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Palliative Care Nurse Practitioner Candidate
Clinical Competencies
Enhancing care through excellence in education and research
2
To download a copy of this booklet go to: www.centreforpallcare.org
To cite these competencies: Quinn, K., Glaetzer, K., Hudson, P., Boughey, M. Palliative Care Nurse Practitioner Candidate Clinical Competencies. Centre for Palliative Care, St Vincent’s Hospital Melbourne: Melbourne, Australia 2011.
Copyright 2011 Centre for Palliative Care, St Vincent’s Hospital Melbourne
Victorian Palliative Care Nurse Practitioner Collaborative c/- Centre for Palliative Care St Vincent’s Hospital Mailbox 65 PO Box 2900 Fitzroy, Victoria 3065 Australia Phone: +61 3 9854 1665
Authors:
• KarenQuinn,CoordinatorEducationandProjectOfficerforVictorianPalliative Care Nurse Practitioner Collaborative, Centre for Palliative Care, St Vincent’s Hospital & Collaborative Centre of The University of Melbourne
• KarenGlaetzer,NursePractitioner–PalliativeCare,SouthernAdelaidePalliative Services
• ProfessorPeterHudson,CentreforPalliativeCare,StVincent’sHospital& Collaborative Centre of The University of Melbourne and Queen’s University, Belfast, United Kingdom
• AssociateProfessorMarkBoughey,DirectorofPalliativeMedicine,StVincent’sHospitalandCo-DeputyDirector,CentreforPalliativeCare,St Vincent’s Hospital & Collaborative Centre of The University of Melbourne
Acknowledgments:
• IreneMurphy,NursePractitioner,MelbourneCitymissionPalliativeCareCommunity Service, Melbourne, Australia
• MembersoftheVictorianPalliativeCareNursePractitionerCollaborative,academics, clinicians and policy developers for generously giving of their time to review the document.
Funded by:DepartmentofHealthVictoria,Australia.
3
Introduction ........................................................................................................ 4
Palliative Care Nurse Practitioner ........................................................................ 5
What is a Palliative Care Nurse Practitioner? .................................................. 5
What is a Palliative Care Nurse Practitioner Candidate? ................................. 6
Roleclarification ............................................................................................ 6
Policy context ..................................................................................................... 7
Key documents .................................................................................................. 8
Guiding principles ............................................................................................... 9
Generic NP guiding practice principles .......................................................... 9
SpecificPalliativeCareNPguidingpracticeprinciples ................................... 9
The Clinical Competencies ............................................................................... 11
Appendix 1: Bondy Scale ................................................................................. 20
Appendix 2: Australian Nursing and Midwifery Council Nurse Practitioner Competencies ..................................................................... 22
Contents
4
The purpose of this document is to provide Palliative Care Nurse Practitioner candidates in Victoria (and potentially candidates in other states of Australia), with a framework to ensure they meet core clinical competencies, to be achieved before they consider applying to the Nursing and Midwifery Board of Australia for EndorsementasaNursePractitioner.
The process for developing the clinical competencies was in six stages and included the following:
1. Establishmentofacorewritinggroupandundertakingaliteraturereview
2. DevelopingadraftofthecompetenciesinconsultationwithNursePractitioners
3. Review of the draft by members of the Victorian Palliative Care Nurse Practitioner Collaborative
4. Revisingandrefiningthedocumentbythewritinggroup
5. National and international expert opinion (including local and international nurse practitioners, members of the Victorian Palliative Care Nurse Practitioner Collaborative, palliative care physicians, policy developers, academics, a pharmacistandmembersofalliedhealth)tofurtherdevelopandrefinethecompetencies with the use of a purpose designed questionnaire
6. Final version of the Victorian Palliative Care Nurse Practitioner Candidate Clinical Competencies developed
These competencies aim to provide guidance to Palliative Care Nurse Practitioner Candidates and their services about how clinical competence in palliative care may beidentifiedandassessedintheworkplace.ItbuildsontheAustralianNursingandMidwifery Council’s document: Australian Nursing and Midwifery Council National Competency Standards for the Nurse Practitioner, 2004.
Nurse Practitioner Competencies provide a guide to a set of standards to demonstrate evidence of safe practice that align with the requirements, expectations and regulations of the role (Gardner, G. et al, 2006).
For further information on the Victorian Palliative Care Nurse Practitioner Collaborative visit: www.vpcnpc.centreforpallcare.org.
Introduction
5
Palliative Care Nurse Practitioner
What is a Palliative Care Nurse Practitioner?
A Nurse Practitioner (NP) is a registered nurse educated and endorsed to practice autonomously and collaboratively in an advanced and extended clinical role (Australian Nursing and Midwifery Council, 2009). The NP title is protected and only those nurses endorsed by the Nursing and Midwifery Board of Australia may call themselves a NP. From 1 July 2010, under national registration, Victorian palliative care (PC) NPs will be endorsed with a notation in the category of ‘acute and supportive care’. The notation is for the purpose of prescribing authority under Medicines, Poisons and Controlled Substances Act 1981.
