Nursing Care Continuum

Framework and Competencies

ICN Regulation Series

Pre-publication copy
ICN Regulation Series

Nursing Care Continuum Framework and Competencies

International Council of Nurses

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Copyright © 2008 by ICN - International Council of Nurses,

3, place Jean-Marteau, 1201 Geneva, Switzerland

ISBN: 978-92-95065-25-3

2
Table of contents

Introduction 4
ICN Framework of Competencies 9

Accountability 12
Ethical Practice 14
Legal Practice 16
Principles of Care Provision 18
Promotion of Health 22
Assessment 23
Planning 24
Implementation 26
Evaluation 27
Therapeutic Communication and Interpersonal Relationships 28
Leadership and Management 30
Safe Environment 32
Delegation and Supervision 34
Inter-Professional Health Care 35
Enhancement of the Profession 36
Quality Improvement 38
Continuing Education 39

Glossary 40

References 42

3
Introduction
For over a century, the International Council of Nurses (ICN) has
acted as a global leader and advocate for improved nursing and
health care services. One of the traditional approaches used has
been international standard-setting. In addition, within the context of
increased migration, ICN more recently began using its global
resources to identify international frameworks and core
competencies for the levels of nursing personnel most commonly
recognised across countries.
Unfortunately, an increasing number of countries are experiencing a
nursing shortage.1 These shortages are intensifying against a
background of growing and changing health needs, health service
reform and expansion, advances in knowledge and technology and
new avenues for treatment and service. Within this environment ICN
is convinced of the need to complete work on defining the range of
knowledge, skills and competencies expected of those providing
care that falls within the Nursing Care Continuum Framework. (The
ICN Nursing Care Continuum Framework and Competencies will
henceforth be referred to as “the Continuum”).
In the context of health care, the term continuum is multi-
dimensional and describes a relationship between the health care
delivery system and those using its services. It is often used to
relate to the setting of care and seamless transitions from one
setting to another, such as from hospital to home to nursing home,
etc.2 It is also used to denote care needs, such as being fully
independent, partially dependent or fully dependent. Finally, it can
4
relate to roles (e.g. aide, enrolled nurse, registered nurse, etc.). This
paper addresses the care continuum from the perspective of
nursing roles.
In today’s highly paced, high cost health care environment, there is
much overlap of health and social care roles as well as increased
demand for value for money services. This is bound to grow as the
elderly make up an increasing proportion of the population and as
chronic disease increasingly takes its toll. The response, seen
already in the midst of the global health human resources crisis, is a
call for less skilled workers and for task shifting from the more
educated to the less educated, and from specialists to generalists.
At the same time, in some countries, the emphasis on education is
creating a range of baccalaureate prepared practitioners in low skill
level jobs which do not fully utilise their potential. All in all, there is
much pressure on nursing to define the profession, share
competencies, task shift, and delegate. Although some countries
are now starting to look at parts of the Continuum, nursing lacks a
coherent global framework within which to respond, let alone be
proactive.
The nursing profession has historically refused to define nursing’s
parameters, aside from the role of the professional nurse. This may
have been acceptable in the past but will not work in current or
future environments.
ICN is challenged to better define the range of capabilities,
responsibilities, authority and relationships occurring among nursing
personnel for, as the ICN report on global shortages, points out:
Achieving a balance of skill mix, with the optimum proportion of
registered nurses and midwives, other health professionals,
support workers, and nursing assistants is one of the main
staffing challenges facing management.3
The need to undertake this work has been widely supported,
including through the Triad Communiqué
(www.icn.ch/triad/inaugural/2006TRiadCommunique.pdf) issued
after the May 2006 WHO/ICN/ICM meeting of government chief
nursing and midwifery officers and representatives of national
nursing and midwifery associations and regulatory bodies from 101
countries. The Communiqué articulated international nursing
leaders’ concerns for patient safety if skill mix changes are
introduced without effective controls and a clear understanding of
accountability, delegation and supervisory responsibilities within the
nursing personnel category.
The work has been endorsed by the ICN Credentialing Forum and
the ICN Observatory on Licensure and Registration. Both agreed
that it is imperative to turn attention to defining the roles and skill
base of the diverse group of health care workers, who are, and will
be, engaged in the delivery of nursing care. In doing so ICN will
contribute to:
5
• providing better tools for more coherent decision-making about
the nature of the nursing work force;
• supporting sound skill mix decisions; and
• managing the current re-configurations occurring within the
health workforce.
Purpose of the ICN Nursing Care Continuum Framework
The Continuum serves several purposes. It:
1. Communicates to nursing and others outside the profession
the range of roles and incremental complexity of the
competencies required to fulfil increasing levels of
responsibility.
2. Clarifies relationships and accountability among the different
levels within the Continuum.
3. Provide a tool to interpret levels of responsibilities and
accountability across health systems and jurisdictions.
4. Assist in a variety of situations such as deciding on curriculum
content, negotiating skill mix and developing job descriptions.
5. Help evaluate and manage the introduction of new or
changing nursing roles and responsibilities.
6. Guide formulation or revision of competencies at a national or
jurisdictional level.
Approach
Using the Continuum Framework, competencies are identified for
the range of personnel most commonly found in the 129 ICN
member countries. The Continuum does not claim to address all the
possible levels that may exist in a particular country or jurisdiction
(e.g. Advanced Enrolled Nurse, Registered Psychiatric Nurse, etc.).
Countries are encouraged to make the necessary adaptation to
include other categories important to them. Additionally, the
Continuum does not seek to describe progression of competencies
within a particular level associated with the development of practice
from that of the newly qualified to the expert practitioner. However,
the support worker is included as this category is widely used and
does carry out nursing care in many countries. Moreover, nurses
have accountability and supervisory relationships for this group.
In the Continuum the following categories are addressed:
1. Support or assistive worker
2. Enrolled nurse/ Registered Nurse Assistant/Licensed Practical
Nurse
3. Registered/Licensed Nurse
4. Specialist Nurse
5. Advanced Practice Nurse
For clarity it is important to state that the competencies are those
associated with a person who is newly qualified in the particular
role.
6
The development of the Continuum is a result of a two step process.
First, a small steering group was invited to comment on the
attached competency matrix and encouraged to consult widely,
particularly with educators and directors of nursing services. After
making modifications based on feedback from this consultation, the
document was circulated widely for comment to all ICN members
and others such as regulators, nurses in government and ICN’s
affiliates.
Definition of Categories within the Continuum
The Nursing Care Continuum is derived from the definition of
nursing4 adopted by ICN. The Continuum:
encompasses nursing care delivered through autonomous
and collaborative practise targeted towards individuals of all
ages, families, groups and communities, sick or well and in all
settings. Within this context, nursing includes the promotion of
health, prevention of illness, and the care of ill, disabled and
dying people. Additionally, advocacy, promotion of a safe
environment, research, participation in shaping health policy
and in patient and health systems management, and
education are also key aspects of nursing.
! Nursing support worker (SW) is the term applied to the
auxiliary category that assists directly in nursing care in
institutional or community settings under the standards and the
direct or indirect supervision of nurses.5 They are paid providers
who are neither registered nor licensed by a regulatory body.
They have no legally defined scope of practice or mandatory
 education or practice standards. Diverse titles are applied to this
health care worker such as nursing assistant, auxiliary, support
worker, orderly, aide, home support workers, personal care
worker, health care assistant, and community health worker.
! An enrolled, registered or licensed practical nurse (EN) is a
person authorised to practise within the limits of a defined scope
of practice and under the supervision (direct or indirect) of a
registered nurse. Titles that may be applied to this category
include licensed or trained practical nurse, and registered
assistant nurse.
! A registered or licensed nurse (RN) is a self-regulated health
care professional who works autonomously and in collaboration
with others and (a) has successfully completed a programme of
education approved by the nursing board/council, (b) has
passed the required assessments established by the nursing
board/council for entry into the profession and (c) continues to
meet the standards of the nursing board/council.6 The terms
licensed, professional or qualified nurse are used in a similar
sense.
! The nurse specialist (NS) is a nurse prepared beyond the level
of a nurse generalist and authorised to practice as a specialist
with advanced expertise in a branch of the nursing field.
Specialist practice includes clinical, teaching, administration,
research and consultant roles.7
7
! The advanced practice nurse (APN) is a registered nurse who
has acquired an expert knowledge base, complex decision
making skills and clinical competencies for expanded practice;
the characteristics of which are shaped by the context and/or
country in which s/he is credentialed to practice. Titles in this
category vary from country to country and are applied
inconsistently, even with the same country. Titles such as nurse
practitioners, clinical nurse specialist, and consultant nurse are
used in conjunction with this category.
For other definitions, refer to the glossary.
Assumptions
The following assumptions have been and should be kept in mind
when interpreting the links and progression of competence levels
across the Continuum:
1. Health care delivery requires a range of personnel providing
nursing services.
2. There will be variability across countries and jurisdictions in the
definition of scope of nursing practice and, therefore, in the way
nursing and non-nursing functions are interpreted.
3. Regulation of roles is in the public interest, but needs to be
sufficiently permissive to encourage innovation and
development to meet changing and new care needs.
4. Roles are described in terms of competencies needed to deliver 10. While competencies are described in terms of practice and do
the service. not include a statement of the associated academic levels,
5. Each set of competencies provides a unique and distinctive progress in the Continuum from support worker to advanced
contribution to health care. In their differentiation (into separate practice nurse is contingent on acquiring the knowledge,
levels), the spectrum of health needs are addressed and are mastery of skills, and experience required to fulfil that role
articulated at the level required for the individual entering that completely. In some jurisdictions that may require undertaking a
level. formal programme of study and achieving a specific
6. The Registered Nurse role is pivotal in the Continuum of nursing qualification.
care delivery. 11. The three major domains in the Continuum Framework overlap
7. Nursing competencies and associated tasks and activities that since the management and provision of care are underpinned
may be performed by other nursing personnel are consistent by professional, ethical and legal practice and, due to changing
with the legal scope of nursing practice and legal requirements needs, require the individual to continue to develop and remain
as defined within a country or as part of an international trade competent as practice evolves.
agreement.
8. Although the responsibility for the performance of a nursing task
or activity may be transferred to a nursing support worker,
accountability rests with the professional (registered/licensed)
nurse who remains answerable for the outcome.
9. Although certain competencies can be shared across two or
more levels of the Continuum, in general they are progressive in
terms of complexity from support worker to advanced practice
nurse.

