Nurse Practitioner Application Guidelines

Nurse Practitioner Scope
of Practice
GUIDELINES FOR APPLICANTS
Updated October 2020
Nurse Practitioner Guidelines

Te Kaunihera Tapuhi o Aotearoa | Nursing Council of New Zealand 1
Contents
Introduction........................................................................................................................................4
About nurse practitioners..........................................................................................................................4
Nurse practitioner scope of practice....................................................................................................4
Area of nursing practice.........................................................................................................................4
Competencies for the nurse practitioner scope of practice.............................................................5
Nurse practitioner qualifications..........................................................................................................6
Continuing competence requirements................................................................................................6
Who can apply to be a nurse practitioner?....................................................................................7
Application criteria......................................................................................................................................7
NPs applying for removal or change of condition..................................................................................8
Achieving prescribing by non-prescribing nurse practitioners............................................................8
Applications: explanatory notes...............................................................................................................8
How to apply............................................................................................................................................8
Application assistance............................................................................................................................9
Council assistance...................................................................................................................................9
Section One: Application Documentation..........................................................................................10
Application overview................................................................................................................................11
Documentation describing your practice:.........................................................................................11
Content guide........................................................................................................................................11
1. Your practice background..........................................................................................................11
2. Attestations, Competence assessment, referee contact details...........................................12
3. Master’s education.......................................................................................................................12
4. Case studies..................................................................................................................................13
5. Professional activities and leadership.......................................................................................14
6. Professional development..........................................................................................................14
7. Teaching........................................................................................................................................14
Important points for your application documentation and evidence...........................................14

Te Kaunihera Tapuhi o Aotearoa | Nursing Council of New Zealand
October 2020 2
Section Two: The Assessment Process..........................................................................................15
Assessment process.................................................................................................................................16
Overview of assessment process.......................................................................................................16
Aim of the assessment process..........................................................................................................16
Educational credentials........................................................................................................................17
Internationally qualified applicants....................................................................................................17
Initial assessment.................................................................................................................................18
Panel assessment.................................................................................................................................18
Assessment panel.................................................................................................................................19
Nursing Council decision.........................................................................................................................21
Review process......................................................................................................................................21
Reassessment panel.........................................................................................................................21
Council review...................................................................................................................................22
Appeal.................................................................................................................................................22
Comprehensive Case Study.....................................................................................................................23
Less comprehensive case studies......................................................................................................24
Clinical Diary..........................................................................................................................................24
Section Three: Forms & Templates................................................................................................25
Appendix One: Competence assessment form....................................................................................26
Nurse Practitioner competencies and elements..................................................................................29
Appendix Two: Clinical diary...................................................................................................................32
Appendix Three: Professional activities/leadership.............................................................................33
Appendix Four: Professional Development..........................................................................................34
Appendix Five: Teaching..........................................................................................................................35
Appendix Six: Evidence Record...............................................................................................................36

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Introduction
These guidelines set out application requirements and detail the documentation and evidence
required.
About nurse practitioners

Nurse practitioner scope of practice
Nurse practitioners have advanced education, clinical training and the demonstrated competence
and legal authority to practise beyond the level of a registered nurse.
Nurse practitioners work autonomously and in collaborative teams with other health
professionals to promote health, prevent disease, and improve access and population health
outcomes for a specific patient group or community. Nurse practitioners manage episodes of care
as the lead healthcare provider in partnership with health consumers and their families/whānau.
Nurse practitioners combine advanced nursing knowledge and skills with diagnostic reasoning
and therapeutic knowledge to provide patient-centred healthcare services including the diagnosis
and management of health consumers with common and complex health conditions. They
provide a wide range of assessment and treatment interventions, ordering and interpreting
diagnostic and laboratory tests, prescribing medicines within their area of competence, and
admitting and discharging from hospital and other healthcare services/settings. As clinical leaders
they work across healthcare settings and influence health service delivery and the wider
profession.
Area of nursing practice

In April 2017 Nursing Council made changes to the nurse practitioner scope of practice and
education programmes that prepare nurse practitioners to meet the future health needs of New
Zealanders. The scope of practice is now broadened and the requirement to restrict nurse
practitioners to a specific area of practice has been removed.
Nurse practitioners as advanced clinicians will be expected to self-regulate and practice within
their area of competence and experience.
No matter what the nurse’s area of practice and/or conditions they may have on their registered
nurse scope of practice, a breadth of nurse practitioner practice is required and all nurse

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practitioners will be expected to be able to do a full health assessment and examination, i.e. full
review of systems and physical examination.
It is expected that all nurse practitioners can differentiate between normal and abnormal findings
in a comprehensive assessment, and appropriately refer on conditions that are out of their area
of expertise
This means that an applicant who practices in mental health is still required to be able to do a full
physical health assessment and examination, and likewise an applicant working in physical health
will be expected to be able to assess a client’s mental health. The expectation is not that the
applicant can diagnose a condition outside their area of practice but that they can assess
abnormalities so they can appropriately refer on. For example, if an applicant is working in
physical health they should be able to assess if the client is possibly depressed, confused or
showing evidence of thought disturbance, and likewise if the applicant is working in mental health
they should be able to identify possible physical abnormalities in the client group with which the
applicant works.
Competencies for the nurse practitioner scope of practice

Six competencies are organised into five themes which describe nurse practitioner practice.
Each competency consists of several elements (see Appendix One). These elements are used
for assessment at application for registration as a nurse practitioner.
Theme A: Provides safe and accountable advanced practice
1. Demonstrates safe and accountable nurse practitioner practice incorporating strategies

to maintain currency and competence.
Theme B: Assesses, diagnoses, plans, implements and evaluates care
2. Conducts comprehensive assessments and applies diagnostic reasoning to identify

health needs/problems and diagnoses.
3. Develops, plans, implements and evaluates therapeutic interventions when managing
episodes of care.
Theme C: Works in partnership with health consumers
4. Consistently involves the health consumer to enable their full partnership in decision
making and active participation in care.
Theme D: Works collaboratively with healthcare teams

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5. Works collaboratively to optimise health outcomes for health consumers /population
groups.
Theme E: Works to improve the quality and outcomes of healthcare
6. Initiates and participates in, activities that support safe care, community partnership and
population health improvements.
Nurse practitioner qualifications

To register in the Nurse Practitioner scope of practice and receive the title Nurse Practitioner, a
nurse must:
a. be registered with the Nursing Council of New Zealand in the registered nurse scope of
practice
b. complete an approved clinical master’s degree programme (or overseas equivalent*) for the
nurse practitioner scope of practice. The programme must include relevant theory and a
minimum of 300 hours of clinical learning
c. have at least four years’ experience in an area of practice at the time of the application
d. pass an assessment against the nurse practitioner competencies by a Council-approved
panel.
Continuing competence requirements

Every three years, nurse practitioners must provide evidence they have maintained
competence, when they apply for their practising certificate. The evidence required is as
follows:
· ongoing peer review of their practice by an authorised prescriber

· at least 40 hours per year of professional development over a 3 year period
· at least 40 days per year of nursing practice as an NP over a 3 year period.

