EXPERIENCE REPORT

ADVANCED PRACTICE NURSING IN STRICTO SENSU POSTGRADUATE STUDIES: EXPERIENCE REPORT

ENFERMAGEM DE PRÁTICA AVANÇADA NA PÓS-GRADUAÇÃO STRICTO SENSU: RELATO DE EXPERIÊNCIA

ENFERMERÍA DE PRÁCTICA AVANZADA EM ESTUDIOS DE POSGRADO STRICTO SENSU: RELATO DE EXPERIENCIA

https://doi.org/10.31011/reaid-2026-v.100-n.3-art.2725

¹Isabelle Caroline Cardoso de Lima

²Isabely Costa Galego

³Juliana Costa Mendes Alves

⁴Lucimara de Souza Cogo

⁵Manuela Martins de Queiróz

⁶Mayara Oliveira Miranda Paludetto

⁷Roberto Tavares

⁸Maynara Fernanda Carvalho Barreto

^{1,2,3,4,5,6,7,8}Universidade Estadual do Norte do Paraná, Bandeirantes, Brazil,

¹Orcid: https://orcid.org/0009-0005-8712-5846

²Orcid: https://orcid.org/0000-0003-0004-0734

³Orcid: https://orcid.org/0009-0009-9602-216X

⁴Orcid: https://orcid.org/0009-0005-1656-143X

⁵Orcid: https://orcid.org/0009-0007-7547-5106

⁶Orcid: https://orcid.org/0009-0007-8129-6219

⁷Orcid: https://orcid.org/0009-0008-6946-3704

⁸Orcid: https://orcid.org/0000-0002-3562-8477

Corresponding Author

Juliana Costa Mendes Alves

Rua Cipriano de Oliveira, 535; CEP: 86330-106, Paraná – PR, Brazil. Phone: +55(43)98411-1661; E-mail: jucmalves@gmail.com

Submission: 21-01-2026

Approval: 18-07-2026

ABSTRACT

Objective: To report the experience of students and faculty of a Professional Master's course on Advanced Practice Nursing (APN) in Brazil and its implementation in the context of Primary Health Care (PHC). Methods: Report of experience lived by students of the discipline “Advanced Practice Nursing in Primary Health Care” between August and December 2024. The discipline, composed of 45 hours, addressed topics such as the conceptual and political bases of Advanced Practice Nursing, care models, essential competencies of advanced practice nurses, and technologies for their performance. Results: Among the competencies studied, leadership was observed to be the central competency, being fundamental for guiding teams and implementing evidence-based care. Professional empowerment, collaborative work, and scientific research strengthen the performance of the advanced practice nurse, contributing to the recognition of the profession in society. The advanced practice nurse is responsible for promoting the continuing education of the health team, disseminating scientific knowledge, and leading teaching, research, and management processes. Final Considerations: This course allowed for an understanding of the competencies, responsibilities, and challenges associated with the performance of advanced practice nurses, highlighting the importance of leadership, continuous training, and work reorganization for the successful implementation of Advanced Practice Nursing (APN). Technical, ethical, and managerial training, combined with a user-centered approach, is fundamental to the effectiveness of advanced practices, promoting excellence in care and greater effectiveness in health services.

Keywords: Advanced Nursing Practice; Leadership; Primary health care; Teaching; Health Care.

RESUMO

Objetivo: Relatar a experiência de alunos e docente de um curso de Mestrado Profissional sobre a Enfermagem de Prática Avançada (EPA) no Brasil e sua implementação no contexto da Atenção Primária à Saúde (APS). Métodos: Relato de experiência vivenciado por alunos da disciplina “Enfermagem de Prática Avançada na Atenção Primária à Saúde” entre agosto e dezembro de 2024. A disciplina, composta por 45 horas, abordou temas como as bases conceituais e políticas da EPA, modelos de cuidados, competências essenciais dos enfermeiros de prática avançada, e tecnologias para sua atuação. Resultados: Dentre as competências estudadas, observou-se que a liderança é a competência central, sendo fundamental para guiar equipes e implementar cuidados baseados em evidências. O empoderamento profissional, o trabalho colaborativo e a pesquisa científica fortalecem a atuação do enfermeiro de prática avançada contribuindo para o reconhecimento da profissão na sociedade. O enfermeiro de prática avançada é o responsável por promover a educação permanente da equipe de saúde, disseminar conhecimento científico e liderar processos de ensino, pesquisa e gestão. Considerações Finais: A disciplina permitiu a compreensão das competências, responsabilidades e desafios associados à atuação do enfermeiro de prática avançada, destacando a importância da liderança, da formação contínua e da reorganização do trabalho para a implementação bem sucedida da EPA. A formação técnica, ética e gerencial, aliada a uma abordagem centrada no usuário, é fundamental para a efetividade das práticas avançadas, promovendo excelência no cuidado e maior resolutividade nos serviços de saúde.