The PC NP is able to demonstrate and deliver comprehensive assessment and management of palliative care patients (inclusive of client, consumers etc.) who have complex needs, using advanced nursing knowledge and skills informed by best practice principles. The practice of a PC NP may include, but is not limited to, the direct referral of patients to other health care professionals, prescribing medicines and ordering diagnostic investigations (Australian Nursing and Midwifery Council, 2004). The NP practises in a clinical leadership role, incorporating research, education and management into the role. “The scope of practice of the nurse practitioner is determined by the context in which the nurse practitioner is authorised to practice” (Australian Nursing and Midwifery Council, 2004).
APCNP’spracticeisdefinedbythenationallyagreedNPcompetencyframeworkthatidentifiesthreestandards:dynamicpractice,professionalefficacyand clinical leadership.
DynamicpracticeisdemonstratedbytheNP’shighlevelknowledgeandskillsinextended practice across stable, unpredictable and complex situations.
Professionalefficacydemonstratesthatpracticeisgroundedinanursingmodeland enhanced by autonomy and accountability.
Clinical leadership influences and progresses clinical care, policy and collaboration through all levels of health care (Australian Nursing and Midwifery Council, 2006).
6
Underpinning the extended clinical practice of a NP are the key essential criteria of:
• Demonstratedwell-developedcommunicationskillstobuildtherapeuticrelationships with patients, families, colleagues and the community that recognise the patient’s needs, circumstances, preferences and geographical contexts
• Acommitmenttoongoingprofessionaldevelopmentofself,othernursesandother health professionals
• Demonstratedcapacitytoundertakeresearch/qualityimprovementactivitiesrelevant to enhancing the practice environment.
What is a Palliative Care Nurse Practitioner Candidate?
InVictoria,nurseswhohavebeenappointedbyanemployertobecomeaNParereferred to as NP Candidates (NPC). A PC NPC is a registered nurse employed by a service/organisation as they work toward meeting the academic (eg. approved NP Masters) and clinical requirements for endorsement as a Nurse Practitioner (NP).Duringtheperiodofcandidature,whichcanvaryinlength,thenurseconsolidates his/her competence at the level of a nurse practitioner, learning his/her new role while engaging with mentors and other learning opportunities both within and outside the candidate’s organisation.
Mentorship in terms of medical and senior nursing support, management skills and clinical teaching are essential components for effective skill development of the nurse practitioner candidate. A registered nurse engaged as a nurse practitioner candidateshallbeclassifiedandpaidtheirsubstantive(usual)salary(AustralianIndustrialRelationsCommission2006).
Role clarification
What are the differences between advanced practice nurses (including Clinical Nurse Specialists and Clinical Nurse Consultants) and Nurse Practitioners?
InAustralia,thetitleof‘NursePractitioner’isprotectedbylegislationandencompasses unique expanded practice privileges, which include authorisation to independently diagnose, prescribe medicines, order diagnostic tests and make referralstootherhealthcareprofessionals(Gardner,Chang&Duffield2007).
While advanced practice nurses are encouraged to complete postgraduate qualificationsspecifictothespecialtyareainwhichtheywork,theyarenotcurrently a requirement for the role. Advanced practice roles in Australia currently lack national consistency with regard to practice standards, unlike the NP role.
7
Policy context
Victorian PC NPs have been appointed to better meet the Government’s palliative carepolicyobjectives,specificallytoensurethatallVictorianswithaprogressive,life-limiting illness and their families and carers have access to a high quality service system which fosters innovation (Strengthening Palliative Care: a policy for health andcommunitycareproviders,2004–2009).Buildingcapacitywithinthenursingworkforce with appropriately skilled and educated PC NP ensures the Government can meet its aims of:
• improvingtheequityofaccesstospecialistpalliativecareservicesforpeoplewith life-threatening illness
• buildingeffectiveandefficientlinksbetweenhospitalsandspecialistpalliativecare services
• buildingeffectiveandefficientlinksbetweenspecialistpalliativecareservicesand other relevant community, health and allied health providers, including disability services and residential aged care (Strengthening Palliative Care: apolicyforhealthandcommunitycareproviders,2004–2009).
PC NPs will be a pivotal link to realising priority three of the Victorian Cancer ActionPlan(2009–2011),whichistoincreasecapacityofpalliativecareservicesto provide care for patients in the place of their choice.
8
Key documents
Key documents underpinning the development of these competencies:
• AustralianNursingandMidwiferyCouncilNationalCompetencyStandardsfor the Nurse Practitioner, 2004.
• AustralianNursingandMidwiferyCouncilStandardsandcriteriafortheaccreditation of Nursing and Midwifery courses leading to registration, enrolment,endorsementandauthorisationinAustralia–withevidenceguide, 2009.
• QueenslandGovernmentQueenslandNursePractitioner:implementationguide, 2008.
