Global Scope of Practice of an APN Anesthesia: A Scoping Review

Purpose: Perioperative care requires health care professionals with more competencies and skills in clinical assessment, patient education, and advocacy to respond to current and future challenges in health care. Advanced practice nurses (APN) in Anesthesia may represent an approach to improve perioperative care. Specialization in anesthesia care already exists in many countries, but rarely on advanced practice level. An APN Anesthesia is an additional role with expanded skills and competencies and is not yet established in all countries. Therefore, defining the role of APN Anesthesia is necessary. To establish the role of APN Anesthesia effectively, the current evidence on the competencies and scope of practice (SOP) of established roles of APN Anesthesia was summarized.

Design: A scoping review according to the framework by Arksey and O'Malley and the JBI reviewer's manual.

Methods: We conducted a scoping review by searching the PubMed, PsycINFO, CINAHL, and Scopus databases. The literature search included papers from 2010 to 2023 dealing with the prerequisites and SOP of APN Anesthesia. Descriptions of APN Anesthesia from the United States of America, Asia, and Europe were assessed.

Findings: A total of 1,749 papers were identified of which 24 were included in this review. There is no uniform SOP for APN Anesthesia. The certified registered nurse anesthetist as an established Advanced Practice role in the United States of America, with a high degree of autonomy, is best described. Some APN Anesthesia focus on specific medical conditions such as dementia or autism. APN Anesthesia also works in postoperative care, outpatient clinics, pediatric day surgery, or palliative care settings. Practice development, clinical assessment, education, and family involvement encompass the expanded role of an APN Anesthesia compared with the specialist nurse in Anesthesia.

Conclusions: The APN Anesthesia is a complementary role in anesthesia because they possess both nursing expertise and advanced medical knowledge. APN Anesthesia provides preoperative assessments with patient and family education, intraoperative care for specific patient populations, and expanded duties in the postanesthesia care unit and palliative care.