Introducing the Advanced Nurse Practitioner Role

Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of
Saudi Arabia: A Quality Improvement Project
Amaal
Capstone Project Submitted for the Master of Science in Nursing: Advanced Practice
School of Nursing and Human Science
Month and Year of Submission

Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
4.0 Quality Improvement Methodology
The framework that guides the project methodology is the knowledge-to-action (KTA)
cycle (Graham et al. 2006; Straus et al., 2009). The KTA cycle helps to address the challenges
that emerge during the translation of scientific evidence into practice by preparing an individual
to deal with the various complex and intertwined factors that interfere with the successful uptake
of such evidence (Field et al. 2014). The KTA cycle is comprised of two major categories:
Knowledge and Action categories. Each category is subdivided into various phases. The
knowledge creation phase is deemed to be a funnel that regards knowledge as usable units that
are tailored to the action component. Knowledge is generated after making and inquiry and
engaging in extensive research to develop evidence in the form of guidelines, algorithms, or
pathways. The action phase entails the stepwise activities through which the knowledge is
actualized by aligning it to an identified problem and later evaluating outcomes while ensuring
their sustainability. In the current project, the evidence-based framework seeks to establish the
role of APNs in KSA in an area where these professionals are undermined; yet, they have the
skills and capabilities to improve the healthcare infrastructure. Such knowledge will be
actualized by following the phases as outlined below:
Phase 1: Problem Identification
There is a salient gap in APN practice because APNs do not get to practice, fully, as per
their trainings in KSA, where the focus will be on the Outpatient Department (OPD) where I
work. The quality improvement plan is based on the need to adapt standards, competencies, and
legal and ethical principles to guide ANP practice in the OPD. The role of ANPs in the context
of providing diagnostic and prescription services to patients needs to be clearly laid down. The
outpatient department is a host to patients with varied needs mainly seeking the attention of a
physician. However, due to long queues and associated long waiting times, the patients are often
disgruntled while the quality of care may be altered as physicians are compelled to attend more

Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
patients than they can handle (Almomani and AlSarheed 2016). There are various nurses in the
department who have studied APN, but they are not recognized as capable of providing
autonomous medical diagnoses (Hibbert et al. 2017). Hence, despite their qualifications and
skills, they remain docile; yet, they are capable of improving the overall quality of care delivered
at the OPD. Nonetheless, the advancing role of nurses has gained recognition, but there is a need
to develop a regulatory framework to guide the operations of these nurses. I, thereby, seek to
display the potential of an APN by empowering one APN with adequate knowledge and
experience to work as an independent entity.
Phase 2: Adaptation
There is no current program in KSA that can help to gain insight on how to go about the
introduction of ANPs. However, the organization will adapt knowledge from the United States
because it is a constellation of various countries representing different cultures. California is the
country with the largest Asian-American population, and the ANP role in this country will be
aligned to that of Saudi-Arabia based on the assumption that the county is a cultural
representation of the Asian beliefs and perceptions that prevail in KSA (Ghosh 2011). The
improvement plan will focus on licensure, scope of practice, standards, competencies, and ethical
and legal principles from case study reports, research papers, and press releases. Most of all, it
will be important to adopt the training and licensure schedules that leads to the acquisition of the
title of an ANP.
Phase 3: Barriers
The lack of a clearly defined role for ANPs poses as a significant challenge as it influences the
perceptions of physicians and managers. It is important to convenience the managers and
physicians about the role and integration of ANPs in the Out Patient Department (OPD). Hence,
meetings will be held with the physicians and OPD managers to clear doubts and misunderstand
the role. It would be a challenge to suddenly assign high-level duties to the specialists 1, as they
are called in KSA. Also, the challenge in assignment of duties is further exacerbated by the fact
that patients who have gotten used to seeking services from physicians would be expected to
develop the same confidence when been cared for by specialists 1 (Munce et al., 2013). There
have been limited educational opportunities for nurses to pursue advanced practice courses and

Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
associated specialist educational programmes; hence, nurses seeking to possess these skills have
been enrolling to universities outside the country. As it stands, I am in the first batch of the
newly introduced program and most of the nurses in KSA are expatriates which makes it difficult
to standardize practice due to variation in training, language, and experience (Hibbert, Al-Sanea,
and Balens, 2012).
Phase 4: Implementation
After getting permission from the healthcare facility’s administrator, I will meet with the
OPD manager to inform him of the proposed quality improvement plan. An APN who has
recently graduated from Prince Norah University will be involved in the implementation of the
quality improvement plan. There will be an introduction of the term ANP as a substitute for
specialists 1 among the healthcare providers and the general public. A streaming video on the TV
screen at the OPD’s waiting area will be used to notify patients about the new position and
associated role of an ANP. The OPD manager, with the help of a selected stakeholders’
committee, will devise guidelines and policies to guide ANP practice within the department by
highlighting what the ANP should and should not do. Expanding the role of the APN will mean
that the APN can diagnose, prescribe, and treat but with oversight from a physician (Simmons
University 2016).
Phase 5: Monitoring and Evaluation of Outcomes
Availability of the selected APN and guiding principles for work will ascertain the
implementation of the plan. The length of the queues will be monitored while wait times and
patient satisfaction will be used to determine the impact of the quality improvement plan. The
trend in the number of patients accessing healthcare services by comparing the statistics before
and after the introduction of ANPs in the unit will help to determine the impact of ANPs.
Phase 6: Sustainability
The fact that the process of laying out the responsibilities of ANPs is just getting started
means that there is a need for continued review of the guidelines based on the monitoring results
to help retain what works and make necessary adjustments to develop a clear scope of practice
and associate policies, expected competencies and standards of the ANPs and associated policies.
The evaluation outcome results will determine the needed number of additional ANPs and
nursing curriculum in the training institutions. Patients’ needs and preferences will be aligned to