McGill-led global analysis of systematic reviews highlights positive impact of increased nursing roles on patient care and healthcare costs in a variety of settings
A new study titled “A global perspective of advanced practice nursing research: A review of systematic reviews” found highly consistent evidence that care provided by advanced practice nurses (APNs), nurse practitioners (NPs), and clinical nurse specialists (CNSs) was equal or superior to usual care for 29 indicator categories across a wide range of clinical settings, patient populations and severity of illness. Representing the most comprehensive and exhaustive assessment of advanced nursing practice to date, the study was published on July 2nd in PLOS One.
“The World Health Organization (WHO) has called for a global expansion of all nursing roles including advanced practice nursing roles to promote equitable delivery of care and respond to the growing demands for healthcare services. A clearer understanding of the impact of these roles will help governments around the world provide cost-effective, quality care to more people as well as inform global priorities for advanced practice nursing education, research and policy,” explains lead author Kelley Kilpatrick, RN, PhD, Associate Professor at McGill University’s Ingram School of Nursing (ISoN). An expert in advanced practice nursing research, Prof. Kilpatrick holds the Susan E. French Chair in Nursing Research and Innovative Practice at the ISoN and is a researcher at the Centre de recherche de l’Hôpital Maisonneuve-Rosemont, part of the CIUSSS de l’Est-de-l’Île-de-Montréal.
Comprehensive review includes patients of all ages and health conditions in rural and urban settings
Prof. Kilpatrick and her research team screened a total of 5840 articles and retained 117 systematic reviews representing 38 countries, published from January 2011 onwards. These systematic reviews represented 1653 primary studies. Patients were from all age groups receiving APN, NP or CNS care for health conditions in acute care and primary settings in urban and rural locations. APNs were defined as nurses who have acquired in-depth expertise, complex decision-making skills and advanced clinical competencies, with master’s or doctoral educational preparation and national board certification for licensure.
Patient indicators in the study included activities of daily living, adaptation to health conditions, clinical outcomes, diagnosis, patient education, mortality, morbidity, patient adherence, quality of life, satisfaction, and signs and symptoms. Provider indicators included adherence to best practice guidelines-provider, education-provider, illness prevention, interprofessional team functioning, prescribing and satisfaction-provider. Health system indicators included access to care, consultations, costs, emergency room visits, health care service delivery, hospitalization, length of stay, patient safety, quality of care, scope of practice and wait times.
Areas for future research identified
The study also identified specific gaps requiring further research to expand global understanding of the impact and benefits of advanced practice nursing roles. These include emerging research related to AI technology, global health research, interprofessional team functioning, workload and working conditions, how to engage patients and families as partners in healthcare, and care of patients in vulnerable situations.
Notably, while countries with a longer history of advanced practice nursing roles are well represented in this review, several countries and regions are under-represented in research related to APN, NP and CNS roles. “It is essential to conduct research that takes into account the specific context of these regions to capture emerging roles, changes to scope of practice and role effectiveness. We also found that some studies showed that patient appointment times were a few minutes longer with nurses in advanced practice roles. An important research question is what happens during these health visits that leads to better outcomes. Better tracking of APN, NP and CNS activities and outcomes is needed to capture key contributions of these roles,” Prof. Kilpatrick said.
Prof. Kilpatrick will be presenting her research at the 13th International Council of Nurses Nurse Practitioner / Advanced Practice Nurse Network Conference, September 9-12, 2024, in Aberdeen, UK.