Stakeholders' Perceptions of the Roles and Regulations of Advanced Practice Nursing and Advanced Practice Midwifery.

Background: Advanced practice nursing (APN) and advanced practice midwifery (APM) in Kenya are critical in healthcare system strengthening by expanding access to quality care, particularly in underserved regions. Globally, the International Council of Nurses (ICN) defines APN as a level of nursing practice that requires a minimum of a master's degree, along with advanced clinical training and competency. Similarly, APM involves midwives with advanced training to provide specialized maternal and neonatal care. In Kenya, the APN and APM concepts were launched in 2020 and are still nascent, and their practice is determined by the context as provided by the country credentialing the practice. Despite the strides made in developing the advanced roles, there is an eminent gap in understanding stakeholders' perceptions of the roles, scope of practice, and regulation. Aim: To explore stakeholders' perceptions of the roles and regulations of APN and APM in Kenya. Design: An exploratory qualitative study was undertaken as part of a larger formative research conducted between January 2022 and November 2023, utilizing a multimethod design that included a gap analysis of the scopes of practice for APN and APM in Kenya. Data collection was conducted among purposively sampled participants using a total of 7 focus group discussions (FGDs), with three of them conducted among 14 APN and APM students and 4 FGDs among 16 members of the Kenyan-based nursing and midwifery associations. Seven key informant interviews (KIIs) were also held with 2 medical doctors (OBGYN), two faculty, and 3 students (practicing APN). A thematic analysis approach was employed, and reporting was done according to the Standards for Reporting Qualitative Research. Findings: Participant's perspectives were reflected in 5 themes: definition of APN/APM and scope; entry qualifications into APN/APM practice; roles of APN/APM; barriers to enacting APN/APM roles; the national policy and regulatory landscape for advanced practice roles. Conclusion: There were varied viewpoints on how APNs/APMs are defined in the Kenyan context. Similarly, views on the entry level qualifications into APN/APM were diverse. Many participants emphasized the importance of licensure, autonomy of practice, ability to manage patients independently, training, and competency. Well-defined policies and regulations can create an enabling environment for practice.