Competences of advanced nursing practice

Advanced nursing practice; It is 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 individual, families, groups and
communities.

It involves analysis and synthesizing knowledge, understanding, interpreting and applying

nursing theory and research and developing and advancing nursing knowledge and the profession
as a whole.

Competences

Are the specific knowledge, skills, judgment and personal attributes required for a registered
nurse to practice safely and ethically in a designated role and setting.

Core competence for advanced nursing practice is based on appropriate depth, breadth and range
of nursing knowledge, theory and research enhanced by clinical experience.

Core competences

The core competences are categorized on four groups;

1. Professional role, responsibility and accountability

2. Health assessment and diagnosis
3. Therapeutic management
4. Health promotion and prevention of illness and injury.

i) Professional role, responsibility and accountability

This nurse practitioner competence category includes;
- Clinical practice
- Collaboration, consultation and referral
- Research
- Leadership
Nurse practitioner practice is characterized by the simultaneous interaction and blending
of competences at a level of complexity that reflects the nurses highly developed critical
thinking skills, clinical nursing experience and advanced education that incorporates a
substantial clinical component.
The competences are fundamental and are integrated in the practice of nurse
practitioners, apply to each other in the framework of service delivery.

a) Clinical practices
It s a cornerstone of advanced nursing practice and expertise in a specialized area of
nursing. Through a holistic and integrated approach, the nurse works in partnership with
the client and other members of the health care team in provision of comprehensive care.
In clinical practice, an advanced nurse practitioner does the following;
Practices in accordance with federal and provincial legislation professional and ethical
standards and policy relevant to nurse Practitioner practice (reference to nursing ethics,
rules and regulations nurse act etc).

Understands the changes in the scope of practice from that of a registered nurse and the
ways such changes affect responsibilities and accountabilities when assuming the
reserved title and scope of practice of a nurse practitioner.
Incorporates knowledge of diversity, cultural safety and determinants of health in the
assessment, diagnosis and therapeutic management of clients and in the evaluation of
outcomes.

Incorporates knowledge of developmental and life stages, pathophysiology,

psychopathology, epidemiology, environmental exposure, demographics and family
processes when performing health assessment, making diagnosis and providing overall
therapeutic management.
Incorporates knowledge of clinical manifestations of normal events of health, acute
illness, injuries, chronic diseases, comorbidities and emergency health needs including
effects f multiple etiologies in the assessment, diagnosis and therapeutic management of
clients and in the evaluation of outcomes.
Integrates the principles of resource allocation and cost effectiveness into clinical
decision making.
Provides client diagnostic information and education that are relevant, theory based and
evidence informed using appropriate teaching, learning strategies.
Promotes safe client care by mitigating harms and addressing immediate risks for clients
and others affected by adverse events and near misses.
Discloses the facts of adverse events to clients and reports adverse events to appropriate
authorities, in keeping with relevant legislation and organizational policies.
Documents clinical data assessment findings, diagnosis, plans of care, therapeutic
interventions, client responses and clinical rationale in a timely and accurate manner.
Adhere to rules and regulations, policies, standards of the profession, controlling the
privacy documentation and information management (verbal written and electronic
records).
Engages in on going professional development and accepts personal responsibility for
maintaining nurse practitioner competence.
Anticipates and explains the wide range of client responses to actual or potential health
problems and what should be done (Action).
Plans, initiates, co ordinates and conducts educational programs based on needs, priorities
and organizational resources.
b) Collaboration consultation and referral
Effect collaboration and communication with clients and others on the health care team
represents important aspects of any nursing practice.
The ability to consult and collaborate with colleagues across sectors and at the
organizational, provincial, district, national and international level is a characteristic of
nurses in advance practice.
The nurse practitioner does the following;
Consults with and or refers clients to other health care providers at any point in the care
continuum when the clients condition is not with in the nurse practitioner scope of
practice or the individual nurse practitioners practice.
Acts as a consultant to and or refers and accepts referrals from health care providers,
community agencies and allied non health care professionals.
 Advocates for clients in relation to therapeutic interventions, health care access, the
health care system and policy decisions that affect health and quality of life.
Collaborates with members of the health care team to promote and guide continuous
quality improvements, initiatives at individual, organizational and system levels.
Applies advanced knowledge and skills in communication, negotiation, coalition
building, change management and conflict resolution, including the ability to analyze,
manage and negotiate conflict.