• CanningD,YatesP,RosenbergJ.(2005)Competency standards for specialist palliative care nursing practice. Brisbane, Queensland University of Technology.
• GardnerG,CarryerJ,GardnerA,DunnS.(2006).NursePractitionercompetencystandards:findingsfromcollaborativeAustralianandNewZealandresearch. International Journal of Nursing Studies 43(5): pp601-610.
• CanadianNursesAssociationCanadianNursePractitionerCoreCompetencyFramework, 2005.
• GardnerG,ChangA,DuffieldC.(2007).Makingnursingwork:breakingthroughthe role confusion of advanced practice nursing. Journal of Advanced Nursing 57(4), 382-391.
• EagarK,SeniorK,FildesD,QuinseyK,OwenA,YeatmanH,GordonRandPosnerN,2003.ThePalliativeCareEvaluationToolKit:Acompendiumoftoolstoaidintheevaluationofpalliativecareprojects.CentreforHealthServiceDevelopment,UniversityofWollongong.
9
Guiding principles
The guiding principles underpinning the Palliative Care Nurse Practitioner Candidate Clinical Competencies are as follows.
Generic NP guiding practice principles:
1. PC NP candidates work within the agreed scope of practice for NPs within their employment context
2. The practice of a PC NP candidate is, wherever possible, based on best available evidence-based practice principles
3. Medical and nursing clinical supervision, management and education mentorship are all critical to the development of the PC NP candidate
4. The scope of an patient NP’s prescribing practice is supported by their employer’s clinical governance framework. As registered nurses, NP practice will also be guided by the Nursing and Midwifery Board of Australia’s professional practice framework that details how professional decision-making within a sound risk management, professional, regulatory and legislative framework is to be managed
Specific Palliative Care NP guiding practice principles:
5.ThepracticeofaPCNPcandidateisinformedbyclinicalexperiencespecificto the context of palliative care
6.Developingaplanofcareshouldinvolvethepatient,theirfamilyandotherrelevant health professionals
7. PC NP candidates have highly developed verbal and written communication skills essential to communicate assessment and management plan, including medicines, to the patient, carer/s, care team and other health professionals
8. PC NP candidates recognise the palliative care phase of illness of the patient and use this knowledge to inform their assessment and management. For example:
• Ifthepatienthasbeenstableandanacuteexacerbationofsymptomissuesoccurs, a full and thorough assessment should be undertaken to determine
10
anyreversiblecauses.Itwouldalsobeappropriatetoinitiateinvestigations(pathology and radiology) or referral to aid the diagnosis
• Ifthepatienthasbeenunstableandanacute,newproblemorunexpecteddeterioration occurs, a full and thorough assessment should be undertaken todetermineanyreversiblecauses.Itwouldalsobeappropriatetoinitiateinvestigations (pathology and radiology) or referral to aid the diagnosis. Candidates need to be able to recognise whether the new problem is related to the underlying disease process or a new, unrelated problem requiring referral
• Ifthepatienthasbeendeterioratinginapredictableandexpectedway,theassessmentmaybemodifiedandinvestigationslimited
• Ifthepatientisintheterminalphasewithevidenceofwelladvanceddiseaseand little possibility or expectation of recovery, it would be inappropriate to initiate a full assessment or investigations and the focus should be on the comfort of the patient
• Aplannedbereavementsupportprogramisavailableincludingcounsellingasnecessary(EagarK,SeniorK,FildesD,QuinseyK,OwenA,YeatmanH,Gordon R and Posner N, 2003)
11
The ClinicalCompetencies
12
Com
pet
ency
and
AN
MC
C
omp
eten
cy R
efer
ence
Key
ele
men
tsP
roce
ssP
erfo
rman