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Who can apply to be a nurse practitioner?
Application criteria
The following are the minimum criteria that must be met by all applicants applying for nurse
practitioner registration:
 Registration in New Zealand in the registered nurse scope of practice.

 Hold a current annual practising certificate.
 Be in good professional and personal standing.
 Completed a Council approved clinical master’s degree programme or, for internationally
qualified nurses, a recognised equivalent qualification with the required courses*.
 Demonstrated ability to meet the competencies for the nurse practitioner scope of practice
Advice for US/Canadian Nurse Practitioners
Council recognizes that US and Canadian NPs scope of practice and level of autonomy and
responsibility is similar to that required of New Zealand NPs.
Only New Zealand RNs can apply for registration in the NP scope of practice, therefore US and
Canadian NPs seeking to practice in New Zealand as nurse practitioners must first register in the
RN scope (see ‘Guidance for internationally qualified nurses’ from the Council website).
Before applying for registration in the NP scope, the New Zealand RN (US/Canadian NP) should
practice in New Zealand in a senior RN role for sufficient time to acquire the required portfolio
evidence and to demonstrate how they meet the Council’s NP competencies. The applicant may
choose to include additional supporting evidence from their recent practice in their home country.
For section 3 evidence of their portfolio please see the advice below.
*Portfolio section 3: Masters education
Council recognizes that clinical Masters /Doctoral programmes completed by licensed practising
US/Canadian nurse practitioners are sufficient to meet the educational requirements for
registration in the NP scope of practice. Therefore US/ Canadian NPs do not need to have their
qualifications assessed for educational equivalence but must include the relevant academic
transcripts in section 3 of their portfolio (as outlined above).
For additional advice, US/ Canadian NPs can email regquality@nursingcouncil.org.nz

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NPs applying for removal or change of condition
Nurse practitioners who wish to remove or change their area of practice condition can apply for a
change of condition by submitting verified evidence of their knowledge and experience of working
safely with clients beyond their area of practice condition.
We recommend applying for this as part of your three-yearly recertification (otherwise there is a
$200 change of condition fee). Change of condition applications are submitted via your MyNC.
The supporting evidence should include:
· A cover letter outlining your request

· current curriculum vitae detailing your work history since registration as a nurse practitioner
· detailed evidence of your recent professional development relevant to caring for clients at an
NP level beyond your area of practice condition
· assessment of practice against the nurse practitioner competencies completed by a nurse
practitioner or medical practitioner. The competence assessment must affirm your
competence in managing care at an NP level for clients beyond your area of practice condition.
This should include relevant examples from your clinical practice.
Achieving prescribing by non-prescribing nurse practitioners

Non-prescribing nurse practitioners (registered before 1 July 2014) should contact Nursing
Council for advice on how to achieve authorised prescriber status.
Applications: explanatory notes

How to apply
From your MyNC ‘details’ page, select the banner ‘I want to apply for nurse practitioner’ (on details
page). You will be prompted to complete your application online including making declarations
regarding your fitness to practice. You will be asked to upload the required documents in PDF
form (one PDF for each Section) and to make payment. You will be able to access a receipt for this
payment via MyNC.
After completing your application, you will be reminded to send in to Council certified evidence of
your completed Masters education by emailing link(s) to your eQuals to
regquality@nursingcouncil.org.nz and/or by posting in originals or certified copies of your
transcript(s) to Nursing Council. The Council’s address for receiving your original or certified

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copies of educational transcripts is: Registrant Quality, Nursing Council of New Zealand, Level 5,
22 Willeston St, Wellington 6011.
if you want us to return your education transcripts returned to you, please also include a prepaid
courier bag with your name and address clearly stated.
Application assistance
We strongly recommend you seek advice and mentorship from a nurse practitioner before
submitting your portfolio, and that you use multiple sources of support while preparing your
application. Help is available from Nurse Practitioners NZ (College of Nursing Aotearoa).
Visit http://www.nurse.org.nz/npnz-nurse-practitioners-nz.
Council assistance
We can’t help you with preparing your application, but if you have questions with regard to your
application that are not covered in these Guidelines you can contact Council staff via
regquality@nursingcouncil.org.nz.

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Section One: Application
Documentation

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Application overview
Documentation describing your practice:
Sections:
1. Your practice background (CV; Area of practice and philosophical statement)

2. Attestations; Competence assessment NP competencies; Referee contact details
3. Masters education
4. Case studies (two), plus (optional) clinical diary and/or brief cases
5. Professional activities and leadership
6. Professional development
7. Teaching
You will also need to submit a completed evidence record (see Appendix 6 in these guidelines).
Content guide
1. Your practice background
Curriculum vitae (CV)
Your CV must outline your work history showing how your practice has developed. You should
include summaries of key achievements and responsibilities for each position (related to the NP
competencies) to highlight the development of your practice over time with cumulative
experience.
Area of Practice and philosophical statement
A description of your area of practice should be included so that assessment of the clinical
competencies can be in the realm of your practice expertise. It is also important that you can
show you know your practice boundaries.
Your practice and philosophical statement (maximum two pages) should:
· define the range and parameters of your practice and your area of clinical focus for
NP registration. It should include population group, key clinical roles/responsibilities,
interventions/treatments you intend to provide and health consumer outcomes you
are seeking to achieve;
· demonstrate an advanced autonomous clinical role, along with evidence of
collaborative approach;
· outline the nursing models/theories/frameworks/values which underpin and guide
your practice.
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2. Attestations, Competence assessment, referee contact details
Professional attestations
Attestations show evidence of meeting specific competencies and can be presented in different
ways. Sometimes an attestation may be one person attesting to a specific competency or co-
signed by two or more colleagues attesting to a broader range of competencies. When attesting to
competencies it is important that referees provide examples and context, rather than just listing
elements from the competencies document.
Include a minimum of two attestation letters (maximum five) of support from senior colleagues.
For international applicants these letters must be from colleagues you have worked with in NZ.
One letter must be from your authorised prescriber mentor with detailed comment on your
prescribing competence. One letter should be from your NP mentor.
The letters must address the following:
· The writer’s relationship to you as a nurse practitioner applicant

