IAANMP: Advanced practice journal article review

The advanced practice journal article review section highlights advanced practitioner reviews of current, practice-relevant research articles that inform and support the evolving role of advanced nurse and midwife practitioners (ANMPs) in Ireland. With an emphasis on clinical leadership, innovation, and evidence-based care, these reviews highlight key findings from contemporary literature and explore their implications for advanced practice.

In this edition, RANP Theresa Lowry Lehnen reviews ‘Integrated care: The way forward for advanced nurse practitioners by using strategy initiatives’. This journal article, written by Prof Marie Carney, presents a compelling analysis of the strategic role ANPs play in advancing integrated, person-centred care.

It highlights the importance of ANP leadership in driving health system reform, promoting interprofessional collaboration, and leading innovative service delivery models that respond to complex patient needs and evolving healthcare demands.

This review showcases how research continues to shape and support advanced practice, reinforcing the importance of critical engagement with the literature in advancing safe, effective, and future-focused healthcare.

Integrated care: The way forward for advanced nurse practitioners by using strategy initiatives

Author: Marie Carney, Professor of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Faculty of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
Reference: Carney M. Integrated care: The way forward for Advanced Nurse Practitioners by using strategy initiatives. Int J Nurs Health Care Res. 2024; 7:1493. https://doi.org/10.29011/2688-9501.101493. 
Published Date: 14 January 2024.
Journal article review author: Theresa Lowry Lehnen, RGN, PG Dip Coronary Care, BSc, MSc, RNP, PGCE (QTS), M Ed, PhD, FFNMRCSI, Registered Advanced Nurse Practitioner General Practice.

Introduction
The journal article provides an insightful and timely exploration of how ANPs can lead integrated care through effective leadership and strategic alignment. Drawing on policy frameworks, professional experience, and contemporary healthcare reform discussions, Prof Marie Carney offers a conceptual analysis of the evolving role of ANPs in systems integration.

As healthcare systems worldwide shift toward models of integrated care, there is an urgent need to reimagine the roles of healthcare professionals in delivering coordinated, cost-effective, and patient-centred services. In this context, the contribution of ANPs has gained increased attention, not merely for their clinical expertise, but for their potential as strategic leaders within health system reform.

Prof Carney’s 2024 publication addresses this opportunity by framing ANPs as pivotal to implementing and sustaining integrated care pathways. Her work aligns closely with national health strategies such as Sláintecare, which call for enhanced community-based services and interprofessional collaboration.

The article sets out to examine how strategic initiatives can support the integration of ANPs into health systems undergoing transformation. With the global burden of rising chronic illness and healthcare systems under increasing financial and human resource pressure, the author argues that ANPs are well-positioned to fill critical leadership and care coordination roles. The publication, which is discursive in nature, offers a conceptual roadmap for integrating ANPs into broader healthcare strategies.

Conceptual focus and strategic context
Central to Prof Carney’s argument is the recognition that integrated care should be viewed as a strategic imperative rather than merely an isolated clinical intervention. She asserts that successful integration requires organisational alignment across policy, workforce planning, service design, and leadership development.

In this landscape, ANPs can act as system connectors, linking primary, secondary, and community services through advanced clinical decision-making, leadership skills, and their ability to work across disciplinary boundaries.

The author draws on existing policy documents and strategic frameworks to contextualise her argument. In doing so, she highlights the alignment between ANP competencies and the aims of integrated care, particularly in delivering continuity, improving access, reducing hospital admissions, and supporting population health. Importantly, she positions ANPs as more than expert clinicians; they are viewed as active agents of change capable of shaping health service delivery and contributing to policy implementation.

The article advocates for formal strategic initiatives to support this vision. These include the development of role-specific career pathways, increased access to leadership development programmes, greater involvement of ANPs in health planning and service redesign, and the establishment of governance structures that enable ANPs to function at the top of their licence. Prof Carney’s approach to integration is multidimensional, requiring changes at both the macro-policy level and within organisational culture and service operations.

Critical evaluation
The conceptual discussion is well-argued and grounded in current healthcare priorities. The identification of the mismatch between ANP capability and the opportunities available for strategic engagement reflects a broader issue in health workforce planning. While the article is not empirical, it draws strength from its policy relevance and the author’s extensive professional insight.

One of the strengths of this article is its holistic vision of ANPs as clinical leaders and policy stakeholders. The author avoids limiting the discussion to the operational level and instead calls for structural reforms that elevate ANPs into decision-making circles. This framing is particularly relevant in Ireland, where the Sláintecare strategy highlights the need for innovative, integrated, and locally responsive care models.

The article provides a highly engaging and persuasive account of the strategic value advanced nurse practitioners bring to healthcare, showcasing their pivotal role in driving innovation, improving outcomes, and influencing policy. The already strong discussion could be further enriched by drawing on well-established theoretical frameworks, such as Kotter’s change management theory or the Chronic Care Model, to provide additional conceptual depth.

Brief illustrative examples or case studies could also enhance understanding by demonstrating how advanced nurse practitioners have contributed to strategic initiatives in practice. Expanding on practical implementation approaches would offer additional value for policymakers and service leaders keen to adopt these recommendations. Exploring structural and systemic factors, including organisational dynamics and role recognition, could offer further context on how ANPs engage in strategic roles.

Relevance to advanced nursing practice and policy
Prof Carney’s article contributes significantly to the discourse on the future of advanced nursing practice, particularly at a time when health systems are increasingly oriented toward prevention, integration, and continuity of care. The publication reinforces the idea that the effective deployment of ANPs must be underpinned by strategic foresight, leadership development, and cross-sectoral collaboration.

In the Irish context, the article resonates strongly with current policy priorities. The HSE’s community healthcare networks and integrated care programmes require clinical leaders who can navigate complex systems and champion innovation. ANPs are ideally suited for such roles, and the author rightly calls for systems that support their full integration into reform efforts. Her call for education providers to embed strategic competencies into ANP training is very important.

Preparing ANPs to engage in systems leadership requires investment in curricula that go beyond clinical expertise to include policy literacy, organisational theory, and change leadership. Positioning ANPs as strategic leaders, contributes to a broader vision of nursing that embraces innovation, collaboration, and systems transformation.