The Nurse Practitioner

Skip Navigation LinksHome > June 10, 2012 - Volume 37 - Issue 6 > International nursing partnerships
Nurse Practitioner:
doi: 10.1097/01.NPR.0000414598.24648.00
Department: Education Matters

International nursing partnerships

Scarr, Ellen M. APRN-BC, MS, FNP, WHNP, PhD(c); Pulcini, Joyce PhD, PNP-BC, FAAN, FAANP; Makonnen, Jerusalem RN, MSN, FNP-C; Turk, Kathryn A. DNP, FNP-BC; Wheeler, Kathy PhD, FNP-BC, FAANP; Eissler, Lee Ann PhD, RN, FNP-BC; Schumann, Lorna PhD, ACNP-BC, NP-C, ACNS-BC, CCRN, ARNP, FNP, ACNP, FAANP; Krauskopf, Patricia Biller PhD, APRN, FNP-BC, FAANP

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Author Information

Ellen M. Scarr is a clinical professor and the Director of the FNP Program at the University of California, San Francisco in San Francisco, CA.

Jerusalem Makonnen is an assistant clinical professor and the director of the UCSF Young Women's Program at the University of California, San Francisco in San Francisco, CA.

Joyce Pulcini is a professor and the director of Community and Global Initiatives at George Washington University School of Nursing in Ashburn, VA.

Kathryn A. Turk is an assistant professor of nursing and the Director of the Family Nurse Practitioner Program at Grand Canyon University in Phoenix, AZ.

Lee Ann Eissler is a director at the Advanced Practice Nursing School of Nursing & Dental Hygiene at the University of Hawaii at Manoa in Honolulu, HI.

Lorna Schumann is an associate professor of nursing at Washington State University College of Nursing, in Spokane WA.

Patricia Biller Krauskopf is an associate professor and DNP/FNP Coordinator at Shenandoah University in Leesburg, VA.

International nursing partnerships have become an increasingly popular method of exchanging nursing knowledge and providing nursing assistance across the globe. The National Organization of Nurse Practitioner Faculties (NONPF) International Special Interest Group is actively involved in educating students via international nursing partnerships and has a wealth of expertise to share regarding initiating working partnerships and preparing for travel.1 From identifying the essential features of international nursing partnerships to ethical issues and safe travel, this column will help nurse practitioners (NPs) and nursing faculty establish and plan for international nursing partnerships.

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What are they?

International nursing partnerships are opportunities for sharing healthcare knowledge and services between global nursing colleagues. Although historically these have often been one-sided service trips that bring the expertise of one group to patients or populations in another country, current nursing partnerships include a multidirectional transfer of knowledge and services. The ultimate goal of international nursing partnerships is to contribute mutual benefits with a sustainable and long-lasting outcome for the patients, community, or country.

Examples of sustainable partnerships include educational programs, systemwide innovations, and healthcare delivery that promotes long-term changes in health status. In today's global healthcare environment, advanced practice nurses (APNs) are educated and poised to respond to challenges presented in international nursing practice and education. As holistic practitioners, the unique needs of the individual, family, or community are top priority. Benefits of such partnerships include greater understanding of another community's healthcare needs, as well as increased understanding of the cultural, political, social, and economic factors that determine the health of a population.

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Initiating partnerships

An essential step in initiating an international nursing partnership is to clearly identify the objectives. Purposes might include: providing direct patient care in an international setting, providing a supervised experience for nursing students, assisting with workforce development, developing curriculum, or collaborative research with international partners. Keeping in mind that the exact scope of work may be dictated by the needs of the host organization or country, it is important to articulate and establish reasons for developing or participating in these partnerships.

After deciding on a purpose, the location and length of the collaboration must also be determined. A location might be chosen based on prior experience, language skills, and existing relationships, or may depend on resources. Some experiences are short-term, lasting 1 to 2 weeks, while others can be longer, lasting up to a year.

Reviewing potential opportunities is also an important factor to consider. Many universities have established programs through schools of medicine, nursing, allied health, or public health. There are also agencies such as the U.S. Agency for International Development (USAID) and the Fulbright Program of the U.S. Department of State, whose role is to promote international exchange.2,3 Direct contact can be made through the respective country's Ministry of Health, various nongovernmental organizations, or a country's nursing or midwifery association or council. The International Council of Nurses (ICN) provides a resource for networking with nurse leaders globally.4

Another critical step is to secure funding. Sometimes, the service is paid via consultancy or through grants from organizations like USAID, Fulbright, Global Health Council, World Health Organization, and President's Emergency Plan for AIDS Relief (PEPFAR).57 Recently, PEPFAR developed the Nursing Education Partnership Initiative to strengthen nursing and midwifery education institutions in Africa, which can be a great opportunity for NPs. Universities and many religious organizations also provide financial support.

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Ethical issues

Ethical issues in nursing partnerships often relate to mutual gain and sustainability of the innovations. International partnerships are often opportunities for a mutual exchange of academic processes, clinical support, and evidence-based practice. This robust exchange typically incorporates lessons in cultural awareness and a mutual respect for cultural diversity.

Despite potential benefits, there are areas of ethical debate. One consideration is educating a person from another country who may be unable to adapt the knowledge to their country of origin. Although developing countries may benefit from learning the role and scope of the APN, it may be challenging to incorporate this knowledge into a culturally different nursing environment.

The cost of international nursing partnerships may also spur debate, with some arguing that money could be better used through direct donation to the organization or country.

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Preparation and safety

Proper preparation is essential for safe international travel. Preparation should begin 1 to 2 years in advance. Getting ready for an international experience includes both cultural and practical preparations. Once a partnership is initiated, the NP must become familiar with the country's history, people, language, culture, and behavioral customs. Even when dealing with complex languages, learning basic conversational words such as “hello,” “please,” and “thank you” is recommended. NPs should also understand the country's healthcare system, the challenges and health disparities that exist, and the role of nursing.

Practical preparation for international travel also includes acquiring the necessary documents and travel arrangements (see Travel preparations). If the program is a medical mission with a focus on the treatment of patients, the team will need to meet the host country's requirements. Most countries require a list of medications and supplies that are being brought into the country. Expiration dates on all products should be at least 1 year beyond the visit date.

It is recommended that NPs not bring a lot of clothing and, depending on the setting, pack darker-colored items that can withstand multiple wearings without washing, as well as sturdy footwear. Bed nets are recommended to provide protection in malaria-endemic countries. Airline, hotel, and transportation safety precautions should also be considered.

The NONPF “Guidelines for Establishing International Experiences” ( and the National League for Nursing's “Faculty Preparation for Global Experiences Toolkit” ( are additional international nursing partnership resources.

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Travel preparations

* Review online travel recommendations from the host country's embassy.

* Review online travel recommendations for medications and immunizations available at:

* Review State Department travel warnings (available at

* Notify the State Department of the trip purpose and travel itinerary (

* Collect team member licenses and colored copies of team members' signed passports and visas (passport applications available at and visa requirements available at

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1. NONPF. National Organization of Nurse Practitioner Faculty website.

2. USAID. U.S. Agency for International Development website.

3. U.S. Department of State. Fulbright International Educational Exchange Program website.

4. ICN. International Council of Nurses website.

5. Global Health Council. Global Health Council website.

6. PEPFAR. The United States President's Emergency Plan for AIDS Relief website.

7. WHO. World Health Organization website.

© 2012 Lippincott Williams & Wilkins, Inc.


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