S trengths W eaknesses O pportunities T hreats Analysis Advanced nursing practice (APN) becoming recognised as a valid part of nursing and health care service provision globally in relation to Carried out 29th June 2006, Sandton, South Africa by Fadwa Affara

Strengths Capable of undertaking complex decision making in relation to patient care Evidence of competence of nurses working in the ANP roles, and managing complex health problems Evidence of capability pf APN to deliver PHC and be entry point into the health system Determination (and stamina) to reach ANP goals Determination (and stamina) to reach ANP goals Participation in policy making and formulation of legislation exists in some countries Participation in policy making and formulation of legislation exists in some countries Highly skilled Highly skilled Able to work independently Able to work independently

Strengths Affiliated/and or organised as a group internationally and nationally in some countries When not organised have a willingness to create some form of professional organisation Show great commitment and will to act to advance practice Consumer trust Consumer trust Demonstrated acceptance by public Demonstrated acceptance by public An international definition of APN exists An international definition of APN exists Information technology is used to access information about APN Information technology is used to access information about APN

Weaknesses Scope of practice conflicts with other health professionals APNs practise under varied levels of autonomy Failure to get ANP into human resources planning (APN needs assessment, role descriptions) Absence of career ladders Poor role clarification Poor role clarification Uncertain identity Uncertain identity Proliferation of titles Proliferation of titles Lack of clear identity affecting ability of APNs to communicate clear messages about ANP Lack of clear identity affecting ability of APNs to communicate clear messages about ANP Lack of recognition by other health professionals Lack of recognition by other health professionals Mistrust in nursing between ANPs and other nurses causing APNs to feel more at easy with medical rather than nursing values Mistrust in nursing between ANPs and other nurses causing APNs to feel more at easy with medical rather than nursing values

Weaknesses Inappropriate reimbursement systems for APNs Inability to properly cost ANP services (private provider) Lack of a political will in supporting the role Fragmentation/ variability in standards and quality of education programmes Fragmentation/ variability in standards and quality of education programmes Educational programmes may not keep up with the changing realities of practice Educational programmes may not keep up with the changing realities of practice Insufficient numbers of mentors Insufficient numbers of mentors

Opportunities Workforce development in flux Changing health care environment Interest in innovative healthcare delivery models Sharing good practice Increasingly aware and vocal consumers who want to be involved in health decision making Strengthening voice of women in the public arena Diversity of APN practice creating discussion/ stimulating interest globally Diversity of APN practice creating discussion/ stimulating interest globally Migration opening new opportunities to learn and advance personal competence Migration opening new opportunities to learn and advance personal competence Health care systems in crisis globally Health care systems in crisis globally Nurses ability to influence health care through grass root means as well as by influencing top policy makers Nurses ability to influence health care through grass root means as well as by influencing top policy makers

Opportunities Nursing education moving into the university sector Rising demand for management of chronic disease APNs being seen as a means to meet unmet health needs Physician shortage Nurses can bring much experience and knowledge to health care and occupy a pivotal position (deal with primary needs of human beings) Nurses can bring much experience and knowledge to health care and occupy a pivotal position (deal with primary needs of human beings) Nurses seen capable of taking a leading role in health/social development Nurses seen capable of taking a leading role in health/social development Creating alliances with groups outside nursing Creating alliances with groups outside nursing

Threats Medicalisation of health systems –medical dominance Medicalisation of health systems –medical dominance Territorial protection Territorial protection Insufficient influence to affect health decisions and resource allocation Insufficient influence to affect health decisions and resource allocation Inadequate political skills/ strategies Inadequate political skills/ strategies Value system of political decision–makers unfavourable to APN goals, e.g. using economic retrenchment to cut APN services to marginalised underprivileged groups Diversity may lead to fragmentation APN perceived to be too expensive

Threats Complacency Complacency Apathy Apathy Burnout Burnout Low status of nurses – poor payment, recognition and contributions health care not valued Low status of nurses – poor payment, recognition and contributions health care not valued Severe staff shortages Severe staff shortages Lack of clinical career pathways Lack of clinical career pathways Insufficient faculty Insufficient faculty Insufficient definition of roles and scope of practice Insufficient definition of roles and scope of practice Low levels of funding– for education and post creation Low levels of funding– for education and post creation Indemnity insurance difficult to obtain and becoming expensive Indemnity insurance difficult to obtain and becoming expensive