A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong Special Administrative Region (SAR), China.
Judith M Parker, Martha N Hill
PMID 31406742WHAT IT FOUND
Advanced practice nursing roles vary by country.
Nurse practitioners in the USA, Canada and Australia have expanded scopes including prescribing, while Hong Kong uses a three-tier career ladder for specialists and consultants within registered nurse limits. No patient outcomes were measured.
Key findings
01The USA, Canada and Australia recognise Nurse Practitioners with legal authority to prescribe, whereas Hong Kong does not develop this role, relying instead on Nurse Specialists and Nurse Consultants working within the Registered Nurse scope.
02Hong Kong implemented a three-tier clinical career ladder distinguishing roles by years of experience, from Registered Nurse to Nurse Consultant, without requiring a Master's degree for all advanced practice roles.
03In Australia, Nurse Practitioner registration requires three years of full-time advanced practice experience and a Master's-level qualification, while other advanced practice nurses may hold graduate certificates.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a systematic review, so it does not assess the quality of the evidence it cites. The paper reports no primary patient data or clinical outcomes. The information is descriptive of policy and workforce structures, not of clinical efficacy. The scope is limited to four specific jurisdictions, which may not reflect global nursing practice.
Declared interests
The authors were invited by the China Medical Board (CMB) China Nursing Network (CCNN) to provide background papers for a meeting. The CMB supported the collaboration between nursing schools. No specific financial conflicts of interest for individual authors are detailed in the text provided.
The easy way to misread this
Do not interpret this paper as evidence that advanced practice nursing improves patient outcomes. It is a descriptive review of workforce policies and role definitions, not a study of clinical effectiveness or patient care results.