8
ICN Framework of Competencies
Initially, the ICN Framework of Competencies for the Generalist
Nurse was developed to identify competencies expected of a
generalist nurse at the point of entry into professional practice.8 It
has been used in various ways internationally. For example, the
regulatory bodies of the concerned countries used it to identify
common competencies for registered nurses in South East Asia and
the Western Pacific.9 Another application was as a guide to the
development of a competency inventory for registered nurses in the
People’s Republic of China.10 In the King Faisal Specialist Hospital
and Research Centre in Saudi Arabia, the ICN Framework formed
the basis for a clinical practice assessment portfolio for new
graduates undertaking a period of internship.11
As a result of the consultation for the Continuum the major domains
and some of the sub-domains of the Framework have been revised
(Figure 1). The competencies under three domains are:
1. Professional, ethical and legal practice
2. Care provision and management
3. Professional, personal, and quality development
In undertaking work on the Continuum the ICN competencies for the
registered (generalist) nurse were used as the initial benchmark
against which all other competencies in the Continuum have been
set. As the registered nurse competencies were five years old ICN
took the opportunity to review and revise them as part of the
Continuum development process. The specialist nurse
competencies were based on those developed as part of work
9
undertaken in collaboration with the European Parkinson’s Disease
Association. The advanced practice competencies have been
developed in collaboration with the ICN International Nurse
Practitioner and Advanced Nursing Network.
In some cases an individual practitioner may develop competencies
in one or more of the areas beyond those set as the initial
benchmarks. This can occur as a result of progress from novice to
expert in their role, as part of preparation for moving to more
developed roles, or as part of a particular demand of the position to
which they have been appointed. Any individual who functions at a
level beyond the initial benchmark in one or more areas is not
considered competent or recognised as functioning at the higher
level unless all requirements are met and any additional formal
preparation or assessment have been completed.
Finally, in developing the Nursing Care Continuum Framework and
Competencies ICN consulted widely in order to arrive at
international consensus. However, these competencies should not
be regarded as prescriptive. Those utilizing the Continuum need to
refer to their particular context and make revisions accordingly.
Some areas may need further expansion and others may be
inappropriate, while areas that are important to practice in their
country may have been omitted. Additionally, some countries may
wish to use the competencies as the basis for developing more
detailed guidance that can inform curriculum development by
identifying the underpinning knowledge and skills required to
achieve the competencies. Figure 2 provides an example of how
this may be developed.
 ICN FRAMEWORK OF COMPETENCIES
Figure 1: Revised ICN Competency Framework

PROFESSIONAL, ETHICAL, LEGAL PRACTICE

Accountability Ethical Practice

Legal Practice

CARE PROVISION AND MANAGEMENT

Key Principles of Care

Health Promotion Assessment

Planning Implementation

Evaluation Therapeutic Communication &

Relationships

Leadership and Management

Inter-professional Health Care Delegation & Supervision

Safe Environment

PROFESSIONAL, PERSONAL &

QUALITY DEVELOPMENT

Enhancement of the Profession Quality Improvement Continuing Education

10
Figure 2: Example of knowledge and skills required to achieve competencies associated with delegation and supervision

Delegation and Supervision

Knowledge & Skills SW EN RN NS APN

Definition and principles of effective delegation (5 rights of delegation) !
Forms of delegation including the use of protocols, guidelines, standing orders !
Relation of delegation to professional role, scope of practice and personal accountability/responsibilities, !
statutory and regulatory authority for delegation
Organisational responsibilities, policies and procedures to support delegation decisions and supervisory !
activities
Definition and principles of supervision of individuals !
Types and methods of supervision (direct and indirect) !
How delegation/supervision contributes to effective use of health resources and the continuum of care !

Role as receiver of delegation/supervision: Concept of delegation/supervision !

How/when to request additional instruction, training and !
support
Right to decline a delegated activity !

Skills: 1. Formulating organisational policies/procedures and creating adequate structures and resources !
to support delegation and supervisory responsibilities
2. Communicating delegated task !
3. Monitoring and providing feedback delegated tasks !
4. Using a variety of methods for guidance, instruction, support !

! Denotes level at which initial knowledge and/or skill is obtained. Knowledge in that area may be further expanded in breadth and depth as a
person progresses in experience and the Continuum.