ce in
dic
ator
sA
sses
smen
t p
rinci
ple
s re
qui
red
to
dem
onst
rate
co
mp
eten
ce
1. C
om
pre
hens
ive
gen
eral
phy
sica
l ass
essm
ent/
exam
inat
ion
and
imp
lem
enta
tion
of
a p
atie
nt-f
ocu
sed
man
agem
ent
pla
n in
clud
ing
re
leva
nt d
iag
nost
ics
AN
MC
Com
pete
ncy
1.1
1.2
1.4
2.2
3.1
AN
MC
Nat
iona
l C
ompe
tenc
y S
tand
ards
fo
r th
e N
urse
Pra
ctiti
oner
(A
ppen
dix
2)
Exa
min
atio
nof
pat
ient
in
clud
ing:
•R
espi
rato
ry
•C
ardi
ac
•G
astr
oIn
test
inal
•A
bdom
inal
•H
epat
ic
•R
enal
•N
euro
logi
cal
•M
uscu
lo-s
kele
tal
•G
enito
urin
ary
•In
tegu
men
t
•E
ndoc
rine
•H
aem
atol
ogic
al
Obs
erve
and
und
erta
ke
patie
nt p
hysi
cal
asse
ssm
ents
. For
ex
ampl
e:
•C
hest
exa
min
atio
nan
d as
sess
men
t of
resp
irato
ry fu
nctio
n re
leva
nt to
a r
ange
of
sym
ptom
s an
d co
nditi
ons
incl
udin
g,
but n
ot li
mite
d to
, dys
pnoe
a,
bron
chos
pasm
, in
fect
ion,
pul
mon
ary
embo
lus
•C
ardi
aca
uscu
ltatio
nan
d as
sess
men
t of
circ
ulat
ory
func
tion
rele
vant
to a
ran
ge o
f co
nditi
ons
incl
udin
g,
but n
ot li
mite
d to
, ar
rhyt
hmia
s, c
onge
stiv
e ca
rdia
c fa
ilure
, and
hy
pert
ensi
on
•In
depe
nden
tlyp
erfo
rms
com
preh
ensi
ve
phys
ical
ass
essm
ent
and
post
ulat
es c
ause
of
sym
ptom
/con
ditio
n
•S
ourc
es,g
athe
rsa
nd
inte
rpre
ts re
leva
nt
info
rmat
ion
from
refe
rral
an
d ot
her
heal
th c
are
prof
essi
onal
s
•In
terp
rets
find
ings
in
the
cont
ext o
f id
entif
ying
the
impa
ct
of il
lnes
s on
pat
ient
•A
bilit
yto
dia
gnos
eae
tiolo
gy o
f con
ditio
n
•O
rder
sap
prop
riate
in
vest
igat
ions
to in
form
di
agno
sis
(incl
udin
g ra
diol
ogy,
pat
holo
gy,
EC
G).
Whe
reo
utsi
de
scop
e of
pra
ctic
e,
liais
es w
ith a
ppro
pria
te
med
ical
col
leag
ue/s
Med
ical
men
tors
hip
esse
ntia
l to
achi
eve
com
pete
nce.
Med
ical
men
tor
requ
ired
toc
onfir
mc
ompe
tenc
e(D
epar
tmen
tofH
ealth
lo
gboo
k m
anda
tory
re
quire
men
t).
Ass
esse
d by
med
ical
and
pr
ofes
sion
al s
uper
viso
rs.
Sug
gest
usi
ng M
ini-
Clin
ical
Eva
luat
ion
Exe
rcis
e(m
ini-C
EX)
(Roy
al
Aus
tral
ian
Col
lege
of
Phy
sici
ans)
, whi
ch w
ould
al
low
for
full
obse
rvat
ion
of c
ases
incl
udin
g hi
stor
y ta
king
, exa
min
atio
n,
form
ulat
ion
of a
pla
n an
d,
impo
rtan
tly, o
ppor
tuni
ty
for
debr
ief/
disc
ussi
on.
Con
tinue
d…
13
Com
pet
ency
and
AN
MC
C
omp
eten
cy R
efer
ence
Key
ele
men
tsP
roce
ssP
erfo
rman
ce in
dic
ator
sA
sses
smen
t p
rinci
ple
s re
qui
red
to
dem
onst
rate
co
mp
eten
ce
1. C
ontin
ued
•Fu
llab
dom
inal
ex
amin
atio
n an
d pa
lpat
ion
rele
vant
to
a ra
nge
of s
ympt
oms
incl
udin
g, b
ut n
ot
limite
d to
, con
stip
atio
n,
anor
exia
, nau
sea,
vo
miti
ng, n
utrit
iona
l st
atus
hep
atic
dy
sfun
ctio
n, b
owel
ob
stru
ctio
n
•A
sses
smen
tofr
enal
fu
nctio
n
•M
uscu
lo/s
kele
tal
exam
inat
ion
rele
vant
to
a ra
nge
of s
ympt
oms
and
cond
ition
s in
clud
ing
but n
ot li
mite
d to
frac
ture
s, b
one
met
asta
ses,
spi
nal c
ord
com
pres
sion
•N
euro
logi
cal
exam
inat
ion
to
reco
gnis
e co
mpo
nent
s su
ch a
s m
otor
sen
sory
re
flexe
s/se
nsat
ion
•P
rovi
des
ratio
nale
,ar
ticul
ates
pro
cess
and
lia
ises
as
appr
opria
te
with
oth
er h
ealth
pr
ofes
sion
als
as re
leva
nt
to th
e ou
tcom
es o
f the
as
sess
men
t
•A
bilit
yto
form
ulat
eas
sess
men
t prio
ritie
s to
info
rm m
anag
emen
t pl
an
•A
rtic
ulat
es
com
preh
ensi
ve
know
ledg
e of
the
med
icat
ion
optio
ns to
tr
eat c
ondi
tion
•Id
entifi
esa
nd
impl
emen
ts a
ran
ge o
f no
n-ph
arm
acol
ogic
al
man
agem
ent s
trat
egie
s
•A
rtic
ulat
esc
linic
al
indi
catio
ns fo
r an
d pr
escr
ibes
med
icat
ions
ap
prop
riate
to th
e co
nditi
on
•D
emon
stra
tes
thor
ough
ev
alua
tion
of tr
eatm
ent
plan
Evi
denc
eof
com
pete
nce
to b
e lo
gged
in lo
gboo
k an
d si
gned
by
med
ical
su
perv
isor
.
