off record
Shaukat Ali Jawaid


Recognition of Advance
Practice Nurses to
improve healthcare


Healthcare is a team work which involves not only the doctors but also nurses, pharmacists as well as paramedics. The doctor of course retains the leadership of this team but this does not mean that we should not recognize or minimize the importance of all other healthcare professionals. In Pakistan, so far we have neither given due respect and recognition to the Pharmacists (for which they are also responsible to some extent) which can go a long way in reducing or eliminating medical errors besides ensuring patient safety nor the nursing profession enjoys due respect with is their due. It is time that the members of the medical profession as well as the health administrators change their outlook recognizing the importance of all members of the healthcare team to ensure efficient health services thus improving the patient satisfaction as well.

In the developed world, now Advance Practice Nurses or Clinical Nurse practitioners are playing a commendable role thereby helping the medical profession in not only patient care but also reducing their burden and workload. Speaking at the recently held Research Symposium organized by Aga Khan University Rozmeen Shivji Acute Care Nurse Practitioner and Critical Care specialist at University of Chicago Hospital in United States did well to highlight the role of advance care nurses in provision of healthcare in developed countries. Their contribution to healthcare, she stated, can be judged from the fact that 870 million patients have visited these Nurse Practitioners.1

Tracing the history of these Nurse Practitioners she pointed out that at present in Nineteen States of United States these Nurse Practitioners have a license to practice independently. She also disclosed that the number of Nurse Practitioners was 2, 34,000 in 2016 and over twenty three thousand new Nurse Practitioners were added in 2015-2016. The American Academy of Nurse Practitioners, she further revealed, plan to increase the number of Nurse Practitioners to 2, 44,000 by the Year 2025. It is because of them that there has been reduction in re-admission rate in hospitals while it has also increased access to healthcare facilities. It has also improved the working relationship as well as patient satisfaction. These Nurse Practitioners are also credited for reduced ICU mortality and reduction in overall healthcare cost. Over the years, we have gained confidence and were shouldering more and more responsibilities. Physician’s shortage is increasing all over the world hence in the days to come, there will be increased use of Acute Care Nurses.

Some of the problems which these Nurse Practitioners face is the fear among the physicians who feel that they will take over their job. The doctors also believe that nurses are not as skillful as doctors and since the training of doctors is different, these nurses cannot become doctors. This is true, we are not doctors and our training is different but we Rozmeen Shivji stated have a job satisfaction. She admitted that of course there will be power struggle and growth opportunities but despite all this, Nurse Practitioners programme is working very well in United States and many other developed countries. However, it does not mean there are no challenges. One of the greatest challenge is who is going to train these Nurse Practitioners, where they will be trained and who is going to accredit them? Speaking about the situation in China, she said, the disease burden is increasing, physician’s shortage is going up which highlights the importance of training these Acute Care Nurses. We the Nurse Practitioners she proudly stated consider ourselves Champions but we are not competitors with doctors.

Aga Khan University which has taken the lead and is pioneer in many new healthcare initiatives has perhaps already started training such Nurse Practitioners. There is also need for specialist nurses in different fields. Some more healthcare facilities in Rawalpindi-Islamabad are considering to start similar training programmes which will enhance the prestige of nurses, it will attract more talent and they will be able to earn respect and recognition which they all deserve. Members of the medical profession should look into all these developments and instead of creating any hurdles become a part of the change and encourage steps and initiatives taken by some medical institutions to develop a well-trained cadre of Nurse Practitioners. Time has shown that no one can stop a change taking place, it will come sooner or later and we have to be ready to accept these developments in the fast changing world. With increasing number of tertiary care facilities being established and functioning in the country, these Nurse Practitioners will be in great demand in the days to come, hence why not start planning for their training before it is too late.


  1. Proceedings of AKUH’s Health Sciences Research Symposium. Pulse International December 1-14th 2017. Page-2. http://www.pulsepakistan.com/index.php/main-news-dec-1-17/2350-tavr-reduces-risk-of-bleeding-while-stroke-risk-is-equal-to-surgery-dr-osman-faheem Accessed on January 26, 2018.
© Professional Medical Publications. All rights reserved.