Advanced Practice Nursing Development Within Diverse Regulatory Landscapes: A Descriptive Survey of European Countries.

Authors

Caroline Bohlender, Karen Bjøro, Paul Gill, John Unsworth

Published in

International nursing review. Volume 73. Issue 4. Pages e70250.

Abstract

To explore the relationship between professional regulatory systems and advanced practice nursing development in Europe.
Advanced practice nursing has expanded rapidly, yet regulatory frameworks have often struggled to keep pace with the extended scope of practice demanded by contemporary service delivery. Misalignment leaves new roles inadequately supported, with consequences for both patient safety and the broader transformative potential of the profession.
For this cross-sectional descriptive study, key informants were recruited by purposive sampling across the World Health Organization's Europe Office member countries, including regulators, educators and nursing association representatives. A purpose-built questionnaire was analysed using descriptive statistics and pattern comparison.
The majority of European countries have advanced practice nursing roles, yet scope of practice and accompanying regulatory mechanisms varied considerably. Independent prescribing authority was the least commonly reported characteristic, having been established in only four countries. An observed descriptive pattern indicated that role maturity was related to government-led or statutory regulation designed specifically to address extended clinical skills. Interest-holders were largely in favour of regulatory intervention.
Regulatory modernisation is a key step for health systems seeking to expand advanced practice nursing. Legal scopes of practice must be realigned with clinical realities. In this sample, reported independent prescribing authority co -occurred with government led or legally mandated regulatory arrangements.
Nursing organisations should advocate for mandatory frameworks encompassing title protection, standardised educational requirements and competency standards for high-risk clinical skills, such as independent diagnosis and prescribing.
Governments should establish statutory advanced practice frameworks, with nursing leadership within government playing a key role.

PMID:
42861839
Bibliographic data and abstract were imported from PubMed on 12 Oct 2026.

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