Indi
vidu
alc
andi
date
’s
leve
l of e
xper
ienc
e w
ill in
fluen
ce a
ctua
l num
ber
of a
sses
smen
ts re
quire
d to
ach
ieve
com
pete
ncy.
Con
side
r us
ing
a B
ondy
sc
ale
(App
endi
x 1)
to
asse
ss c
ompe
tenc
e.
14
Com
pet
ency
and
AN
MC
C
omp
eten
cy R
efer
ence
Key
ele
men
tsP
roce
ssP
erfo
rman
ce in
dic
ator
sA
sses
smen
t p
rinci
ple
s re
qui
red
to
dem
onst
rate
co
mp
eten
ce
2. C
om
pre
hens
ive
asse
ssm
ent
and
man
agem
ent
of
phy
sica
l sym
pto
ms
and
imp
lem
enta
tion
of
a p
atie
nt-f
ocu
sed
man
agem
ent
pla
n in
clud
ing
rel
evan
t d
iag
nost
ics
AN
MC
Com
pete
ncy
1.1
1.2
1.3
1.4
2.1
2.2
AN
MC
Nat
iona
l co
mpe
tenc
y st
anda
rds
for
the
Nur
se P
ract
ition
er
(App
endi
x 2)
Obt
ain
clin
ical
his
tory
of
the
sym
ptom
.
Und
erta
ke a
full
syst
ems-
base
d ph
ysic
al
asse
ssm
ent.
Ord
er a
ppro
pria
te
inve
stig
atio
ns.
Rev
iew
pre
viou
s an
d cu
rren
t tre
atm
ents
and
th
eir
effe
ctiv
enes
s.
Asc
erta
in/id
entif
y pa
tient
ex
pect
atio
ns.
Dem
onst
rate
un
ders
tand
ing
of
unde
rlyin
g pa
thol
ogy
and
its im
pact
s on
the
curr
ent
sym
ptom
s.
Pat
ient
inte
rvie
w.
Use
of r
elev
ant
asse
ssm
ent t
ools
eg.
to
ols
for
scre
enin
g/di
agno
sing
/ass
essi
ng
delir
ium
, fat
igue
, pai
n,
naus
ea a
nd v
omiti
ng,
cons
tipat
ion,
dys
pnoe
a.
Con
duct
rele
vant
phy
sica
l ex
amin
atio
n.
Inte
rpre
t/ev
alua
tere
sults
of
inve
stig
atio
ns a
nd
exam
inat
ions
.
Diff
eren
tiald
iagn
osis
.
Form
ulat
e a
plan
of c
are
incl
udin
g ne
cess
ary
refe
rral
s to
oth
er h
ealth
ca
re p
rofe
ssio
nals
as
requ
ired.
Aut
onom
ousl
y pe
rform
s co
mpr
ehen
sive
sym
ptom
as
sess
men
ts.
Art
icul
ates
kno
wle
dge
and
abilit
y, in
clud
ing
inte
rpre
tatio
n, o
f sc
reen
ing
tool
s to
ass
ist
with
ass
essm
ent.
Per
form
s fu
ll sy
stem
s-ba
sed
appr
oach
to
phys
ical
ass
essm
ent.
Inte
rpre
tsa
nda
rtic
ulat
es
colle
ctiv
efin
ding
sfro
m
phys
ical
exa
min
atio
n,
hist
ory,
inve
stig
atio
ns.
Find
ings
are
co
mpr
ehen
sive
ly
docu
men
ted,
co
mm
unic
ated
and
in
corp
orat
ed in
a
com
preh
ensi
ve c
are
man
agem
ent p
lan.
Diff
eren
tiald
iagn
osis
is
iden
tified
.
Med
ical
men
tors
hip
esse
ntia
l to
achi
eve
com
pete
nce.
Med
ical
men
tor
requ
ired
toc
onfir
mc
ompe
tenc
e(D
epar
tmen
tofH
ealth
lo
gboo
k m
anda
tory
re
quire
men
t).
Ass
esse
d by
med
ical
and
pr
ofes
sion
al s
uper
viso
rs.
Sug
gest
usi
ng M
ini-
Clin
ical
Eva
luat
ion
Exe
rcis
e(m
ini-C
EX)
(Roy
al
Aus
tral
ian
Col
lege
of
Phy
sici
ans)
, whi
ch w
ould
al
low
for
full
obse
rvat
ion
of c
ases
incl
udin
g hi
stor
y ta
king
, exa
min
atio
n,
form
ulat
ion
of a
pla
n an
d,
impo
rtan
tly, o
ppor
tuni
ty
for
debr
ief/
disc
ussi
on.
