Professional Regulation’s Contribution to the Development of Advanced Practice Nursing: A European Exploration

Abstract

This thesis investigates the contribution of professional regulation to the development and integration of advanced practice nursing across Europe. Against a backdrop of rising healthcare demands, workforce shortages and shifting disease profiles, advanced practice nursing has emerged as a key strategy to strengthen health systems. However, its implementation varies widely across countries, shaped by regulatory structures, legal frameworks and systemic factors.

A pragmatic, sequential mixed-methods design was employed. Phase one involved a survey of 53 countries within the WHO European Region, mapping the presence of advanced practice roles, in conjunction with scope of practice, alongside regulatory typologies and mechanisms. The survey has a response rate of 43 countries, with 36 having responses from more than one stakeholder group. Phase two comprised in-depth case studies from six countries, selected for their contrasting levels of advanced practice nursing development and regulatory maturity. Interviews with key stakeholders; regulators, educators, nursing association representatives and policymakers, provided rich contextual data, for thematic analysis on facilitators and barriers of advanced practice development.

Findings reveal that professional regulation is a critical enabler of integration into the health systems, essential to manage risk when full practice authority is incorporated into roles. Full practice authority is defined as the ability to independently diagnose, prescribe and manage entire episodes of patient care. Countries with statutory regulation, clear operational definitions and standardised educational pathways demonstrated more successful advanced practice integration. Regulatory mechanisms such as registration, title protection and revalidation were commonly employed by countries with an integrated advanced practice workforce to support public safety and facilitate strategic workforce planning.

However, regulation alone is insufficient. Legal and financial barriers, such as restrictive scope-of-practice laws and lack of funding for training and remuneration, significantly hinder implementation. Organisational constraints, outdated healthcare models and professional resistance further complicate integration. The study highlights the importance of nursing leadership at policy level, stakeholder collaboration and evidence-based regulation to overcome these challenges and unlock the full potential of advanced practice in addressing Europe’s evolving healthcare needs.

Limitations include a Western-centric sample response and a focus on nursing perspectives. Future research should explore APN access to political engagement, effectiveness of regulatory strategies and stakeholder perceptions of trust, as well as the integration of advanced practice regulation within broader healthcare governance frameworks.

Ultimately, this thesis demonstrates that while professional regulation is not the sole driver of APN development, it is essential for ensuring safe, effective and sustainable integration of advanced practice roles into modern healthcare systems.

Date of Award	18 Dec 2025
Original language	English
Awarding Institution	Northumbria University
Supervisor	John Unsworth (Supervisor) & Paul Gill (Supervisor)