College of Registered Nurses of Nova Scotia Nurse Practitioner Competency Framework June 2011
2011, College of Registered Nurses of Nova Scotia, Halifax, NS All rights reserved. No portion of this publication may be reproduced in any form or by any means without the written permission of the copyright owner. First printing (2002) Revised (2005 / 2009 / 2011) 2
TABLE OF CONTENTS Introduction...4 Purpose of the Nova Scotia Nurse Practitioner Competency Framework...4 Profile of the Nurse Practitioner...5 Nurse Practitioner Practice in Nova Scotia...6 Overview of Competencies...7 Assumptions...8 Competencies...9 1. Professional Role, Responsibility and Accountability...9 2. Health Assessment and Diagnosis...13 3. Therapeutic Management...14 4. Health Promotion and Prevention of Illness and Injury...16 Glossary of Terms...17 Bibliography...21 Appendix A: NP Competency Working Group Members...24 Note to readers: A number of words in the following document are highlighted in bold. This is to indicate that the meaning of these words, in the context of this document, is defined in the Glossary of Terms, beginning on page 17. 3
INTRODUCTION Purpose of the Nova Scotia Nurse Practitioner Competency Framework This document outlines and describes the knowledge, skills, judgment and attributes that nurse practitioners must demonstrate in order to competently practice their profession. Safe, effective, ethical nurse practitioner practice requires the integration and simultaneous performance of many competencies. The Nova Scotia Nurse Practitioner Competency Framework also describes the range of activities that nurse practitioners perform within the health care system to improve the health and wellbeing of the people and communities they serve. While specific roles and responsibilities of nurse practitioners may vary by context and focus of practice, this document outlines the essential competencies that all nurse practitioners must master. It provides a concise, detailed and specific reference that serves a variety of purposes for a number of users and potential users: Nurse practitioner educators can refer to this framework when designing educational curricula and systems for assessing learner performance. Nurse practitioners can use this document as a guide to support their self reflection, selfevaluation, and continuing competence. They can also share it with allied health professionals, service providers, members of the public, and others, to educate them about the professionalism, role and competencies of nurse practitioners. Registered nurses and potential future nurses who may be interested in pursuing a career as a nurse practitioner can look to this document for insight into the profession and what it entails. The College of Registered Nurses of Nova Scotia (the College) relies on this document, in combination with other policy documents 1, to guide it in key aspects of regulating nurse practitioners. It provides the College with information it needs to effectively: review and approve/recognize nurse practitioner education programs develop/approve the examinations nurse practitioners must pass in order to obtain a license to practice in Nova Scotia assess nurse practitioners initial competence when they apply for a license, and/or when they change their client populations or practice settings assess nurse practitioners continuing competence 2 and ongoing performance improvement 3. 1 Nurse Practitioner documents 2 Building Your Profile 3 Nurse Practitioner Quality Monitoring and Improvement Program (NP-QMP) 4
The Nova Scotia Nurse Practitioner Competency Framework can be widely used to inform stakeholders including government agencies, employers, health providers and the public about what they can expect of nurse practitioners. In presenting the Nova Scotia Nurse Practitioner Competency Framework, the College acknowledges the nationwide collaborative effort that produced the Canadian Nurse Practitioner Competency Framework (2010). Provincial nursing regulators, nurse practitioners, the Canadian Nurses Association, and Assessment Strategies Inc., used a consensus-building approach to develop this national framework. With input from key stakeholders, the College has adapted the national document to reflect the Nova Scotia context. Profile of the Nurse Practitioner Nurse practitioners are autonomous health professionals with education in advanced nursing practice and theory. Sometimes known as advanced practice nurses, they provide a comprehensive range of essential health services grounded in professional, ethical and legal standards, within a holistic model of care. In providing these services, nurse practitioners draw on their practical experience and in-depth knowledge of the biological and psychosocial aspects of health and disease. They also apply their understanding of health management, health promotion, health protection, disease and injury prevention, and the determinants of health. Nurse practitioners work in collaboration with their clients and other healthcare providers to provide high-quality, person-centred care. They work with diverse client populations in a variety of contexts and practice settings. For example, some nurse practitioners