Advanced Practice Nurse System -focused on Japan’s system-

1. Advanced Practice Nurse System-focused on Japan’s system- HORII Satoko, Ph.D, RN, PHN Chief advisor, Project for Strengthening Clinical Training System for New Graduate Nurses, JICA VIETNAM

2. Advanced Education in Nursing in Japan at least 3years • Ph.D(Doctor of Philosophy) in Nursing • Doctor • D.N.P (Doctor of Nursing Practice) Master at least 2years • C.N.S(Clinical Nurse Specialist) • M.S.N(Master of Science in Nursing) Experience as registered nurse Clinical training in employed health facility (1year ) National examination to obtain license for Registered Nurse • B.S. or B.A. • B.S.N(bachelor of Science in Nursing) • Bachelor or • Equivalent CNSisAPN(Advanced Practice Nurse) in Japan ※ different pre-licensing courses besides B.S.N are not included in this figure

3. What is Advanced Practice Nurse (APN)? • 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/or country in which s/he is credentialed to practice. • A master's degree is recommended for entry level. International Council of Nurses (ICN) https://international.aanp.org/Practice/APNRoles

4. EffectivenessofAPN –evidences • A Cochrane review of the substitution of GPs with nurses in primary care (4253 articles were screened, 25 included) concluded that appropriately trained nurses are able to provide equally high quality care and good health outcomes for patients. Laurant M, Reeves D, Hermens R . 2009. • In a longitudinal study assessing the impact of palliative care, APN care led to significant improvements in quality of life (emotional and cognitive functioning) and a decrease in anxiety scores. Corner J, Halliday D, Haviland J et al .2003 • APN clinical outcomes, care processes, use of services and cost-effectiveness have been found to be equivalent or superior to GP care. Stanik-Hutt J, Newhouse R, White K. 2010 APNcontributestowell-beingofindividual and society withintegration of “CURE”and“CARE”in more than 70 countries Source: Lisbeth Fagerström, the impact of advanced practice nursing in healthcare: recipe for developing countries. Ann Neurosci. 2012 Jan; 19(1): 1–2.

5. Proportion of “CURE”? Country specific regulations underpin APN practice • Right to diagnose • Authority to prescribe medication • Authority to prescribe treatment • Authority to refer clients to other professionals • Authority to admit patients to hospital • Legislation to confer and protect the title "Nurse Practitioner/Advanced Practice Nurse" • Legislation or some other form of regulatory mechanism specific to advanced practice nurses • Officially recognized titles for nurses working in advanced practice roles https://international.aanp.org/Practice/APNRoles

6. Comparison of Advanced Practice Nurse system

7. Certified nurse specialist (CNS) system, since1994 • CNS system is designed to contribute to the development of healthcare and welfare as well as to improve nursing science by forwarding CNSs with specific advanced nursing knowledge and skills into society to provide high-level nursing care efficiently for individuals, families and groups having complex and intractable nursing problems. • Role of CNS • Provision excellent nursing practice for individual, family and community • consultation with care providers including nurses • coordination among the concerned parties, ethical coordination to protect the rights of individuals, etc. • education of nursing personnel • research activities at clinical settings

8. Credentialing System of CNS obtaining a national license for Registered Nurses 1. completing a master's program at a graduate school (26, 38 or 46credits), which certified by Japan Association of Nursing program in University (JANPU) 2. accumulating a certain amount of experience (at least 5 years experience including 3 years in the field of her/his expertise) the credentialing examination （documentationand written exam) by Japan Nursing Association (JNA) Certificate issued and registered by JNA It is required to renew the certification every five years （documentation about nursing practice, training experience and publication）

9. Number of certified nurse specialists by field (as of December 2018 according to JNA)

10. Background: Health Transition, Current Health Issues in Japan Reference: Hishinuma and others (1990) Development of Nursing Model based on PHC

11. Scope of practices- Nurse and Medical Practitioners • General Provisions incl. Definition etc. • Licensure • Examinations • incl. National Exam and Clinical Training • Practice • Penal provisions • Medical Practitioners’ Act Medical practice assist to medical practice • following practice can be done under the direction of medical practitioner; • Utilization of medical equipment • Administration of medicine • Consultation regarding medicine etc. Medical treatment • Act on Public Health Nurses, Midwives and Nurses

12. Implementation agencies Japan Association of Nursing program in University (JANPU) training • Mission, Program, Faculty, Facilities etc. • Renew every 10years accreditation master's program at a graduate school in Nursing (13fields, 301 programs in 106 graduate schools※) National license for Registered Nurses regulated by Act on Public Health Nurses, Midwives and Nurses examination and certified by Japan Nursing Association (JNA) certification ※175 universities have master courses out of 263 universities in nursing

13. Regulatory environment of Health Professional Education Institutions, HPEI The standards : -general provision, -basis for academic activities, -faculty qualifications of professors, -admission capacity, curricula, -graduation requirements and others, -facilities such as school sites and school, buildings and equipment, and etc., -organization for clerical work, -special provisions -concerning inter-university curricula, and -miscellaneous provisions. Source: Junko Tashiro, Contributions of Public and Private Health Professional Education Institutes – Perspective of Nursing Education in Japan, PMAC 2015

14. Accreditation for Education Institutes Quality Evaluation Based on Standards set by JUAA 1. Mission and Goals2. Educational and Research Structure3. Faculty Members and Faculty Structure4. Educational Program, Instruction and Outcomes5. Student Admissions6. Student Services7. Educational and Research Environment8. Social Cooperation and Social Contribution9. Administration and Financial Affairs10. Internal Quality Assurance Japan University Accreditation Association (JUAA) Universities take quality evaluation every seven years. Source: Junko Tashiro, Contributions of Public and Private Health Professional Education Institutes – Perspective of Nursing Education in Japan, PMAC 2015

15. Conclusion • APN system is developing in worldwide. Evidences supportAPN’s contribution to improvement of well-being of individual and society with integration of “CURE” and “CARE” through interprofessional collaborative practice. • Scope of practice should be considered according to the context of the country - whether it necessary to establish legal base to define the scope of practice of nurse and medical doctor etc. in Viet Nam? • Credential and accreditation mechanism is crucial to maintain the quality of APN system • Clinical training is anyway necessary as entry point to meet complexity of needs of society and response medical technology development

16. Thank you for your attention Contact information: horii-satoko@umin.ac.jp https://www.jica.go.jp/project/vietnam/038/index.html