11

Support Worker
1 Accepts accountability to
client, employer and registered
nurse.
2 Undertakes functions as
directed.
Knows and communicates
own limits of knowledge and
skill when accepting
assignments.
3 Seeks assistance and
guidance from a registered
nurse when encountering
situations beyond training
and/or when undertaking a
delegated task.
4 Understands different levels of
accountability for the range of
available personnel.
5 Participates in activities
Enrolled Nurse
Accepts accountability for own
professional judgement,
actions, outcomes of care and
continued competence in
accordance with scope of
practice, legislative acts and
regulations.
Recognizes the limits of scope
of practice and own
competence.
Seeks guidance from a
registered nurse with the
required knowledge, skills and
when encountering situations
that fall beyond own
knowledge, competence or
scope of practice.
Recognizes and respects
different levels of
accountability for the range of
available personnel.
Accountability
Registered Nurse
Accepts accountability for own
professional judgement,
actions, outcomes of care and
continued competence in
accordance with scope of
practice, increased
responsibility, legislative acts
and regulations.
Recognizes the limits of scope
of practice and own
competence.
Seeks guidance from the
appropriate others when
encountering situations
beyond own knowledge,
competence or scope of
practice.
Recognizes and respects the
different levels of
accountability for the range of
available personnel.
related to improving the
access to the range of
services required for effective
health services.
12
Specialist Nurse
Accepts accountability for
increased responsibility, for
own professional judgement,
actions, outcomes of care and
continued competence in
accordance with scope of
practice, legislative acts and
regulations.
Recognizes the limits of scope
of practice and own
competence.
Consults with or refers to the
appropriate others when
encountering situations
beyond own knowledge,
competence or scope of
practice.
Recognizes and respects
different levels of
accountability for the range of
available personnel.
Participates in activities
related to improving the
access to the range of
services required for effective
specialist services.
Advanced Practice Nurse
Accepts accountability for
increased role responsibilities,
own professional judgement,
actions, outcomes of care and
continued competence in
accordance with changing
scope of practice, legislative
acts and regulations.
Sets boundaries that
acknowledge practice changes
and developments as well as
conform to legal requirements,
policies and own level of
competence.
Consults with or refers to the
appropriate others when
encountering situations
beyond own knowledge,
competence or scope of
practice.
Recognizes and respects
different levels of
accountability for the range of
available personnel.
Works collaboratively with
other health care
professionals, planners, policy
makers and community
leaders to improve service
access, clinical efficacy and
quality of care.
13

Support Worker
6 Conforms to employer’s code
of conduct.
7 Recognizes ethical issues as
they relate to own role, and
seeks guidance in dealing
with situations with ethical
implications.
8 Upholds right for the client to
be cared for in circumstances
that sustain human and
patient rights, and report
violations.
9 Maintains confidentiality and
security of written and verbal
information acquired during
the course of work.
10 Respects the client’s right to
privacy and dignity.
11 Respects the client’s right to
choice and self-determination
in nursing and health care.
Enrolled Nurse
Practises in a manner that
conforms to the ICN Code of
Ethics, the professional code in
force in the jurisdiction and
employer’s code of conduct.
Engages in effective ethical
decision-making in
collaboration and consultation
with other team members.
Acts in an advocacy role to
protect human rights and
questions violations of client in
accordance with jurisdictional
and the ICN Codes of Ethics.
Maintains confidentiality and
security of written, verbal and
electronic information acquired
in a professional capacity.
Respects the client’s right to
privacy and dignity.
Respects the client’s right to
choice and self-determination
in nursing and health care.
Ethical Practice
Registered Nurse
Practises in a manner that
conforms to the ICN Code of
Ethics, the professional code
in force in the jurisdiction and
employer’s code of conduct.
Engages in effective ethical
decision-making with respect
to own professional
responsibilities or where
ethical issues affect the
broader health care team.
Acts in an advocacy role to
protect human rights and
questions violations of client
in accordance with
jurisdictional and the ICN
Codes of Ethics.
Maintains confidentiality and
security of written, verbal and
electronic information
acquired in a professional
capacity.
Respects the client’s right to
privacy and dignity.
Respects the client’s right to
information, choice and self-
determination in nursing and
health care.
14
Specialist Nurse
Practises in a manner that
conforms to the ICN Code of
Ethics, the professional code
in force in the jurisdiction and
employer’s code of conduct.
Engages in effective ethical
decision-making with respect
to own professional practice
areas or where ethical issues
affect the broader health care
team.
Acts in an advocacy role to
protect human rights and
questions violations of client
in accordance with
jurisdictional and the ICN
Codes of Ethics.
Maintains confidentiality and
security of written, verbal and
electronic information
acquired in a professional
capacity.
Respects the client’s right to
privacy and dignity.
Respects the client’s right to
information, choice and self-
determination in nursing and
health care.
Advanced Practice Nurse
Practises in a manner that
conforms to the ICN Code of
Ethics, the professional code
in force in the jurisdiction and
employer’s code of conduct.
Engages in effective ethical
decision-making and
contributes to resolution and
the positive promotion of
ethical practice in the health
system.
Acts in an advocacy role to
protect human rights and
questions violations of client
in accordance with
jurisdictional and the ICN
Codes of Ethics.
Participates in policy and
system development to
increase the levels of
confidentiality and security of
written verbal and electronic
information acquired in a
professional capacity.
Respects the client’s right to
privacy and dignity.
Participates in establishing
policies that confirm the
client’s right to information,
choice and self-determination
in nursing and health care
and applies these in practice.

Support Worker
12 Follows organisational
procedures to report observed
behaviour, actions or
situations that could
compromise client safety,
privacy or dignity.
13
Ethical Practice (cont.)
Enrolled Nurse
Challenges behaviour and
health care practice that could
compromise client safety,
privacy or dignity.
Registered Nurse
Challenges behaviour and
health care practice that could
compromise client safety,
privacy or dignity.
15
Specialist Nurse
Challenges behaviour and
health care practice that could
compromise client safety,
privacy or dignity.
Demonstrates professional
integrity, probity and ethical
conduct in response to
industry marketing strategies
when prescribing drugs and
other products.
Advanced Practice Nurse
Participates in creating
mechanisms to monitor and
respond to situations where
behaviour or health care
practice may compromise
client safety, privacy or
dignity.
Demonstrates professional
integrity, probity and ethical
conduct in response to
industry marketing strategies
when prescribing drugs and
other products.

Support Worker
14 Works within existing legal
and organisational framework.
15 Adheres to organisational
policies and procedural
guidelines.
16 Raises concerns to direct
supervisor or those in
authority, in cases of harm or
abuse of clients.
Enrolled Nurse
Practices in accordance with
professional, relevant civil
legislation and regulations.
Practices in accordance with
jurisdictional and local policies
and procedural guidelines.
Recognizes and acts upon
breaches of law relating to the
professional role and/or
professional code of
conduct/code of practice.
Legal Practice
Registered Nurse
Practices in accordance with
professional, relevant civil
legislation and regulations.
Practices in accordance with
jurisdictional and local policies
and procedural guidelines.
Recognizes and acts upon
breaches of law relating to the
professional role and/or
professional code of
conduct/code of practice.
16
Specialist Nurse
Practices in accordance with
professional, relevant civil
legislation and regulations
including those specific to
area of specialty practice.
Practices in accordance with
jurisdictional and local policies
and procedural guidelines.
Recognizes and acts upon
breaches of law relating to the
professional role and/or
professional code of
conduct/code of practice.
Advanced Practice Nurse
Practices independently in
accordance with professional,
relevant civil legislation and
regulations including those
specific to the advanced
practice role.
Practices in accordance with
jurisdictional and local policies
and procedural guidelines
pertaining to the advanced
practice nursing role.
Recognizes and acts upon
breaches of law relating to the
professional role and/or
professional code of
conduct/code of practice.
17

Support Worker
17 Can accurately describe
activity or task.
18 Uses acquired knowledge
and skills when fulfilling role
requirements.
19 Recognizes and reports a
problem when it occurs
during the course of work.
20 Delivers care according to
instructions of the supervisor,
and in concordance with
nursing and organisational
standards and procedures.
21 Understands that care may
need to be modified to
cultural needs.
Principles of Care Provision
Enrolled Nurse
Provides a rationale for the
nursing care delivered.
Uses current knowledge
based on best practice when
carrying out professional
responsibilities.
Uses clinical problem solving
skills to guide practice.
Delivers care consistent with
professional and
organisational standards,
policies, protocols and
procedures.
Recognizes culturally
sensitive needs and adapts
practice accordingly.
Registered Nurse
Uses knowledge from nursing,
health and other disciplines
combined with best available
evidence to explain nursing
decisions and interventions.
Applies contemporary
knowledge from different
sources and the best
available evidence to base
professional decision-making
and practice.
Applies critical thinking skills
and a systems approach to
problem solving and nursing
decision-making across a
range of professional and
care delivery contexts.
Delivers care consistent with
professional and
organisational standards,
policies, protocols and
procedures.
Recognizes culturally
sensitive needs and adapts
practice accordingly.
18
Specialist Nurse
Uses knowledge from nursing,
health and other disciplines
combined with best available
evidence to explain nursing
decisions and interventions.
Applies contemporary
knowledge from different
sources and area for
speciality and the best
available evidence to base
professional decision-making
and practice.
Applies critical thinking skills
and a systems approach to
problem solving and nursing
decision-making and
speciality care delivery
contexts.
Delivers care consistent with
professional and
organisational standards,
policies, protocols and
procedures applicable to
specialist nursing practice.
Recognizes culturally
sensitive needs and adapts
practice accordingly.
Advanced Practice Nurse
Draws on knowledge within
nursing and across other
disciplines and best available
evidence to provide a
rationale for APN decisions
and interventions.
Integrates scientific
knowledge, best available
evidence and expert
judgement to guide and
advance practice.
Applies critical thinking,
clinical reasoning and expert
judgement to decision-
making in complex areas of
practice and across a range
of professional and care
delivery contexts.
Delivers care consistent with
professional guidelines,
standards, policies, protocols
and procedures applicable to
advanced nursing practice.
Recognizes breaches and
intervenes at the practice and
system levels to ensure that
care is sensitive to cultural
needs.

