Educational Considerations for International Clinical Nurse Specialist Students: Part I

The growth of advanced practice nursing has been described as a ‘‘global trend. ’’ ‘‘As clinical experts, leaders, and change agents, APNs (advanced practice nurses) are recognized as an important human resource strategy for improving access to high-quality, costeffective, and sustainable models of healthcare. ’’ The demand for APNs is stimulated by multiple factors, including societal demands for healthcare services; local system, cultural, and environmental influences; government priorities; and the nursing and advanced practice communitiesat-large. Althoughmore than 50 countries have developed, or are developing, advanced nursing roles, many barriers to the education and worldwide acceptance of APNs exist. Many international students come to the United States for graduate nursing education. This type of educational outreach is encouraged by universities interested in increasing internationalization within the nursing curricula. A major benefit of internationalization is to increase cultural awareness and promote personal and professional bonds between US and international clinical nurse specialist (CNS)/APN colleagues. However, the education of students from other countries presents unique challenges that require special consideration from US faculty. This article is the first in a series that will focus on issues significant to the facilitation of the educational experience for select student populations. Advanced Practice Nursing as a Global Movement The International Council of Nurses defined the nurse practitioner/APN as a registered nurse (RN) who has acquired the expert knowledge base, complex decisionmaking skills, and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which he/she is credentialed to practice. A master-level degree is recommended for entry level.11({1)Of the 4 recognizedAPN roles, nurse practitioners and CNSs are the most common roles instituted globally. TheCNS roleVemphasizing theory-guided andevidencebased practiceVbenefits patients, nurses, and organizational systems. Many countries have developed or are developing APN educational programs. Although the operationalization of the CNS role varies across the United States and the world, and the more generic title of APN may be used in some countries, evidence has shown the value of the CNS/APN to improving healthcare in the United States and abroad. The expectations of APN programs in the United States differ from those in other countries, although commonalities exist. Advanced practice nurses are leaders in healthcare, expertly integrating theory, practice, and research to provide high-quality nursing care and promote positive patient outcomes. International APN programs have these principles in common, although the literature describing programs in detail is scarce. In Europe, opportunities for nursing education at a master’sor doctoral-level are growing, but at this time are limited to a few programs; this fact, and the excellent reputation of the US higher education system, is a big draw for international students, with ‘‘more students worldwide choosing to study in the United States. ’’5({5) In the United States, the numbers of international students are increasing, and the numbers of international Author Affiliations: Student (Ms Terada), Adult-Gerontology Clinical Nurse Specialist PostYMaster’s Certificate Program, and Associate Professor (Dr Thompson), College of Nursing, University of Colorado Anschutz Medical Campus, Aurora. The authors report no conflicts of interest. Correspondence: Cathy J. Thompson, PhD, RN, CCNS, College of Nursing, University of Colorado Anschutz Medical Campus, 13120 E 19thAve, Room4211, Aurora, CO80045 (cathy.thompson@ucdenver.edu). DOI: 10.1097/NUR.0b013e318267c2ec