A Systematic Review on the Definition Advanced Nursing Practice

Review Article

Ann Nurs Res Pract. 2023; 8(2): 1057.

A Systematic Review on the Definition Advanced Nursing Practice

Muayyad M Ahmad, PhD, RN¹; Hayat Sulieman Abu-Shaikha²; Feda Al-Shatnawi³

¹Department of Clinical Nursing, School of Nursing, University of Jordan, Jordan

²Faculty of Nursing, Philadelphia University, Jordan

³College of Nursing - Al-Balqa Applied University, Jordan

*Corresponding author: Muayyad M Ahmad Professor, Clinical Nursing Department, School of Nursing, University of Jordan, Amman – Jordan 11942, Jordan. Email: [email protected]; [email protected]

Received: August 12, 2023 Accepted: September 25, 2023 Published: October 02, 2023


This study aims to review and critique the definitions of Advanced Practice Nursing (APN) in the literature. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Following the methodology of Arksey and O’mllay, four electronic databases were searched between 1990 and 2022. Articles published in English that discuss the definition of APN were screened for eligibility based on their full texts. Extracted, compiled, and summarized data. After removing duplicates, screening the titles and abstracts of the articles, and eliminating those that did not meet the eligibility requirements, the final number of articles included in this review was 11. Results revealed a variety of APN definitions and referral models, as well as the fact that APN titles, laws, roles, and regulations vary by country. The absence of standardized measures that enable stakeholders and health care providers to distinguish APN from other levels of nursing practice. It is necessary to clearly define APN at international levels in order to advance and improve our nursing disciplines. However, we advise utilizing the robust model of APN “as presented by Glenn and Budd [1]” to distinguish their roles from those of other related practices.

Keywords: Advanced practice nurse; Advance practice nursing; APN; Definition


Advanced Practice Nursing (APN) is a relatively new term that has been widely used in recent nursing literature. There are numerous factors that have contributed to the evolution of advanced practice nursing, including changes in the healthcare system, population needs, and clinical standards and training [2]. Advanced nursing practice encompassed four advanced roles of practice: nurse anesthetist, nurse midwife, clinical nurse specialist, and nurse practitioner. In the United States, the first two APN roles to emerge were nurse anesthetist and nurse midwife [3]. During World War I and II, nurse anesthesia was developed to reduce anesthesia-related mortality. While nurse midwifery was introduced as early as 1920 to meet the needs of impoverished women in rural areas, it remains largely unregulated [4]. In 1954, when psychiatric nurses were provided with advanced training, the Clinical Nurse Specialist (CNS) position emerged [5]. The Nurse Practitioner emerged as the fourth advanced role.

It is well documented in the literature that advanced practice nursing holds the promise of delivering quality, cost-effective, and patient-satisfying health care [6]. In addition, the position contributes uniquely to health promotion, disease prevention, and disease treatment [7]. However, no consensus has been reached regarding the definition of APN [8]. Regarding the precise definition of this concept in terms of its roles, responsibilities, and regulations, there is a great deal of ambiguity. Additionally, the definitions vary depending on the context and even the country [9,10]. Literature revealed the international complexity of advanced practice roles and the difficulty of identifying the unique contribution of advanced practitioners in nursing and midwifery to health care [11] (Dowling, Beauchesne, Farrelly, & Murphy, 2013). To advance APN internationally and to have a standardized understanding of their roles, responsibilities, and scope of practice, universal consensus is required. This concept's clarity will be reflected in the provision of clear and precise responsibilities for APNs, other health care professionals, clients and users of services, and academic institutions designing and marketing degrees [10,12]. The purpose of this paper was to review and summarize the available literature regarding the definition of APN.



This analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [13]. We used the five-stage framework developed by Arksey and O'Malley for this evaluation [14]. Identify the research question, identify the relevant literature, select the literature, chart the data, and compile, summarize, and report results are the stages of the process [15].

Search Methods

The following databases were searched: PubMed, Sage publication, Wiley, and Science Direct. APN, advanced practice nurse, advance practice nursing, and their respective definitions as well as their Boolean search variants were used. This range was chosen in relation to the recent evolution of the APN and encompasses articles published from 1990 to June 2022. In total, 216 articles were retrieved and screened according to the eligibility criteria, resulting in the review of 11 studies.

Search Outcomes

The criteria for inclusion in this review were articles discussing the definition of APN. Included research designs may be qualitative, quantitative, review articles, or grey literature. Two reviewers screened the titles and abstracts of 174 articles after removing duplicates from a total of 216 articles identified by our search strategy. Two investigators independently evaluated the full texts of the remaining 28 articles to determine their eligibility. Eleven articles remained as remaining eligible studies in this review (Figure 1).

Citation: Ahmad MM, Abu-Shaikha HS, Al-Shatnawi F. A Systematic Review on the Definition Advanced Nursing Practice. Ann Nurs Res Pract. 2023; 8(2): 1057.