Experts call for measurement and documentation of APN care outcomes

Faculty and advanced practice nurses from NUS Nursing, Vanderbilt Nursing and National University Polyclinics convened to discuss how to maximise and document the impact advanced practice nurses make to the evolving healthcare landscape.

Faculty and researchers from Singapore and the U.S co-hosted an informative webinar on the role of advanced practice nursing. The discussion focused on how advanced practice nurses (APNs) can advocate for and lead sustainable models of healthcare. The webinar aimed to increase understanding and awareness of the role to reduce barriers to its uptake.

The webinar gathered together experts from the National University of Singapore’s Alice Lee Centre for Nursing Studies (NUS Nursing), Vanderbilt University’s School of Nursing and National University Polyclinics, including Dr Brigitte Woo, Professor Ruth Kleinpell and Advanced Practice Nurse Liau Wei Fong. It was moderated by Associate Professor Zhou Wentao.

Key takeaways from the webinar

Associate Professor Zhou Wentao from NUS Nursing opened the session with an in-depth explanation of the preparatory training for APNs. A large portion of the training and education takes place within the NUS Master of Nursing programme. The 18-month programme is seamlessly interlinked with a one-year integrated internship at a healthcare institution where the APN is empowered with clearly-stated levels of entrustment via entrustable professional activities.

She highlighted that APNs in Singapore have contributed significantly to improving the quality of care and increasing access to healthcare across care settings. “Moving forward, APNs, by nature of their diverse and expanded practice competencies and scope of practice, are in a strategic position to lead the fast changing, pandemic-to-endemic healthcare landscape,” she said. This dovetails with the Singapore Ministry of Health’s plans to ramp up professional development of APNs and expand the APN workforce with a projected 700 APNs with prescribing rights to serve the population by 2030.

Advanced Practice Nurse Liau Wei Fong from the National University Polyclinics (NUP) called to attention four specific primary care challenges facing Singapore: an ageing population, rising costs of healthcare; fragmentation of care; and increased patient expectations. A key initiative in the Polyclinic that tackles these issues from a primary care perspective is the Project Value Enabled Care Transformation (VECTor) programme, which promotes right-siting of care from acute hospitals, strengthens primary care and prevention, and reduces unnecessary visits to the Emergency Department.

While chronic disease management, interprofessional collaboration and telehealth remain cornerstones of APN practice at NUP, the patient profiles seen by and services rendered by an APN changes as he transits from a novice to an expert, said Ms Liau. She described that an APN in his first year would review patients with common chronic diseases such as hyperlipidaemia, type II diabetes mellitus, chronic obstructive pulmonary disease and asthma. In contrast, an APN in his third year would review the general pool of chronic disease patients and have a specialised area of focus such as atrial fibrillation.

Dr Brigitte Woo, a Research Fellow at NUS Nursing whose research centres around the role and development of APNs in Singapore, shared the preliminary findings from an APN-led atrial fibrillation (AF) clinic implemented in Bukit Batok Polyclinic. There, the APN leads services and work in close collaboration with a family physician in the Polyclinic and a senior cardiologist from National University Heart Centre (NUHCS). The APN-led AF clinic also provides fast-tracked Trans-Thoracic Echogram (a key ultrasound diagnostic test for AF patients) appointments at NUHCS.

“Typically, patients have to wait at least two months for their Trans-Thoracic Echogram but patients in the AF clinic can wait less than two weeks for an appointment,” she said. The implementation of the APN role in the primary care setting, in the form of the APN-led AF clinic, has also made significant improvements in patient’s disease knowledge, adherence to medications and depression scores within the span of 12 months, according to her findings.

“The APN-led AF clinic started out as a PhD research initiative but has since been made a permanent service at Bukit Batok Polyclinic,” she added.

The final speaker was Professor Ruth Kleinpell, the Associate Dean for Clinical Scholarship, Independence Foundation Chair in Nursing Education at Vanderbilt University School of Nursing.

Prof Kleinpell stressed the importance of identifying the impact of the APN role and gave practical handles on documenting the outcomes of services rendered by APNs. She recommended documenting the outcome values by the organisation and area of practice.

Prof Kleinpell ended the session by imploring APNs to begin identifying and showcasing the outcomes of their care. “By doing so, the value of the APN role can be effectively communicated to the stakeholders of healthcare,” said Prof Kleinpell, who is a certified acute care nurse practitioner and is known nationally and internationally for her expertise related to advanced practice nursing. She is also a Visiting Professor for the Master of Nursing programme at NUS nursing.

The seminar ended with a brief Q&A session, led by A/Prof Zhou, where the panellists reiterated the critical need to promote and document APNs’ roles in and contributions to the care of patients, the nursing profession and healthcare system now and in the future.

By Dr Brigitte Woo