Palavras-chave: Prática Avançada de Enfermagem; Liderança; Atenção Primária à Saúde; Ensino; Atenção à Saúde

RESUMEN

Objetivo: Relatar la experiencia de estudiantes y docentes de un curso de Maestría Profesional en Enfermería de Práctica Avanzada (APN) en Brasil y su implementación en el contexto de la Atención Primaria de Salud (APS). Métodos: Relato de experiencia vivida por estudiantes de la disciplina “Enfermería de Práctica Avanzada en Atención Primaria de Salud” entre agosto y diciembre de 2024. La disciplina, compuesta por 45 horas, abordó temas como las bases conceptuales y políticas de la Enfermería de Práctica Avanzada, modelos de atención, competencias esenciales de las enfermeras de práctica avanzada y tecnologías para su actuación. Resultados: Entre las competencias estudiadas, el liderazgo se identificó como la competencia central, fundamental para guiar a los equipos e implementar la atención basada en la evidencia. El empoderamiento profesional, el trabajo colaborativo y la investigación científica fortalecen el desempeño de la enfermera de práctica avanzada, contribuyendo al reconocimiento de la profesión en la sociedad. La enfermera de práctica avanzada es responsable de promover la formación continua del equipo de salud, difundir el conocimiento científico y liderar los procesos de docencia, investigación y gestión. Consideraciones finales: Este curso permitió comprender las competencias, responsabilidades y desafíos asociados con el desempeño de las enfermeras de práctica avanzada, destacando la importancia del liderazgo, la capacitación continua y la reorganización del trabajo para la implementación exitosa de la Enfermería de Práctica Avanzada (EPA). La capacitación técnica, ética y gerencial, combinada con un enfoque centrado en el usuario, es fundamental para la eficacia de las prácticas avanzadas, promoviendo la excelencia en la atención y una mayor efectividad en los servicios de salud.

Palabras clave: Enfermería de Práctica Avanzada; Liderazgo; Atención primaria de Salud; Docencia; Atención de Salud

INTRODUCTION

Advanced Practice Nursing (APN) is an approach that aims to expand the scope of nursing practice by granting nurses advanced clinical competencies, decision-making autonomy, and a more prominent role in health management and care delivery. In countries where APN is already well-established, its implementation has demonstrated positive results regarding expanded access to health services, improved clinical outcomes, and greater health system efficiency. In Brazil, the incorporation of APN is still in its early stages, yet it is viewed as a strategy to address challenges such as unequal access to healthcare, the growing demand for specialized care, and the need to strengthen Primary Health Care (PHC). ⁽¹⁾

 PHC serves as the structural foundation of the Unified Health System (SUS) and is largely operationalized through the Family Health Strategy (ESF). This strategy seeks to put into practice the guidelines established by the National Primary Care Policy (PNAB). The ESF has contributed significantly to increasing the presence of nurses within PHC, enabling interventions to be more effectively targeted at the population's health needs. The nurse's role in this context encompasses both direct patient care and the organization and management of activities, focusing on practices that place the service user at the center of care. Although there is not yet a fully standardized framework for all these responsibilities, the multifaceted nature of the nurse's work, comprising management, care delivery, research, and education, is a key highlight. ⁽²⁾

 Against this backdrop, Minosso et al., emphasize the importance of investing in professional training, adopting national continuing education strategies, and utilizing evidence-based practice as guiding principles for implementing APN within PHC in Brazil. ⁽³⁾ Based on this, the present study addresses the following guiding question: what strategies are necessary to consolidate the establishment and implementation of APN in Brazil? The rationale for this study lies in the scientific importance of exploring the key strategies employed for the introduction and implementation of Advanced Practice Nursing (APN) in Brazil, highlighting successful experiences and the challenges faced during this process. Furthermore, the study aims to demonstrate how these practices can contribute to strengthening the Unified Health System (SUS) by promoting care that is of higher quality, equitable, and centered on the health service user.

