Barriers that have slowed down the progress of advanced practice nursing and strategies

• • Public Education and Awareness Campaigns: Educating the public, policymakers, and other healthcare professionals about the qualifications, skills, and positive impact of APNs is crucial. Clear and consistent messaging through various media channels can help dispel misconceptions and build support for expanded APN roles. Highlighting successful examples of APN-led care in Kenya and internationally can be effective.
  • Demonstrating Positive Outcomes: APNs need to actively participate in research and data collection to demonstrate the high quality and safety of their care. Publishing outcomes data in peer-reviewed journals and presenting findings at conferences can provide compelling evidence to support expanded practice authority.
  • Building Collaborative Relationships: While advocating for independent practice where appropriate, fostering collaborative relationships with physician groups based on mutual respect and understanding of each profession's unique contributions can help alleviate concerns and build alliances for legislative change. Joint initiatives focused on improving patient care can be a starting point.

2. Lack of Uniformity in Education, Credentialing, and Licensure:

• Barrier: Inconsistent standards for APN education programs, credentialing processes, and licensure requirements across different regions or even institutions can create confusion for patients, employers, and policymakers. This lack of uniformity can hinder the mobility of APNs, make it difficult to establish clear scopes of practice, and impede the recognition of APN qualifications. In Kenya, the standardization of advanced nursing education and the establishment of clear pathways for advanced practice roles might still be developing, potentially leading to similar inconsistencies.

• Strategies to Overcome:

  • Developing National Standards for APN Education: APN professional organizations (if established in Kenya) should work towards developing and advocating for national standards for APN education programs, including curriculum content, clinical hour requirements, and faculty qualifications. Collaboration with universities and regulatory bodies is essential in this process.
  • Establishing Standardized Credentialing and Certification Processes: Promote the development and adoption of national or regional credentialing and certification processes for APNs in specific specialties. This provides a recognized benchmark of competency and ensures a consistent level of expertise. Exploring international certification models that could be adapted to the Kenyan context might be beneficial.
  • Implementing Uniform Licensure Requirements: Advocate for the establishment of clear and consistent licensure requirements for APNs across all jurisdictions within Kenya. This would facilitate interstate (or inter-regional within Kenya) practice and ensure a consistent level of regulatory oversight.
  • Promoting Accreditation of APN Programs: Encourage and support the accreditation of APN education programs by recognized national or international accrediting bodies. Accreditation ensures that programs meet established quality standards.

3. Lack of Full Understanding and Acceptance of the APN Role by Other Healthcare Professionals and the Public:

• Barrier: Despite the growing evidence of APNs' ability to provide high-quality, cost-effective care, there can still be a lack of full understanding and acceptance of their role by some physicians, other healthcare professionals, and the general public. This can manifest as resistance to APNs practicing to the full extent of their education and licensure, turf battles between professional groups, and a lack of patient awareness about the qualifications and services offered by APNs. In Kenya, where the APN role might be newer or less established in some areas, this lack of understanding could be more pronounced.

• Strategies to Overcome:

  • Interprofessional Education and Collaboration Initiatives: Promote opportunities for interprofessional education and collaborative practice experiences for APN students and practicing professionals alongside medical students and physicians. This can foster mutual understanding, respect, and appreciation for each profession's unique skills and contributions.
  • Joint Professional Organization Initiatives: Encourage collaboration between APN organizations and physician organizations on initiatives that benefit patient care and the healthcare system as a whole. This can help build trust and break down professional silos.
  • Targeted Public Awareness Campaigns: Develop and implement targeted public awareness campaigns to educate patients about the role of APNs, the types of services they provide, and their qualifications. Use clear and accessible language and highlight the benefits of seeing an APN, such as increased access and personalized care. Utilizing trusted community health channels in Kenya could be particularly effective.
  • Integrating APNs into Leadership and Policy-Making Roles: Increasing the representation of APNs in healthcare leadership positions and on policy-making bodies can raise their visibility, ensure their perspectives are considered, and promote a better understanding of their capabilities at higher levels.

By addressing these barriers through strategic advocacy, standardization efforts, and targeted education, the progress of advanced practice nursing in Kenya and globally can be accelerated, leading to improved access to high-quality, patient-centered care.

Based on Saunders (2014) and considering the context of advanced practice nursing (APN) which has global relevance even if the specific healthcare landscape differs in Kenya, here are three key barriers that have historically slowed down the progress of APNs, along with strategies to overcome them:

1. Restrictive Scope of Practice Regulations and Legislation:

• Barrier: One of the most significant impediments to the advancement of APNs is the presence of laws, regulations, and institutional policies that limit their scope of practice. This can include restrictions on independent prescribing authority, the ability to diagnose and treat certain conditions without physician oversight, limitations on admitting patients to hospitals, and requirements for collaborative practice agreements that may be overly burdensome or unnecessary based on the APN's education and competency. These restrictions often stem from lobbying efforts by other healthcare professional groups, outdated perceptions of APN capabilities, and legal uncertainties. In Kenya, while the role of advanced practice nurses is evolving, similar limitations might exist regarding independent practice and prescriptive authority compared to physicians.

• Strategies to Overcome:

  • Legislative and Regulatory Advocacy: APN organizations (nationally and regionally, if they exist in Kenya) must actively engage in lobbying efforts to advocate for legislative and regulatory changes that reflect the full scope of APN education, training, and expertise. This includes providing evidence-based data on APN safety, quality of care, and cost-effectiveness. Collaborating with consumer advocacy groups and highlighting the benefits of expanded APN roles in improving access to care can strengthen these efforts.