A literature review of the Dutch debate on the nurse practitioner role: efficiency vs. professional development.

AIM: To explore the debate on the development of the nurse practitioner profession in the Netherlands. BACKGROUND: In the Netherlands, the positives and negatives of nurse practitioners working in the medical domain have been debated since the role was introduced in 1997. The outcome of the debate is crucial for nurse practitioners' professional development and society's justification of their tasks. METHOD: Review of 14 policy documents, 35 opinion papers from nurses, 363 opinion articles from physicians and 24 Dutch research papers concerning nurse practitioners from 1995 to 2012. RESULTS: Two discourses were revealed: one related to efficiency and one to the development of the profession. In both, the nurse practitioner role was presented as a solution for healthcare and workforce problems, while arguments differed. The efficiency discourse seemed most influential. Opinions of nurse practitioners were underrepresented; taking up new responsibilities was driven by the wish to improve patient care. While most physicians were willing to delegate tasks to nurse practitioners, they wished to retain final responsibility for medical care. LIMITATIONS: All available publications were extensively studied, which could not include unpublished policy documents from the government or influential parties. This may have led to some selectivity. CONCLUSION: The case of the Netherlands shows that nurses in developing their advanced role are facing barriers, similar to those in other countries. The dominance of efficiency arguments combined with protection of medical autonomy undermines the development towards nursing care that really benefits patients. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse practitioners should strive to obtain positions in which they are allowed to make their own decisions and wise use of healthcare resources for the good of patients and society. Nurse practitioners should aim to become members of influential healthcare Boards in their countries, in which they can raise their voices and be involved in policy making.

The Bologna Agreement and its impact on the Master in Advanced Nursing Practice Program at Rotterdam University of Applied Science: incorporating mandatory internationalization in the curriculum.

AIM: The aim of this paper is to discuss the impact on nursing education in the Netherlands since the implementation of the Bologna Agreement. BACKGROUND: In 1999, the Bologna Agreement was constructed to establish a comparable and transferable degree system in universities within the European Union for nine subject areas (chemistry, physics, mathematics, geology, history, business, education science, nursing and European studies). The target date for implementation of the undergraduate and graduate degrees is 2010. CONCLUSION: Since 2004, Rotterdam University of Applied Science has offered a Master in Advance Nursing Practice degree. This graduate study offers nursing students the opportunity to continue career and academic mobility within the nursing profession. This paper reports on the need for internationalization within nursing curriculum to meet the demands of the increasingly mobile nursing workforce.