Enhancing Healthcare Delivery: The Role of Advanced Nurse Practitioners in Saudi Arabian Primary Care

Should ANPs Be Considered Valuable Resources in Primary Healthcare Settings?

Quality Improvement Methodology

Given a Primary Healthcare Setting, Should Anps To Be Considered Valuable Resources?

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:

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 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.

Problem Identification

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.

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 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).

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).


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.

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 the healthcare provider in that female patients will be attended to by the ANPs in matters related to sexuality, and the same goes for men in the context of conditions such as prostate cancer.

The proposal will be presented to the Institutional Review Board (IRB) to seek ethical approval that will ascertain that the plan is being conducted in a responsible and accountable way. The plan should aim to yield positive outcomes and not expose the participants to harm or risks.


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