· Details of how you demonstrate advanced nursing practice, with reference to the nurse
practitioner competencies.
All letters must be on letterhead, must be signed and dated and be no more than six months old
at the time of your application.
Competence assessment
Submit an assessment of practice against the competencies for the nurse practitioner scope of
practice using the Competence assessment form for nurse practitioners (Appendix One, and
also available for download on the Nursing Council website).
The competence assessment must be completed by an authorised prescriber, or more than

one authorised prescriber, providing examples of your advanced practice. For international
applicants the competence assessment must refer to your advanced nursing practice in New
Zealand.
Referee contact details
Provide the names, email addresses and phone numbers of two referees who are authorised
prescribers with current knowledge of your advanced nursing practice and who are able to
comment on your nursing practice and prescribing in relation to the nurse practitioner
competencies.

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3. Master’s education
Include transcript(s) of your approved clinical master’s degree programme detailing papers
completed. If your clinical master’s papers were completed at more than one education
provider you must include a transcript from each provider.
Please ensure you include the date your master’s was conferred. This may be stated in your
academic transcript but if it is not please include a copy of your degree award certificate.
A link to My eQuals should be provided, or you can post originals or certified copies of
transcripts to the Nursing Council.
If you are an internationally qualified applicant, to ensure your master’s degree includes
equivalent papers of those required, you will need your master’s degree assessed by a NZ
clinical master’s provider (see page 18). You should include a letter from the NZ clinical
master’s provider who has assessed your master’s degree. When making your application you
will need to submit details of your equivalent qualification eg transcript(s) detailing papers
completed and date the qualification was awarded).
NB: US/ Canadian NPs should review the specific advice on page 18 of these Guidelines.
4. Case studies
Include two comprehensive case studies which show evidence of nurse practitioner
competence. These must include a full health assessment, relevant examination, differential
diagnoses, ordering and interpretation of diagnostic tests, and therapeutic management at an
advanced level. They should showcase your clinical decision making justified by the application
of advanced knowledge, including an understanding of pathophysiological processes and
pharmacotherapeutic knowledge. Information on writing a case study is included on page 24 of
these Guidelines.
Your comprehensive case studies should showcase your knowledge of pharmacological issues
for your client and more broadly regarding your prescribing competence. Other types of
evidence for prescribing are likely to include your professional attestations, competence
assessment and written feedback from your prescribing mentor.
The case studies must review clients whose care you have led and managed. The case studies
must demonstrate clinical practice and decision making at an advanced level, confirming your
ability as an autonomous practitioner. You must also include any evaluation and follow-up
interventions you completed about the case study clients. Comprehensive case studies must
not exceed 10 pages each.
Optional additions

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You may also choose to submit up to four less comprehensive cases (see page 24) to provide
further evidence for the clinical competencies. These additional case studies must not exceed four
pages each.
You may also choose to submit a brief clinical diary (see page 25/33) which provides supporting
evidence for your clinical practice and nurse practitioner competence. Please use the template
provided in Appendix Two. The clinical diary must not exceed five pages.
5. Professional activities and leadership
Include activities in which you have taken an active/lead role. This evidence must be provided in
table form, as shown in Appendix Three of this document.
6. Professional development
Include evidence of your continuing professional development relevant to your area of practice in
the nurse practitioner scope. This evidence must be presented in table form (see Appendix Four).
7. Teaching
Include evidence of teaching and/or lecturing within your area of practice. This evidence must be
presented in table form (see Appendix Five) and can be augmented with a maximum of three
PowerPoint presentations, presented as six slides per page.
Important points for your application documentation and evidence

Your application is your opportunity to describe and provide evidence of your advanced nursing
practice. Only include evidence that showcases your recent advanced nursing practice.
Certification
Certification of copies of your academic transcripts, if not using My eQuals, must be completed by a
Justice of the Peace, Solicitor, Notary Public, Registrar of the Court, or other officer authorised to take
statutory declarations.
Privacy
Remember to maintain privacy in all documents. If you are including correspondence from, or
with, other professionals please ensure their identity is either deleted or their permission to use
these documents in your application is explicit.
Any inclusion of patient details or identifiable situations will be considered a privacy breach and
you will be notified to remove such details.
If you decide to use test results, case notes or referrals, all patient identifiers and other health
professionals’ details must be removed or effectively edited.
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Please refer to the Council’s Code of Conduct and the Privacy Act.

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Section Two: The Assessment
Process

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Assessment process
Overview of assessment process
The table below outlines the application and assessment process.
Application Education Initial assessment Preparation for panel Panel assessment

documentation credentials assessment
Application submitted Has the applicant Assessment of application If successful initial Assessment
via MyNC and achieved the required for the meeting of assessment the applicant interview for
payment processed. content and level of competencies 1, 4, 5 & 6. will be notified of this and competencies 2 & 3
education? the panel date will be
Initial assessment must identified.
Does the applicant be passed/met in order to
demonstrate equivalence proceed to panel Review of application
(for international qualified assessment. documentation/evidence
nurses)? by panel members.
Verbal referee checks
Applicant (with Nursing Council staff. NP Initial Assessor Nursing Council staff Nursing Council
mentor support). Completed within 3 weeks Nursing Council panel panel and applicant.
of receipt of application. members.
Panel date within 5
weeks of passing
Initial Assessment
(excluding public
holidays).
Aim of the assessment process

Under the Health Practitioners Competence Assurance Act (2003) the role of the Council is to
protect public safety. For nurse practitioner registration this is achieved by ensuring the
assessment process conforms to set standards, including the requirements of the Medicines
Amendment Act (2016).
Assessment panels have the key role of undertaking a peer evaluation of an applicant’s practice
and making a recommendation to the Council based on their assessment.