provide primary care in family practice settings, while others work in highly specialized fields in hospitals and specialized clinics. Regardless of where they practice and with whom, nurse practitioners are accountable for their own practices and for providing leadership to enhance client care and caredelivery systems within their focus of practice. Nurse practitioners are educated and licensed to diagnose, treat and manage acute and chronic physical and mental illness. They conduct comprehensive health assessments, order and interpret screening and diagnostic tests, diagnose health/illness conditions, perform procedures, prescribe medications, and monitor treatment results. At the same time, nurse practitioners have the expertise, advanced communication skills and professional frame of reference to provide health and wellness counseling with an emphasis on prevention and proactive health management. Communication is at the core of the nurse practitioner-client relationship. Nurse practitioners listen thoughtfully to their clients, learn about their health status, and counsel them on a range of health- and illness-related concerns. This could include advising clients about how to manage their symptoms or maintain their health through self-care strategies, medications, or complementary and alternative therapies. Nurse practitioners also communicate clearly with clients about health assessment findings, diagnoses, further testing that may be required, and potential courses of treatment and their implications. When necessary, nurse practitioners refer clients to other healthcare professionals, services and programs. 5
In their interactions with clients, nurse practitioners support clients strengths, capabilities, needs, values, culture and choices. They work closely with clients to help them make informed decisions about their health and to develop and monitor an appropriate plan of care. As they perform these activities, nurse practitioners have a responsibility to consider issues of resource allocation and the cost-effectiveness of healthcare decisions, in accordance with federal and provincial policy and legislation. They are also accountable for setting up processes that enable them to effectively receive and track test results, interventions, referrals, consultations and outcomes. Finally, they are required to collaborate with other healthcare providers and/or agencies in a timely manner when needed. In addition to their role in clinical care, nurse practitioners have the knowledge and skills to play a broader role in the healthcare system and society at large. They are equipped with the expertise to assess population health, evaluate health outcomes, and develop health policies and health services. Nurse practitioners also provide leadership to multi-stakeholder efforts to design, implement and evaluate strategies aimed at promoting health and preventing illness and injury. They pursue these goals in collaboration with other healthcare providers and community members in the healthcare sector, as well as in non-healthcare sectors such as education and law enforcement. Nurse Practitioner Practice in Nova Scotia In Nova Scotia, the practice of a nurse practitioner is defined in the RN Act (2006): Practice of a nurse practitioner means the application of advanced nursing knowledge, skills and judgment in addition to the practice of nursing in which a nurse practitioner in collaborative practice may, in accordance with standards for nurse practitioners, do one or more of the following: (i) make a diagnosis identifying a disease, disorder or condition, (ii) communicate the diagnosis to the client and healthcare professionals as appropriate, (iii) perform procedures, (iv) initiate, order or prescribe consultations, referrals and other acts, (v) order and interpret screening and diagnostic tests, and recommend, prescribe or reorder drugs, blood, blood products and related paraphernalia, and also includes research, education, consultation, management, administration, regulation, policy or system development relevant to subclauses (i) to (v). In order to practice as a nurse practitioner in Nova Scotia, nurse practitioners must have a collaborative practice relationship with a physician or a group of physicians. The purpose of this collaborative relationship is to ensure that a physician has agreed to be available for collaboration, consultation and referral when needed. 6
Prior to beginning their practice, nurse practitioners must notify the College of their intention to establish a practice, and provide the College with an official document (the Collaborative Practice Relationship Verification Form) to identify the physician(s) who has/have agreed to enter a collaborative practice relationship. The Collaborative Practice Relationship (CPR) Verification Form is available on www.crnns.ca > Nurse Practitioners > Resources & Links. Nurse practitioners are also required to submit a CPR verification form when there is a change in collaborating physician(s), they are leaving their current position, or they are changing their client population, practice setting and/or employer. When embarking on collaborative practice relationships, it is important that all