 COFEN Technical Note No. 001/2023 addresses the implementation of Advanced Practice Nursing (APN) in Brazil, underscoring its importance for strengthening the SUS. The Advanced Practice Nurse (APN) possesses specialized training and works autonomously, with competencies in diagnosis, prescribing, and care management, playing an essential role in managing acute and chronic conditions and promoting holistic care. Despite having robust educational and health systems, Brazil still faces challenges in expanding APN, primarily due to a shortage of nurses holding professional master's and doctoral degrees. COFEN has encouraged graduate programs, such as the CAPES/COFEN, agrément, to increase the training of these professionals. APN implementation is currently underway, with the goal of expanding access to quality health services. ⁽¹⁾

 In this process, it is important to evaluate the role of nurses in Primary Health Care (PHC). To this end, instruments such as the Modified Advanced Practice Nurse Role Delineation Scale (EMDF/EPA) - originally developed in English and validated for Spanish and Portuguese, can be used. This scale covers five domains: the first concerns Direct and Comprehensive Care provided to the patient; the second relates to Systems Support; the third, Education; the fourth, Research; and the final domain, Publication and Professional Leadership. ⁽⁴⁾

Given the above, the objective of this study was to report the experiences of students and a faculty member from a Professional Master's program regarding Advanced Practice Nursing (APN) in Brazil and its implementation within the context of PHC.

METHODS

Study type

This is an experience report describing strategies for the introduction and implementation of Advanced Practice Nursing (APN) in Brazil.

Study setting, timeframe, and participants

The experience report was developed by regular and non-regular students enrolled in the course "Advanced Practice Nursing in Primary Health Care," part of the curriculum of the Graduate Program in Primary Health Care Nursing (PPGEnf-APS) in southern Brazil, between August and December 2024.

 The course, comprising 45 hours distributed across 11 sessions, included both theoretical and practical activities. Topics addressed during the course included: conceptual foundations, historical dimensions, policies, and legislation regarding APN; models, care networks, and Primary Health Care (PHC); APN and its integration into PHC dimensions; core competencies of the advanced practice nurse; the role and practice of the advanced practice nurse; and technologies supporting advanced practice nursing.

 To describe the strategies related to the introduction and implementation of APN in Brazil, the theoretical framework relied on Technical Note No. 001/2023 from the Federal Nursing Council (COFEN), which outlines the context, concepts, actions taken, implementation, and regulation of APN in Brazil, as well as the Brazilian version of the Modified Advanced Practice Nurse Role Delineation Scale (EMD/EPA). ^{(1, 4)}

Ethical aspects

As this is an experience report based on an activity conducted exclusively for the education and training of professionals specializing in the field, submission of the report to the National Research Ethics Council (CONEP) was not required.

 RESULTS

This experience report was developed by students participating in the course to deepen their knowledge regarding the role of Advanced Practice Nursing (APN) in Primary Health Care (PHC).

 Theoretical activities covered concepts, history, policies, and legislation related to APN, as well as care models, care networks, and essential competencies for advanced practice. These topics were explored through discussion circles and dialogues regarding applied technologies and strategies for implementing APN in Brazil.

 The theoretical framework included Technical Note No. 001/2023 from the Federal Nursing Council (COFEN) and the Modified Advanced Practice Nurse Role Delineation Scale (EMD/EPA). ⁽⁴⁾

 As part of the practical activities, students carried out interventions in the PHC settings where they already work, focusing on scenario analysis and the identification of essential competencies for the performance of an advanced practice nurse. This practical experience provided an evidence-based, contextualized perspective on the potential and challenges of APN in PHC, forming the basis for this report.

 This dynamic format allowed students to integrate theory and practice, fostering a comprehensive and well-grounded understanding of the APN role in PHC and its essential competencies.

 Among the essential competencies identified for the development of advanced practice, leadership stands out. The advanced practice nurse must exercise leadership in both clinical and organizational spheres, guiding teams and promoting the implementation of evidence-based care plans. Nursing education and training, such as pursuing a professional master's degree, broaden horizons and enable the recognition of details that previously went unnoticed, thereby contributing to the quality of care delivery.

 Another essential competency is the ability to adapt and reorganize the work process. To achieve this, it is crucial for the nurse to develop a distinct perspective on service users, centered on their needs, and to devise personalized care plans. Furthermore, knowledge of professional ethics, information systems, and digital health, including the proper completion of medical records and clinical proficiency, is essential for advanced practice. In Primary Health Care (PHC), nurses possess greater autonomy; to fully exercise this autonomy, they must actively seek solutions, implement protocols, and issue evidence-based prescriptions.

 Finally, professional empowerment is a cornerstone for improving outcomes in PHC within an environment that values nurses and their work. Nurses must develop educational competencies, effective communication skills, and the ability to collaborate within multiprofessional teams. It is crucial to understand the population profile, organize work schedules to streamline processes, and perform risk stratification to ensure safe and effective care. Clinical practice should be person-centered, incorporating scientific research and community engagement, thereby strengthening the nurse's role as a key reference point and representative of the profession within society.