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Educational credentials
All applicants must have successfully completed a Council accredited clinical master’s degree
programme and meet the competencies for the nurse practitioner scope of practice. A list of all
the accredited Master of Nursing programmes (Nurse Practitioner) is on the website
http://www.nursingcouncil.org.nz/Education/Nurse-practitioner
Those applicants who do not have the required master’s degree will need to contact an
approved clinical master’s programme provider to identify any additional courses required.
The required courses are those that focus on advanced knowledge of pathophysiology,
pharmacology, assessment and diagnostic reasoning in relation to clinical management
of and prescribing for clients in New Zealand.
Internationally qualified applicants

(NB US/ Canadian NPs please see page 7 for additional advice)
For internationally qualified nurses to determine educational equivalence of their master’s

degree, including the equivalent papers of those required, they will need to contact an
approved New Zealand clinical master’s programme provider for assessment of equivalence.
A letter from the master’s provider who has assessed the master’s degree should be included
in portfolio evidence to confirm equivalence. Transcript(s) detailing papers completed and date
the master’s qualification was awarded must also be included.
Certified copies of the letter, transcript(s), and certificates included in portfolio evidence should
be posted to Nursing Council (see postal address on page 9 of the guidelines).
If the applicant’s master’s degree is not assessed for equivalence by an approved New Zealand
clinical master’s provider, the qualification can be assessed by Council staff when an application
for Nurse Practitioner is made. Applicants will need to include transcripts and course
descriptors as part of their portfolio if they have not obtained equivalence from an approved
provider.
The nurse practitioner competencies are focused on the clinical context within New Zealand.
This can make it difficult for a nurse practitioner from another country who has not practised
as a nurse in New Zealand to make an immediate transition to the different health care system,
cultural practices and legislative requirements, particularly regarding prescribing.
Letters of attestation (see page 12) and the competence assessment (see page 12) must be in
relation to the applicant’s practise in New Zealand.

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Initial assessment
Once an application is received it is reviewed by Council staff to:
i. confirm the professional good standing of the applicant

ii. ensure the applicant has provided all required information
iii. confirm the applicant has completed an approved clinical master’s degree programme or, if
an internationally qualified nurse an equivalent qualification.
The application is then assessed by an NP assessor for the meeting of competencies 1, 4, 5, & 6.
The purpose of the initial assessment is to:
a. confirm the evidence supplied by the applicant appears to reflect the nurse practitioner
competencies and elements;
b. assess for meeting of the nurse practitioner competencies regarding the provision of safe
and advanced practice (competency 1), working in partnership with health consumers
(competency 4), working collaboratively with healthcare teams (competency 5), and
working to improve the quality and outcomes of healthcare (competency 6).
Applicants will be asked to attend to their evidence if incomplete or insufficient, or if the
applicant has not demonstrated meeting the competencies as identified in item (b) above.
Updated application documentation/evidence must then be returned to the Council within
three months. After three months the application will be treated as a new application and a
new application fee will be payable.
Panel assessment
When all required documentation is present, and an applicant has demonstrated meeting the
required competencies (item (b) above) an assessment panel is arranged.
The role of the assessment panel is to evaluate candidates for their assessment, diagnosing,
planning, implementation and evaluation of care (competencies 2 & 3), and triangulate the
evidence (application documentation/evidence, telephone reference checks, panel interview).
Panel review
In preparation for the panel interview, panel members review the applicant’s
documentation/evidence.
Reference checks
Verbal referee reports will be obtained from the two authorised prescribers nominated by the
applicant. The panel may also request permission to seek further references.

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Assessment panel
Panels will normally consist of a Chair plus two nurse practitioner panelists. There may also be
an observer panel member present.
Please note that all panel interviews will be held by videoconference (Zoom). The applicant will
need to ensure they have a quiet working space and adequate IT resources so they can participate
in their videoconference assessment interview.
Any request for a face to face panel interview should be emailed to the Registrant Quality
Manager (regquality@nursingcouncil.org.nz) at the time of submitting your application.
An applicant may elect to challenge the nomination of a panel member if it is believed there is a
conflict of interest in relation to their application. The conflict of interest must be put in writing
by emailing the Registrant Quality Manager (via regquality@nursingcouncil.org.nz ).
Panel assessment on Marae
It is possible for the panel assessment to be held on an applicant’s local marae and this option is
welcomed by Council if it is preferred.
At the same time the nurse submits their application for nurse practitioner via MyNC, they should
email regquality@nursingcouncil.org.nz with brief advice about their request including advising of
the name and location of the nurses marae and the contact details of a person for Council staff to
liaise with. Council staff would also contact the applicant to confirm the plans for their
assessment.
Panel interview
The purpose of the assessment interview is to give you an opportunity to present your practice
and your achievement of nurse practitioner competencies two and three including elements.
The panel assessment builds on the evidence already provided in the application and allows
panel members to explore some areas in more depth and seek clarification of information
provided.
A written clinical scenario is used as part of the panel assessment.
Key areas of focus within the interview may include:
· assessment, differential diagnosis, treatment and evaluation;

· critical and reflective thinking/practice;
· application of nursing knowledge and evidence-based practice;
· cultural safety;

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· clinical judgment and management of complex situations;
· competence related to prescribing.
You should expect the formal panel interview to take approximately one and a half hours.
You are welcome to have a support person with you to the panel assessment. The role of the
support person is to support the applicant, rather than actively participate. This means the
support person is not able to assist you with the clinical scenario or oral questions, but they will
have opportunity to comment at the end of the panel interview.
Applicants may bring any usual resources they would use in their clinical practice to access
during the allocated time of preparation of response to the clinical scenario.
At the end of the panel interview the assessment panel deliberates and completes the formal
evaluation using the nurse practitioner competencies. The outcome of the assessment is
documented in a report and a recommendation is made to the Council.
You will be informed of the recommendation at the end of your panel interview.
Clinical scenario
During the panel assessment interview for nurse practitioner scope of practice the candidate is
given a written scenario of a clinical situation. The scenario includes standard questions which
will assess competencies two and three:
1. Provide a comprehensive overview of your assessment. The panel will provide answers to
questions you may want to ask.
2. What are your differentials? Discuss rationale to rule in or rule out diagnoses.
3. Present your plan of care based on your assessment and diagnosis.
The purpose of clinical scenario assessment is to test the candidate on their clinical knowledge,
their critical thinking, and their assessment and diagnostic skill. Candidates are expected to
highlight their clinical strengths and demonstrate clinical reasoning.
Candidates are given 20 minutes to prepare for their response and discussion. During the
preparation time the candidate may access any resources they have with them.
Additional questioning around the scenario may be used to assess competence.

