Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed methods study

Kim, Sue, Lee, Tae Wha, Kim, Gwang Suk, Cho, Eunhee, Jang, Yeonsoo, Choi, Mona, Baek, Seoyoung, Lindsay, David, Chan, Sally, Lee, Regina L.T., Guo, Aimin, Wong, Frances Kam Yuet, Yu, Doris, Chair, Sek Ying, Shimpuku, Yoko, Mashino, Sonoe, Lim, Gigi, Bonito, Sheila, Rumsey, Michele, Neill, Amanda, and Hazarika, Indrajit (2021) Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed methods study. Human Resources for Health, 19. 19.

PDF (Published Version) - Published Version
Available under License Creative Commons Attribution.

Download (1MB) | Preview
View at Publisher Website:


Background: The Western Pacific region constitutes one-quarter of the world’s population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses’ professional development within the Western Pacific region.

Methods: This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 – December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare.

Results: Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research.

Conclusions: Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.

Item ID: 67135
Item Type: Article (Research - C1)
ISSN: 1478-4491
Keywords: Advanced practice nursing, Health equity, Health services accessibility, Nurse's role, Professional role
Copyright Information: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Funders: Yonsei University (YU)
Projects and Grants: YU College of Nursing grant number 6-2017-0112
Date Deposited: 28 Jul 2021 23:40
FoR Codes: 42 HEALTH SCIENCES > 4205 Nursing > 420505 Nursing workforce @ 100%
SEO Codes: 20 HEALTH > 2003 Provision of health and support services > 200307 Nursing @ 100%
Downloads: Total: 713
Last 12 Months: 19
More Statistics

Actions (Repository Staff Only)

Item Control Page Item Control Page