Making a Case for Advancing Primary Health Care Nurse Practitioner Practice

Allison Bitonti-Brito, PharmD (Candidate)

Differences in regulations between countries largely prevent advanced practice nurses from treating patients at the top of their licenses.

Studies have shown that nurse practitioners (NPs) provide patients with the same level of care as primary care physicians (PCPs),1,2making these advanced practice nurses (APNs) aptly suited to fill the gaps left by a shrinking PCP population across the globe.

An international standard definition of an APN does not currently exist in global regulatory bodies and health care agencies, and so cross-border exchange of practitioners is difficult. A recentarticlepublished inThe Journal of Nurse Practitionersdiscussed the importance of globalization in the realm of NPs.

The study authors found that differences in regulations between countries largely prevent APNs from treating patients at the top of their licenses. Since a standard requirement for licensure both nationally and abroad does not exist, an NP in one country or region may not be considered as such in another.

In addition, title protection only exists in the more economically developed countries such as the United States, meaning that there is no standardization of who is or who can become an NP in a vast number of countries. This leads to a lack of outcomes data and promotion. Different regulations within each US state can stunt an NP’s growth.

At the 2014 Global APN Symposium, 5 recommendations were made to help guide standardization of the field. Among the recommendations were removing policy barriers and having an agreed upon definition of what an APN is to allow for a smoother transition when changing jurisdictions.

With the ever-growing need to fill the patient-provider gap that leaves patients without primary care, these recommendations will provide APNs with the option to access patients in their home country or abroad. Collaborations between educational institutions as well as nursing regulatory bodies are needed to ensure the success of globalization within the nurse practitioner field.


  1. Mundinger MO, Kane RI, Lenz ER, et al. Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial.JAMA. 2000;283:59—68.
  2. Lambing AY, Adams DL, Fox DH, et al. Nurse practitioners and physicians’ care activities and clinical outcomes with an inpatient geriatric population.J Am Acad Nurse Pract. 2004;16(8):343—52.

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