The University of Oldenburg launched its new master's degree programme "Advanced Nursing Practice" in the winter semester 2024/25. In this interview, Rebecca Palm, Professor of Nursing Science at the university, talks about why strengthening nursing education as an academic discipline is important.
You yourself first worked as a nurse at a hospital before pursuing an academic career. What motivated you to follow this path?
Prof. Dr. Rebecca Palm: I was unhappy because I wasn't allowed to make certain decisions on my own and because I had to carry out procedures the effectiveness of which had never been questioned. Back then I worked in the surgery department, and I had to pull off plasters, spray disinfectant onto the wound and then apply a new plaster on a daily basis – even in cases of primary healing of surgical wounds, which generally heal without complications. It didn't do any harm, but nor did anyone question whether it was doing any good. Today, thanks to studies on the topic we know that there is no reliable evidence that a plaster will prevent infection in such cases. There are many examples of practices whose effectiveness has not been scientifically proven, yet nurses perform them on a daily basis. To this day, I feel driven to review nursing knowledge and actions and compile evidence that is useful for nursing practice.
I studied nursing science 20 years ago. Back then, there were no attractive job profiles for graduates in hospitals. This was why many of my fellow students went into management, research or work with associations. Today, however, Advanced Nursing Practice (ANP) students have the option to work directly with patients once they graduate. I myself would have liked to work as an advanced practice nurse – it's a really attractive professional field.
What do students learn in the new Advanced Nursing Practice master's degree programme?
Palm: First of all, they learn how to research topics related to nursing science, evaluate evidence and present it in a clear and understandable way – in greater depth and detail than in the bachelor's degree programmes they have already completed. Clinical nursing research – the scientific investigation of the effectiveness of nursing practices – is an important field of research. Another aim of the programme is to familiarise students with the broad scope of action of this relatively new professional field. We help students to find their role in their respective clinical environment and prepare them for defining their scope of action as advanced practice nurses in relation to other professional groups.
What kind of work do they do later on?
Palm: Advanced practice nurses work in a wide range of clinical fields where they perform tasks that have never been performed in this way before. This can mean specialising in a specific area of nursing, be it chronic wound management, pain management for children with oncological diseases, delirium management or weaning from mechanical ventilation in intensive care. Advanced practical nurses are trained not only to keep an eye on the latest studies, but also to present the findings in such a way that the teams on the wards can plan and adapt their work accordingly. In this sense, they also provide advice and professional guidance to their colleagues. However, the core of their work is patient care.
The degree is designed as a part-time course. Why is that important?
Palm: We qualify students for clinical work, which is why it is important that they also practice their profession during their studies. Only with this approach can we also support them in finding and developing their role in their respective work environment. We encourage them to develop their own areas of clinical expertise in which they want to work later on already during their studies.
We confined lectures and seminars to two days a week and spread the course content over five semesters. Parts of the course are designed for online learning to make it more flexible. We focused on long-term and reliable planning so that students can fulfil their job obligations. Nevertheless, we make it clear in consultations with prospective students that to ensure that their course workload is manageable they shouldn't work more than 50 percent of the working hours of a full-time job.
Why are advanced practice nurses important for the healthcare system?
Palm: They can help to optimise care processes and improve the quality of care – patients benefit from this. This is the most important goal and it is the measure of the success of advanced practice nursing. We also hope that this qualification option will make the nursing profession more attractive, because it allows nurses to develop their skills while continuing to work in a clinical setting. This could also counteract the trend of nurses leaving the profession due to a lack of career prospects.
And what about autonomy, which you felt was lacking when you worked as a nurse in a hospital?
In recent years, the legislator has defined certain tasks that may only be carried out by nurses and has also expanded nursing competences. In future, nurses with a bachelor's degree will be able to perform what we call "extended medical tasks" that were previously reserved for doctors. This concerns tasks related to the care of people with dementia, chronic wounds and diabetes. Legislative texts are in preparation that explicitly extend the competences of advanced practice nurses. The aim here is not to turn them into mini doctors, but to enable them to practice their profession with more autonomy than up to now.
Is the labour market prepared for this new professional profile?
I have spoken to employers who have tried in vain to fill APN positions, and others who even avoid mentioning their advanced practice nurses by name on their website because they are afraid they will be headhunted. People with this qualification are currently in short supply on the labour market, which is why it makes more sense for hospitals to integrate a corresponding degree course into their own professional qualification concept. No hospital can afford to lose a qualified nurse, so it makes sense for them to create prospects for those who want to study – otherwise they will go elsewhere. Our new degree programme builds on a project in which the partner hospitals of University Medicine Oldenburg (UMO) were also involved, and we have set up a network to meet regularly and discuss the implementation of advanced practice nursing. We want to follow clinical requirements closely and continuously develop the programme accordingly.
This interview was conducted by Sonja Niemann.