IAANMP advanced practice research

Journal article review

In this section, Theresa Lowry Lehnen reviews the article titled ‘Identifying the landscape and contribution of Advanced Nurse Practitioners in supporting healthcare provision in Ireland in the 21st Century: An integrative review’, which was recently published in the International Journal of Nursing Studies Advances.

Background and rationale
Since the formal introduction of the Advanced Nurse Practitioner (ANP) role in Ireland in 2001, its scope and impact have expanded significantly to address evolving healthcare challenges. The increasing complexity of patient care, an ageing population, and the need for cost-effective healthcare solutions have emphasised the necessity of highly skilled nursing professionals.

ANPs have emerged as key contributors to patient care, offering advanced clinical decision-making, leadership, and expert management within multidisciplinary teams. As the role of ANPs continues to expand in the Irish healthcare system, a comprehensive evaluation is necessary to fully capture and quantify their impact on healthcare delivery.

This integrative review by Doody et al (2025) seeks to provide a comprehensive evaluation of the current landscape of ANP practice in Ireland, examining their impact on healthcare delivery, professional development, and patient outcomes.

Objectives
The primary aim of the study is to identify and evaluate the role and contributions of ANPs within the Irish healthcare system. It seeks to examine the various competencies and professional attributes that define ANP practice, providing a comprehensive understanding of their expertise and scope.

The study aims to assess the impact of ANPs on patient care, healthcare teams, and overall system efficiency and provide valuable insights that can inform policy decisions and guide future research on the expansion and optimisation of ANP roles.

Methodology
This study employs an integrative review approach, a well-established method for synthesising existing research across diverse study designs. The authors conducted a comprehensive literature search across eight major academic databases, including: CINAHL; Embase; PsycINFO; Scopus; Medline; Academic Search Complete; Cochrane Library; and Web of Science.

Articles were selected based on strict inclusion and exclusion criteria to ensure relevance and methodological rigour. Studies that focused on the role, competencies, impact, and evolution of ANPs in the Irish healthcare setting were prioritised. Data was systematically analysed and categorised into key domains that include the contributions and competencies of ANPs.

Findings and key themes
The review identified six core domains where ANPs have demonstrated a substantial impact:

1. Clinical decision-making and patient care
ANPs enhance the efficiency and effectiveness of clinical decision-making through advanced assessment, diagnostic reasoning, and treatment planning. They contribute to early interventions, timely referrals, and reduced waiting times for patients. Their autonomy in prescribing medications and managing minor and complex illnesses significantly improves patient flow within healthcare systems.

2. Leadership and professional scholarship
ANPs act as leaders and change agents, promoting evidence-based practice and driving improvements in healthcare quality. They play an integral role in mentorship, education, and supervision of junior nurses and healthcare professionals. ANPs contribute to research and policy development, strengthening the academic and professional credibility of nursing practice.

3. Management and team coordination
ANPs advanced expertise allows them to take on extended roles within multidisciplinary teams, ensuring seamless collaboration among healthcare providers. They contribute to enhanced resource management, optimising healthcare delivery while maintaining high standards of patient care.

4. Professional values and ethical practice
ANPs uphold high ethical standards, accountability, and professionalism, ensuring that patient safety and dignity remain at the forefront of care. Their practice is guided by a patient-centered approach, emphasising compassionate and individualised care.

5. Communication and interpersonal competence
ANPs excel in effective communication with patients, families, and healthcare colleagues, fostering a collaborative environment in clinical settings. Their ability to engage in shared decision-making and health promotion enhances patient education and self-management.

6. Knowledge and cognitive competence
ANPs integrate advanced clinical knowledge with critical thinking and problem-solving skills, allowing them to navigate complex healthcare challenges effectively. They continuously engage in professional development and lifelong learning, ensuring they remain at the cutting edge of nursing practice.

Implications for healthcare and policy
The findings of this study highlight the critical role of ANPs in strengthening the Irish healthcare system. ANPs contribute significantly to reducing hospital admissions by proactively managing patients in primary care and emergency settings, ensuring timely interventions that help prevent unnecessary hospital stays.

They also play a key role in addressing workforce shortages by bridging gaps in healthcare delivery and reducing reliance on medical practitioners, thereby improving the efficiency of the healthcare system. Additionally, ANPs enhance patient outcomes through early intervention, the provision of high-quality care, and improved accessibility to healthcare services.

To maximise the contributions of ANPs, the study highlights the need for continued policy support, increased funding for ANP positions, and further research into the long-term impact of ANPs on both patient outcomes and overall healthcare system efficiency.

Strengths
This study provides a robust synthesis of existing literature, offering a comprehensive and holistic understanding of the contributions of ANPs in Ireland. By utilising an integrative review methodology, the research ensures a broad and in-depth analysis of various aspects of ANP practice. The findings are highly relevant for policymakers and healthcare leaders, as they provide valuable insights that can inform future workforce planning and healthcare policy development.

Limitations
The study offers valuable insights into the role of ANPs in Ireland, but limitations were acknowledged by the authors. The quality and rigour of the included studies varied, with some relying on small sample sizes, self-reported data, or descriptive designs, which may affect the strength of the findings.

The exclusive focus on Ireland, while intentional, limits the generalisability of the results to healthcare systems with different regulatory and organisational structures. The diverse range of settings, specialisations, and methodologies among the reviewed papers also made it challenging to synthesise a cohesive narrative.

As many studies were cross-sectional and a significant portion consisted of discussion or clinical case reports, assessing the long-term impact of ANPs on healthcare provision and patient outcomes remains difficult. Despite these limitations, the study highlights the significant contributions of ANPs in Ireland and provides a strong foundation for future research and policy development.

Considerations for future research
The study offers a thorough review of existing literature, and integrating more recent data could further strengthen its relevance by reflecting emerging trends and current challenges faced by ANPs. Exploring additional factors influencing the growth of ANP roles, such as regulatory frameworks, funding, and professional integration within healthcare teams, could provide valuable insights. Including primary data or qualitative perspectives from practicing ANPs could also deepen the findings, offering a comprehensive view of their real-world experiences.

Conclusion
This integrative review provides a comprehensive and evidence-based analysis of the evolving role of ANPs in Ireland, demonstrating their significant contributions to healthcare provision. By offering advanced clinical expertise, leadership, and interdisciplinary collaboration, ANPs play an indispensable role in enhancing patient care and optimising healthcare efficiency.

The study serves as a valuable resource for policymakers, healthcare administrators, and nursing educators, reinforcing the necessity of continued investment in ANP roles to meet the growing healthcare demands of the 21st Century.

As Ireland’s healthcare system continues to evolve, the expansion and optimisation of ANP roles will be essential in ensuring accessible, efficient, and high-quality care for all patients. With continued policy support, ongoing professional development, and effective interdisciplinary collaboration, ANPs will remain leaders in healthcare innovation, shaping practice, and enhancing patient outcomes for the future.

Authors