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Assessment criteria for NP clinical scenario
A candidate is assessed as having achieved, or not, against each criterion. A candidate must
achieve all criteria, unless criteria are not applicable, to pass the clinical scenario assessment.
1. Patient/client assessment is systematic and comprehensive.

2. Patient/client assessment includes full or focused (as appropriate) physical examination.
3. Patient/client assessment presentation requires minimal or no prompting.
4. Most relevant/critical differential diagnoses are identified.
5. Ruling in and ruling out of differential diagnoses shows critical thinking.
6. Ruling in and ruling out of differential diagnoses includes clear and correct rationale
7. Diagnosis is able to be identified by candidate or confirmed/provided by assessor(s).
8. Management plan for definitive diagnosis is according to evidence and guidelines.
9. Prescribes appropriate dose, duration, and route of medications for the person and clinical
condition.
10. Prescribing decisions can be justified.
11. Prescribing decisions are supported by correct explanation of pharmacokinetics and
pharmacodynamics, including age related considerations.
12. Explanations of physiology, pathophysiology and pharmacotherapy are correct.
13. Patient education information, if relevant, is appropriate and correct.
Nursing Council decision

The recommendation of the assessment panel will be considered by the Registrar. Successful
applicants will be registered in the nurse practitioner scope of practice.
Review process
Reassessment panel
Applicants who are unsuccessful will be informed in writing of the competencies they have not
met, and in some instances the panel may recommend the applicant meet with a panel again
at the next available opportunity to provide further evidence for the competencies not met.

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A reassessment must be requested in writing to the Registrant Quality Manager (via
regquality@nursingcouncil.org.nz) within 20 working days of receiving the panel outcome letter.
If the applicant is returning for reassessment, they are strongly encouraged to submit additional
evidence. Any additional evidence would be to support achievement of the competencies not
met at first panel assessment. This evidence will therefore differ between applicants depending
on their individual achievement and non-achievement of competencies.
It is suggested that an applicant reviews their NP Assessment Record following the panel
assessment with their NP mentor and other relevant authorised prescribers in preparation for
the re-assessment panel interview.
The re-assessment panel will consist of different NP panel members.
Council review
Applicants who have been declined registration in the nurse practitioner scope of practice may
request a review of the decision by the Council (via regquality@nursingcouncil.org.nz). The
request for a review to the Council must be made in writing within 20 working days of receiving
the letter declining registration.
Grounds for a review of the decline decision are:
· that there are issues of justice and fairness related to the assessment process; and/or
· that the decision clearly is incorrect.
Requests for review of the decline decision must be made in writing to the Registrant Quality
Manager. The Council will consider any written or oral submission made by the applicant in
support of their request and may make one of two decisions:
1. Uphold the decline decision, or

2. Recommend a new assessment panel is convened.
Appeal
Alternatively, applicants who have been declined registration may also appeal to the District
Court under section 106 of the Health Practitioners Competence Assurance Act 2003.
Should such an appeal be made through the District Court, applicants will no longer be able to
seek a Council review.

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Comprehensive Case Study
Inclusive of assessment, diagnosis, treatment, pharmacotherapy, and evaluation
1. Chief complaint/presenting problems/illness
2. Full history
· Demographics
· Statement of reliability
· Past medical history
· Family history
· Personal and social history
· Medication history and current medications
· Review of systems detailing any organ impairment
3. Physical examination
4. Review of previous laboratory tests and ordering/review of new tests
5. Diagnosis/differential diagnoses
· List all the differential diagnoses and discuss how these were eliminated by you until final diagnosis (or
diagnoses) was identified.
6. Patient treatment plan
· Include problem identification and prioritisation.

· Include interventions/treatments, including health education.
· The patient’s attitude and expectations, including patient’s participation in the
decision-making/health care plan, his/her ability to participate in the treatment plan, self-
management goals.
· Show a nursing focus.
7. Drug therapy assessment, prescribing, monitoring and evaluation
· List all medications you have prescribed for the patient and the rationale for their inclusion as part of care
(i.e. indication/purpose for drug).
· Discuss pharmacodynamics, pharmacokinetics, dosing and administration issues.
· Discuss adverse effects, appropriateness for the patient – contraindications/patient precautions
· List the potential adverse reactions for each of the medications prescribed.
· Identify any potential emergencies or crises arising from the use of these medications and outline how you
would address these.
· Discuss how medications were monitored.
· Discuss effectiveness.
· Discuss any revisions in plan of care or referrals made based upon response to your initial therapy.
8. Collaboration
· Outline any collaboration with other health professionals.
9. Review of patient outcomes and reflection on your practice
· Evaluation of your patient’s response to intervention(s) and/or effectiveness of the plan, and
Nurse Practitioner
appropriate Guidelines
modification of the care plan.
· Describe the nursing
October 2020 24 model or framework that underpinned and guided your practice in caring for this
patient.
Less comprehensive case studies
If you require further evidence for the clinical competencies you can select some
assessments/consultations and add the clinical evidence you are seeking to
demonstrate, e.g. they may be mini (condensed/bullet-pointed) case studies.
Clinical Diary
A clinical diary can show an outline or snapshot of your recent clinical practice. For
example, a calendar outline of a typical working month or week. If you choose to include
a clinical diary a template for this is in Appendix Two.

October 2020 25
Section Three: Forms &
Templates

October 2020 26
Appendix One: Competence assessment form
Competence assessment form for the nurse practitioner
scope of practice
This form is for nurse practitioners only.
Please refer to the competencies and elements included at the end of this document.
This assessment must be completed by an authorised prescriber.
Sufficient comments must be completed under each competency to substantiate the assessment.
Please complete all the details in the following appropriate boxes:
Name of nurse: Registration Number:
Practice area:
Assessor (authorised prescriber)
Name: Registration number:
Job title: Date:
Email address: Signature:
There are five areas of competence with six competencies for the nurse practitioner scope of practice.
Evidence of safety to practise as a nurse practitioner is demonstrated when the nurse meets all the
competencies.
Provides safe and accountable advanced practice

October 2020 27
Competency Met / Please supply a supporting comment and
Not Met example of how the nurse has met each
Please complete
this box competency.
Competency 1
Demonstrates safe and accountable
nurse practitioner practice
incorporating strategies to maintain
currency and competence.
Assesses, diagnoses, plans, implements and evaluates care

Please complete
Competency 2
Conducts comprehensive
assessments and applies
diagnostic reasoning to identify
health needs/problems and
diagnoses.