Support Worker
22 Is aware of clients’ beliefs and
practices in traditional healing
practices.
23 Consults with supervisor
before providing information
about rights of a health
service user.
24 Demonstrates awareness of
resources available for
assisting clients with changes
in health, disability and death.
25 Provides support in the
development and/or
maintenance of independent
living skills.
26 Under the guidance of a
supervisor, gives simple
instruction appropriate to level
of knowledge and work
responsibility.
Principles of Care Provision (cont.)
Enrolled Nurse
Understands the significance
of traditional healing practices
within a client’s health belief
system.
Informs clients about rights of
a health service user.
Knows how to access and use
resources available to assist
clients deal with changes in
health, disability and death.
Provides guidance/ instruction
in the development and/or
maintenance of independent
living skills.
Uses opportunities to
introduce health-related
instruction during the care
process.
Registered Nurse
Incorporates traditional
healing practices valued by
clients and with proven
beneficial/or harmless effects
into care activities.
Applies advocacy skills to
assist clients unable to
represent or speak for
themselves.
Acts as an information and
education resource and for
clients seeking to improve life
styles, adopt illness/injury
prevention activities and
cope with changes in health,
disability and death.
Provides guidance/
instruction in the
development and/or
maintenance of independent
living skills.
Recognizes opportunities and
provides guidance/education
to individuals, families and
communities to encourage
adoption of illness prevention
activities and maintenance
healthy lifestyles.
19
Specialist Nurse
Incorporates traditional
healing practices valued by
clients and with proven
beneficial or harmless effects
into care activities.
Applies advocacy skills to
assist clients unable to
represent or speak for
themselves regarding
speciality care requirements.
Acts as an information and
education resource in the
speciality area for clients
seeking healthier life styles,
adopt illness/injury prevention
activities and cope with
changes in health, disability
and death.
Provides guidance/
instruction in the
development and/or
maintenance of independent
living skills.
Recognizes opportunities and
provides guidance/ education
to individuals, families and
communities to encourage
adoption of illness prevention
activities and maintenance of
healthy lifestyles.
Advanced Practice Nurse
Searches for evidence to
support claims for the
beneficial effects of traditional
healing practices and
incorporates as appropriate.
Uses advocacy skills to
influence health policy and
planning and service access
on behalf of clients unable to
represent or speak for
themselves.
Develops resources,
programmes and formulates
implementation strategies
designed to promote healthy
life styles, and adoption of
illness/injury prevention
activities of individuals,
families or communities.
Contributes to planning and
policy development designed
to promote self sufficiency
and independent living skills.
Identifies and responds
creatively to new opportunities
for health education/patient
education based on client and
community needs, and
available resources, and
using strategies based on the
best evidence available.
 Principles of Care Provision (cont.)
Support Worker Enrolled Nurse Registered Nurse
27 Contributes to the teaching Selects teaching/learning
plan established by the strategies appropriate to the
registered nurse. needs and characteristics of
the individual or group.
28 Gives feedback to client and Evaluates learning outcomes
supervisor on results of and modifies
instruction. teaching/learning approaches
and content accordingly.
.
29 Demonstrates awareness of
major developments and the
potential application of current
communication/health
technologies in health care.
20
Specialist Nurse
Selects teaching/learning
strategies appropriate to the
needs and characteristics of
the individual or group.
Evaluates learning outcomes
and modifies
teaching/learning approaches
and content accordingly.
Keeps abreast of
developments and potential
applications of emerging
communication/health
technologies in health care.
Advanced Practice Nurse
Participates in creating, and
establishing evidence-based
implementation strategies for
education programmes
designed to encourage
learning about health
promotion and illness/injury
prevention, and stimulate
participation of clients to meet
own health needs.
Monitors educational
programme implementation
and evaluates outcomes and
impact on behaviour.
Uses evaluation data to
improve educational
programme outcomes.
Identifies opportunities for and
participates in the
assessments of new
communication/health
technologies to practice prior
to introduction into the
practice context.
21

Support Worker
30 Maintains own health and
personal fitness for/at work.
31 Seeks involvement in
activities designed to reduce
illness and promote healthy
life styles and environments.
32 Demonstrates an
understanding of how health
and disease are affected by
basic hygiene, sanitation and
nutrition.
Enrolled Nurse
Maintains own health and
personal fitness for/at work.
Participates with nurses, other
professionals and community
groups in activities to reduce
illness and promote healthy
life styles and environments.
Demonstrates an
understanding of how health
and disease are affected by
multiple and interconnected
factors.
Promotion of Health
Registered Nurse
Maintains own health and
personal fitness for/at work.
Cooperates with nurses, other
professionals and community
groups in activities to reduce
illness and promote healthy
life styles and environments.
Incorporates into practice a
perspective that takes
account of the multiple
determinants of health.
22
Specialist Nurse
Maintains own health and
personal fitness for/at work.
Cooperates with other
professionals and community
and speciality interest groups
in activities to reduce illness
and promote healthy life
styles and environments in
areas important to speciality
practice.
Incorporates into practice a
perspective that takes
account of the multiple
determinants of health.
Advanced Practice Nurse
Maintains own health and
personal fitness for/at work.
Engages actively with other
health professionals,
planners, policymakers,
advocacy and community
groups to formulate strategies
and mobilize resources for
improving the health status of
the community.
Incorporates a perspective
that takes account the
multiple determinants of
health when developing
illness prevention, health
promotion and capacity
building strategies for
individuals, families and
communities.

Support Worker
33 Undertakes delegated
aspects of health data
collection within sphere of
competence.
34 Reports changes that may
affect health and well being.
35 Reports observations and
complies with organisational
policy.
Enrolled Nurse
Undertakes delegated
aspects of health data
collection within sphere of
competence and contributes
data and information to the
assessment made by the
registered nurse.
Identifies common and overt
actual and potential health
problems and notes findings
that lie outside the norm.
Reports and keeps accurate,
timely records of findings
complying with professional
standards and organisational
policies.
Assessment
Registered Nurse
Gathers accurate and relevant
objective and subjective data
through systematic health and
nursing assessments-
Organises, synthesizes,
analyses, and interprets data
from different sources to
derive a nursing diagnosis
and determine a care plan.
Shares and documents
findings accurately and in a
timely manner complying with
professional standards and
organisational policies.
23
Specialist Nurse
Gathers accurate and relevant
objective and subjective data
required for practice in
specialty area through
systematic health and nursing
assessments, ordering
diagnostic tests and
procedures as permitted in
the scope of specialist
practice and legislation.
Organises, synthesizes,
analyses, and interprets data
from different sources to
derive nursing diagnoses and
determine a care plan.
Shares and documents
findings accurately and in a
timely manner complying with
professional standards and
organisational policies.
Advanced Practice Nurse
Gathers accurate and relevant
objective and subjective data
for client assessment using
multiple data collection
strategies and information
sources, ordering diagnostic
tests and procedures as
permitted in the scope of
advanced nursing practice
and legislation.
Applies advanced clinical
reasoning judgement and in-
depth knowledge to derive a
differential diagnosis and
determine a comprehensive
care plan.
Shares and documents
findings accurately and in a
timely manner complying with
professional standards and
organisational policies.

