Advanced practice nursing, critical care, and Spain: A point of view

Advanced Practice Nursing (APN) continues to gain recognition. Despite the guidelines published by the International Council of Nurses in 2020, there is still some confusion about this concept. In general, APN is used in three different and not necessarily compatible ways: as an umbrella term that regulates four different roles, as a level of practice, or as a role itself. Specialization in nursing does not always imply advanced practice, although both concepts are not mutually exclusive. The "Acute Care Nurse Practitioners" in the United States can conduct physical examinations and medical histories, diagnose, prescribe medications, or request and interpret complementary tests. They pose no risk to patients and have shown positive clinical outcomes in Critical Care Units. They also add "value" by improving communication, interprofessional coordination, or adherence to protocols. The "Clinical Nurse Specialists" in Critical Care help improve quality, staff education, and provide care to complex patients. They have a beneficial impact on reducing nosocomial infections, adverse events, hospital stay, or costs. The implementation of APN roles in Spain faces challenges due to its circumstances, such as the high number of physicians or the lack of systematic and transparent measurement of outcomes. Historically, the nursing corporation has promoted a disproportionately positive view of the Spanish healthcare system and nursing. The corporation has followed the model of medical specialization without supporting studies and a framework that hinders its integration into APN. The orthodox vision of Spanish nursing still holds significant weight, where experience is valued more than education, complicating the expansion of competencies. Numerous regional projects have been developed without a unified voice or approach. APN should not be a distraction from continuing to advocate for improvements in nurses' working conditions.