Please complete
Competency 3
Develops, plans, implements and
evaluates therapeutic interventions
when managing episodes of care.

October 2020 28
Works in partnership with health consumers

Please complete
Competency 4
Consistently involves the health
consumer to enable their full
partnership in decision making and
active participation in care.
Works collaboratively with healthcare teams

Please complete
Competency 5
Works collaboratively to optimise
health outcomes for health
consumers /population groups.
Works to improve the quality and outcomes of healthcare

Please complete
Competency 6
Initiates and participates in activities
that support safe care, community
partnership and population health
improvements.

October 2020 29
Nurse Practitioner competencies and elements
Competency Elements
1. Demonstrates safe and 1.1 Practises in accordance with legislation, professional standards and health policy relevant to
accountable nurse practitioner nurse practitioner practice.
practice incorporating
strategies to maintain currency 1.2 Practices within safe boundaries around a clearly defined area of practice (client/population
and competence. group) and demonstrates timely referral and consultation when an issue is outside scope, area
of practice, experience or competence.
1.3 Confidently and autonomously provides the full spectrum of healthcare services in relation to
client/population group including health promotion and protection, disease prevention,
guidance and counselling, disease management, maintenance and restoration of health,
rehabilitation and palliative care.
1.4 Self-monitors and critically reflects on practice including through regular professional
supervision, collaborative case review and audit of practice, including prescribing.
1.5 Continually reviews and updates knowledge and skills to ensure currency and adaptability to
address broad and changing population health needs and to practice safely across healthcare
settings.
1.6 Integrates a broad base of nursing knowledge, human sciences (pathophysiology and
psychosocial) and clinical knowledge and skills within a framework of nurse practitioner
practice.
1.7 Demonstrates accountability in considering access, cost and clinical efficacy and applies ethical
decision making when providing health services.

Competency Elements
2. Conducts comprehensive 2.1 Completes a comprehensive health history relevant and appropriate to the client’s presentation.
assessments and applies
diagnostic reasoning to identify 2.2 Actively explores the health consumer’s concerns, preferences, health behaviors, attitudes and
health needs/problems and priorities using a strengths based health promotion focus and risk identification to identify
diagnoses. health care needs.
2.3 Identifies the level of assessment (focused or comprehensive) required and performs a
systematic review based on the client’s presenting condition and health history.
2.4 Demonstrates comprehensive skill in obtaining and interpreting data that informs clinical
judgement and differential diagnosis including prior treatment outcomes, physical findings and
test results.
2.5 Applies analysis, clinical reasoning and problem solving to assessment findings and synthesises
clinical and human science knowledge to develop differential diagnoses.
2.6 Orders or performs diagnostic investigations using evidence to support or rule out diagnoses.
2.7 Formulates an accurate diagnosis from an informed set of differential diagnoses using clinical
reasoning and best available evidence.
2.8 Demonstrates a high level of clinical proficiency in managing common and complex client
situations and acts to prevent and/or diagnose urgent, emergent or life threatening situations.
Competency Elements
October 2020 30
3. Develops, plans, implements and 3.1 Works in partnership with the health consumer to determine therapeutic goals and options.
evaluates therapeutic interventions
when managing episodes of care. 3.2 Makes decisions about healthcare management and interventions informed by critical
evaluation of research findings.
3.3 Develops an individual plan of care and communicates this to health consumer and
appropriate members of the healthcare team and relevant agencies.
3.4 Applies a comprehensive knowledge of pharmacology to make safe and appropriate risk-
benefit prescribing decisions including considerations of antibiotic stewardship and drug
dependency where appropriate.
3.5 Verifies the suitability of evidence-based treatment options including medicines, in regard to
commencing, maintaining/titrating or ceasing treatment/interventions.
3.6 Safely prescribes therapeutic interventions based on accurate knowledge of the
characteristics and concurrent therapies of the health consumer.
3.7 Safely and effectively performs evidence-informed invasive/non-invasive interventions for
the clinical management and/or prevention of illness, disease, injuries, disorders or
conditions.
3.8 Makes appropriate decisions regarding admission and discharge of health consumers from
healthcare services.
3.9 Monitors, critically evaluates and documents treatments/interventions in accordance with
health consumer determined goals and healthcare outcomes.
3.10 Considers a plan for appropriately ceasing and/or modifying treatment in partnership with
the health consumer, and other members of the healthcare team.

Competency Elements
4. Consistently involves the health 4.1 Works to establish a relationship with the health consumer that is characterised by mutual
consumer to enable their full trust and respect, empathy, and collaboration.
partnership in decision making and
4.2 Demonstrates respect for difference in cultural, social and developmental responses to
active participation in care.
health and illness and incorporates health beliefs of the health consumer / community into
care planning and implementation.
4.3 Supports, educates, coaches, motivates, counsels and works in partnership with the health
consumer and their family/whanau where relevant regarding diagnoses, prognoses and
self-management, including their personal responses to illness, injuries, risk factors and
therapeutic interventions.
4.4 Advises the health consumer and their family/whanau where relevant on therapeutic
interventions including benefits, potential side effects, unexpected effects, interactions,
importance of compliance and recommended follow-up.
4.5 Discloses the facts of adverse events to the health consumer and other health professionals;
mitigates harm and reports adverse events to appropriate authorities.
4.6 Respects the rights of the health consumer to make informed decisions whilst taking
accountability to ensure access to accurate and appropriately interpreted information.
4.7 Assesses and contributes to health literacy by sharing knowledge with the health consumer
to achieve evidence-informed management plan.
4.8 Uses appropriate teaching/learning strategies and style to provide diagnostic information,
health promotion and health education to meet health consumer learning needs.

October 2020 31
Competency Elements
5. Works collaboratively to 5.1 Establishes and maintains effective collegial relationships as a senior member of
optimise health outcomes interprofessional teams.
for health consumers
5.2 Collaborates with other health professionals and agencies to ensure timely access
/population groups.
and smooth transition to quality services for the health consumer.
5.3 Demonstrates advanced interpersonal, leadership and management skills to foster
and maintain collegial relationships by communicating and engaging effectively and
professionally with diverse groups and communities to improve healthcare.
5.4 Effects nursing practice and healthcare change using broad based skills including
negotiating, consensus building and partnering.
5.5 Articulates the nurse practitioner role and promotes nursing in clinical, political and
professional contexts.
5.6 Contributes to the health care team by supporting, directing, educating and
mentoring colleagues, students and others.