team members clearly understand the client population they are serving, their context of practice, and their respective responsibilities and accountabilities. This involves open discussion and consensus building at the outset of the relationship. The College has developed Guidelines for Collaborative Practice Teams and Employers of Nurse Practitioners (2009) to facilitate discussion regarding team members responsibilities and accountabilities. These guidelines can be accessed on www.crnns.ca > Nurse Practitioners > Resources & Links. Overview of Competencies The Nova Scotia nurse practitioner competencies are organized into four categories: 1. Professional Role, Responsibility and Accountability clinical practice collaboration, consultation and referral research leadership 2. Health Assessment and Diagnosis 3. Therapeutic Management 4. Health Promotion and Prevention of Illness and Injury Competency statements in each of these categories describe the entry-level knowledge, skills, and judgment essential to the practice of nurse practitioners regardless of their client population or practice environment. Throughout their careers, nurse practitioners acquire additional knowledge and skills specific to their focus of practice. At all levels of experience, nurse practitioners must practise in accordance with their educational preparation, competence and legislated scope of practice. In order to understand how the nurse practitioner competencies apply to the practice of this profession in all roles and settings, it is necessary to examine the assumptions on which the competencies are based. 7
ASSUMPTIONS In defining the competencies described in this document, the stakeholders involved made the following baseline assumptions: 1. The practice of nurse practitioners is grounded in the values, knowledge and theories of professional nursing practice. 2. Nurse practitioner competencies build and expand upon the competencies required of a registered nurse. 3. The nurse practitioner competencies incorporate the competencies identified for advanced nursing practice: clinical practice, research, leadership, consultation, and collaboration as defined in Advanced Nursing Practice: A National Framework (2008). 4. Nurse practitioner competencies require additional nursing education at the graduate level, with a substantial clinical component. 5. Nurse practitioner competencies are the foundation for all areas of nurse practitioner practice and apply across diverse practice settings and client populations. 6. Defined nurse practitioner competencies are essential for assessing nurse practitioner competence. 7. Nurse practitioner practice is grounded in the five World Health Organization (WHO) principles of primary health care: accessibility, public participation, health promotion, appropriate technology and intersectoral collaboration. 8. Nurse practitioners provide person-centred care informed by the current best-available evidence and the determinants of health. 9. Nurse practitioners assess and diagnose clients, manage client care (therapeutic management) and evaluate client health outcomes in their clinical practice. 10. Nurse practitioners provide services relating to health promotion, illness and injury prevention, rehabilitative care, curative and supportive care, and palliative and end-oflife care. 11. The nurse practitioner competencies specifically address the activities included in nurse practitioners legislated scope of practice. 12. Nurse practitioners work in collaboration with their clients and other healthcare providers to provide high-quality safe, effective and ethical healthcare services. 13. Collaborative relationships with other healthcare providers involve both independent and shared decision-making. All parties are accountable in the practice relationship as determined by their scopes of practice, educational backgrounds and competencies. 14. Nurse practitioners expand the breadth and depth of their practice over time, with support from employers, mentors and members of the healthcare team. 8
COMPETENCY 1: Professional Role, Responsibility and Accountability There are several key characteristics that apply to all nurse practitioner practice. Nurse practitioners provide patient-centred health care. Their practice is informed by current evidence and a deep understanding of the determinants of health. They possess strong critical thinking skills. Nurse practitioners combine competencies to address complex situations. They have solid nursing experience backed by advanced education that incorporates a substantial clinical component. The Professional Role, Responsibility and Accountability competencies are fundamental and underlie and permeate every aspect of nurse practitioner practice, including the other competencies in this framework: Health Assessment and Diagnosis, Therapeutic Management, and Health Promotion and Prevention of Illness and Injury. Clinical Practice Within their focus of practice, nurse practitioners: 1.1 Practise in accordance with federal and provincial legislation, professional and ethical standards, and policies relevant to nurse practitioner practice. 