This presentation highlighted the process that the MoH in Oman used to build consensus on the importance of establishing the role of NP in Oman. All of what has been presented could be used by other health systems especially in GCC

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Establishing the Nurse Practitioner Role in Oman
Dr. Majid Al Maqbali, RN, PhD
Director of Nursing & Midwifery Affairs
MOH(HQ) - Oman
September 17, 2013
Leading Through Change Excellence Beyond Limits
17&18th
September 2013 / 12-13th Dhu Al-Qada 1434

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Objectives:
 Develop awareness about the process of developing a new role in a
health system
 Appreciate the role of using evidence, stakeholder’s opinions, and
international models in developing new roles in nursing
 Recognize the model of scholarship, practice, and leadership in
transforming nursing

3. Advanced Nurse Practitioner
“ A registered nurse who has acquired the expert knowledge
base, complex decision making skills and clinical competencies
for expanded practice, the characteristics of which are shaped
by the context and /country in which she or he is credentialed
to practice. A master’s degree is recommended for entry level”
(ICN, 2002)
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Driving Forces In Oman
 Service Driven – ‘Shortfall’ in Doctors both numbers and specific
expertise .
 Emerging Health problems due to lifestyle changes e.g. Diabetes,
hypertension.
 People are living longer and are more likely to develop long term
conditions requiring specialist care.
 The global trend of moving care closer and deeper in the
community
 Clinical career pathway for nurses to stay at the bedside.

5. Methodology: Triangulated Approach
1. Gathered data on specific advanced practice skills practiced by nurses,
service configuration, practice standards, education process and
professional regulation.
2. Assessed the perceptions of Health Care Professionals.
3. Seek the advice and support of the experts in the field (WHO Consultants,
Academics, Health Administrators, and Decision makers).
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6. Consultancies: Dr. Tesfamicael Ghebrehiwet, ICN
 Brainstorming and focus groups:
 Profession is ready.
 The role has to be legitimized.
 Epidemiologic and demographic Imperatives.
 Public acceptance.
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7. Consultancies: Madrean Schober
 Site visits and discussions in the health centers: suggested a more
in-depth evaluation.
 Workshop with key multidisciplinary stakeholders: SWOT analysis of
the current situation - identification of common health problems, client
characteristics, settings, scope of practice, educational preparation,
facilitating factors and hindrances.
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Our Process: Needs Analysis
 Build on the work of Schober– Site visits, focus groups, workshop.
 Data gathering and analysis from Primary Healthcare setting.
 Nursing stakeholder focus groups discussions
 A review of International literature on Nurse Practitioners / Advanced
Practice.
 Perceptions of health professionals on the ANP role in Oman

9. Findings
 The infrastructure in the country is well positioned to progress towards
development and implementation of ANP.
 Nurses are functioning in an extended role due to the demand and need for
care.
 Legitimizing the role with appropriate training and supervision will surely
serve as an innovative way of ensuring quality of care, system efficiency, and
cost effectiveness.
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10.  Statistical analysis: 60 % of the nurses working in primary health care centers
 Nurses, 95% of whom were diploma trained, were carrying out these tasks
without the necessary education and legal authority
 56% of the PHC nurses who practice this role have less than 5 years of
experience that is alarming
 Nurses are prescribing drugs that are not permissible by them including broad
spectrum antibiotics for which they are not legally authorized
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Findings

11.  The doctor patient ratio in primary health care is much lesser than the doctor
patient ratio in the hospital, resulting in a population being underserved by
doctors.
 The emergent needs appear to be twofold:
 Extended nursing role - Provision of local professional development to upgrade nursing
education for those nurses already functioning in an extended capacity.
 Developing a program for advanced nurse practice within the country based on the local
needs (Schober & Affara, 2012).11
Findings

12. Findings (Focus Group):
 Internationally the role, responsibilities, titles, and educational preparation
of Nurse Practitioners is not standardised.
 International Council of Nurses have defined a role and recommend a
‘Masters’ preparation (I.C.N, 2002)
 We need a clear definition of ‘Advanced Practice’ for Oman’s context.
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13.  Internationally minimum educational preparation is a Bachelor degree.
 Curriculum development – Local – ‘v’ – Abroad.
 Clinical Practice and Assessment to be done in Oman as Omani nurses are
registered to practice.
 The need to address preventative health strategies – health promotion – health
education rather than just ‘curative’ strategies.
 The role of Consultants / Senior specialists as mentors and assessors of
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Findings (Focus Group):

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 Internationally most cited reason for implementing Advanced Practice is Physician
shortage (USA, UK Netherlands, France, Switzerland).
 Internationally Nurse Practitioners provide similar outcomes of care to Medical
staff (Horrocks, et al. 2002).
 Currently there is a global shortage of nurses - planning one profession to replace
the work of another needs careful thought (Simoens et al. 2005).
Findings (Focus Group):

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 Workforce planning to meet population needs – move from curative to preventive
strategies & management of chronic illnesses.
 Current service gaps include – Palliative care, community mental health, care of
the elderly, and discharge planning (Focus groups Muscat).
Findings (Focus Group):

16.  The appropriate duration of clinical experience required as a pre-
requisite for the ANP role is at least 4 years.
 Specific skills required by the ANP as expressed were emergency
life saving skills and implementing treatment regimen.
 Critical thinking skills and skills to work autonomously were
considered the most important decision making skills of an ANP.
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Perceptions of health care professionals

17.  The most important roles of the ANP include history taking, physical
assessment, acting in emergency situation, critical thinking and engaging
in knowledge generating activities.
 The core competencies required for the ANP role included
communication skills, knowledge generating skills and assessment skills.
 There should be one ANP for each Wilayat/District.
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Perceptions of health care professionals

18. Perceptions of health care professionals
 ANP’s could be trained locally with clinical placements to meet the
country’s needs in a cost effective way .
 The major issues that could be addressed by the ANP’s include health
promotion, managing acute /severe illnesses and disability limitation
and rehabilitation.
 ANP’s should work within a multi-professional team communicating
across professional boundaries.
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19. Perceptions of health care professionals
 Introducing the ANP role will enable physicians to spend more time with acutely ill
and sicker patients.
 The public will accept the role of the ANP in the health care system as part of the
multidisciplinary team.
 Doctors should be involved in the clinical preceptorship and theoretical
preparation of the ANP’s.
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20. Suggested Model of Practice
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21. Conclusion
O: Ownership (Health care providers, decision makers, government, and public)
M: Model
A: Accept everybody’s point of view and use them (participatory leadership)
N: Nursing is caring
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References:
Directorate of Nursing and Midwifery Affairs, (2011b) Advanced Nursing Practice – A data
collection process to assess the situation nationally; DNMA, Ministry of Health, Sultanate
of Oman
Horrocks S, Anderson E, Salisbury C, (2002) Systematic review of whether nurse
practitioners working in primary care can provide equivalent care to doctors. BMJ;
324(7341): p 819–23.
International Council of Nurses, (2002) Definitions and characteristics for nurse
practitioner / advanced practice nursing roles. www.icn.ch/networks_ap.htm
[Accessed Feb 23rd
2011]
Schober, M. (2007) Development of Advanced Community Nursing / Nurse Practitioner
Roles & Educational Programs in Oman, World Health Organisation; short term
consultancy.
Simoens S, Villeneuve M, Hurst J. (2005) Tackling Nurse Shortages in
OECD Countries. OECD Health Working Papers No. 19, English, 59 pages, doi:
10.1787/172102620474