A Global View on Clinical Autonomy for Advanced Practice Nurses

This new volume, endorsed by the International Council of Nurses, offers a structured, comprehensive examination of clinical autonomy for global advanced practice nurses (APNs), namely, nurse-midwives, nurse anesthetists, nurse practitioners, and clinical nurse specialists, whose autonomy is a critical factor in expanding access to care and enhancing care outcomes. Designed to address the gap in literature concerning how APNs navigate decision-making within clinical environments, the Editors offer practical guidance with an exploration of the legal, regulatory, and ethical dimensions of autonomous practice within all four advanced practice nursing roles in various areas of the world. Comparisons, challenges, and recommendations for maximizing the use of advanced practice nurses are offered with the goal of improving healthcare globally.

The book is structured to guide APNs through the underlying principles of professional practice autonomy for APNs and include actionable strategies for improving independent decision-making while fostering collaborative healthcare models. The inclusion of case studies and expert commentary bring the discussion to life, making it both a practical guide for clinicians and a scholarly text for advanced nursing courses.

Aimed at clinicians, nurse educators, policymakers, health system administrators, regulators, and researchers, this book addresses the critical need to strengthen advanced nursing practice autonomy for expanding healthcare to underserved and vulnerable populations while providing a foundation for nursing students transitioning into APN positions. It also serves as a vital reference for healthcare administrators and regulators to better understand the linkages between accountability for health outcomes and professional practice autonomy as accountability for outcomes is commensurate with authority and responsibility.  Filling a crucial gap, this book combines research with practical implementation strategies, positioning APNs to thrive in complex healthcare systems while amplifying the reach and effectiveness of APN led care.

Dr. April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN is a senior nurse executive, scholar, and global leader in advanced practice nursing with more than 30 years of experience across clinical practice, health system leadership, academia, and policy. She is the Senior Associate Dean for Strategic Partnerships and Global Affairs at Vanderbilt University School of Nursing in Nashville, Tennessee, where she leads global initiatives and academic–clinical partnerships focused on advanced practice education, workforce development, and health system transformation. Dr. Kapu practiced for more than two decades as a critical care nurse practitioner and previously served as Associate Chief Nursing Officer for Advanced Practice at Vanderbilt University Medical Center. In that role, she established enterprise-wide advanced practice infrastructure and expanded advanced practice models of care across a large academic health system, with a focus on governance, quality, outcomes, and workforce sustainability. A recognized expert in advanced practice leadership, Dr. Kapu has been widely consulted by health systems, academic institutions, and professional organizations. She has authored and co-authored numerous peer-reviewed manuscripts, editorials, and book chapters addressing advanced practice outcomes, leadership, workforce models, and health policy, and is a frequent invited speaker at national and international conferences. Dr. Kapu has held extensive national and international leadership roles, including serving as President of the American Association of Nurse Practitioners. She is a Fellow of the Society of Critical Care Medicine, the American Association of Nurse Practitioners, and the American Academy of Nursing, and remains actively engaged in global efforts to advance advanced practice nursing education, regulation, and clinical autonomy.

Dr. Jackie Rowles is a Certified Registered Nurse Anesthetist (CRNA), a board-certified Adult Nurse Practitioner and holds a CRNA subspeciality board certification in Nonsurgical Pain Management. She is a recognized globally as an APN leader and nursing advocate. Rowles is President of the International Federation of Nurse Anesthetists, and a former President of the American Association of Nurse Anesthestists (AANA). She has been active on the international level since 2010, lecturing in 20 countries and serving as an advocate for APN recognition, education, licensing, and full practice authority. Rowles serves as Vice-Chair of the United Nations Global Surgery Learning Hub Project Content Committee, a member of the World Federation of Societies of Anaesthesiologists Global Manpower Survey Committee, a committee member of the WHO Acute Care Action Network, and served 3 years as an elected board member and treasurer of the Global Alliance for Surgical, Obstetrics, Trauma and Anesthesia Care (the G4 Alliance). A catalyst for development of the 2021 ICN Advanced Practice Nursing Guidelines: Nurse Anesthetist, Rowles was also a co-editor and chapter author of the 2021 book "The Voice for Global Anesthesia: The International Federation of Nurse Anesthetists (1989-2021)" and the co-editor and a chapter author of the 2023 book "Nurse Practitioners and Nurse Anesthetists: Evolution of the Global Roles,” part of the ICN Advanced Practice Nursing book series. She is also the co-chair of the ICN APN Health Policy subcommittee. Dr. Rowles has been the recipient of numerous awards throughout her career including the AANA's Alice Magaw Clinical Practitioner of the Year Award in 2005, AANA Agatha Hodgins Award for Outstanding Accomplishment in 2012, the 2018 IFNA Hermi Lohnert Award for Outstanding Global Accomplishment and the 2022 AANA Foundation's Rita L. Leblanc Philanthropist of the Year Award. She is a Fellow of the National Academies of Practice (Nursing Academy), a Fellow of the AANA and a Fellow of the American Academy of Nursing. Dr. Rowles is an Associate Professor of Professional Practice and Director of the Advanced Pain Management Fellowship at Texas Christian University, Fort Worth, Texas, USA.

Dr. Jennifer M. Manning, PhD, ACNS-BC, CNE, FCNS, FAAN, serves as the Associate Dean for Undergraduate Programs at the Louisiana State University Health Sciences Center (LSUHSC) School of Nursing, leveraging over three decades of diverse experience as a clinician, academic, and regulator. A recognized global authority in advanced nursing practice, she has dedicated her career to elevating the role of the Clinical Nurse Specialist (CNS) through her leadership as the former President of the National Association for Clinical Nurse Specialists and her current role as Associate Editor for Clinical Nurse Specialist: The International Journal for Advanced Nursing Practice. Dr. Manning’s extensive scholarly portfolio includes numerous books and peer-reviewed chapters focused on nursing leadership, health policy, and regulation. As a Fellow of the American Academy of Nursing and the National Association of Clinical Nurse Specialists, she continues to bridge the gap between academia and clinical practice through her work as a Clinical Nurse Researcher at LCMC Health East Jefferson General Hospital, contributing significantly to the international discourse on high-acuity care and professional nursing standards.

Dr. Mavis N. Schorn PhD, CNM, CNE, FACNM, FNAP, FAAN is a highly accomplished nurse-midwife, educator, and scholar with a career spanning over four decades. Throughout her career, she has held various academic and clinical roles, serving on the Vanderbilt University faculty from 2002 to 2024. She is Senior Associate Dean for Academics Emerita at the Vanderbilt University School of Nursing after serving in the role from2013 to 2024. Schorn has authored numerous peer-reviewed publications and book chapters on topics such as the management of the third stage of labor, postpartum hemorrhage, interprofessional education, and APRN practice. Schorn has secured over $21 million in grant funding, including over $19 million in grants related to advanced practice nurse education or workforce development. Throughout her professional career, Schorn has served on a multitude of national, regional, state, and local committees with leadership roles in various organizations including the Accreditation Commission for Midwifery Education, Fellowship of the American College of Nurse-Midwives, and the Directors of Nurse-Midwifery Education. Schorn has received numerous honors and awards, including the Distinguished Fellow of the American Academy of Practice, the Fellow of the American Academy of Nursing, and Fellowship of the American College of Nurse-Midwives. Her commitment to excellence, innovation, and interprofessional collaboration has made her a highly respected and influential figure in the nursing and midwifery communities.