Evi
denc
eof
com
pete
nce
to b
e lo
gged
in lo
gboo
k an
d si
gned
by
med
ical
su
perv
isor
.
Con
tinue
d…
15
Com
pet
ency
and
AN
MC
C
omp
eten
cy R
efer
ence
Key
ele
men
tsP
roce
ssP
erfo
rman
ce in
dic
ator
sA
sses
smen
t p
rinci
ple
s re
qui
red
to
dem
onst
rate
co
mp
eten
ce
2. C
ontin
ued
Lead
s ca
se d
iscu
ssio
n in
con
text
of h
ealth
car
e te
am m
eetin
g.
Indi
vidu
alc
andi
date
’s
leve
l of e
xper
ienc
e w
ill in
fluen
ce a
ctua
l num
ber
of a
sses
smen
ts re
quire
d to
ach
ieve
com
pete
.
Con
side
r us
ing
a B
ondy
sc
ale
(App
endi
x 1)
to
asse
ss c
ompe
tenc
e.
16
Com
pet
ency
and
AN
MC
C
omp
eten
cy R
efer
ence
Key
ele
men
tsP
roce
ssP
erfo
rman
ce in
dic
ator
sA
sses
smen
t p
rinci
ple
s re
qui
red
to
dem
onst
rate
co
mp
eten
ce
3. C
om
pre
hens
ive
psy
cho
log
ical
, so
cial
, sp
iritu
al a
nd c
ultu
ral a
sses
smen
t an
d im
ple
men
tatio
n o
f a
pat
ient
-fo
cuse
d c
are
pla
n
AN
MC
Com
pete
ncy
1.1
1.2
1.3
1.4
2.2
3.1
AN
MC
Nat
iona
l C
ompe
tenc
y S
tand
ards
fo
r th
e N
urse
Pra
ctiti
oner
(A
ppen
dix
2)
Det
erm
ine
the
patie
nt’s
ps
ycho
logi
cal,
soci
al,
spiri
tual
and
cul
tura
l co
ntex
t (in
clud
ing
the
fam
ily).
Con
duct
a
com
preh
ensi
ve
psyc
holo
gica
l, so
cial
, cu
ltura
l and
spi
ritua
l as
sess
men
t of c
urre
nt
stat
us a
nd r
isk
of p
oor
psyc
hoso
cial
wel
l-bei
ng
incl
udin
g:
•a
geno
gram
•fa
mily
his
tory
•so
cial
sup
port
and
ne
twor
ks
•ps
ycho
logi
calh
isto
ry
and
asse
ssm
ent
•id
entif
ying
mos
tsi
gnifi
cant
per
son
to
the
patie
nt
Use
of r
elev
ant v
alid
ated
to
ols.
Iden
tifica
tion
ofp
atie
nts
requ
iring
ong
oing
su
ppor
t.
Eva
luat
ese
ffica
cyo
ftr
eatm
ent p
lan
and
inte
rven
tion.
Art
icul
ates
kno
wle
dge
and
abilit
y, in
clud
ing
inte
rpre
tatio
n of
scr
eeni
ng
tool
s to
ass
ist w
ith
diag
nosi
s of
dis
orde
rs
incl
udin
g:
•de
pres
sion
•an
xiet
y
•di
stre
ss
•qu
ality
ofl
ife
•de
liriu
m
Art
icul
ates
pro
cess
an
d in
itiat
es re
ferr
al
to a
ddre
ss/m
anag
e ps
ycho
logi
cal,
soci
al,
spiri
tual
and
cul
tura
l is
sues
.
Med
ical
men
tors
hip
esse
ntia
l to
achi
eve
com
pete
nce.
Med
ical
men
tor
requ
ired
toc
onfir
mc
ompe
tenc
e(D
epar
tmen
tofH
ealth
lo
gboo
k m
anda
tory
re
quire
men
t).
Ass
esse
d by
med
ical
and
pr
ofes
sion
al s
uper
viso
rs.
Sug
gest
usi
ng M
ini-
Clin
ical
Eva
luat
ion
Exe
rcis
e(m
ini-C
EX)
(Roy
al
Aus
tral
ian
Col
lege
of
Phy
sici
ans)
, whi
ch w
ould
al
low
for
full
obse
rvat
ion
of c
ases
incl
udin
g hi
stor
y ta
king
, exa
min
atio
n,
form
ulat
ion
of a
pla
n an
d im
port
antly
, opp
ortu
nity
fo
r de
brie
f/di
scus
sion
.
Con
tinue
d…
17
3. C
ontin
ued
Mak
e re
ferr
al to
sp
ecia
list s
ervi
ce, w
here
ap
prop
riate
.
Pro
vide
s re
leva
nt a
nd
appr
opria
te in
form
atio
n an
d ed
ucat
ion
to th
e pa
tient
and
prim
ary
fam
ily
care
r/s.