Support Worker Enrolled Nurse
36 Contributes information to Assists the registered nurse to
assist with care planning. formulate a care plan for
clients based on assessment
results.
37 Uses relevant knowledge
from nursing and other
disciplines to contribute to
care planning.
38 Establishes priorities for care
with nurse supervisor.
39 Directs questions from clients Provides accurate information
about care plan to the nurse to clients about aspects of
supervisor. care plan that fall within own
responsibility.
Planning
Registered Nurse
Formulates a comprehensive
care plan with identified care
outcomes based on nursing
diagnoses, findings from a
nursing and health
assessment, inputs from other
health team members, and
nursing practice standards.
. practice standards.
Applies critical thinking and
clinical reasoning skills
underpinned by knowledge of
nursing and other disciplines
to the care planning process.
Establishes priorities for care
in collaboration with other care
providers and clients.
Involves clients where
possible in care planning
ensuring that they receive
accurate, understandable
information on which to base
consent for care.
24
Specialist Nurse
Formulates a compre-
hensive care plan with
identified care outcomes
based on nursing diagnoses,
findings from a nursing and
health assessment, inputs
from other health team
members, and nursing
Applies critical thinking and
clinical reasoning skills
underpinned by knowledge
of the area of specialist
practice and other
disciplines to the care
planning process.
Establishes priorities for
care in collaboration with
other care providers and
clients.
Involves clients where
possible in care planning
ensuring that they receive
accurate, understandable
information on which to base
consent for care
Advanced Practice Nurse
Formulates and mobilizes
resources for a coordinated
comprehensive care plan with
identified care outcomes and
based on advanced nursing
practice standards, and
informed decisions about
preventive, diagnostic and
therapeutic interventions.
Applies critical thinking and
complex clinical reasoning
underpinned by in depth
theoretical, scientific and
contemporary clinical and
health system knowledge to
the care planning process.
Negotiates to meet priorities
for care within available
health resources and the
system capabilities.
Involves clients where
possible in care planning
ensuring that they receive
accurate, understandable
information on which to base
consent for care.

Support Worker
40 Reports concerns regarding
clients’ ability to understand
and make decisions.
41 Contributes to care plan
review and revision.
42 Keeps records of activities.
Enrolled Nurse
Reports and requests an
advocate when clients and/or
carers ask for support, have
limited abilities in decision-
making, giving informed
consent, or where there is a
language barrier.
In collaboration with a
registered nurse, regularly
reviews and revises the care
plan.
Under the supervision of a
registered nurse maintains a
current, accurate care plan
and related records.
Planning (cont.)
Registered Nurse
Involves an advocate when
clients, families or carers
request support or have
limited abilities in decision-
making, giving informed
consent, or where there is a
language barrier.
Regularly reviews and
revises the care plan, where
possible in collaboration with
other members of the
health/social health team,
and clients.
Maintains a current, accurate
care plan and related
records.
25
Specialist Nurse
Involves an advocate when
clients, families or carers
request support or have
limited abilities in decision-
making, giving informed
consent, or where there is a
language barrier.
Regularly reviews and revises
the care plan, where possible
in collaboration with other
members of the health/social
health team, and clients.
Maintains a current, accurate
care plan and related
records.
Advanced Practice Nurse
Implements a mechanism to
assure the presence of an
advocate when clients,
families or carers request
support or have limited
abilities in decision-making,
giving informed consent or
where there is a language
barrier.
Regularly reviews and revises
the care plan, where possible
in collaboration with other
members of the health/social
health team, clients and/or
carers.
Maintains a current, accurate
care plan and related
records.

Support Worker
43 Assists with care under the
direction of an enrolled or
registered nurse.
44 Records task undertaken
and observations accurately
and in a timely fashion
according to organisational
procedures.
45 Identifies and reports
unexpected changing
situations.
46 Summons immediate
assistance in an emergency/
disaster situation.
Applies life support skills until
assistance arrives.
Enrolled Nurse
Under the supervision of the
registered nurse, implements
planned nursing
interventions in accordance
with nursing and best
practice standards.
Documents interventions
and client responses
accurately and in a timely
manner.
Identifies and reports
unexpected changing
situations.
Summons immediate and
appropriate assistance to the
emergency/disaster
situation.
Applies life support skills
until assistance arrives.
Implementation
Registered Nurse
Implements a range of
procedures, treatments and
interventions that fall within
scope of practice for the
registered nurse and are in
accordance with nursing and
best practice standards.
Documents interventions
and client responses
accurately and in a timely
manner.
Responds appropriately and
in time to unexpected or
rapidly changing situations.
Responds immediately and
appropriately to emergency
and disaster situations,
including launching life
support procedures when
necessary, and other
emergency/disaster
procedures.
26
Specialist Nurse
Implements a range of
procedures, treatments
and interventions that fall
within scope of specialist
practice and are in
accordance with specialist
nursing and best practice
standards.
Documents interventions
and client responses
accurately and in a timely
manner.
Responds appropriately
and in time to unexpected
or rapidly changing
situations.
Responds immediately and
appropriately to emergency
and disaster situations
taking a leadership role in
triage and coordination of
care for clients with
specialty care needs.
Advanced Practice Nurse
Implements procedures,
treatments and interventions
that fall within the legal
authority, scope of extended
practice and are in accordance
with nursing and best practice
standards.
Documents interventions and
client responses accurately
and in a timely manner.
Adapts interventions to the
needs of the client and/or the
environment in unexpected or
rapidly changing situations.
Mobilizes and coordinates
resources and assumes
leadership in emergency
and/or disaster situations.

Support Worker Enrolled Nurse
47 Contributes information to the Monitors and documents
evaluation of progress toward progress toward expected
expected care outcome. outcomes accurately and
completely.
48 Contributes to team
evaluation of progress
towards planned outcomes.
49 Contributes evaluation data
and suggests modifications in
the care plan to the registered
nurse.
Evaluation
Registered Nurse
Monitors and documents
progress toward expected
outcomes accurately and
completely.
In consultation with clients,
families and/or carers, and
health team members,
evaluates progress towards
planned outcomes.
Uses evaluation data to
modify the care plan.
27
Specialist Nurse
Monitors and documents
progress toward expected
outcomes accurately and
completely.
In consultation with clients,
families and/or carers, and
health team members,
evaluates progress towards
planned outcomes.
Uses evaluation data to
modify the care plan.
Advanced Practice Nurse
Monitors and documents
progress toward expected
outcomes accurately and
completely.
In consultation with clients,
families and/or carers,
participates in interdisciplinary
evaluation of progress
towards planned outcomes.
Uses evaluation data to
influence care strategies and
inform future practice trends.

