Documentation of advanced practice nurses' (APNs) effectiveness globally is essential in developing educational programs and standards, regulations, titling, prescribing privileges, and scope and standards of practice. Based on the body of research on APN effectiveness to date, two major factors have emerged in developing future studies, (1) careful, deliberate choice of outcomes and (2) dose effects. The purpose of this paper is to review these measurement issues. Careful selection in choice of patient outcomes important to regional and national health care challenges is essential in developing studies to document APN effects on outcomes important to the country and region. It is equally important to consider the concept of dose effects of the APNs. Dose effects consist of 3 components: dose (number of APNs at the clinical practice site, region or country and amount of APN care in minutes or contacts); APN (education, expertise, and experience); and host and host response (organizational, governmental or patient and/or family receptiveness to APNs and to APN practice). Considering each component of the concept is essential in developing studies to examine APN effectiveness internationally.
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