Lead
s ca
se d
iscu
ssio
n in
con
text
of h
ealth
car
e te
am m
eetin
g.
Initi
ate
trea
tmen
t.
Evi
denc
eof
com
pete
nce
to b
e lo
gged
in lo
gboo
k an
d si
gned
by
med
ical
su
perv
isor
.
Indi
vidu
alc
andi
date
’s
leve
l of e
xper
ienc
e w
ill in
fluen
ce a
ctua
l num
ber
of a
sses
smen
ts re
quire
d to
ach
ieve
com
pete
nce.
Con
side
r us
ing
a B
ondy
sc
ale
(App
endi
x 1)
to
asse
ss c
ompe
tenc
e.
Com
pet
ency
and
AN
MC
C
omp
eten
cy R
efer
ence
Key
ele
men
tsP
roce
ssP
erfo
rman
ce in
dic
ator
sA
sses
smen
t p
rinci
ple
s re
qui
red
to
dem
onst
rate
co
mp
eten
ce
18
Com
pet
ency
and
AN
MC
C
omp
eten
cy R
efer
ence
Key
ele
men
tsP
roce
ssP
erfo
rman
ce in
dic
ator
sA
sses
smen
t p
rinci
ple
s re
qui
red
to
dem
onst
rate
co
mp
eten
ce
4. P
rep
arat
ion
for
safe
and
ap
pro
pri
ate
pre
scri
bin
g o
f m
edic
ines
AN
MC
Com
pet
ency
1.4
2.2
2.3
3.1
3.2
AN
MC
Nat
iona
l co
mp
eten
cy s
tand
ard
s fo
r th
e N
urse
Pra
ctiti
oner
(A
pp
end
ix 2
)
Ob
serv
e p
ract
ice
of
med
ical
col
leag
ues
in
rela
tion
to d
ecis
ion-
mak
ing
pro
cess
re
gard
ing
pre
scrib
ing
of
med
icin
es.
Bec
ome
fam
iliar
with
m
edic
ines
tha
t ca
n b
e p
resc
ribed
.
Eac
h nu
rse
pra
ctiti
oner
w
ill o
nly
pre
scrib
e fr
om
the
med
icin
e fo
rmul
ary
as d
eter
min
ed b
y th
e N
MB
A a
nd c
onsi
sten
t w
ith t
heir
scop
e of
pra
ctic
e. T
his
is
sup
por
ted
by
clin
ical
go
vern
ance
str
uctu
res
such
as
clin
ical
pra
ctic
e gu
idel
ines
at
thei
r w
orkp
lace
.
Und
er s
uper
visi
on
(dis
cuss
ion
and
m
ento
rshi
p):
Sel
ect
med
icin
e ap
pro
pria
te t
o p
atie
nt
and
sym
pto
m b
eing
tr
eate
d, p
atie
nt
pre
fere
nce
and
sta
ge o
f d
isea
se.
Con
sid
er a
cces
s to
m
edic
ine,
car
e se
ttin
g of
pat
ient
and
fina
ncia
l im
pac
t w
hen
pre
scrib
ing
med
icin
es.
Con
sid
er t
he Q
ualit
y U
se o
f Med
icin
es a
s p
art
of t
he d
ecis
ion-
mak
ing
fram
ewor
k.
Iden
tify
app
rop
riate
d
ose,
rou
te, f
req
uenc
y an
d t
itrat
ion
pla
n fo
r ea
ch m
edic
ine.
Pre
scrib
e ac
cord
ing
to
legi
slat
ion
guid
elin
es.
Art
icul
ates
clin
ical
in
dic
atio
ns o
f med
icin
es
that
can
be
pre
scrib
ed
and
are
con
sist
ent
with
th
e sc
ope
of p
ract
ice.
Dem
onst
rate
s co
mp
rehe
nsiv
e kn
owle
dge
of
pha
rmac
olog
y,
pha
rmac
okin
etic
s an
d
sid
e-ef
fect
s of
cla
sses
of
med
icin
es fr
om P
C N
P
pre
scrib
ing
list.
Dem
onst
rate
s ab
ility
to
sel
ect
med
icin
es
app
rop
riate
to
trea
t a
rang
e of
sym
pto
ms
com
mon
ly s
een
in
pal
liativ
e ca
re.
Dem
onst
rate
s ab
ility
to
ass
ess
effic
acy
of
med
icat
ion.
Ind
ivid
ual c
and
idat
e’s
leve
l of e
xper
ienc
e w
ill
influ
ence
act
ual n
umb
er
of a
sses
smen
ts r
equi
red
to
ach
ieve
com
pet
ency
re
qui
red
.
Med
ical
and
pha
rmac
y m
ento
rshi
p e
ssen
tial t
o ac
hiev
e co
mp
eten
ce.
