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Clinical Nurse Specialists International

Fulton, Janet S., PhD, RN, ACNS-BC, ANEF, FAAN

doi: 10.1097/NUR.0000000000000412

Author Affiliation: Professor and Associate Dean for Graduate Programs, Indiana University School of Nursing, Indianapolis.

The author reports no conflicts of interest.

Correspondence: Janet S. Fulton PhD, RN, ACNS-BC, ANEF, FAAN, Indiana University School of Nursing, 600 Barnhill Dr, Indianapolis, IN (

The 10th International Council of Nurses (ICN) Advanced Practice Nursing Conference was held in Rotterdam, Netherlands, August 2018. Attendance topped 1400 advanced practice nurses (APNs), APN nurse educators, and leaders in nursing from over 50 countries. This wonderful conference was hosted by the Dutch Nurse Practitioner (NP) section of the Dutch Nurses’ Association. Rotterdam, a beautiful port city with innovative architecture and a gorgeous skyline, served as the host city promoting collegiality, scientific curiosity, and professional community among attendees.

The ICN was founded in 1899 as a federation of national nursing organizations and currently includes over 130 associations representing more than 20 million nurses worldwide. As a global voice for nurses and nursing, ICN’s goal is to ensure quality nursing care for all, sound health policies, advancement of nursing knowledge, and a respected professional nursing workforce worldwide. To facilitate communication among common professional interests, ICN establishes networks at the request of members. The NP/APN Network was established about 20 years ago with the aim of serving as an international resource for nurses practicing in advanced practice nursing roles and others who are interested in these roles, such as educators, policy makers, regulators, and health administrators. The objectives of the network are as follows:

  1. Make relevant and timely information about practice, education, role development, research, policy and regulatory developments, and appropriate events widely available.
  2. Provide a forum for sharing and exchange of knowledge expertise and experience.
  3. Support nurses and countries who are in the process of introducing or developing NP or advanced nursing practice roles and practice.
  4. Access international resources that are pertinent to this field (

Clinical nurse specialists (CNSs) should be aware of and engaged in this network. The Rotterdam conference included presentations by CNSs from Belgium, Canada, Finland, Germany, Japan, Norway, United Kingdom, and the United States. Some countries, such as Canada and the United States, have had CNS roles for many years, whereas other countries are just beginning to develop the CNS role and practice. Connecting with colleagues is an exciting way to see how CNS practice is shaped by differing delivery systems, national health priorities, and regulatory options.

The Advanced Practice Nursing Network of the ICN is led by a steering group and several subgroups for carrying out specific activities, including practice, research, health policy, education, communication, membership, and fundraising subgroups. Currently, the Network has an initiative to revise the global definition of advanced practice nursing and to develop separate definitions for the CNS and NP roles. Drafts of these definitions should be available soon for public comment.

Worldwide, there are common challenges to advanced practice roles that the Network is addressing. In many countries, nurses lack access to collegiate and higher education. We are called to work collaboratively in creating, implementing, and promoting advanced practice/CNS competencies grounded in academic preparation. Specialist education is defined by ICN as preparation beyond the generalist level but is not well articulated with or differentiated from the CNS role and practice. Clinical nurse specialists need to be involved in working through these differences. In addition, a continuing barrier to advanced practice, including CNS practice, is inappropriate or inadequate regulatory mechanisms for supporting practice to the full scope of abilities. Conference speakers emphasized the need for collaboration with other healthcare providers and organizations to promote the utilization of APNs globally and promote independent, fully practice authority.

The conference was a wonderful opportunity to celebrate our collective successes and raise unified voices to confront barriers. Consider joining ICN’s NP/APN Network. It is totally free! Just sign up on the website——and receive a free e-newsletter. Join a steering subgroup, share your expertise, and make some new friends! And think about attending the 2020 Conference in Halifax, Canada, August 30 to September 2, 2020. Plan to submit an abstract and share your work with colleagues across the world. Be part of the international conversation!

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