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BackgroundIn 2006, the countries of the Association of Southeast Asian Nations (ASEAN) signedMutual Recognition Arrangements (MRA) in relation to nursing services in the region.This agreement was part of a set of policies to promote the free flow of skilled laboramong ASEAN members and required mutually acceptable professional regulatoryframeworks. his paper presents a narrative review of the literature to 1) describe progress in thedevelopment of the regulatory framework for nursing professionals in Cambodia andVietnam since 2000 and 2) identify key factors, including the MRA, that affect theseprocesses.MethodsDocument review. Policy documents, laws, regulations, and published peer-reviewedand gray literature were reviewed. Data were triangulated and analyzed using a tooldeveloped by adapting McCarthy et al.'s regulatory function framework and coveringeight functions (legislation, accreditation of preservice education, competencyassessment, registration and licensing system, tools and data flow of registration,scope of practice, continuing professional development, professional misconduct anddisciplinary powers).ResultsCambodia and Vietnam have made remarkable progress in developing their regulatory frameworks for nursing. A number of key influences contributed to the development of nursing regulations, including the signing of the MRA in 2006 and the establishment of the Joint Coordinating Committee on Nursing (AJCCN) in 2007 as key milestones. Macroeconomic and political factors affecting the process were economic growth and an emerging private sector, social demand for quality care and professionalism, global attention to health workforce competencies, the role of development partners, and regular monitoring and mutual learning through AJCCN. A period of incubation enabled countries to develop consensus among stakeholders regarding regulatory arrangements; this trend accelerated after 2010 by bringing national regulatory schemes into conformity with the regional framework. Some similarities in the process (e.g., preservice education first, legislation later) and differences in key actors (e.g., professional councils and the capacity of nursing leaders) were observed in two countries.ConclusionFurther development of the regulatory framework will require strong nursing leadershipto sustain achievements and drive continued progress. The adapted tool to assessregulatory capacity works well and may be of value in assessing the development ofregulations in the nursing profession.

Background The Western Pacific region constitutes one-quarter of the world's population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses' professional development within the Western Pacific region. Methods This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 - December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare. Results Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research. Conclusions Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.