 1960s in the United States • Established in 33 countries including several neighboring Asian countries such as Thailand, Singapore, Taiwan, Hong Kong, and Japan (Sheer and Wong, 2008) • Meta-analysis of 69 studies about APN found that APNs provide effective, highquality patient care (Newhouse., et al, 2011) • 28 outcome measures suggest that APNs garner similar and in some ways better outcomes than their physician counterparts (Newhouse., et al, 2011)
© 2012 Minnesota APRN Coalition

APN DEFINITION
Advanced practice nursing (APN) is broadly defined as nursing interventions that influence health care outcomes, including the direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy (AACN Position Paper, 2004).
© Adventist Health System

CURRENT SITUATION AND PROBLEM
• According to the Department of Labor and Employment statistics, there are about 100,000 nurses who are unemployed (Dioquino, 2012).

• The nurse to patient ratio remains dismal at 1 nurse for every 15-26 patients. In countryside hospitals, this could reach up to 44-45 patients per 1 nurse each shift. (Dioquino, 2012).
• There is also a critical shortage of physicians. WHO recommends a doctor to patient ratio of 1:10,000 but the Philippines’ doctor to patient ratio stands at 1:28,000 (Villar, 2012)
© 2013 Roper Center

POOR HEALTHCARE OUTCOMES
• Philippine Health data (DOH, 2009) • Morbidity rate in communicable diseases is 42.8 per 100,000 population • Morbidity rate in non-communicable diseases is 90.4 per 100,000 population
• Maternal mortality rate is high at

© Cheryl Ravelo/Reuters

94 deaths per 100,000 live births
• Infant Mortality Rate is 12.5 per 1,000 live births

OPPORTUNITY
Implementation of Advanced Practice Nursing (APN) in the Philippines with 4 degrees of specializations: 1. Certified Nurse-Midwife (CNM) - licensed and trained health care practitioner who can provide care to women of childbearing age such as prenatal care, birth, gynecological exams, newborn care, family planning, menopausal management, and other women’s health counseling. 2. Certified Registered Nurse Anesthetist (CRNA) - is a licensed and trained advanced practice nurse who provides anesthetics to patients in collaboration with other health care professionals such as surgeons, dentists, podiatrists, etc.

3. Clinical Nurse Specialists (CNS) - licensed nurse clinician who is

an expert on a specific area of specialization (e.g. pediatrics, critical care, cardiovascular, mental health, etc). They function as consultants and provide coaching, guidance, and clinical leadership in various clinical setting 4. Nurse Practitioners (NP) - are licensed and trained advance practice nurses who can take health histories, provide physical examinations; diagnose and treat many common acute and chronic problems; interpret laboratory results and x-rays; prescribe and manage medications; and refer patients to other health professionals as needed. NPs can be of different subspecialties such as: a. Family Nurse Practitioner b. Adult Nurse Practitioner c. Pediatric Nurse Practitioner d. Psychiatric Nurse Practitioner

MODEL OF MASTER’S NURSING CURRICULUM (AACN, 2013)

CONCLUSION
• Advanced practice nursing (APN) is a professional role for nurses that serve to fill the gap between lack of physicians and high demands of health care needs among Filipinos especially in rural areas. • There are presently legislative moves to amend the Nurse Practice Act of 2002 (RA 9173) to reflect the APN role but it needs support from various stakeholders to make it all the way into law. • Implementation of Advanced Practice Nursing in the Philippines will bring jobs to graduates of nursing, improve their status, and positively impact the health care outcomes in the community as proven in other countries with existing APN professionals.

jt/August 25, 2013

REFERENCES

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