1.2 Understand how the nurse practitioner s scope of practice differs from that of a registered nurse and how these differences affect their responsibilities and accountabilities when they assume the title and scope of practice of a nurse practitioner. 1.3 Apply knowledge of diversity, cultural competence, cultural safety and the determinants of health in their clinical practice. 1.4 Apply knowledge of development and life stages, pathophysiology, psychopathology, epidemiology, pharmacotherapeutics, environmental exposure, infectious diseases, behavioural sciences, demographics, and family processes in their clinical practice. 1.5 Apply knowledge of the clinical manifestations of normal health events, acute/ emergent illness or injury, chronic disease, and co-morbidities including the effects of multiple etiologies in their clinical practice. 1.6 Integrate the principles of resource allocation and cost-effectiveness into clinical decision-making. 9
1.7 Educate clients using relevant, theory-based and evidence-informed approaches to teach them about their health status and how they may best maintain, improve, recover or manage their health. 1.8 Promote safe client care by addressing potential or actual risks with clients, and taking steps to mitigate harm from potential or actual adverse events. 1.9 Disclose the facts of adverse events to clients and report adverse events to appropriate authorities, in keeping with relevant legislation and organizational policies. 1.10 Set up effective processes to receive and track test results, interventions, referrals, consultations and provide necessary follow-up. 1.11 Document clinical data, assessment findings, diagnoses, plans of care, clinical rationales, therapeutic interventions, and client responses in a timely and accurate manner (in written and/or electronic documents). 1.12 Adhere to federal and provincial legislation, policies and standards related to privacy, documentation and information management (this applies to verbal communication as well as written and electronic records). 1.13 Engage in ongoing professional development and accept personal responsibility for maintaining nurse practitioner competence. Collaboration, Consultation and Referral Within their focus of practice, nurse practitioners: 1.14 Establish collaborative relationships with physicians and other healthcare providers. 1.15 Consult with and/or refer clients to other healthcare providers when the client s condition is outside the nurse practitioner scope of practice or the individual nurse practitioner s competence. 1.16 Consult with and/or refer clients to a physician or other appropriate healthcare provider when the client s condition is unstable or could destabilize or deteriorate. 1.17 Consult with and/or refer clients to a physician or other appropriate healthcare provider when signs, symptoms, and/or test results suggest a previously undiagnosed systemic illness, obstruction of a vital organ, or systemic infection that threatens life, limb or senses. 10
1.18 Act as a consultant to, and accept referrals from, healthcare providers and community agencies (including those in non-healthcare sectors). 1.19 Collaborate with clients and other members of the healthcare team to provide and promote interprofessional person-centred care at the level of the individual, organization and system. 1.20 Collaborate with clients and other members of the healthcare team to lead and promote continuous quality improvement initiatives. Research Within their focus of practice, nurse practitioners: 1.21 Engage in evidence-informed practice by critically appraising and applying relevant research findings, best-practice guidelines and theories. 1.22 Develop, apply and evaluate processes that facilitate the coordination of health services within the practice setting. 1.23 Identify and implement evidence-informed innovations for improving client care within their focus of practice. 1.24 Create and implement processes to identify, collect data on, and evaluate the outcomes of client care within their focus of practice. 1.25 Collaborate with other members of the healthcare team and/or the community to identify research opportunities and conduct and/or support research. Leadership Within their focus of practice, nurse practitioners: 1.26 Develop innovative approaches to improving health service delivery in their practice setting, and support others to do the same (by acting as a resource person, facilitator, educator and role model). 1.27 Act as a preceptor, mentor and coach to nursing colleagues, other members of the healthcare team and students. 11