Competency Elements
6. Initiates and participates 6.1 Utilises systems thinking and critical inquiry skills to audit and evaluate the quality of
in, activities that support and improve health services.
safe care, community
6.2 Uses relevant tools to monitor and measure the effectiveness of strategies, services
partnership and population
and interventions to promote safe practice.
health improvements.
6.3 Monitors and minimises risks to health consumers and healthcare service providers
at the individual and systems level.
6.4 Applies knowledge of health systems, socio-political issues, new technologies, and
funding/business practices to advocate for, influence and manage innovative
changes to healthcare services to improve access, equity of outcomes, quality and
cost-effective healthcare for specific groups or populations.
6.5 Critically appraises scientific literature and shares new knowledge and research
through discussions, presentations, publications, and the development of best
practice guidelines.
6.6 Incorporates understanding of diversity, cultural safety and socio-economic
determinants of health and uses cultural models of care when planning and
providing healthcare services.
6.7 Demonstrates commitment to the Treaty of Waitangi/Tiriti o Waitangi and applies
advanced knowledge of Maori health and socio economic disparities when working
in partnership with Maori health consumers and local iwi/ Maori health providers to
improve access and health outcomes.
6.8 Influences and critiques health policy and nursing practice through leadership and
active participation in workplace and professional organisations.

October 2020 32
Appendix Two: Clinical diary
NP CLINICAL DIARY
Registratio
n
Typical presentations in the clinical environment
Date and time Demographics Presenting My Role in the
Problem/Reason Activity
for Presentation

Pertinent Diagnosis/Diagnostic
history Reasoning
findings
Appendix Three: Professional activities/leadership
NP NP Professional Activities/Leadership
Registratio
n
October 2020 34
Date Activity Others Involved My Role in the Activity
Appendix Four: Professional Development
NP NP Continuing Professional Development Record

Registratio
n

October 2020 35
Date Course/Conference/Seminar/Forum/ My Learning Hours of
Symposium/Workshop etc Attendance
Appendix Five: Teaching
NP Teaching
Registratio
n

October 2020 36
Date Topic Audience Aim of Education
Appendix Six: Evidence Record

(Applicant to complete and submit with application)

Competency Elements Applicant to
complete
The nurse practitioner: Evidence source
& page number

October 2020 37
1. Demonstrates safe and 1.1 Practises in accordance with legislation, professional standards and health policy relevant to
accountable nurse nurse practitioner practice.
practitioner practice 1.2 Practices within safe boundaries around a clearly defined area of practice (client/population
incorporating strategies group) and demonstrates timely referral and consultation when an issue is outside scope, area
to maintain currency of practice, experience or competence.
and competence. 1.3 Confidently and autonomously provides the full spectrum of healthcare services in relation to
client/population group including health promotion and protection, disease prevention,
guidance and counselling, disease management, maintenance and restoration of health,
rehabilitation and palliative care.
1.4 Self-monitors and critically reflects on practice including through regular professional
supervision, collaborative case review and audit of practice, including prescribing.
1.5 Continually reviews and updates knowledge and skills to ensure currency and adaptability to
address broad and changing population health needs and to practice safely across
healthcare settings.
1.6 Integrates a broad base of nursing knowledge, human sciences (pathophysiology and
psychosocial) and clinical knowledge and skills within a framework of nurse practitioner practice.
1.7 Demonstrates accountability in considering access, cost and clinical efficacy and applies ethical
decision making when providing health services.

complete
& page number
2. Conducts
2.1 Completes a comprehensive health history relevant and appropriate to the client’s
comprehensive presentation.
assessments and 2.2 Actively explores the health consumer’s concerns, preferences, health behaviours, attitudes
October 2020 38
applies diagnostic
and priorities using a strengths based health promotion focus and risk identification to identify
reasoning to identify health care needs.
health needs/problems 2.3 Identifies the level of assessment (focused or comprehensive) required and performs a
and diagnoses. systematic review based on the client’s presenting condition and health history.
2.4 Demonstrates comprehensive skill in obtaining and interpreting data that informs clinical
judgement and differential diagnosis including prior treatment outcomes, physical findings and
test results.
2.5 Applies analysis, clinical reasoning and problem solving to assessment findings and
synthesises clinical and human science knowledge to develop differential diagnoses.
2.6 Orders or performs diagnostic investigations using evidence to support or rule out diagnoses.
2.7 Formulates an accurate diagnosis from an informed set of differential diagnoses using clinical
reasoning and best available evidence.
2.8 Demonstrates a high level of clinical proficiency in managing common and complex client
situations and acts to prevent and/or diagnose urgent, emergent or life threatening situations.

October 2020 39
complete
& page number
3. Develops, plans, 3.1 Works in partnership with the health
implements and consumer to determine therapeutic goals and
evaluates therapeutic options.
interventions when 3.2 Makes decisions about healthcare

management and interventions informed by
managing episodes of critical evaluation of research findings.
care. 3.3 Develops an individual plan of care and
communicates this to health consumer and
appropriate members of the healthcare
team and relevant agencies.
3.4 Applies a comprehensive knowledge of
pharmacology to make safe and appropriate
risk-benefit prescribing decisions including
considerations of antibiotic stewardship and
drug dependency where appropriate.
3.5 Verifies the suitability of evidence-based
treatment options including medicines, in
regard to commencing, maintaining/titrating or
ceasing treatment/interventions.
3.6 Safely prescribes therapeutic interventions
based on accurate knowledge of the
characteristics and concurrent therapies of the
health consumer.
3.7 Safely and effectively performs evidence-
informed invasive/non-invasive
interventions for the clinical management
and/or prevention of illness, disease,
injuries, disorders or conditions.
3.8 Makes appropriate decisions regarding
admission and discharge of health
consumers from healthcare services.
3.9 Monitors, critically evaluates and documents
treatments/interventions in
accordance with health consumer determined goals and healthcare outcomes.
3.10 Considers a plan for appropriately ceasing and/or modifying treatment in partnership with the
health consumer, and other members of the healthcare team.

