On 26 January 2023, the virtuous circle of the Advanced Practice Nursing (APN) program at the Pontificia Universidad Católica de Chile completed the graduation of the first five nurses who will contribute to improving the quality of care in priority areas for Chile, such as the fight against cancer.
It had been 12 years since a group of professionals from the UC School of Nursing decided to generate relevant changes for the country. Opportunities often come without looking for them. This time, it was the call of the Pan American Health Organization (PAHO) and World Health Organization (WHO) with an open invitation to create this type of program, and it was related to the reality of the country and its public health needs.
The call coincided with the work being done to create an innovative graduate degree. While there were questions about its purpose and place in the national environment, there was no doubt that it should consider competencies related to leadership, evidence-based practice, and the expanded role of nursing, but its emphasis was on improving the quality of care received by millions of people in Chile's public health system.
Since the UC School of Nursing is a collaborating center of PAHO, the work was reoriented toward the creation of an APN Master's program with different mentions—incorporating innovative components to the country's nursing education. The challenge now was to find the specialty for this program.
The second opportunity emerged from the urgency and interest expressed in 2016 by oncology physicians of the UC CHRISTUS Health Network. They needed Advanced Practice Nurses to help address the serious problems of access to and coverage of cancer care.
At that time, latency times were prolonged, compromising the survival of people with cancer. Three people died every hour in Chile as a result of this disease. But that was not all. The deficit of general practitioners and specialists in regions and isolated sectors was worrying with only seven oncologists per 1 million people—far from the Organisation for Economic Co-operation and Development’s recommendation of 21 professionals per 1 million inhabitants.
By training competent and qualified professionals, the opportunity arose to contribute to society's and the country's health welfare. These professionals can now carry out actions for promotion, prevention, diagnosis, and collaborative treatment and enhance resolution by working in established oncology teams.
An alliance between the UC CHRISTUS Health Network and Enfermera-matrona Pontificia Universidad Católica de Chile (EEUC) jump started the collaborative work between the career center nurses, headed by Silva Palma, and academics from EEUC, led by me because I was the director of postgraduate studies at the time. With the experience of both teams, we proposed the creation of a professional master's degree oriented to clinical specialization.
For the development of the program, we followed the steps proposed by the PEPPA Framework, which establishes criteria and guidelines for the implementation of the APN role in health systems, with the need to influence legislation and bring about changes in care models. We also took ICN’s (2008) proposed definition into account, which understands the APN as "a registered nurse who has acquired expert knowledge, complex decision-making skills, and clinical competencies for expanded practice, adapted to the context, in which the master’s degree is the recommended level of training."
To start training future APNs in cancer care, we first conducted a survey to determine the necessary competencies. Then, we identified nurses who already performed part of this role and used them as a basis for a pilot training program.
As a result of the responsibility and leadership that UC School of Nursing has in this area—and given that it is a role that is not currently implemented in the country—the training of nurses from the UC CHRISTUS Health Network as master’s in Advanced Practice Nursing has been promoted in order to strengthen the academic body of the program. To get to know the international reality, two nurses trained at Boston College, which is recognized worldwide for its knowledge in this area and with which there is an agreement at the postgraduate level.
But that wasn't the only thing. The team had the opportunity to work on the development of the national cancer plan that was launched in October 2018. It elaborated on the urgency for having specialized professionals for cancer care, including advanced practice nurses, and followed the model that has operated for decades in Europe, the United States, and Canada.
Thus, in 2021, we achieved the approval of the master’s program in APN with mention in oncology. This two-year training program includes pharmacology, pathophysiology, and advanced assessment, in addition to clinical courses with more than 1,300 hours of clinical experience.
Thanks to the collaborative work of UC School of Nursing, oncologists from the UC CHRISTUS Health Network, the School of Medicine, nurses from the UC Cancer Center, and the support of the associated clinical fields to receive future students of the program in their clinical practices, there are plans to work on more specialties, such as palliative care, family, and community health. In addition, the Ministry of Health is studying the possibility of incorporating the APN in the certification regulations for the specialties of individual healthcare providers. This will facilitate the positioning and validation of the role of the APN at the national level. This is why we see a window of opportunity to promote and project the change that is needed in Chile!
Many people have contributed to the development and implementation of the APN role in Chile—so many that it is difficult to name each one of them. For the process that we are currently undertaking, I would like to highlight the contributions of my fellow Alpha Beta Omicron Chapter members:
- Professor Paz Soto, who has worked to pursue the legal recognition of the APN role in the country. She has also been fundamental in disseminating the role of nurse practitioners within the nursing community—both within Chile and throughout the Americas—through continuing education.
- Assistant Professor Marcela Gonzalez-Agüero, who, as Director of International Affairs at the EEUC, has sought opportunities to enhance the leadership and advocacy competencies of our APN students with the involvement of international faculty. She has also contributed to finding opportunities for international internships for our students with the aim of empowering them in their new roles.
- Associate Professor Camila Lucchini-Raies, who has worked from the beginning to develop relationships with key actors in Spain that have helped us to understand the required APN competencies for our program. Furthermore, we recognize Camila’s contribution in the drafting of papers that allowed us to socialize this process with peers both within and outside Chile. In her current position as Director of the EEUC, Camila has maintained her support for the positioning of this role within the health system, creating spaces for dialogue and training for Chilean and Latin American nurses through the School of Nursing Collaborating Centre, our Sigma chapter, and the UC Faculty of Medicine.
Francisca Marquez-Doren, PhD, MNSc, RN, is an Associate Professor at Pontificia Universidad Catolica de Chile in Santiago, Chile. She is a member of Sigma’s Alpha Beta Omicron Chapter and Beta Tau Chapter