1.28 Articulate the role of the nurse practitioner to clients, other healthcare providers, policymakers and the public. 1.29 Develop strategies with healthcare providers and employers to optimize the nurse practitioner role within the collaborative practice team, enhance the team s capacity and improve service delivery to clients. 1.30 Identify issues related to health-service delivery within their focus of practice and help develop, implement and evaluate strategies to address these issues. 1.31 Advocate for equitable access to healthcare services, quality therapeutic intervention, a navigable healthcare system, and policy decisions that support health and quality of life. 1.32 Advocate for and participate in creating an organizational culture and practice environment that supports excellence, collaborative practice, continuous learning and professional growth. 1.33 Act as change agents by interpreting and disseminating knowledge through a variety of methods (i.e., presentations, informal discussions, development of best practice guidelines and policies, etc). 1.34 Initiate, support and participate in developing, implementing and evaluating standards and practice guidelines, as well as quality assurance, education and research initiatives. 1.35 Initiate, support and participate in efforts to positively influence practice, health services and policy. 1.36 Apply advanced knowledge and skills in communication, negotiation, coalition building, change management and conflict-resolution (anticipate, analyze, deflect, manage and negotiate conflict). 12
COMPETENCY 2: Health Assessment and Diagnosis 2 Nurse practitioners integrate a broad knowledge base with clinical assessment and critical appraisal skills to diagnose conditions and determine client needs. Nurse practitioners understanding of relevant theory, evidence and the determinants of health guides them in their assessment and diagnosis process as does their person-centred approach. Within their focus of practice, nurse practitioners: 2.1 Perform comprehensive or focused health histories appropriate to clients situations, including physical, mental, psychosocial, emotional, ethnic, cultural and spiritual dimensions of health. 2.2 Perform comprehensive or focused physical examinations, and identify and interpret normal and abnormal findings in light of clients health histories and current symptoms. 2.3 Use and adapt assessment tools and techniques based on client needs, culture and stage of life. 2.4 Use clinical reasoning to synthesize information obtained from histories and physical examinations in order to formulate differential diagnoses. 2.5 Determine which investigations are needed based on differential diagnoses, client information, current available evidence, and best-practice guidelines. 2.6 Order and/or perform screening and diagnostic investigations and interpret results using evidence-informed clinical reasoning and critical inquiry. 2.7 Establish a preliminary or definitive diagnosis for acute and chronic diseases, disorders, injuries, and conditions. 2.8 Anticipate emergent, urgent and life-threatening situations. 2.9 Identify health needs based on clients overall life situations and responses to the diagnosis/illness. 2.10 Discuss health assessment findings and/or diagnoses and health needs with clients, including prognoses and potential courses of action tailoring the communication to clients needs and responses. 13
COMPETENCY 3: Therapeutic Management 3 Nurse practitioners respect and affirm clients rights to make decisions related to their health. Nurse practitioners work with clients to set goals and priorities, and provide information and advice to support appropriate healthcare decisions. Nurse practitioners identify and recommend potential interventions (non-pharmacological and pharmacological) to help clients restore or maintain their physical or mental health and functional abilities. They also provide information and advice regarding therapeutic interventions and self-care strategies that may help clients achieve optimal health. Nurse practitioners and clients work together to develop and adjust a plan of care, based on clients responses and outcomes. Within their focus of practice, nurse practitioners: 3.1 Create an environment that allows them to communicate effectively with clients about diagnoses and evidence-informed treatments and/or therapeutic options. 3.2 Explore the implications of treatments and therapeutic options with clients while respecting clients concerns and choices. 3.3 Initiate therapeutic interventions in collaboration with clients and other members of the healthcare team as appropriate. 3.4 Initiate interventions to stabilize clients in emergent, urgent and life-threatening situations. 3.5 Support, educate, coach and counsel clients regarding diagnoses, prognoses and selfmanagement, including their personal responses to diseases, disorders, conditions, injuries, risk factors, lifestyle changes and therapeutic interventions. 3.6 Promote client confidence and ability to navigate the healthcare system and to identify and access necessary resources. 3.7 Coordinate and facilitate client care with other healthcare providers, agencies and community resources. 3.8 Perform invasive and non-invasive procedures to manage and/or prevent diseases, injuries, disorders or conditions. 3.9 Prescribe pharmacological and non-pharmacological therapy in accordance with provincial and federal standards and legislation. These therapies include but are not limited to medications, blood and blood products, medical gases, alternative therapies, health programs and services, and healthcare equipment and supplies. 14
