[OPINION] The case for advanced practice nursing

Low wages, inadequate benefits, poor working conditions, and a disconnect between training and actual practice push nurses out of the country for greener pastures. These longstanding issues equally demand immediate attention. However, an often overlooked factor driving migration is the lack of a clear and meaningful nursing career pathway within the country.

Currently, Filipino nurses navigate a narrow professional landscape. After passing their licensure exam, they face two primary paths: clinical practice or advanced degrees. 

Clinical nurses usually start as general hospital staff nurses before undergoing specialty training to be assigned in areas like emergency or operating rooms. However, this additional expertise rarely leads to career advancement. Meanwhile, nurses pursuing advanced degrees may qualify for academic positions or “promotion” to administrative roles, but such qualifications do little to enhance their clinical practice. For example, while higher education is required for senior nursing positions in public hospitals, according to the competency model by the Department of Health, these degrees don’t translate into improved clinical skills or broader responsibilities.

What it’s all about

The International Council of Nurses technically defines Advanced Practice Nursing (APN) as a level of nursing practice based on advanced education and preparation that improves overall patient and population health. Many countries have embraced APN as a pathway to greater professional autonomy and expanded scope of practice. 

Advanced Practice Nurses acquire specialized knowledge, advanced clinical competencies, and decision-making skills through graduate education. Such a skillset allows them to diagnose conditions, prescribe medications, and manage patient care independently according to the context in which they are credentialed to practice. They serve across various clinical specialties – from primary care to emergency medicine – and focus on specific populations, from pediatrics to gerontology. 

The most common APN roles are the clinical nurse specialist and nurse practitioner, but other roles like the Certified registered nurse anesthetist (CRNA) and the Certified nurse-midwife (CNM) are well-established in countries like the United States.

These expanded roles are not just career advancements — they are essential in addressing gaps in healthcare delivery and health workforce shortages, particularly in underserved areas, as evidenced by global literature. They also contribute to improving patients’ health outcomes and overall quality of life, reducing patient costs and length of stay, and increasing patient satisfaction. Overall, APN roles are guaranteed to provide added value to healthcare systems worldwide.  

Nurses already perform some of these advanced duties through “task shifting” and “task sharing.” The World Health Organization endorsed this as an intervention to address the global health workforce crisis amidst the growing burden of disease. It is commonly practiced in rural communities, especially in geographically isolated and disadvantaged areas (GIDAs), where physicians and healthcare workers are scarce. For instance, nurses in Benguet routinely dispense medication, conduct diagnostic testing, and perform health assessments. In other areas of the country, other community-based health personnel, including barangay healthcare workers (BHWs) and midwives, are also task shifting and task sharing, conducting basic consultations and childhood immunizations.

It is noteworthy that task shifting helps manage immediate healthcare needs, albeit failing to provide career advancement or the authority and compensation associated with APN roles. Establishing formal APN programs would empower nurses with advanced training, certification, and autonomy, creating a win-win for the workforce and the healthcare system.

Missing legal framework

Despite the growing need, the Philippines lacks the legal framework to institutionalize Advanced Practice Nursing, as the Philippine Nursing Act of 2022, which seeks to establish the practice of APN, remains a Senate Bill awaiting passage. 

Establishing APN roles requires accredited master’s or PhD-level programs, along with proper systems for licensure, registration, and certification. 

The Philippine Qualifications Framework (PQF) has recently approved standards for APN in critical care, outlining advanced functions such as managing critically ill patients and developing health programs for critical care. However, the absence of a formal APN framework would leave these standards underutilized.

By creating a robust APN framework, the Philippines can elevate its nursing profession, offering clear career pathways, professional recognition, and competitive credentials. This framework seeks to formalize and standardize the advanced duties many nurses already perform, ensuring quality care delivery while providing appropriate compensation and authority. To achieve this, extensive consultation and robust collaboration among the education (e.g., PRC, CHED), labor (e.g., DOLE, DFA), and health sectors are essential in developing the framework.

However, equally important are parallel efforts to build on existing progress in task shifting and task sharing, ensuring that local working conditions for nurses are improved alongside these advancements.

As the nation strives for health security and universal healthcare, it’s time to recognize nurses as the backbone of our healthcare system. Investing in higher pay, better working conditions, and expanded professional roles will not only help retain skilled professionals but also enhance healthcare delivery and improve health outcomes for all Filipinos. Advanced Practice Nursing is the future of healthcare—and the Philippines must embrace it. – Rappler.com

This piece draws from the study titled “Confronting the Care Crisis: A Comprehensive Analysis of the Nursing Crisis in the Philippines.” The study and other working papers may be accessed here. The views expressed herein are those of the authors and do not necessarily reflect the views of Ateneo de Manila University.