Contextual factors influencing the implementation of advanced practice nursing in Catalonia, Spain

• Published in: International nursing review Vol. 71; no. 2; pp. 309 - 317
• Main Authors: Rivera, Darinka, Prades, Joan, Sevilla Guerra, Sonia, Borras, Josep M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2024
• Subjects: Accountability; Acknowledgment; Adult; Advanced practice nurses; Advanced Practice Nursing; Autonomy; barriers; Cancer; Clinical medicine; Clinical standards; context; contextual factors; Female; Health care; Hospitals; Humans; Implementation; Interdisciplinary aspects; Male; Middle Aged; Multidisciplinary teams; Networking; Nurse's Role; Nursing; Oncology; Oncology Nursing; Professional practice; Qualitative Research; Regulation; Spain; Sustainability; Workforce; Spain; barriers; implementation; context; cancer; nursing; contextual factors; qualitative research; Advanced practice nursing; Spain
• ISSN: 0020-8132; 1466-7657
• DOI: 10.1111/inr.12866

Background Advanced practice nurse (APN) roles bring great added value to health systems. However, their integration into the health workforce and the sustainability of the role depend on contextual factors surrounding their implementation. Aim To explore the contextual factors that influence the organization, implementation, and performance of clinical practice among oncology APNs in Catalonia (Spain). Methods This is a descriptive qualitative study. A framework of contextual factors was applied to explore the perspectives of 14 oncology APNs in public hospitals in Catalonia by means of semistructured interviews. Data were analyzed according to the thematic analysis approach. The COREQ checklist was used to report the study. Results APNs in cancer care strongly depend on the hospital environment where they are introduced. Recognition by the multidisciplinary team, the existence of mentoring experiences, and networking between APNs are critical factors that can help or hinder the development and autonomy of the APNs. Likewise, support from nursing managers and directors is decisive in defining the professional profile, establishing accountability mechanisms, and securing financial resources, including economic recognition. Factors related to the external environment can also contribute, including a standardized national APN model and scientific societies. Conclusions Contextual factors around clinical practice, institutional structures, and professional networks are crucial determinants for adequately integrating APNs at the health system level. Implications for nursing policy Professional bodies and national nursing organizations should lay the groundwork for defining standards of practice and advocate for specific regulations. In addition, financial recognition and accountability mechanisms to assess the impact of their contribution should be a priority to ensure sustainability and APN satisfaction.