3.10 Prescribe medications based on clients health history, diseases, disorders, or conditions, as well as their individual circumstances and stage of life. 3.11 Use evidence and knowledge of pharmacodynamics and pharmacotherapy in prescribing and monitoring medication therapy. 3.12 Counsel clients on medication therapy, including the benefits, potential side effects, interactions, importance of adherence, and recommended follow-up. 3.13 Intervene with appropriate measures when use, misuse or abuse of medication or other substances could potentially have, or is actually having, a negative effect on clients health and safety. 3.14 Provide clients with evidence-informed recommendations about the likely benefits and potential risks of complementary and alternative therapies, including potential interactions between natural health products and over-the-counter and/or prescription medications. 3.15 Analyze the effect of marketing strategies used to promote health products, health programs, medical devices, medications, and complementary and alternative therapies, and discuss with clients as appropriate. 3.16 Monitor, evaluate and revise the plan of care based on current evidence-informed practice and clients goals, preferences, health status, responses to therapeutic interventions, and outcomes. 15
COMPETENCY 4: Health Promotion and Prevention of Illness and Injury Nurse practitioners play a vital role in health promotion and illness/injury prevention within their focus of practice. They work collaboratively with clients and others to identify and mitigate health risks, promote understanding of health issues, and support healthy behaviours. They focus on maintaining, improving and restoring health in individuals, groups, communities and populations. Nurse practitioners work with professionals, service providers and community members in health and non-healthcare sectors to develop programs that promote health and reduce the risk of complications, illness and injury. Within their focus of practice, nurse practitioners: 4.1 Counsel and teach individuals and groups using the principles of health promotion, health protection and illness and injury prevention. 4.2 Identify, assess and critically analyze information from a variety of sources to determine trends and patterns that have health implications for individuals, groups, communities and populations. 4.3 Develop or take part in developing strategies to address trends and patterns that have health implications. 4.4 Initiate or take part in designing and implementing services/interventions for health screening, health promotion, health protection, and the prevention of injury, illness, disease and complications. 4.5 Initiate or take part in developing and implementing processes for evaluating health screening, health promotion, health protection and prevention strategies and programs. 16
GLOSSARY OF TERMS Accountability: The obligation to acknowledge and assume responsibility for the professional, ethical and legal aspects of one s activities and duties, and to answer for the consequences and outcomes of one s actions. Accountability resides in a role and can never be shared or delegated. Advanced nursing practice: An umbrella term describing an advanced level of clinical nursing practice that maximizes the use of graduate educational preparation, in-depth nursing knowledge, and expertise in meeting the health needs of individuals, families, groups, communities and populations. It involves analyzing and synthesizing knowledge; understanding, interpreting and applying nursing theory and research; and developing and advancing nursing knowledge and the profession as a whole (CNA, 2008). Adverse event: An event that results in unintended harm to the patient and is related to the care and/or service provided to the patient, rather than the patient s underlying condition. Advocate: To actively support a right and good cause; to support others in speaking for themselves; to speak on behalf of those who cannot speak for themselves. Attributes: Characteristic qualities that include, but are not limited to, attitudes, values and beliefs. Client: The individual, group, community or population who is the recipient of nursing services and, where the context requires, includes a substitute decision-maker for the recipient of nursing services (RN Act, 2006). Collaborative practice: The relationship among a nurse practitioner, a physician or group of physicians, an employing organization and other relevant health professionals that enables these healthcare providers to work together using their separate and shared knowledge and skills to provide optimum client-centered care in accordance with standards of practice for nurse practitioners and guidelines for collaborative practice teams and employers of nurses practitioners as approved by the College (RN Act, 2006). Competence: The ability to integrate and apply the knowledge, skills, abilities and judgment required to practise safely and ethically with a designated client population in a specific nurse practitioner role and practice setting. Competencies: The specific knowledge, skills, abilities, and judgment required for a nurse practitioner to practise safely and ethically with a designated client population in a specific role and practice setting. 17
