More responsibility and autonomy for graduate primary health care nurses will lead to better access to quality care in vulnerable areas and areas with limited health care coverage
Washington, D.C., 10 May 2018 (PAHO / WHO) - Expanding the role of graduate, primary health care nurses will improve access to health care, particularly in areas with limited numbers of health care professionals, reveals a new report from the Pan American Health Organization (PAHO), launched in the run-up to International Nurses Day on 12 May.
"If we are to meet the needs of an aging population and subsequent increase in the number of non-communicable diseases, we must expand the role of nurses, who make up the majority of the region's health-care professionals," said James Fitzgerald, Director of the Department of Health Systems and Services at PAHO.
The report - Expanding the Role of Nurses in Primary Health Care - reveals that nurses can play a crucial role in expanding access to primary health care, and in particular, in health promotion, disease prevention and care, without leaving anyone behind.
It is estimated that in the Americas region, around 800,000 additional health care professionals are required in order to meet current needs. The region also has an inadequate distribution of health care professionals, the majority of whom are concentrated primarily in urban areas with greater economic resources. In the United States, for example, there are 111.4 nurses for every 10,000 citizens, whereas in Haiti there are only 3.5. In half of the countries of the region, the average number of nurses per 10,000 citizens is 10.4 or fewer.
The PAHO report emphasizes that the implementation of new roles, such as Advanced Practice Nurses (APNs), would enable a broader range of primary health care responsibilities to be carried out in vulnerable parts of cities and in remote areas. This would contribute to better promotion of health, disease prevention and a reduction in mortalities.
In countries such as Australia, Canada, the United States, the United Kingdom, Ireland and Finland, nurses with four and five-year university degrees already carry out a broader range of responsibilities that enable them to meet patient needs.
The concept of APN's or nurse practitioners (nurses authorized to make diagnoses, request examinations and issue prescriptions), began in Canada and the United States during the 1960s. These nurses practice as autonomous professionals, without supervision from a doctor, and can work within health care services or as independent practitioners.
In Latin America, there is still no regulation or training for APNs in primary health care, and issuing prescriptions, one of the central elements of this advanced practice, is still prohibited in many countries. Recently, however, Mexico passed a law to enable nurses to prescribe medication in the absence of a doctor, but only during an emergency.
Jamaica and Puerto Rico are the Caribbean countries with most developed training programs, regulation and professional integration of APNs.
The report also highlights Argentina, Brazil, Chile, Colombia, Mexico, Panama and Peru as countries with a high level of access to postgraduate nursing programs that could, in the future provide the training necessary for APNs.
These highly-trained nurses, with Masters and PhD-level degrees, would be able to carry out advanced duties in primary health care, as well as other activities such as diagnosis and medical treatment, all within the framework of the nursing practice model: prevention, awareness, holistic and patient-centered.
"Broadening the role of graduate nurses is not about substituting or replacing another professional, but about complementing other professionals while increasing efficiency, improving results and reducing cost," said Silvia Cassiani, Advisor on Nursing and Allied Health Personnel at PAHO.
The report offers nine recommendations for expanding the role of advanced practice nurses in the Americas, and suggests that governments, professional associations, nursing schools, health institutes and other interested organizations debate, implement and broaden the role of nurses in line with the needs and context of each individual country.
