Strengths Weaknesses Opportunities Threats Analysis in relation to

Strengths Weaknesses Opportunities Threats Analysis in relation to Advanced nursing practice (APN) becoming recognised as a valid part of nursing and health care service provision globally Carried out 29 th June 2006, Sandton, South Africa by Fadwa Affara

Strengths q Determination (and stamina) to reach ANP goals q Capable of undertaking complex decision making in relation to patient care q Participation in policy q Evidence of competence making and formulation of legislation exists in some countries q Highly skilled q Able to work independently of nurses working in the ANP roles, and managing complex health problems q Evidence of capability pf APN to deliver PHC and be entry point into the health system

Strengths q Consumer trust q Demonstrated acceptance by public q An international definition of APN exists q Information technology is used to access information about APN q Affiliated/and or organised as a group internationally and nationally in some countries q When not organised have a willingness to create some form of professional organisation q Show great commitment and will to act to advance practice

Weaknesses q Poor role clarification q Uncertain identity q Proliferation of titles q Scope of practice conflicts with other health professionals q APNs practise under varied levels of autonomy q Lack of clear identity affecting ability of APNs to communicate q Failure to get ANP into clear messages about ANP human resources planning q Lack of recognition by other (APN needs assessment, health professionals role descriptions) q Mistrust in nursing between q Absence of career ANPs and other nurses causing ladders APNs to feel more at easy with medical rather than nursing values

Weaknesses q Fragmentation/ variability in standards and quality of education programmes q Educational programmes may not keep up with the changing realities of practice q Insufficient numbers of mentors q Inappropriate reimbursement systems for APNs q Inability to properly cost ANP services (private provider) q Lack of a political will in supporting the role

Opportunities q Diversity of APN practice creating discussion/ stimulating interest globally q Migration opening new opportunities to learn and advance personal competence q Health care systems in crisis globally q Nurses ability to influence health care through grass root means as well as by influencing top policy makers q Workforce development in flux Changing health care environment q Interest in innovative healthcare delivery models q Sharing good practice q Increasingly aware and vocal consumers who want to be involved in health decision making q Strengthening voice of women in the public arena

Opportunities q Nurses can bring much experience and knowledge to health care and occupy a pivotal position (deal with primary needs of human beings) q Nursing education moving into the university sector q Nurses seen capable of taking a leading role in health/social development q APNs being seen as a means to meet unmet health needs q Creating alliances with groups outside nursing q Physician shortage q Rising demand for management of chronic disease

Threats q Medicalisation of health systems –medical dominance q Territorial protection q Insufficient influence to affect health decisions and resource allocation q Inadequate political skills/ strategies q Value system of political decision–makers unfavourable to APN goals, e. g. using economic retrenchment to cut APN services to marginalised underprivileged groups q Diversity may lead to fragmentation q APN perceived to be too expensive

Threats q Complacency q Apathy q Burnout q Low status of nurses – poor payment, recognition and contributions health care not valued q Severe staff shortages q Lack of clinical career pathways q Insufficient faculty q Insufficient definition of roles and scope of practice q Low levels of funding– for education and post creation q Indemnity insurance difficult to obtain and becoming expensive