RESEARCH; an advanced nurse practitioner is able to perform as follow as;

Engages in evidence- informed practice by critically appraising and applying relevant
research, best practice guidelines and theory when providing health care services.
Develops, utilizes and evaluates processes with in the practice and setting /health care
systems to ensure that clients/patients receive coordinated health services that identify
client outcomes and contribute to knowledge development.
Identifies and implements research based innovations focusing on improving client
/patient care at all levels, individuals, families and communities.
Acts as a change agent through knowledge translation and dissemination of new
knowledge that may include formal presentations, publications, informal discussions to
help in development of best practice guide lines and policies.
As either a primary investigator or collaborator with other members of health care team
or community, identifies, conducts and supports research that enhances or benefits
nursing practice.
d) Leadership competences
Advanced practice nurses are leaders in organizations and communities work. They are
agents of change, consistently seeking effective new ways to practice, to improve the
delivery of care to shape organizations to benefit the public and to influence health
policy.

Advanced practice nurse demonstrate leadership by;

Advocating for individuals, families, groups and communities in relation to treatment, the health
care system and policy decisions that affect health and quality of life.
Provide leadership in the management of clinical care as a resource education and role model.

Acts as a preceptor, mentor and couch to nursing colleagues, other members of the health care
team and students.

Articulate s and promotes the role nurse practitioner to clients, other health care providers, social
and public service sectors, the public, legislators and policy makers.

Provides leadership in the development and integration of the nurse practitioner role with in the
health care system.

Advocates for and participates in creating an organizational environment that supports safe client
care collaborative practice and professional growth.

Guides, initiates and provides leadership in policy-related activities to influence practice, health
services and public policy.

Health assessment and diagnosis

The nurse practitioner integrates abroad knowledge base with critical appraisal to obtain the
required information for determining diagnosis and client needs.

Throughout the process, the nurse practitioner works in collaboration with clients to identify and
mitigate health risks, promote understanding of health issues and support health behaviors.

Therefore a nurse practitioner shall or is able to:

Perform a focused health assessment and an advanced comprehensive health assessment using
and adapting assessment tools and techniques based on client needs and relevant client stage of
life.

Perform a complete and focused health history appropriate to client situation, including physical,
psychosocial, emotional, ethnics, cultural and spiritual dimensions of health.

Perform complete and focused physical examination, identifies and interprets normal and
abnormal findings as appropriate to client presentation.
Synthesize health assessment information using critical inquiry and clinical reasoning to
diagnose health risks and states of health /illness.

Formulates differential diagnosis through the integration of client information and evidence
informed clinical reasoning and critical inquiry and assumes responsibility for follow up.

Diagnoses diseases, disorders, injuries and conditions and identifies health needs while
considering the clients responses to the health/illness experiences.

Communicate with clients about health assessment findings or diagnosis including outcomes or
prognosis.

Therapeutic management

Nurse practitioner collaborates with clients to set priorities for the provision and overall
coordination of care along the health /illness continuum. Selects appropriate interventions from a
range of non- pharmacological and pharmacological interventions to assist clients in restoring or
maintaining functional, physiological and mental stability to achieve optional health.

The nurse practitioner does the following;

Creates an environment in which effective communication of diagnostic and therapeutic

intervention can take place.

Explores therapeutic options considering implications for clients through the integration of client
information and evidence informed practice.

Supports, educates, coaches clients /patients on self care management, including their personal
responses to diseases, disorders, injuries, risk factors, life style changes and therapeutic
interventions.

Perform invasive and non invasive procedures for the clinical management and prevention of
diseases, injuries, disorder or conditions.

Promotes client self efficiency in navigating the health care system and identifying and accessing
the necessary resources.
Initiates interventions for the purposes of stabilizing clients in emergent, urgent and life
threatening situations.

Determines care options and initiates therapeutic interventions in collaboration with clients,
while considering client perspective feasibility and best outcomes.

Prescribes pharmacotherapy by applying knowledge and evidence informed in prescribing,

monitoring and dispensing drugs basing on the clients health history, disease, disorder, condition,
state of life and individual circumstances.

Counsels clients on medication therapy, benefits, potential side effects, interactions, importance
of compliance and recommended follow up.

Demonstrates awareness of and is mindful of marketing, strategist used to promote health

products, medical devices, medications, alternative therapies and health programs.

Intervenes as appropriate when potential or actual problematic substances use and or misuse of
drugs including complementary and alternative therapies are identified.

Uses evidence- informed approach in the selection or consideration of complimentary and

alternative therapies and consider the benefits and risks of clients health and safety.

Monitors, evaluates and revises the plan of care and therapeutic intervention based on current
evidence- informed practice and on client goals, preferences, health status and outcomes.

Health promotion and prevention of illness and injury

Nurse practitioners in all practice settings focus on improving and restoring health
The nurse practitioner leads or collaborates with any other health care team members , other
sectors and or community that promote health and reduce the risk of complications, illness and
injury for their individual clients, groups and population as a whole.`
The nurse practitioner is able to:

Assess, identify, and critically analyze information from a variety of sources to determine client
or population trends and patterns that have health implications.
Initiate or participate in the development and implementation of evaluation processes including
identification of indicators for ongoing monitoring of strategies, service and interventions.