Complementary and alternative therapies: Complementary therapies are health modalities or interventions that tend to be used alongside conventional healthcare services, while alternative therapies tend to be used in place of conventional healthcare. Consultation : A request for another health professional s advice on the care of a client. The goal is to enhance patient care and/or improve the skills and confidence of the professional making the request (consultee). The consultant may or may not see the patient directly. The responsibility for clinical outcomes remains with the consultee, who is free to accept or reject the advice of the consultant (Barron & White, 2009, p. 194). Critical appraisal: The process of systematically examining research evidence to assess its validity, reliability, results and relevance before using it to make an informed decision. It is an essential part of evidence-informed practice. Cultural competence: The provision of care within the cultural context of the client. Cultural competence refers to congruent behaviours, attitudes and policies that come together in a system of care to enable effective care in cross-cultural situations. This does not mean every nurse has expert knowledge of all cultures and cultural groups. However, nurses must be aware of their own culture, values and biases, and be open to learning about clients cultures. They must respect how a client s culture may impact and influence client care. This includes understanding that clients perspectives, expectations, behaviours, and decisions reflect their history, lived reality, values and beliefs, and adapting nursing practice to meet diverse needs. Cultural safety: Addresses power relationships between the service provider and the people who use the service. It requires nurse practitioners to recognize and foster the cultural expression of clients. This usually requires nurse practitioners to reflect on their own cultural identity and learn how to practise in a way that affirms the cultures of clients and colleagues. Unsafe cultural practice is any action that demeans, diminishes or disempowers people s cultural identity and wellbeing. Determinants of health: The range of social, economic, geographic and systemic factors that influence a person s health status and outcomes. These factors include: access to appropriate health services, biology, coping abilities, culture, education, employment and working conditions, environment (natural and built, emotional and psychological), gender, genetics, health behaviours, income, lifestyle, and social status. Disease and injury prevention: Measures taken to prevent the occurrence of disease and injury (i.e. risk-factor reduction), and to arrest the progress and reduce the consequences of disease or injury. Diversity: The variation among people with respect to such factors as ethnicity, national origin, race, gender, ability, age, physical characteristics, religion, values, beliefs, sexual orientation, education and socio-economic status. 18
Etiologies: The cause, or set of causes, that leads to a disease, disorder or condition. Evidence-informed practice: An approach to clinical practice that requires the nurse practitioner to conscientiously integrate critically appraised evidence with their experience and knowledge of contextual factors to decide (in consultation with clients) what best suits clients needs. Evidence may include, but is not limited to, published and unpublished research, clinical practice guidelines, consensus statements, expert advice, and quality assurance and patient safety data. Focus of practice: The nurse practitioner s client population (family, all ages, adult, child, neonate), area of specialty (e.g., primary health care, women s health, nephrology, cardiology, gerontology) and practice setting (e.g., community care, primary care, acute care, emergency care, long-term care). Health: A state of complete physical, mental, spiritual and social wellbeing, and not merely the absence of disease. (WHO, 1946). Health management: The range of activities required to care for a person s health, including assessment and diagnosis, therapeutic management, monitoring, follow-up and evaluation. Health promotion: The process of enabling people to increase control over and improve their health. It embraces actions directed not only at strengthening the skills, confidence and capabilities of individuals, but also at changing social, environmental, political and economic conditions to alleviate their impact on public and individual health. Health protection: Activities in food hygiene, water purification, environmental sanitation, medication safety, and other areas designed to eliminate or minimize the risk of adverse consequences to health. Holistic model of care: An approach to healthcare that incorporates all aspects of clients physical, psychological, emotional, spiritual, and social needs in the provision of care. Palliative care: Treatment or care aimed at reducing the impact of symptoms on a person s quality of life, rather than altering the course of the illness. Person-centred care: A process that places a person at the centre of the collaborative healthcare team and supports that person s strengths, capabilities, needs, values, culture and choices. Persons are defined as the individuals/families/friends and communities that are the focus of the health system. 19
