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Establishing the Nurse Practitioner Role in Oman

Dr. Majid Al Maqbali, RN, PhD

Director of Nursing & Midwifery AffairsMOH(HQ) - Oman

September 17, 2013

Leading Through Change Excellence Beyond Limits17&18th September 2013 / 12-13th Dhu Al-Qada 1434

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Objectives:

Develop awareness about the process of

developing a new role in a health system

Appreciate the role of using evidence,

stakeholder’s opinions, and international

models in developing new roles in nursing

Recognize the model of scholarship, practice,

and leadership in transforming nursing

Advanced Nurse Practitioner

“ A registered nurse who has acquired the expert

knowledge base, complex decision making skills

and clinical competencies for expanded practice,

the characteristics of which are shaped by the

context and /country in which she or he is

credentialed to practice. A master’s degree is

recommended for entry level” (ICN, 2002)

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Driving Forces In Oman

Service Driven – ‘Shortfall’ in Doctors both

numbers and specific expertise .

Emerging Health problems due to lifestyle

changes e.g. Diabetes, hypertension.

People are living longer and are more likely to

develop long term conditions requiring specialist

care.

The global trend of moving care closer and deeper

in the community

Clinical career pathway for nurses to stay at

the bedside.

Methodology: Triangulated Approach

1. Gathered data on specific advanced practice skills

practiced by nurses, service configuration, practice

standards, education process and professional regulation.

2. Assessed the perceptions of Health Care Professionals.

3. Seek the advice and support of the experts in the field

(WHO Consultants, Academics, Health Administrators,

and Decision makers).

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Consultancies: Dr. Tesfamicael Ghebrehiwet, ICN

Brainstorming and focus groups:

Profession is ready.

The role has to be legitimized.

Epidemiologic and demographic

Imperatives.

Public acceptance.6

Consultancies: Madrean Schober

Site visits and discussions in the health centers: suggested a more in-depth evaluation.

Workshop with key multidisciplinary stakeholders: SWOT analysis of the current situation - identification of common health problems, client characteristics, settings, scope of practice, educational preparation, facilitating factors and hindrances.

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Our Process: Needs Analysis

Build on the work of Schober– Site visits, focus groups,

workshop.

Data gathering and analysis from Primary Healthcare setting.

Nursing stakeholder focus groups discussions

A review of International literature on Nurse Practitioners /

Advanced Practice.

Perceptions of health professionals on the ANP role in Oman

Findings

The infrastructure in the country is well positioned to

progress towards development and implementation of

ANP.

Nurses are functioning in an extended role due to the

demand and need for care.

Legitimizing the role with appropriate training and

supervision will surely serve as an innovative way of

ensuring quality of care, system efficiency, and cost

effectiveness.9

Statistical analysis: 60 % of the nurses working in primary

health care centers

Nurses, 95% of whom were diploma trained, were carrying out

these tasks without the necessary education and legal

authority

56% of the PHC nurses who practice this role have less than 5

years of experience that is alarming

Nurses are prescribing drugs that are not permissible by them

including broad spectrum antibiotics for which they are not

legally authorized10

Findings

The doctor patient ratio in primary health care is much

lesser than the doctor patient ratio in the hospital,

resulting in a population being underserved by doctors.

The emergent needs appear to be twofold:

Extended nursing role - Provision of local professional

development to upgrade nursing education for those nurses

already functioning in an extended capacity.

Developing a program for advanced nurse practice within the

country based on the local needs (Schober & Affara, 2012). 11

Findings

Findings (Focus Group):

Internationally the role, responsibilities, titles, and

educational preparation of Nurse Practitioners is not

standardised.

International Council of Nurses have defined a role

and recommend a ‘Masters’ preparation (I.C.N, 2002)

We need a clear definition of ‘Advanced Practice’ for

Oman’s context. 12

Internationally minimum educational preparation is a Bachelor

degree.

Curriculum development – Local – ‘v’ – Abroad.

Clinical Practice and Assessment to be done in Oman as Omani

nurses are registered to practice.

The need to address preventative health strategies – health

promotion – health education rather than just ‘curative’ strategies.

The role of Consultants / Senior specialists as mentors and assessors

of Advanced practice.

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Findings (Focus Group):

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Internationally most cited reason for implementing

Advanced Practice is Physician shortage (USA, UK

Netherlands, France, Switzerland).

Internationally Nurse Practitioners provide similar outcomes

of care to Medical staff (Horrocks, et al. 2002).

Currently there is a global shortage of nurses - planning one

profession to replace the work of another needs careful

thought (Simoens et al. 2005).

Findings (Focus Group):

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Workforce planning to meet population needs –

move from curative to preventive strategies &

management of chronic illnesses.

Current service gaps include – Palliative care,

community mental health, care of the elderly, and

discharge planning (Focus groups Muscat).

Findings (Focus Group):

The appropriate duration of clinical experience required

as a pre-requisite for the ANP role is at least 4 years.

Specific skills required by the ANP as expressed were

emergency life saving skills and implementing treatment

regimen.

Critical thinking skills and skills to work autonomously

were considered the most important decision making

skills of an ANP.16

Perceptions of health care professionals

The most important roles of the ANP include history

taking, physical assessment, acting in emergency

situation, critical thinking and engaging in knowledge

generating activities.

The core competencies required for the ANP role included

communication skills, knowledge generating skills and

assessment skills.

There should be one ANP for each Wilayat/District.17

Perceptions of health care professionals

Perceptions of health care professionals

ANP’s could be trained locally with clinical placements

to meet the country’s needs in a cost effective way .

The major issues that could be addressed by the ANP’s

include health promotion, managing acute /severe

illnesses and disability limitation and rehabilitation.

ANP’s should work within a multi-professional team

communicating across professional boundaries.

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Perceptions of health care professionals

Introducing the ANP role will enable physicians to

spend more time with acutely ill and sicker patients.

The public will accept the role of the ANP in the health

care system as part of the multidisciplinary team.

Doctors should be involved in the clinical

preceptorship and theoretical preparation of the

ANP’s.

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Suggested Model of Practice

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Conclusion

O: Ownership (Health care providers, decision makers,

government, and public)

M: Model

A: Accept everybody’s point of view and use them

(participatory leadership)

N: Nursing is caring21

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References:

Directorate of Nursing and Midwifery Affairs, (2011b) Advanced Nursing Practice – A data collection process to assess the situation nationally; DNMA, Ministry of Health, Sultanate of Oman

Horrocks S, Anderson E, Salisbury C, (2002) Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ; 324(7341): p 819–23.

International Council of Nurses, (2002) Definitions and characteristics for nurse practitioner / advanced practice nursing roles. www.icn.ch/networks_ap.htm [Accessed Feb 23rd 2011]

Schober, M. (2007) Development of Advanced Community Nursing / Nurse Practitioner Roles & Educational Programs in Oman, World Health Organisation; short term consultancy.

Simoens S, Villeneuve M, Hurst J. (2005) Tackling Nurse Shortages in

OECD Countries. OECD Health Working Papers No. 19, English, 59 pages, doi: 10.1787/172102620474