DISCUSSION

Implementing Advanced Nursing Practice (ANP) in Brazil requires not only continuing education but also a work environment that values nurses, including fair compensation and a structured career path.

 Nurses are responsible for spearheading the continuing education process. ⁽⁵⁾

 It is important to incorporate this into daily practice, as group-based inquiry proves more effective and enriching for the nursing team's growth, thereby improving the quality of care and strengthening the profession. ⁽⁶⁾

 Continuing education for the healthcare team is a fundamental aspect of advanced nursing practice. The healthcare team, comprising professionals with diverse specialties and levels of training, must stay constantly updated on new guidelines, protocols, and best practices. Continuing education aims to foster the ongoing development of these competencies, ensuring that all team members are equipped to provide high-quality care based on scientific evidence and nursing best practices. ⁽⁵⁾

 Activities such as training sessions, workshops, lectures, case discussions, and multidisciplinary meetings are part of the educational strategies aimed at team development. Advanced practice nurses often lead this process, acting as learning facilitators and creating an environment for the exchange of knowledge, experiences, and reflections on clinical practice.

 Beyond education for healthcare professionals, ANP also encompasses activities aimed at the general public, focusing on health promotion and disease prevention. Health education is a powerful tool for empowering patients and their families to make informed decisions about their healthcare, adopt healthy behaviors, and effectively manage chronic conditions.

 Training students, at both undergraduate and postgraduate levels, is a primary function of the specialized nurse. Conveying up-to-date scientific knowledge, reflecting on practice, and fostering critical thinking in education are essential for training new professionals. Advanced Nursing Practice (ANP) contributes significantly to student development by fostering high-quality education that extends beyond technical content to encompass critical thinking and the application of science to clinical practice.

 Another key aspect of education in advanced nursing practice is the delivery of formal presentations to other healthcare professionals. These presentations, held at conferences, seminars, multidisciplinary meetings, or continuing education courses, aim to disseminate current scientific knowledge and encourage reflection on new practices. Active participation in scientific and academic events strengthens the nurse's role as a leader in the educational process and contributes to the dissemination of new evidence that directly impacts the quality of patient care.

 What distinguishes advanced practice from generalist practice is the mindset, the language used, the questions asked, and the relationships prioritized. The complexity of health issues addressed in primary care units, combined with the burden of chronic and communicable diseases affecting the population, requires nursing professionals, particularly nurses, to combine instrumental and relational knowledge. This integration is essential to meet the needs of individuals and the general population while ensuring universal coverage and access to health services. ⁽⁷⁾

Nursing work organization appears more effective when supported by regulations—such as protocols , and professional continuing education. However, there is a noted risk of professional burnout when nurses are tasked with more complex responsibilities, such as prescribing medications and ordering diagnostic tests. Nurses must integrate practical know-how with the ability to take informed action, combining clinical and technical knowledge to understand the context of specific healthcare needs. This highlights the importance of continuing education and training to support these roles. Nevertheless, it is important to note that the successful implementation of ANP also depends on adequate working conditions, including appropriate salaries, reasonable workloads, and career paths that value professional practice. Such conditions entail challenges, as the definition of advanced practice nursing roles, their implementation process, and their impacts on the health system remain subjects for debate. ⁽⁸⁾

Advanced Practice Nursing (APN) demands leadership skills that encompass the management of teams, resources, and various organizational levels. These competencies are essential for ensuring the quality of care and the effective functioning of health services. Furthermore, leadership is considered a fundamental pillar of nursing practice, including for Advanced Practice Nurses (APNs), and is indispensable for developing complex skills involving clinical practice, management, education, and research. ⁽⁸⁾

 According to Gualdezi, leadership is an essential competency in health management and care, indispensable for the professional growth and development of those being led, which results in optimized care. ⁽⁹⁾ The International Council of Nurses (ICN) highlights that professionals with this profile must be innovators and motivators, and must play a leadership role in society. This role is particularly evident among Advanced Practice Nurses, who possess autonomy regarding clinical decisions, diagnoses, and care planning. ⁽¹⁰⁾ These professionals stand out for their evidence-based competencies and their ability to innovate in care delivery. ⁽¹¹⁾

 A 2016 study revealed that the majority of nursing graduates have little habit of reading or conducting clinical research. Generally, graduates reported having limited time due to work commitments and the demands of pursuing specializations, courses, or even additional degree programs, which already require specific reading. When they do find time, they choose to read publications relevant to their specific field of work in order to stay up to date. Thus, we observe that the higher the level of academic qualification, the greater the nurses' involvement and dedication to clinical research. ⁽¹²⁾