Support Worker
50 Operates within scope of work
to initiate, develop and
discontinue interpersonal
relationships with
patients/clients and/or carers.
51 Maintains a relationship that
respects the boundary
between clients and self.
52 Listens to others in an
unbiased manner, respects
points of view of others.
53 Communicates clear,
consistent and accurate
information about client status
that falls within scope of work
and maintains confidence in
care.
54 Interacts in a manner that is
respectful and culturally
appropriate to the clients,
family and/or carers from
diverse cultural backgrounds.
55 Facilitates access to
information or refers request
to the appropriate person.
Therapeutic Communication and Interpersonal Relationships
Enrolled Nurse
Initiates, develops and
discontinues therapeutic
relationships through the use
of appropriate communication
and interpersonal skills.
Maintains a relationship that
respects the boundary
between clients and self.
Listens to others in an
unbiased manner, respects
points of view of others.
Communicates clear,
consistent and accurate
information verbally, or in
written and electronic forms,
that falls within professional
responsibility and maintains
confidence in care.
Interacts in a manner that is
respectful and culturally
appropriate to the clients,
family and/or carers from
diverse cultural backgrounds.
Facilitates access to
information or refers request
to the registered nurse.
Registered Nurse
Initiates, develops and
discontinues therapeutic
relationships through the use
of appropriate communication
and interpersonal skills.
Maintains a relationship that
respects the boundary
between clients and self.
Listens to others in an
unbiased manner, respects
points of view of others, and
promotes the expression of
diverse opinions and
perspectives.
Communicates clear,
consistent and accurate
information verbally, or in
written and electronic forms,
that falls within professional
responsibility and maintains
confidence in care.
Interacts in a manner that is
respectful and culturally
appropriate to the clients,
family and/or carers from
diverse cultural backgrounds.
Facilitates access to
information or refers request
to the appropriate person.
28
Specialist Nurse
Initiates, develops and
discontinues therapeutic
relationships using a range of
advanced communication and
interpersonal skills.
Maintains a relationship that
respects the boundary
between clients and self.
Listens to others in an
unbiased manner, respects
points of view of others, and
promotes the expression of
diverse opinions and
perspectives.
Communicates clear,
consistent and accurate
information verbally, or in
written and electronic forms,
that falls within professional
responsibility.
Interacts in a manner that is
respectful and culturally
appropriate to the clients,
family and/or carers from
diverse cultural backgrounds.
Facilitates access to
information or refers request to
the appropriate person.
Advanced Practice Nurse
Initiates, develops and
discontinues therapeutic
relationships through the use
of advanced communication
and interpersonal skills.
Maintains a relationship that
respects the boundary
between clients and self.
Listens to others in an
unbiased manner, respects
points of view of others, and
promotes the expression of
diverse opinions and
perspectives.
Communicates clear,
consistent and accurate
information verbally, or in
written and electronic forms,
that falls within professional
responsibility and maintains
confidence in care.
Interacts in a manner that is
respectful and culturally
appropriate to the clients,
family and/or carers from
diverse cultural backgrounds.
Advocates for and assists with
establishing policies that
facilitate access for clients to
information relevant to their
situation.
 Therapeutic Communication and Interpersonal Relationships (contd.)

Support Worker Enrolled Nurse Registered Nurse Specialist Nurse Advanced Practice Nurse

56 Communicates activities
carried out to other team
members, providing sufficient
information for their needs.
Communicates and shares
relevant information, including
views of clients, families
and/or carers with other
health team members
involved in providing services.
Communicates and shares
relevant information including
views of clients, families
and/or carers with other
health team members
involved in providing services.
Communicates and shares
information including views of
clients, families and/or carers
with other health team
members involved in
providing services.
Takes measures to create
effective mechanisms for
communicating and sharing
information with other health
team members involved in
providing services.

29

Support Worker
57 Understands factors that
contribute to creating a
positive workplace
environment.
58
59 Recognizes conflicts and uses
interpersonal skills and
available organisational
mechanisms to achieve
resolution.
60
61
62 Manages assigned work
within agreed timeline.
Leadership and Management
Enrolled Nurse
Advocates for and contributes
to creating a positive working
environment.
Understands the need for
different leadership styles and
approaches in different
situations.
Recognizes conflicts and uses
interpersonal skills and
available organisational
mechanisms to achieve
resolution.
Supports leader in a
consistent manner that
promotes respect and
confidence amongst the team.
Prioritizes workload and
manages time effectively.
Registered Nurse
Advocates for and acts within
span of control to create a
positive working environment.
Adapts leadership style and
approaches to different
situations.
Confronts conflict in a non-
judgemental fashion, making
effective use of
communication skills and
existing mechanisms to
achieve resolution.
Contributes to team
leadership by reinforcing
goals so as to promote
respect and confidence
amongst the team.
Able to articulate own
leadership contributions and
support expectations of other
team members.
Prioritizes workload and
manages time effectively.
30
Specialist Nurse
Advocates for and acts within
span of control to create a
positive working environment.
Adapts leadership style and
approaches to situations
specific to the speciality
practice area.
Confronts conflict in a non-
judgemental fashion, making
effective use of
communication skills and
existing mechanisms to
achieve resolution.
Leads in a manner to inspire
respect and confidence from
others.
As team leader and in line
with current job description,
clearly defines contributions
and expectations required of
team members
Prioritizes workload, manages
time effectively and allocates
resources to optimise
outcomes.
Advanced Practice Nurse
Advocates for and implements
policies and strategies within
the health system to establish
positive practice
environments, including the
use of best practices in
recruiting, retaining and
developing human resources.
Engages in succession
planning and active
preparation of future leaders
through education, coaching
and mentoring.
Addresses conflicts promptly
and creatively, recognizing
the potential for opportunities
for new solutions.
Creates confidence in self and
in the organisation to inspire
others by tailoring leadership
behaviours to maximise the
contribution of others.
Creates a vision and acts to
provide all members of the
team with a sense of
ownership and control over
their work.
Prioritizes caseload,
manages time effectively and
allocates resources to
optimise outcomes.

Support Worker
63 Demonstrates awareness of
the role of policies and
procedures in the
management of the
organisation.
64 Participates in unit based
teaching/ learning activities.
65 Offers suggestions and
provide feedback for changes
in own sphere of work.
Leadership and Management (cont.)
Enrolled Nurse
Demonstrates understanding
of how policies and
procedures are developed
and contributes to feedback to
review committees.
Participates in unit based
teaching/ learning activities.
Provides feedback and offers
suggestions for changes in
own sphere of practice and
deals effectively with the
impact of change on own
practice.
Registered Nurse
Contributes to the review and
modification of current
organisational and practice
policies and procedures
currently in force.
Contributes to education and
professional development of
students and colleagues in
the work place.
Provides feedback, offers
suggestions for changes and
deals effectively with the
impact of change in own
practice or on the
organisation.
31
Specialist Nurse
Contributes to the review and
modification of current
organisational and practice
policies and procedures
currently in force and provides
leadership in developing and
implementing organisational
and practice policies and
procedures specific to the
specialty area.
Contributes to the
development and
implementation of specialist
education and professional
development of students and
colleagues in the work place.
Uses the change process to
influence the introduction of
innovations and adaptations
to specialist practice and
service organisation.
Advanced Practice Nurse
Develops and implements
mechanisms for periodic
monitoring and evaluation of
policies that impact on nursing
services and translates these
into health plans, structures,
and programmes.
Promotes policies and
advocates for resources to
support education and
professional development in
the work setting.
Introduces, evaluates and
manages innovation and
change in the health system
through encouraging
creativity.

Support Worker
66 Identifies and reports
situations that may impact on
the safety of patients/clients
or staff.
67 Contributes to safety and
security measures through
timely action and adherence
to national legislation and
workplace health and safety
measures.
68
69
Enrolled Nurse
Identifies and reports
situations that may impact on
the safety of patients/clients
or staff.
Maintains a safe care
environment through timely
action and adherence to
national legislation and
workplace health and safety
requirements, policies and
procedures.
Stores therapeutic substances
safely and securely.
Administers and records
medication under the
supervision of a registered
nurse when legally permitted.
Safe Environment
Registered Nurse
Uses appropriate assessment
tools to identify actual and
potential risks to safety and
reports concerns to the
relevant authority.
Takes timely action through
the use of quality
improvement risk
management strategies to
create and maintain safe care
environment and meet
national legislation and
workplace health and safety
requirements, policies and
procedures.
Ensures the safe and proper
storage, administration and
recording of therapeutic
substances.
Administers and records
medication, assesses side-
effects and titrates dosages in
accordance with authorised
prescriptions.
32
Specialist Nurse
Uses appropriate assessment
tools to identify actual and
potential risks to safety and
security and reports concerns
to the relevant authority.
Takes timely action through
the use of quality
improvement risk
management strategies to
create and maintain safe care
environment and meet
national legislation and
workplace health and safety
requirements, policies and
procedures.
Ensures the safe and proper
storage, administration and
recording of therapeutic
substances.
In accordance with
prescriptive authority selects/
prescribes/ administers
medication, including accurate
dosage, routes and frequency
pattern, based upon accurate
knowledge of the
pharmacological effect,
patient characteristics and
concurrent therapies.
Advanced Practice Nurse
Uses regular assessments to
identify actual and potential
environmental, patient,
personnel safety and security
risks and reports concerns to
the relevant authority.
Uses multiple interventions
and risk management
strategies to initiate change
and maintain safe
environments within the
system and that meet national
legislation and health and
safety requirements.
Ensure that policies and
procedures are in place for
the safe and proper storage,
administration and recording
of therapeutic substances.
In accordance with
prescriptive authority
selects/prescribes/
administers medication,
including accurate dosage,
routes and frequency pattern,
based upon accurate
knowledge of the
pharmacological effect,
patient characteristics and
concurrent therapies.

