Many countries are seeking to expand the role of their nursing workforces, and they have much to learn from countries like Canada that have had the longest experience in using advanced practice nurses — commonly known as nurse practitioners.

This is the advice of a recent working paper by the Organisation for Economic Co-operation and Development (OECD) that examined the experiences of 12 countries. It also found that while the use of nurse practitioners can improve access and reduce wait times, it may not be the best strategy for reducing costs.

The paper looked at the advanced practice nursing experiences in Canada, U.S., Australia, Belgium, Cyprus, Czech Republic, Finland, France, Ireland, Japan, Poland, and the U.K.

Canada and the U.S. have had the longest experience with advanced practice nurses dating back to the 1960s. However, it was not until the 1990s that the profession really came into its own.

Like many other countries, Canada nurtured two broad categories of nurse practitioners (NPs) to improve access to care: nurse practitioners who work in primary care or acute care settings, and clinical nurse specialists who work mainly in hospitals.

The paper said the main barrier to developing the NP profession in Canada has been opposition by organized medicine “who have perceived a loss of control in clinical care” while the chief stumbling block for clinical nurse specialists has been hospital restrictions on their autonomous ability to order drugs and tests.

Ontario, a leader in the use of NPs in this country, recently signalled that it wants to push ahead with additional powers for NPs giving them the authority to diagnose and treat hospital in-patients and prescribe drugs for them.

The OECD study said most evaluations of advanced practice nurses find high levels of patient satisfaction by virtue of the fact that they tend to spend more time with patients.

It also said some evaluations have tried to estimate the cost impact of using advance practice nurses. The findings were mixed.

“When new roles involve substitution of tasks, the impact is either cost reducing or cost neutral. The savings on nurses’ salaries – as opposed to doctors – can be offset by longer consultation times, higher patient referrals, and sometimes the ordering of more tests. When new roles involve supplementary tasks, some studies report that the impact is cost increasing.”

The paper can be found at www.oecd.org/officialdocuments/displaydocumentpdf/?cote=delsa/hea/wd/hwp(2010)5&doclanguage=en. HE