Pharmacodynamics: The biochemical and physiological effects of drugs on the body or on microorganisms or parasites within or on the body including the mechanisms of drug action and the relationship between drug concentration and effect. Pharmacotherapy: Treatment and prevention of diseases, disorders and/or symptoms by means of medication therapy. This includes consideration of the characteristic interactions of a medication with the body in terms of absorption, distribution, metabolism and excretion, and the interactions that may occur between medications. Population health: The health of populations and the factors that influence health and health risks. Referral: An explicit request for another health professional to become involved in the care of a client. The goal of referral is to enhance patient care by relinquishing care, or aspects of care, to another professional whose expertise is perceived to be more essential to the patient's care than that of the professional making the referral. The focus is on establishing a connection between a patient and the professional who is accepting the referral and to negotiate which professional (i.e., the professional making the referral or the professional receiving the referral) will be responsible for what outcomes. The responsibility for clinical outcomes is negotiated but responsibility is often assumed (at least for aspects of care) by the professional accepting the referral. (Barron & White, 2009, p. 194). Responsibility: A duty or obligation that is required or expected as part of a professional role and/or position. Responsibility can be shared, delegated or assigned. Safe client care: An approach to care that reduces or mitigates unsafe acts or situations by using evidence-informed and/or best practices shown to lead to optimal client outcomes. Scope of practice: The roles, functions, and accountabilities that nurse practitioners are educated and authorized to perform, as established through legislated definitions of nurse practitioner practice, and complemented by standards, guidelines and policy positions issued by professional nursing bodies. Standards: Authoritative statements that describe the required behavior of every nurse practitioner and are used to evaluate individual performance. They provide a benchmark below which performance is unacceptable. Therapeutic management: The pharmaceuticals, non-pharmaceuticals, therapies and interventions that nurse practitioners prescribe to promote and protect health, prevent disease, and treat diseases, injuries, illnesses and conditions. 20
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Muir Gray, J. A. (1997). Evidence-based medicine: How to make health policy and management decisions. London, UK: Churchill Press. National Framework for Nurse Standards Working Group. (2008). National framework for nursing standards. [Unpublished report]. Toronto, ON: Author. Public Health Agency of Ontario. (August 2007). Glossary of terms relevant to the competencies for public health. Retrieved from http://www.phac-aspc.gc.ca/ccph-desp/ glos-a-d-eng.php Public Health Agency of Ontario. (2008). Competencies for public health in Canada. Retrieved from http://www.phac-aspc.gc.ca/ccph-cesp/pdfs/cc-manual-eng090407.pdf Ramsden, I. (1990). Cultural safety. New Zealand Nursing Journal, 83, 18-19. Canadian Journal of Nursing Leadership. (2010). Special Issue on Advanced Nursing Practice in Canada, 23. Retrieved from http://www.longwoods.com/content/22264?utm_sourc e=longwoods+master+mailing+list&utm_campaign=17b93e9e2d-nl_vol23sp_issue_ TOC_Alert4_8_2011&utm_medium=email University of Victoria. (n.d.). Cultural safety: Module 1: Peoples experiences of colonization. Retrieved from http://www.web2.uvcs.uvic.ca/courses/csafety/mod1/index.htm Wilson, R. M., Harrison, B. T., Gibberd, R. W., & Hamilton, J. D. (1999). An analysis of the causes of adverse events from the Quality in Australia Health Care Study [Electronic Version]. Medical Journal of Australia, 170, 411-415. 23
APPENDIX A: NP COMPETENCY WORKING GROUP MEMBERS The following individuals committed their time and expertise to developing the Nova Scotia Nurse Practitioner Competencies. NP Competency Working Group Members Teri Crawford, RN, MN Policy Consultant, CRNNS Halifax, Nova Scotia Sandra Duke, NP, MN Geriatrics, Capital Health Halifax, Nova Scotia Ruth Martin-Misener, NP, PhD School of Nursing, Dalhousie University Halifax, Nova Scotia Lynn Miller, NP, MN Primary Health Care, Cumberland Health Pugwash, Nova Scotia Paula Prendergast, RN, MN Policy Consultant, CRNNS Halifax, Nova Scotia Acknowledgements The revision of the Nova Scotia Nurse Practitioner Competencies was made possible by feedback from the following stakeholders: Nova Scotia nurse practitioners, including those involved in NP education Nova Scotia Department of Health & Wellness Employers of nurse practitioners College of Physicians and Surgeons of Nova Scotia Nova Scotia College of Pharmacists 24
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College of Registered Nurses of Nova Scotia 4005-7071 Bayers Road Halifax, Nova Scotia B3L 2C2 902.491.9744 Toll-free NS 1.800.565.9744 info@crnns.ca www.crnns.ca