Advanced Nursing Practice in Thailand:
An Initiative or Old Wine in the New Bottle!
Assistant Professor Nanthaphan Chinlumprasert, Ph.D., R.N.
Faculty of Nursing Science,
Assumption University of Thailand
The Development of APN in Thailand
1974 1988 1994 2000Present
NP
Existed
NP
ExistedCCS granted
“Nursing Expertise”
CCS granted “Nursing
Expertise”
NNCT approved
CNS in 5 areas
NNCT approved
CNS in 5 areas
NHSRNHSR
PCUPCU
APN
NP
Advanced Practice Nurse (APN)
1. Nurse - Anesthetist
2. Nurse - Midwife
*3. Clinical Nurse Specialist
*4. Nurse Practitioner
Nurse Practitioner (NP)
In 1974 : NP first established to serve people in the remote area and to ease the Physician shortage
: 4-month-training
: Work as physician extender
: No autonomy Legitimate limitation
Not well accepted by NNCT
Nursing Experts (NE)
In 1988 : The Commission of Civil Servant (CCS) has granted the career ladder for promoting experienced nurses to become Nursing Experts
: Academic report and experiences were used to consider the promotion
: Nursing service system has no distinctive organizational line and scope of practice for Nursing Expert position
: No continuous support by Nursing Organization
Clinical Nurse Specialist (CNS)
In 1994 : The National Nursing Council of Thailand (NNCT) has approved CNS in 5 areas
1) Community Nursing
Family Nursing
Occupational Health Nursing
School Health Nursing
2) Mental Health & Psychiatric Nursing
3) Pediatric Nursing
4) Maternal & Child Nursing
5) Medical – Surgical Nursing
National Health System:
Is the entire system of the national health that interrelated or interconnected as the holism. It effects to the health of all population including other factors such as individual, environment, economic, social, physical, biological, and the factor of health care system.
Principle of NHSR
Holistic Participatory Public Policy for Health Equity * Efficiency * Quality * Consumer responsiveness and
protection
Health Service System
University/Regional Hospital
Provincial/General Hospital
Health Center, PCU, Com. Hospital
Village, CPHCSelf Care, Self Reliance
Tertiary
Secondary Care
Primary Care
Primary Health Care
Requirement for APN Certification
1. Master degree in nursing specialty
2. Three years working experiences in the specific area of expertise
3. The curriculum must be approved by NNCT
The number of APN in Thailand
APN Thailand (2003)
CNS-MCH
CNS-Ped.
CNS-Med.
CNS-Surg.
CNS-Psy.
CNS-Community
1
8
9
10
12
9
Total 49
The ratio of APN to nursing population
Thailand (2003) U.S. (1996)
Total Nurses Population
APN
120,000
49
2.55 million
161,700 persons
APN : Nsg Pop 1:2,449 1:16
Educational requirement for Master degree in Nursing to meet APN requirement
Plan A Total credit hours 42 Cr.
1. General Core Courses 15 Cr. Master core courses 8 Cr. APN core courses 7 Cr.
1. General Core Courses 15 Cr.
2. Specific Courses 18 Cr.
Theory courses 6 Cr.
Practicum courses 9 Cr.
Seminar 3 Cr.
Plan B Total credit hours 42 Cr.
Advanced Nursing Practice initiative requires:
Goal & Strategy : Participative management, Public/Private sectors involvement
Professional leadership
Initiation/creativity
Vision
Good governance
Social & Political Movement
: Lobbying, Negotiating power
Evidence-based policy making
: Research utilization
Research: Public demands
Market driven trend
Customer satisfaction
Cost effectiveness
Job analysis & Evaluation
APN-NP positioning
Reimbursement/Incentives
What did NNCT accomplish?
Enactment Nursing and Midwifery Acts B.E. 2528/2540
Advanced educational degree Certified NP,
CNS in Master level
Set up standard criterion core competency and qualification of APN
Standardize primary medical care as a competency in generic nursing program (BNS)
Research
A study of characteristics of nursing services in Thailand
A need survey of Thai people on health care delivery and nursing services
A study of nurses’ role in hospitals of the Northern Thailand
A study of service efficiency of nursing/midwifery private clinics in Thailand
Challenging trend : What should nurse leader do?
Empowerment
Actual evidence-based decision making and policy setting
APN-NP positioning in NHSR/NHIS
UnityQuality AssurancePursue APN
Public relation / Social movement ↑ Nursing Image⊕
Political movement
Useful research/study goals attainment
The nursing profession
movement can no longer be
governed and managed by only
opinions and casual intuition of
nursing leaders
Continually relevant research
will provide definite answers
for the challenging question …
Is APN an initiative or old
wine in the new bottle?