A Global SWOT Analysis of Advanced Practice Nursing: Policy, Regulation, and Practice

Abstract Background: The advanced practice nursing role has been characterized as task sharing between physicians and nurses, and commonly is a part of national or health system schemes to expand healthcare access and/or to improve efficiencies. However, lack of regulatory uniformity can lead to inconsistent qualifications, competencies, and a limitation of expansion of healthcare services, based on regulated scope of practice. Methods: The SWOT analysis technique (strengths, weaknesses, opportunities, threats) was used to assess the current state of advanced practice nursing worldwide, with specific focus on regulation, education, licensure, and practice. Data were collected broadly from peer reviewed, governmental and regulatory sources, as well as grey literature. Results: Key regulatory elements that frame advanced practice nursing vary significantly by country and region and remain dynamic. However, practice and educational models are outpacing regulatory standards in all six WHO regions. Overall, advanced practice nursing is expanding at an accelerated pace in order to meet population and health system needs, despite weaknesses of the regulatory system, or threats from systems that are not ready to accept innovative strategies. Conclusion: Advanced practice nursing is an innovative role that is progressing broadly in response to the global drivers of an aging population, workforce shortages, the increasing prevalence of non-communicable disease, and the need to develop system-based efficiencies for cost containment. The role is developing organically, driven by local needs, but still lags in terms of the formal regulatory legitimization in many countries. Notably, it is being buoyed by the global movement toward universal health coverage.