Development of a conceptual policy framework for advanced practice nursing: an ethnographic study

Area of Science:

• Healthcare Policy
• Nursing Practice
• Health Services Research

Background:

• Advanced practice nursing (APN) roles are increasingly integrated globally.
• Supportive policies are crucial for optimal APN utilization.
• The process of APN policy development and implementation remains underexplored.

Purpose of the Study:

• To examine the policy development process for advanced practice nursing, from initial intent to practical realization.
• To gain an in-depth understanding of APN policy experiences in Singapore.

Main Methods:

• An instrumental case study using ethnography was employed.
• Data collection involved document analysis (n=47), interviews with policymakers (n=12), nursing managers/medical directors (n=11), and APNs (n=15) over four years (2008-2012).
• Participant observation with APNs was also conducted.

Main Results:

• Policymaker authority facilitated policy initiation but lacked strategic implementation planning.
• Ambiguity among nursing managers and medical directors regarding APN roles created execution uncertainty.
• APNs struggled to define their practical roles due to a gap between academic preparation and unclear guidelines, causing institutional challenges.

Conclusions:

• Strategic planning is essential for integrating APNs into the healthcare workforce.
• A Conceptual Policy Framework is proposed to guide coordinated APN policy development and implementation.