Sug
gest
usi
ng M
ini-
Clin
ical
Eva
luat
ion
Exe
rcis
e (m
ini-
CE
X)
(Roy
al A
ustr
alia
n C
olle
ge
of P
hysi
cian
s), w
hich
w
ould
allo
w fo
r fu
ll ob
serv
atio
n of
cas
es
incl
udin
g hi
stor
y ta
king
, ex
amin
atio
n, fo
rmul
atio
n of
a p
lan
and
, im
por
tant
ly, o
pp
ortu
nity
fo
r d
ebrie
f/d
iscu
ssio
n in
clud
ing
dis
cuss
ion
of
med
icin
es a
pp
rop
riate
to
cas
e.
Con
tinue
d…
19
Com
pet
ency
and
AN
MC
C
omp
eten
cy R
efer
ence
Key
ele
men
tsP
roce
ssP
erfo
rman
ce in
dic
ator
sA
sses
smen
t p
rinci
ple
s re
qui
red
to
dem
onst
rate
co
mp
eten
ce
4. C
ontin
ued
Dem
onst
rate
d
awar
enes
s of
prin
cip
les
of d
ose
adju
stm
ent
with
reg
ard
to:
frai
l, el
der
ly, c
hild
ren,
alte
red
m
etab
olis
m, o
rgan
failu
re
and
imm
inen
t d
eath
Con
sid
er u
sing
a B
ond
y sc
ale
(Ap
pen
dix
1) t
o as
sess
com
pet
ence
(s
elf-
asse
ssed
by
cand
idat
e an
d t
hen
by
men
tor)
.
20
Appendix 1: Bondy Scale
Grade Performance criteria Quality of performance Assistance required
Independent(I) Level of clinical practice is of a high and safe standard
• soundleveloftheoretical knowledge applied effectively in clinical practice
• coordinatedandadaptable when performing skills
• achievesintendedpurpose
• proficientandperforms within expected time frame
• initiatesactionsindependently and in cooperation with others to ensure safe delivery of patient care
Without supporting cues
Supervised (S) Level of clinical practice is of a safe standard but with some areas of improvement required
• correlatestheoreticalknowledge to clinical practice most of the time
• coordinatedandadaptable when performing skills
• achievesintendedpurpose
• performswithinareasonable time frame
• initiatesactionsindependently most of the time and in cooperation with others to ensure a safe delivery of patient care
Requires occasional supportive cues
* (Bondy 1983)
21
Assisted (A) Level of clinical practice is of a safe standard but with many areas of improvement required
• demonstrateslimited correlation of theoretical knowledge to clinical practice
• attimeslackscoordination when performing skills
• achievesintendedpurpose most times
• performswithinadelayed time period
• lacksinitiativeandforesight
Requires frequent supportive cues and direction
Dependent(D) Level of clinical practice is unsafe if left unsupervised
• unabletocorrelatetheoretical knowledge to clinical practice
• lackscoordinationwhen performing skills
• unabletoachieveintended purpose
• unabletoperformwithin a delayed time period
• noinitiativeorforesight
Requires continuous supervision and direction
Bondy,K.N.,(1983).Criterion-referenceddefinitionsforratingscalesinclinicalevaluation. Journal of Nursing Education, 22(9), 376-382.
Grade Performance criteria Quality of performance Assistance required
Appendix 1 (continued)
22
Appendix 2: Australian Nursing and Midwifery Council Nurse Practitioner Competencies
Competency Framework
Standard 1: Dynamic practice that incorporates application of high-level knowledge and skills in extended practice across stable, unpredictable and complex situations
Competency 1.1: Conducts advanced, comprehensive and holistic health assessmentrelevanttoaspecialistfieldofnursingpractice.
Competency1.2:Demonstratesahighlevelofconfidenceandclinicalproficiencyin carrying out a range of procedures, treatments and interventions that are evidenced-based and informed by specialist knowledge.
Competency 1.3: Has the capacity to use the knowledge and skills of extended practice competencies in complex and unfamiliar environments.
Competency1.4:Demonstratesskillsinaccessingestablishedandevolvingknowledge in clinical and social sciences, and the application of this knowledge to patient care and the education of others.
Standard 2: Professional efficacy whereby practice is structured in a nursing model and enhanced by autonomy and accountability
Competency 2.1: Applies extended practice competencies within a nursing model of practice.
Competency2.2:Establishestherapeuticlinkswiththepatient/client/communitythat recognise and respect cultural identity and lifestyle choices.
Competency2.3:Isproactiveinconductingclinicalservicethatisenhancedandextended by autonomous and accountable practice
23
Standard 3: Clinical leadership that influences and progresses clinical care, policy and collaboration through all levels of health service
Competency3.1:Engagesinandleadsclinicalcollaborationthatoptimiseoutcomes for patients/clients/communities.
Competency3.2:Engagesinandleadsinformedcritiqueandinfluenceatthesystems level of health care.
Centre for Palliative Care | St Vincent’s Hospital Melbourne
PO Box 2900 Fitzroy VIC 3065 Australia6 Gertrude Street Fitzroy VIC 3065 Australia
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