Assessing System Readiness for Advanced Practice Nurse Integration: A Multidimensional Policy Framework for Primary Care Transformation

Abstract

The increasing burden of chronic diseases, aging populations, and healthcare workforce shortages has intensified the demand for primary care transformation globally. Advanced Practice Nurses (APNs) have emerged as key contributors to healthcare delivery, yet their integration into primary care remains uneven due to systemic barriers and varying levels of readiness. This study aims to develop a multidimensional framework for assessing system readiness to integrate APNs effectively. The framework was developed through an extensive review of policy literature and readiness models, incorporating seven domains: Regulation, Financing, Workforce, Clinical Governance, Information Systems, Professional Acceptance, and Quality & Safety. Each domain includes measurable indicators derived from validated maturity models, policy analyses, and health system assessments. A pilot application using hypothetical data (Country A) demonstrated the framework's diagnostic capabilities, revealing how imbalances across domains impact implementation capacity. Key findings indicate that successful APN integration depends on coordinated progress across all readiness domains. Systems with strong governance and digital infrastructure may still fail to implement APN models effectively if financing or regulatory mechanisms are underdeveloped. The radar chart visualization and scoring tools offer practical methods for identifying gaps, prioritizing reforms, and benchmarking readiness over time. This framework provides a strategic tool for policymakers and health system leaders seeking to enhance APN integration. It supports evidence-based reform, enables systematic planning, and aligns implementation efforts with national health goals. Future research should focus on real-world testing, indicator refinement, and adaptation to other health professional roles.