The development and the introduction of
APN roles in a specific health care setting represents
a paradigm shift for nurses, physicians and
other health care workers. On the one hand the
traditional and strongly defended notion of
“equality” among clinical nurses is challenged
when nursing education varies from a basic education
of three years to university educational
preparation at Master (minimum 5 years) and
Doctoral level (minimum 8 years). This differentiation
in educational preparation and therefore
competency levels in clinical practice calls for a
system that allows differentiation in clinical nursing
positions. This is realised in so-called clinical
career ladders which define the roles, responsibilities
and required competencies in clinical nursing
care for each level including that of APN.