October 2020 41
complete
& page number
4. Consistently involves 4.1 Works to establish a relationship with the health consumer that is characterised by mutual
the health consumer to trust and respect, empathy, and collaboration.
enable their full 4.2 Demonstrates respect for difference in cultural, social and developmental responses to
partnership in decision health and illness and incorporates health beliefs of the health consumer/community into
care planning and implementation.
making and active
4.3 Supports, educates, coaches, motivates, counsels and works in partnership with the health
participation in care. consumer and their family/whanau where relevant regarding diagnoses, prognoses and self-
management, including their personal responses to illness, injuries, risk factors and
therapeutic interventions.
4.4 Advises the health consumer and their family/whanau where relevant on therapeutic
interventions including benefits, potential side effects, unexpected effects, interactions,
importance of compliance and recommended follow-up.
4.5 Discloses the facts of adverse events to the health consumer and other health professionals;
mitigates harm and reports adverse events to appropriate authorities.
4.6 Respects the rights of the health consumer to make informed decisions whilst taking
accountability to ensure access to accurate and appropriately interpreted information.
4.7 Assesses and contributes to health literacy by sharing knowledge with the health consumer to
achieve evidence-informed management plan.
4.8 Uses appropriate teaching/learning strategies and style to provide diagnostic
information, health promotion and health education to meet health consumer learning needs.

October 2020 42
complete
& page number
5. Works collaboratively
5.1Establishes and maintains effective collegial relationships as a senior member of
to optimize health interprofessional teams.
outcomes for health 5.2 Collaborates with other health professionals and agencies to ensure timely access and smooth
consumers/population transition to quality services for the health consumer.
groups 5.3 Demonstrates advanced interpersonal, leadership and management skills to foster and
maintain collegial relationships by communicating and engaging effectively and
professionally with diverse groups and communities to improve healthcare.
5.4 Effects nursing practice and healthcare change using broad based skills including negotiating,
consensus building and partnering.
5.5 Articulates the nurse practitioner role and promotes nursing in clinical, political and
professional contexts.
5.6 Contributes to the health care team by supporting, directing, educating and mentoring
colleagues, students and others.

October 2020 43
complete
& page number
6. Initiates and 6.1 Utilises systems thinking and critical inquiry skills to audit and evaluate the quality of and
participates in, improve health services.
activities that support 6.2 Uses relevant tools to monitor and measure the effectiveness of strategies, services and
safe care, community interventions to promote safe practice.
partnership and 6.3 Monitors and minimises risks to health consumers and healthcare service providers at
the individual and systems level.
population health
6.4 Applies knowledge of health systems, socio-political issues, new technologies, and
improvements
funding/business practices to advocate for, influence and manage innovative changes to
healthcare services to improve access, equity of outcomes, quality and cost-effective healthcare
for specific groups or populations.
6.5 Critically appraises scientific literature and shares new knowledge and research
through discussions, presentations, publications, and the development of best practice
guidelines.
6.6 Incorporates understanding of diversity, cultural safety and socio-economic determinants
of health and uses cultural models of care when planning and providing healthcare
services.
6.7 Demonstrates commitment to the Treaty of Waitangi/Tiriti o Waitangi and applies advanced
knowledge of Maori health and socio economic disparities when working in partnership with
Maori health consumers and local iwi/ Maori health providers to improve access and health
outcomes.
6.8 Influences and critiques health policy and nursing practice through leadership and active
participation in workplace and professional organisations.

October 2020 44

Nurse Practitioner Application Guidelines

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Nurse Practitioner Scope

GUIDELINES FOR APPLICANTS

Updated October 2020

Nurse Practitioner Guidelines

About nurse practitioners..........................................................................................................................4

Nurse practitioner scope of practice....................................................................................................4

Area of nursing practice.........................................................................................................................4

Competencies for the nurse practitioner scope of practice.............................................................5

Nurse practitioner qualifications..........................................................................................................6

Continuing competence requirements................................................................................................6

Who can apply to be a nurse practitioner?....................................................................................7

NPs applying for removal or change of condition..................................................................................8

Achieving prescribing by non-prescribing nurse practitioners............................................................8

Applications: explanatory notes...............................................................................................................8

Section One: Application Documentation..........................................................................................10

Documentation describing your practice:.........................................................................................11

1. Your practice background..........................................................................................................11

2. Attestations, Competence assessment, referee contact details...........................................12

5. Professional activities and leadership.......................................................................................14

Important points for your application documentation and evidence...........................................14

Nurse Practitioner Guidelines

Overview of assessment process.......................................................................................................16

Aim of the assessment process..........................................................................................................16

Internationally qualified applicants....................................................................................................17

Nursing Council decision.........................................................................................................................21

Comprehensive Case Study.....................................................................................................................23

Less comprehensive case studies......................................................................................................24

Section Three: Forms & Templates................................................................................................25

Appendix One: Competence assessment form....................................................................................26

Nurse Practitioner competencies and elements..................................................................................29

Appendix Two: Clinical diary...................................................................................................................32

Appendix Three: Professional activities/leadership.............................................................................33

Appendix Four: Professional Development..........................................................................................34

Appendix Five: Teaching..........................................................................................................................35

Appendix Six: Evidence Record...............................................................................................................36

Nurse Practitioner Guidelines

About nurse practitioners

Area of nursing practice

Nurse Practitioner Guidelines

Competencies for the nurse practitioner scope of practice

Theme A: Provides safe and accountable advanced practice

1. Demonstrates safe and accountable nurse practitioner practice incorporating strategies

Theme B: Assesses, diagnoses, plans, implements and evaluates care

2. Conducts comprehensive assessments and applies diagnostic reasoning to identify

Theme C: Works in partnership with health consumers

Theme D: Works collaboratively with healthcare teams

Nurse Practitioner Guidelines

Theme E: Works to improve the quality and outcomes of healthcare

Nurse practitioner qualifications

Continuing competence requirements

· ongoing peer review of their practice by an authorised prescriber

Nurse Practitioner Guidelines

 Registration in New Zealand in the registered nurse scope of practice.

Advice for US/Canadian Nurse Practitioners

*Portfolio section 3: Masters education

For additional advice, US/ Canadian NPs can email regquality@nursingcouncil.org.nz

Nurse Practitioner Guidelines

The supporting evidence should include:

· A cover letter outlining your request

Achieving prescribing by non-prescribing nurse practitioners

Applications: explanatory notes

Nurse Practitioner Guidelines

Nurse Practitioner Guidelines