Throughout the region of the Americas, health care provider shortages present a barrier towards achieving Universal Access to Health and Universal Health Care (together referred to as Universal Health). In 2013, member states of the Pan American Health Organization (PAHO), the World Health Organization's Regional Office for the Americas, approved Resolution CD52.R13 Human Resources for Health: Increasing Access to Qualified Health Workers In Primary Health Care-Based Health System¹1 Pan American Health Organization. Resolution CD52.R13 Human Resources for Health: Increasing Access to Qualified Health Workers In Primary Health Care-Based Health System. 2013 Oct;[cited 2016 may 12]. Available: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=25587&Itemid
http://www.paho.org/hq/index.php?option=... , to guide the strengthening of the counties' health systems. The resolution states that we must empower and support multi-professional teams and enhance the scope of practice of all health professionals to their full potential according to their competencies, including Advanced Practice Nurses (APN). In 2014 CD53/5, Rev. 2 Strategy for Universal Access to Health and Universal Health Coverage²2 Pan American Health Organization. Strategy for Universal Access To Health And Universal Health Coverage;[cited 2016 may 12]. Available: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=27312&Itemid=270&lang=en9
http://www.paho.org/hq/index.php?option=... was approved. It outlined four strategic lines of action such as: 1.Expanding equitable access to comprehensive, quality, people- and community-centered health services; 2.Strengthening stewardship and governance; 3. Increasing and improving financing, with equity and efficiency, and advancing toward the elimination of direct payment that constitutes a barrier to access at the point of service, and 4. Strengthening intersectoral coordination to address social determinants of health. The Advanced Practice Nurse role provides a cost effective, culturally sensitive tool for advancing the missions stated in these resolutions³3 Cassiani, S.H., Zug, K.E. Promoting the Advanced Nursing Role in Latin America. Rev. bras. enferm. 2014;[cited 2016 may 12];67(5):673-4. Available: http://dx.doi.org/10.1590/0034-7167.2014670501
http://dx.doi.org/10.1590/0034-7167.2014... .

The Advanced Practice Nurse is defined as "...a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A master's degree is recommended for entry level"⁴4 International Council of Nurses. Nurse practitioner/advanced practice nurse: definition and characteristics; 2009;[cited 2016 may 12]. Available: https://international.aanp.org/Practice/APNRoles
https://international.aanp.org/Practice/... .

Although the role of advanced practice nurse has existed since the 1970s in the United States and Canada, it is not well known by health professionals or the public outside of these countries in the region. However, interest in APN has grown increasingly in the last three years in response to the approved resolutions. PAHO initiatives have aimed to broadly support APN implementation by facilitating collaboration and technical cooperation with countries, Ministries of Health and national nursing organizations. In 2015 the PAHO/WHO Collaborating Center at McMaster University School of Nursing in Canada hosted a summit to discuss implementation the APN role in Latin America. Nursing leaders from across the region discussed the context of the nurses' changing role and responsibilities in access to primary health care (PHC), the development of strategies for the implementation of the APN role in PHC in Latin America, and the advancement of this role in the Caribbean.

In April 2016 the summit reconvened at the PAHO/WHO Collaborating Center at the University Of Michigan School Of Nursing, with more than 50 participants from the United States, Canada, Brazil, Chile, and Colombia. They met with the objectives of examining the core competencies for the APN role in primary health care, identifying the resources and strategies needed for universities to prepare the APN to have a role in PHC in Latin America, and identifying core curriculum development for APN education.

Another PAHO initiative with the Collaborating Centers was the organization of a six-part webinar series titled "Advanced Practice Nursing: PAHO Activities and Strategy for Development in Latin America" organized by McMaster University. The webinars have been simultaneously presented in English and Spanish with the goal of increasing interest and awareness of the APN role among nurses and key stakeholders in Latin America. Currently, over 300 individuals have registered for the series representing nursing in over 20 countries in this region. The topics covered by the webinars include, an overview of the APN role, implementation framework, and strategies for establishing regulation and effective implementation of APNs in the countries.

Brazil, Colombia, and Chile have begun taking steps towards the implementation of APN in PHC. In 2015, representatives from the Federal Council of Nursing in Brazil and the Brazilian Nursing Association discussed in PAHO headquarters the future of the APN role in Brazil. Several conferences have occurred in Brazil since then.

In February 2016, the Faculty of Nursing at Pontifica Universidad Javeriana, Colombia, hosted a workshop titled Possibilities and Realities of Advanced Practice Nursing in Colombia Ahead of Universal Health Coverage. The goal of the workshop was to discuss the contributions of nursing to primary health care and the APN role in Colombia.

Meanwhile in Chile, the University of Los Andes and the Chilean Association of Nursing Schools held a symposium to analyze the health context of the country and strategize the implementation of APN in primary health care in Chile. There, the network of Advanced Practice Nursing for Primary Health Care in Chile was created with the mission to increase understanding of APN and also to demonstrate the effectiveness of this role on health outcomes in primary health care.

Many challenges exist for the implementation of APN in Latin American and the Caribbean. Some of the challenges include the need to scale up graduate nursing education, the importance of enacting changes to health systems that enable nurses to practice to their full scope of practice, and to develop nursing leadership capacity to influence policy and government. With the support of PAHO, nursing organizations, and Ministries of Health, several countries have taken their first steps towards APN implementation in primary health care. These countries' experiences, as well as the collaboration from the United States and Canada can be the foundation for the implementation of APN in Latin America and the Caribbean in the coming years.

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