key: cord-0897358-9fqbbkkw authors: Poghosyan, Lusine; Maier, Claudia Bettina title: Advanced Practice Nurses Globally: Responding to Health Challenges, Improving Outcomes date: 2022-04-26 journal: Int J Nurs Stud DOI: 10.1016/j.ijnurstu.2022.104262 sha: c3d0af6a751793e21e015d692a77406021b903e6 doc_id: 897358 cord_uid: 9fqbbkkw nan Advanced practice nurse delivered care models are being implemented globally and research is growing to highlight the importance of optimally supporting and utilizing this critical workforce in patient care. Over the past several decades, research has been accumulating showing that advanced practice nurses-provided care is associated with positive patient outcomes and that these nurses add critical value across various health care settings (Newhouse et al., 2011 , Swan et al., 2015 , Aiken et al., 2021 . The papers included in this special issue contribute to this growing body of evidence by demonstrating how advanced practice nursing care impacts patient outcomes. They highlight the effectiveness and quality of advanced practice nursing roles in countries at various stages of implementation (e.g., Norway at an early stage, England and USA at a more advanced stage) and across a range of specializations (e.g., orthopedic surgery, oncology, mental health, cardiac surgery) and care settings (e.g., emergency care, inpatient and ambulatory care). For example, in Norway, a country early in the process of introducing advanced practice nurses, Boman et al. (2022) demonstrates that advanced practice nurses are as safe in diagnosing and treating patients with minor orthopedic surgeries in emergency care. A systematic review of the effectiveness of advanced practice nursing roles in postoperative cardiac settings found inconsistent results with regard to 13 identified patient outcomes parameters as well as organizational outcomes (Audet et al., 2022) . The studies included in the review were based on small sample sizes and several were assessed as having a high risk of bias. Future research with larger sample sizes is required in cardiac settings to evaluate the contribution of advanced practice nurses and their effects on patient outcomes in this particular setting. In England, a country with an established tradition of advanced nursing practice, a retrospective cohort study of 108,115 lung cancer patients found that specific practice patterns of advanced practice specialist nurses were associated with improvements for patients. For instance, there was a 17% lower risk of death and lower rate of unplanned cancer-related J o u r n a l P r e -p r o o f Journal Pre-proof admissions when an assessment was performed by a lung cancer nurse specialist compared with no assessment (Stewart et al., 2021) . Practice patterns of advanced practice nurses working with children and young people in mental health care were analysed in the U.S. The study (Yang et al., 2021) , which sampled 12,991 Medicaid-insured youths ages 0 to 20 years, found that youths treated by nurse practitioners were more likely to live in small and non-metropolitan areas compared with youths treated by physicians. Prescribing patterns of psychotropic medications showed no major differences. Advanced practice nursing roles are growing in many new areas including mental health and care settings for individuals with intellectual disability. The paper by Scheydt and Hegedüs (2021) pandemic. Empirical studies from England and the U.S. have analyzed the rapidly changing practice and policy environments of advanced practice nurses during the pandemic exemplifying how the nursing workforce was able to adapt under challenging conditions. The study by Morley et al (2022) showed that advanced practice clinicians, which in England cover interdisciplinary clinicians including those with nursing background, transferred their advanced practice skills into areas of clinical need during the pandemic. They took on leadership positions to respond to the pandemic yet they faced challenges about lack of knowledge about their role and tension with physicians. A survey of advanced practice nurses assessed how removal of restrictions during the pandemic affected this workforce's performance (O'Reilly-Jacob et al., 2022) . This study found that temporary removal of statelevel restrictions alone is not sufficient for advanced practice nurses to achieve their full scope of practice. The studies reported in this special issue provide key insights into this workforce and highlight several emerging lessons. First, studies show that advanced practice nursing roles Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States Value of Nurse Practitioner Inpatient Hospital Staffing Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study Health workers at the core of the health system: framework and research issues The association between advanced practice nursing roles and outcomes in adults following cardiac surgery: A systematic review of randomized controlled trials Implementation of advanced practice nursing for orthopaedic patients in the emergency care context -A study protocol for outcome studies The roles and key activities of Clinical Nurse Specialists and Advanced Nurse Practitioners in supporting healthcare provision for people with intellectual disability: An integrative review Task shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study Task shifting between physicians and nurses in acute care hospitals: cross-sectional study in nine countries The changing role of Advanced Clinical Practitioners working with older people during the COVID-19 pandemic: a qualitative research study Advanced practice nurse outcomes 1990-2008: a systematic review Nurse practitioners' perception of temporary full practice authority during a COVID-19 surge: A qualitative study Factors supporting career pathway development amongst advanced practice nurses in Thailand: A cross-sectional survey Tasks and activities of Advanced Practice Nurses in the psychiatric and mental health care context: A systematic review and thematic analysis The pediatric nurse-practitioner program: expanding the role of the nurse to provide increased health care for children