HS 8013 PRESENTATION
HOW CAN AN ADVANCED PRACTICE NURSE PLAY A
SIGNIFICANT ROLE IN IMPROVING PATIENT CARE
OUTCOMES IN NURSING PRACTICE?
(In alphabetical order)
• Jiang Ying
You will learn about:
• 1) What is an APN?
• 2) APN in Singapore
• 3) Major roles of the APN
• 4) Improving Patient Care Outcomes
• 5) The Way Forward
What is an APN?
An Advanced Practice Nurse (APN) is an umbrella term
given to a registered nurse who has acquired the
expert knowledge base, complex decision-making skills
and clinical competencies for expanded practice, the
characteristics which are shaped by the context and/or
country in which he/she is credentiated to practice.
(International Council of Nurses, 2002)
2) APN IN SINGAPORE
• to manage common chronic stable conditions
• to manage early discharges into the community
• an aging population
• expansion of nurses’ role
• establishment of clinical career path for nurses
• to stabilize clinical environment during the
transitional phase for Housemen >>> Medical
APN Development in Singapore…
• Yr 2003 – Master of Nursing programme
• Yr 2005 – Nurses & Midwives Act
amended to make provisions for the
registration and regulation of APNs
Requirement for APN
To qualify as an APN:
- Master of Nursing (NUS/MOH )
- 80 module credits
- 18 months full time programme
- 1 year internship
- Application for APN title with SNB
APN in Singapore…
Population Ratio: 0.2%
APNs are practicing in a wide variety of settings:
Polyclinics, hospitals, ….
- Collaborate with Clinical Head of Department to
manage a group of patients
Scope of Practice:
- Clinical Role (65%), Professional Role (35%)
The APN role is still evolving……….
3) MAJOR ROLES OF THE APN
• The roles of the APN are circular and
• (Andrews, 2001)
Professional Roles between Nurse Clinician and
Advanced Practice Nurse
Nurse Clinician Advanced Practice Nurse
Professional Qualification: - MN -Master of Nursing (Clinical)
BSN (+/-) BSN
Nursing Duties: - member of the MDT
Clinical nursing leader Performs comprehensive screening history,
An established knowledge in a particular physical examination, and psychosocial
clinical setting assessment of patient
Works with groups of nurses and patients Provides nursing for pts. who have complex
Co-ordinates the assignment of care and needs and requirements
monitors outcomes to ensure optimal care Advance nursing/medical knowledge
Refers clinical issues and concerns to nurse Clinical consultant
Review and revises existing policies and
Staff Support:- Review pts with mental and common
Assess the clinical competencies medical problems
Ensure that care assignments are Resource person to the nurse clinicians
congruent between nurses’ and nurses in training and
Clinical teaching and identify nurses Initiate and facilitate clinical case
training and developmental needs conferences and RCA
Plans ongoing learning activities for Provides Clinical Supervision and
their wards preceptor to nurse clinicians, APN-
Guide nurses in their case Interns.
presentations to the doctors during the
daily ward rounds
Collaborates with nurse educator
Corporate Support: Participates with Director of Nursing
Participate in nursing committee in promoting the development and
Conducts clinical audits services of the APN
Provides clinic consultation service at
the Specialist Outpatient Clinic
Provides support in the Corporate
Share knowledge to schools,
polytechnics and professional
4) IMPROVING PATIENT CARE
As discussed in previous meeting….. for further
• Compliance with Treatment
• Cost-Effectiveness (Length of stay etc…..)
• Quality Care
• Specialised Care
• Patient’s Satisfaction
LET’S HEAR FROM A REAL APN
FROM IMH? NUH? (Video Clip)
Some ideas for interview Qs:
• How do you play the various roles of the APN to improve patient
• What have your biggest challenges been?
• What have been the biggest barriers you have faced?
• What do you find the most rewarding?
• What are the most critical issues you feel APNs are facing today?
• Premarani, K. (2005) Development of advanced practice nursing.
• Andrews, J.L. (2001).Roles of the Advanced Practice Nurse. In
Robinson, D., and Kish, C.P. (Ed.). Advanced Practice Nursing
(pp261-267). St Louis: Mosby Inc.
• Stanley, J.M. (2005). Advanced Practice Nursing (2nd ed).
Philadelphia: F.A. Davis Co.
• Ministry of Health (2004). Public consultation on the proposed
establishment of an advanced practice nurse register and
associated amendments to the nurses and midwives act. [online]
(2009, May 9).
• Singapore Nursing Board. [online] Available:
http://www.snb.gov.sg/html/SNB_Home.html. (2009, May 9}