Support Worker
70 Complies with infection
prevention procedures.
71 Knows actions to take in the
event a disaster is declared.
Safe Environment (cont.)
Enrolled Nurse
Complies with infection
prevention procedures.
Knows actions to take in the
event a disaster is declared.
Registered Nurse
Complies with infection
prevention procedures and
challenges breaches in other
practitioners’ practice.
Knows responsibilities’ and
procedures to follow in the
event a disaster is declared.
33
Specialist Nurse
Complies with infection
prevention procedures and
challenges breaches in other
practitioners’ practice.
Identifies and plans for
specific measures necessary
to deal with patients/clients in
area of specialty practice in
the event of a disaster.
Advanced Practice Nurse
Is proactive in highlighting and
proposing improvements to
infection control strategies for
all practice sites.
Contributes to the formulation
of service disaster and
recovery plans.

Support Worker
72 Accepts delegated/
assigned activities for which
preparation has been
provided and proficiency
has been assessed.
Provides feedback to
73 persons delegating/
assigning activities and
supervising work.
74 Accepts responsibility for
delegated activity.
75
Delegation and Supervision
Enrolled Nurse
Accepts delegated activities in
line with personal level of
proficiency and legal scope of
practice.
Provides feedback to persons
delegating/assigning activities
and supervising work.
Maintains accountability for
outcomes of delegated activity.
Registered Nurse
Delegates to others, activities
according to ability, level of
preparation, proficiency and
legal scope of practice.
Accepts delegated activities in
line with personal level of
proficiency and legal scope of
practice.
Monitors and uses a range of
supportive strategies including
precepting when supervising
and/or monitoring delegated
care.
Maintains accountability and
responsibility when delegating
aspects of care to others.
Contributes to policy and
protocol development that
relates to delegation of clinical
responsibilities.
34
Specialist Nurse
Delegates to others, activities
according to ability, level of
preparation, proficiency and
legal scope of practice.
Accepts delegated activities
in line with personal level of
proficiency and legal scope
of practice.
Monitors and uses a range of
supportive strategies
including precepting and
mentoring when supervising
and/or monitoring delegated
care.
Maintains accountability and
responsibility when
delegating aspects of care to
others.
Contributes to policy and
protocol development that
relates to delegation of
clinical responsibilities
specific to speciality practice.
Advanced Practice Nurse
Delegates to others, activities
according to ability, level of
preparation, proficiency and
legal scope of practice.
Offers supportive strategies
including mentoring, coaching
and precepting as part of
supervisory responsibilities.
Maintains accountability and
responsibility when delegating
aspects of care to others.
Contributes to policy and
protocol development that
relates to delegation of clinical
responsibilities within nursing
and across the health
professions.
 Inter-Professional Health Care
Support Worker Enrolled Nurse
76 Understands some roles and Understands and values the
skills of other care providers roles, knowledge and skills of
in relation to own members of the health care
responsibilities. team in relation to own
responsibilities.
77 Cooperates to maintain Cooperates to maintain
effective multidisciplinary effective multidisciplinary
teamwork. teamwork.
78 Uses basic knowledge of
effective inter- and intra-
professional working
practices.
79 Communicates views of
patients/clients and/or carers
to assist with decision-making
by the inter-professional team.
80 Refers clients to a registered
nurse to ensure
patients/clients have access
to best available interventions.
81
Registered Nurse
Understands and values the
roles, knowledge and skills of
members of the health team in
relation to own responsibilities.
Works collaboratively with
other professionals in health
care to enhance nursing and
other health services being
accessed by clients.
Uses knowledge of effective
inter- and intra-professional
working practices.
Presents and supports the
views of clients, families
and/or carers during decision-
making by the inter-
professional team.
Refers clients to ensure
patients/clients have access to
best available interventions.
35
Specialist Nurse
Understands and values the
roles, knowledge and skills of
members of the health team
in relation to own
responsibilities.
Works collaboratively with
other professionals in health
care to enhance nursing and
other services offered in
specialty area.
Uses knowledge of effective
inter- and intra-professional
working practices.
Presents the views of clients,
families and/or carers in
decision-making by the inter-
professional team and assists
with negotiation of mutually
agreed decisions.
Refers clients and accepts
referrals from other health
care providers to ensure
clients have access to best
available intervention.
Advanced Practice Nurse
Creates an environment that
fosters trust among health
care providers, and familiarity
of the knowledge and skills
that different professions and
disciplines bring to health
service delivery.
Utilizes leadership, team
building, negotiation and
conflict resolution skills to
build intra-/inter-professional,
agency and community
partnerships to improve
quality of care and address
gaps/barriers to access.
Engages in active promotion
of inter- and intra-professional
collaborative working
practices within the practice
environment.
Presents the views of /clients,
families and/or carers in inter-
and intra-professional team
decisions and assists and/or
leads in the negotiation of
mutually agreed decisions.
Makes referrals to and
receives referrals from other
health care providers to
promote continuity of care and
ensure offer best available
intervention.
Accepts accountability and
responsibility for caseload
management.
 Enhancement of the Profession
Support Worker Enrolled Nurse
82 Understands how professional Knows and follows
standards contribute to the professional standards and
safety and quality of care. best practices applicable to
professional responsibilities.
83 Promotes and maintains a
positive image of nursing.
84 Acts as an effective role
model for enrolled nurse
students and support staff.
85 Acts as a resource for
enrolled nursing students and
support staff.
86
Registered Nurse
Promotes dissemination, use,
monitoring and review of
professional standards and
best practice guidelines.
Promotes and maintains a
positive image of nursing.
Acts as an effective role
model for students and within
the care team.
Acts as a resource for
students, other members of
the health team and the
public.
Values research in
contributing to developments
in nursing and uses findings
as a means to improving
standards of care.
36
Specialist Nurse
Promotes dissemination, use,
monitoring and review of
professional specialist
standards and best practice
guidelines and participates in
developing and adapting
standards to the practice
context.
Promotes specialist nursing
practice as an essential part
of health service delivery.
Acts as an effective role
model for students and within
the care team.
Acts as a resource in
speciality area for students,
other members of health
team, health planners and the
public
Contributes to knowledge and
practice development of the
clinical nursing speciality
through identifying and
conducting research in areas
of need.
Advanced Practice Nurse
Provides leadership in
developing the evidence base
for professional standards and
best practice and leads in
developing and adapting
standards to the practice
context.
Articulates and promotes the
advanced practice nursing
role in the clinical, political
and professional contexts.
Acts as an effective role
model for students and within
the care team.
Acts as a resource on
advanced nursing practice for
students, other members of
the health team, health
planners and the public.
Contributes new knowledge
to practice development by
conducting research,
dissemination and
incorporating findings into
practice.
 Enhancement of the Profession (cont.)
Support Worker Enrolled Nurse
87
88
89 Engages in advocacy
activities through the
professional organisation to
influence health and social
care service policies and
access to services.
Registered Nurse
Scans practice environment
and nursing literature to
identify emerging trends and
issues.
Engages in advocacy
activities through the
professional organisation to
influence health and social
care service policies and
access to services.
37
Specialist Nurse
Advocates for and participates
in obtaining public, legal and
employer recognition of
specialist qualifications, title
protection and related scope
of practice.
Scans practice environment
and specialist nursing
literature to identify emerging
trends and issues.
Engages in advocacy
activities through professional
organisations to influence
health and social care service
policies and service provision
important to the area of
speciality practice.
Advanced Practice Nurse
Advocates for and
participates in obtaining
public, legal and employer
recognition of advanced
practice nursing
qualifications, title protection
and scope of practice.
Scans the global environment
for emerging trends in
advanced practice and health
care.
Leads advocacy activities
through professional
organisation to influence
health and social care service
policies that impact on the
availability and access to
advanced nursing practice
services.

