The journey from nurse to advanced nurse practitioner: applying concepts of role transitioning

Ireland has a government-funded healthcare system with means-tested access. Around 37% of the population has free access and the rest pay subsidised fees for elements of care, while some aspects are free for all. In addition, private costed healthcare services are available. There are special access systems for those with long-term conditions, to cover pregnancy, childbirth, children under 6 years, and those on long-term medications. There is an agenda of continuous improvement to the service. For example, the Report of the Commission on Nursing: a blueprint for the future (Government of Ireland, 1998) championed a complete revision of the structure of Irish nursing that included a recommendation for the establishment of advanced practice roles. The registered advanced nurse practitioner (ANP) role represents an important development within healthcare in Ireland. Currently 336 advanced practitioners are registered with the Nursing and Midwifery Board of Ireland (NMBI), working across more than 40 specialties (DoH, 2019). Significantly, the Health Service Executive (HSE), as provider of public health services in Ireland, has pledged to increase the number of ANPs in response to population demand and emerging service needs. Current integrated care service delivery is focused on addressing critical areas including older persons, chronic diseases, and unscheduled/scheduled care. The current planned workforce projection is in line with the current Irish Sláintecare strategy (a health reform plan) (DoH, 2017) and by 2021 it is proposed that there will be a total of 750 practising advanced practitioners in Ireland addressing population-based service needs (DoH, 2019).