 Nursing requires practices that strengthen collaborative leadership and enable primary health care professionals not only to meet patients' immediate needs but also to contribute to long-term policies that improve community health and well-being. ⁽¹³⁾

 Nurses play a crucial role in conducting clinical research, contributing to the continuous improvement of patient care. The Code of Ethics for Nursing Professionals, via Cofen Resolution No. 564/2017, highlights that nursing care is grounded in the profession's specific body of knowledge as well as in the human, social, and applied sciences; it is carried out by professionals through the social and daily practice of providing care, managing, teaching, educating, and conducting research. ⁽¹⁴⁾

Nurses demonstrate little proactivity in identifying sources of funding. According to a recent study, the higher the level of education, the greater the importance attributed to research and project funding competencies. ⁽¹⁵⁾

Drennan concludes that Master’s programs in Nursing have a positive impact on nurses' leadership capabilities and management skills, which can be applied in the workplace. ^{(16, 17)}

 Developing evidence-based solutions to meet patient needs is crucial. Optimizing protocols and improving the quality of care are necessary within the Brazilian context. To achieve this, it is important for nurses to be qualified and up-to-date. Nurse involvement in clinical research is a growing field within the Brazilian healthcare sector. Research indicates that, in practice, nurses often assume non-standardized responsibilities, making the work environment challenging; therefore, there is a need to monitor care practices, develop new interventions, and optimize or create protocols. ^{(18, 14)}

 Although education regarding the Nursing Process (PAE) is essential for improving the quality of care, there are significant challenges to overcome. Time constraints, limited financial resources, and resistance to change among some team members can hinder the implementation of effective educational programs. Furthermore, it is crucial that education be accompanied by continuous assessment to ensure that objectives are met and that the knowledge acquired is effectively applied in practice.

 Recent research on organizational culture highlights that participants recognized the complexity of workplace change; 57.5% of nurses agreed that "there is generally the capacity to adapt to new norms or procedures, even if they are imposed," followed by 53.5% and 49.5% who agreed with the statements "people are willing to adjust their usual work in response to what is happening around them" and "there is flexibility to deal with change," respectively. ⁽¹⁹⁾ Resistance to change can be a factor that hinders clinical research. Regarding expectations for the development of nursing research, there is a need for continuing education and incentives for research activity. Therefore, it is necessary to implement strategies that focus on overcoming the challenges associated with implementing evidence-based practices.

 Institutions could create incentive strategies, invest financial resources in partnership with other organizations, and provide greater support to nurses in their pursuit of scientific Knowledge, through research, evidence-based practice, and specialization. In doing so, they would not only improve direct patient care but also enhance the representation and visibility of these professionals across various work environments, forums, conferences, and other settings within the Brazilian healthcare system.

FINAL CONSIDERATIONS

The reported experience achieved the objective of exploring and reflecting on the role of Advanced Practice Nursing (APN) in Brazil, particularly within the context of Primary Health Care (PHC). The course fostered a broader understanding of the competencies and responsibilities of advanced practice nurses, highlighting the importance of leadership, education, and the reorganization of work processes for the successful implementation of APN in Brazil.

Practical learning within real-world PHC settings enabled the identification of challenges and the proposal of evidence-based strategies to improve care delivery and strengthen the role of APN. This approach is essential for its consolidation as a strategic component in enhancing the quality of health care.

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Funding and Acknowledgments:

This work was supported by the Araucária Foundation/SETI through a scholarship awarded to Juliana Costa Mendes Alves, Lucimara de Souza Cogo, and Mayara Oliveira Miranda Paludetto.

Acknowledgments:

To Prof. Dr. Carine Teles Sangaleti Miyahara for the profound knowledge and guidance that were fundamental to the completion of this work.

Conflict of interest statement

None to declare.

Data availability statement

No databases were generated in this study. The information presented is described in the body of the article.

Authorship criteria (author contributions)

Study conception and/or design: Barreto MFC, De Lima ICC, Alves JCM, Tavares R;

Data collection, analysis, and interpretation: Paludetto MOM, Queiróz MM;

Drafting and/or critical revision of the manuscript: Cogo LS, Galego IC;

Approval of the final version to be published: De Lima ICC, Galego IC, Alves JCM, Cogo LS, Queiróz MM, Paludetto MOM, Tavares R, Barreto MFC.

Scientific Editor: Ítalo Arão Pereira Ribeiro. ORCID: https://orcid.org/0000-0003-0778-1447

Rev Enferm Atual In Derme 2026;100(3): e026073