Support Worker
90 Undertakes tasks as directed
and in line with policies,
procedures, quality measures
and with level of training.
91 Suggests ideas to the
appropriate person for
services improvement.
Enrolled Nurse
Undertakes tasks as directed
and in line with policies,
procedures, quality measures
and with level of training.
Participates in quality
improvement and quality
assurance procedures.
Quality Improvement
Registered Nurse
Follows evidence-based and
best practice guidelines in the
delivery of nursing practice.
Participates in quality
improvement and quality
assurance procedures.
38
Specialist Nurse
Uses and contributes to
research into the evidence
base for safe, effective,
efficient practice in speciality
area.
Uses systematic review to
improve client experience and
outcomes in area of speciality.
Advanced Practice Nurse
Translates and integrates
research to produce evidence
based practice to improve
safety, efficiency and
effectiveness of care.
Participates in intra- and inter-
disciplinary peer supervision
and review to improve client
experience and outcomes.

Support Worker
92 Identifies gaps between
current work requirements
and current knowledge,
understanding and skills.
93 Routinely attends up-date
sessions relevant to
developments on own and
associated areas of work.
94 Takes opportunities to learn
together with others
contributing to health.
Enrolled Nurse
Undertakes regular review of
own practice by engaging in
reflection and peer review.
Assumes responsibility for
lifelong learning, own
professional development and
maintenance of competence.
Takes opportunities to learn
with others contributing to
health care.
Continuing Education
Registered Nurse
Undertakes regular review of
own practice by engaging in
reflection, critical examination
and evaluation and seeking
peer review.
Assumes responsibility for
lifelong learning, own
professional development and
maintenance of competence.
Takes opportunities to learn
with others contributing to
health care.
39
Specialist Nurse
Undertakes regular review of
own practice by engaging in
reflection, critical examination
and evaluation and seeking
peer review.
Assumes responsibility for
lifelong learning, own
professional development and
maintenance of competence.
Participates in uni- and
multidisciplinary teaching
learning.
Advanced Practice Nurse
Undertakes regular review of
own practice by engaging in
reflection, critical examination
and evaluation and seeking
peer review.
Assumes responsibility for
lifelong learning, own
professional development
and maintenance of
competence.
Promotes and encourages
programmes that support
interdisciplinary health care
education.
GLOSSARY

Accountability: The readiness or preparedness to give an explanation or justification to relevant others (for one's judgements, intentions, acts
and omissions) when appropriately called upon to do so.

Competence: The effective application of a combination of knowledge, skill and judgement demonstrated by an individual in daily practice or
job performance. In nursing definitions, there is wide ranging agreement that, in the performance of nursing roles to the standards required in
employment, competence reflects the following:

" Knowledge, understanding and judgement;

" A range of skills cognitive, technical or psychomotor and interpersonal; and

" A range of personal attributes and attitudes.12

Clinical Judgement: The process of arriving at a clinical decision after assessment of alternatives.

Clinical Reasoning: The cognitive process that informs and underpins autonomous clinical practice, involving the gathering and interpretation
of data, generation of hypotheses and making of decisions regarding patient care.

Critical Thinking: Critical thinking is essential as a tool of inquiry. It is a purposeful, results-oriented process that focuses on information
seeking, decision making and problem solving and involves a process of interpretation, analysis, inference and evaluation of information.

Delegation: Delegation involves the transfer of responsibility for the performance of a task from one individual to another while the person
whose task is being delegated retains accountability for the outcome.13 It involves assessment of the needs of the client and the abilities of the
person being assigned the delegated activities and includes the responsibility of the person whose task is being delegated for the ongoing direct
or indirect supervision and monitoring of patient outcome and performance of the individual undertaking the delegated activities.

Scope of Practice: The range of roles, functions, responsibilities and activities, which a registered/licensed professional is educated for,
competent in, and is authorised to perform. It defines the accountability and limits of practice.14

40
Skill Mix: The mix of posts in the establishment; the mix of employees in a post; the combination of skills available at a specific time; or the
combination of activities that comprise each role, rather than the combination of different job titles.15

Supervision: The active process of directing, guiding and influencing the outcome of an individual’s performance of a task.16 Direct supervision
refers to the situation when the supervisor is physically present when the task is being done. Indirect supervision occurs when the supervisor is
not physically present but communicates instruction, directions and guidelines through various forms of communication – written, verbal or
electronic.

Task: A set of activities aimed at reaching a specific goal or objective. It involves a number of skills. It is at a lower level than a competency,
stipulating what is done but not indicating why it is done.17

41
REFERENCES

1
Buchan J & Calman L (2004). The Global Shortage of Registered Nurses: An Overview of Issues and Actions, International Council of Nurses.
2
Center to Improve Care of the Dying, Continuity of Care. Retrieved 17 May, 2006 from www.gwu.edu/~cicd/toolkit/contin.htm.
3
Buchan J & Calman L. (2004). Op. Cit., p41
4
Adapted from the ICN Definition of Nursing. Available on www.icn.ch/definition.htm
5
International Council of Nurses (1993). Nursing Support Workers: Position Statement and Guidelines. No longer in print.
6
Adapted from Regulation Terminology, International Council of Nurses (2005), p21. Available on icn.ch/regterms.htm.
7
Affara FA & Styles MM (1992). Nursing Regulation Guidebook: From Principle to Power.
8
Alexander MF & Runciman PJ (2003). ICN Framework of Competencies for the Generalist Nurse, International Council of Nurses.
9
Australian Nursing and Midwifery Council (2004-2005). 13th Annual Report.
10
Lui M, Kunaiktikul W, Tonmukayakul O and Eriksen L (2006). Development of Competency Inventory for Registered Nurses in the People’s
Republic of China: Scale Development. Int. J. Nurs. Stud.: 4, 2006.
11
King Faisal Specialist Hospital & Research Centre, Nursing Saudization Department, Clinical Practice Assessment Portfolio. Retrieved 17
May 2007 from www.kfshrc.edu.sa/saudization/files/Clinical%20Practice%20Assessement%20Portfolio.doc
12
Adapted from Regulation Terminology, International Council of Nurses (2005), Op. Cit. p9.
13
American Nurses Association (2005). Principles for Delegation. Retrieved 17 May 2007 from
www.indiananurses.org/education/principles_for_delegation.pdf, p4.
14
Adapted from Regulation Terminology, International Council of Nurses (2005), Op. Cit. p33.

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15
Buchan J, Ball J and O’May F (2000). Determining skill mix in the health workforce: guidelines for managers and health professionals. Issues
in health services delivery paper no. 3. Department of Organisation of Health Services Delivery. World Health Organisation. Retrieved 17 May
2007 from www.who.int/mipfiles/2361/Disc.3-
Determiningskillmix.pdf#search='Determining%20skill%20mix%20in%20the%20health%20workforce%3A%20guidelines%20for%20managers%
20and%20health%20professionals
16
American Nurses Association (2005). Op. Cit, p4.
17
Uys LR (2004). Competency in Nursing. World Health Organization. Retrieved 17 May 2006 from
www.rsdesigns.com/extranet/IMG/pdf/Competency_in_Nursing.pdf#search='Competency%20in%20Nursing%20uys', p3.

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