Services for children and young people ix C: Paediatric nurse practitioner competencies 38 References 42 Contents Introduction Health care practitioners are usin g many different role

R O Y A L C O L L E G E O F N U R S I N G

Services for children

and young people:

preparing nurses

for future roles

RCN guidance

Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN

© 2004 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in anyform or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers or a licence permittingrestricted copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. This publication may not be lent, resold,hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it is published, without the prior consentof the Publishers.


1

Services for children and young people:preparing nurses for future rolesRCN guidance

Introduction 2

Section 1: The basis for the role framework 4

Section 2: The core role framework for children’s and young people’s nursing 5

Section 3: Specialist children’s and young people’s nursing practice 10

Section 4: Expanded children’s and young people’s nursing roles 18

Section 5: Educational provision and career pathways 22

Conclusion 26

Appendix A: Paediatric diabetes specialist nursing roles – job descriptions and person specifications 27

Appendix B: Paediatric nurse practitioner – job description and person specification 33

Appendix C: Paediatric nurse practitioner competencies 38

References 42

Contents

Introduction

Health care practitioners are using many differentrole development frameworks to support careerdevelopment, educational planning, paynegotiation and workforce planning. To ensureconsistency, and to help nurses and others makesense of nursing roles as they work in the realworld, children and young people’s (CYP) nursingneeds an integrated framework, one whichincorporates other relevant frameworks such as theoccupational standards framework beingdeveloped by the NHS.

This Royal College of Nursing (RCN) documentpresents a role framework that specifies the coreand additional competencies required for thenursing roles which deliver modern health servicesto children and young people.

It was developed by members of the RCN Children’sand Young People’s Field of Practice. We workedtogether to agree an integrated framework whichwill meet many needs, including:

✦ helping practitioners in career planning andpersonal development

✦ guiding future role development and theassociated educational preparation to underpinspecialist and expanded roles

✦ supporting future pay negotiations byspecifying detailed role content descriptors

✦ supporting managers in workforce planningand in developing role requirements/jobdescriptions for specific posts.

The role framework

The framework consists of role descriptors andcompetencies mapped across a continuum fromnovice to expert, according to the:

✦ scope of the particular role (i.e. the level ofdecision-making autonomy and the range ofclinical actions)

✦ setting(s) in which the role is practised

✦ level of underpinning knowledge and skillsrequired

✦ length of experience required to undertakethe role.

The framework was built on the RCN Children’sand Young People’s Field of Practice’s NursingEducation Position Statement, and provides:

✦ Sections 1 and 2: outline core children’s andyoung people’s* nursing role descriptors andcompetencies derived from the Agenda forChange and Skills for Health initiatives

✦ Section 3: a role framework for specialistchildren’s and young people’s nursing practice(using paediatric diabetes nursing as anexample), with an associated outline educationframework

✦ Section 4: a role framework for expandedchildren’s and young people’s nursing practice(using the paediatric nurse practitioner as anexample), set within an associated outlineeducation framework

✦ Section 5: a proposal for an educationalframework to underpin CYP specialist andexpanded nursing roles.

2

S E R V I C E S F O R C H I L D R E N A N D Y O U N G P E O P L E

* The term ‘children and young people’ in this document refers to infants (neonates), children and young people up to the age of18, or the point at which the individual’s transition to adult health care is completed (RCN (2003) Preparing nurses to care forchildren and young people, London: RCN).

Developing the framework

A core group of RCN Children’s and Young People’sField of Practice members developed a first draft ofthe framework. This draft was then refinedfollowing consultation with many more Field ofPractice members and other stakeholders.

As one of a number of related RCN developments,this role framework will contribute to the evolutionand validation of the RCN’s generic career andcompetency framework. Once issues of professionalaccreditation and regulation of specialist educationand practice are resolved, this document will formthe basis for further developing standards againstwhich practitioners can be accredited.

RCN specialist forums and groups are nowencouraged to apply the framework to definespecialist roles at national level for these samepurposes. As nursing and the context for nursingcontinue to change, so the role framework willneed to evolve, building on feedback from thosewho use it.


3

4


The basis for therole framework

Derivation

The framework draws upon previous competencydevelopments and role definitions 1,2,3,4,5,6,7,8,9,10,11,12

and in particular builds upon a generic nursingrole framework.

Generic nursing role framework

A unifying framework for nursing roles needs to begeneric enough to accommodate other relevantframeworks – and specific enough to reflect thecomponents of clinical nursing work at a level ofdetail suitable for what the framework needs toachieve. The core constructs in the genericframework are role components and levels offunctioning.

For clinical nursing roles, the role components are:

✦ core (direct care)

✦ core (indirect care)

✦ specialist

✦ expanded

(see Figure 1).

The values on the ‘level of functioning’ axis are notspecified in the generic framework, so that userscan agree the most appropriate model for theirpurposes. For example, Agenda for Change uses fivelevels, and many nursing competency frameworksuse ‘novice to expert’ levels.

Figure 1: The generic nursing role framework

Depending on the setting and the purpose, the corecomponents could be those expected at registrationand beyond of any registered nurse, of thegeneralist children’s nurse or, for example, thegeneral children’s cancer nurse in a role profile for acancer outreach nurse. Role components could beexpressed as tasks, experience, knowledge,competencies or any combination of these.

We make a distinction between the corecomponents of direct and indirect care, becausethese may differ with different roles: for exampleyou might expect a children’s and young people’snurse to be competent in educating children andfamilies, but they might be a beginner in teachingand assessing students.

Within any role profile, we sometimes need severalspecialty components and several expanded rolecomponents. For example, a community child andadolescent mental health nurse will have specialistknowledge and skills both in relation to child andadolescent mental health and to working in thecommunity. A neonatal nurse practitioner mayhave expanded role competencies in ventilationmanagement, as well as those related toinvestigation, diagnosis and treatment.

Nurses practising at an expert level can practicefrom both an expanded and specialised knowledgebase – as we describe in Sections 3 and 4. Thesenurses demonstrate the acquisition and applicationof a range of clinical knowledge and skills, the useof clinical reasoning, and autonomy in clinicaldecision-making and their subsequent range ofclinical actions. Many nurses will, however, havespecialty and expanded role elements at differentlevels within their particular role.

1

Role component

Core (direct care)

Core (indirect care)

Specialist

Expanded

Level of functioning


5

The core roleframework forchildren’s and youngpeople’s nursing

In developing this nursing role framework, we tookaccount of the diversity in emerging nursing roles,using a novice-to-expert13 approach. The frameworkidentifies core role descriptors and competencies forCYP nursing, which in turn provide a base forspecifying competencies for CYP specialist orexpanded practice.


The framework shows the level of functioning of aqualified CYP nurse along a novice-to-expertcontinuum. The general characteristics of theselevels cover clinical reasoning and care provisionrole elements, and are defined as:

1. Novice13,14 [i.e. new to role or clinical area]

✦ Relies on theoretical principles and rules toguide performance.

✦ Requires support/direction from those withgreater experience to increase personalconfidence.

✦ Recalls information.

✦ Able to perform immediate tasks/procedures.

2. Advanced Beginner13,14

✦ Able to transfer aspects from prior experience.

✦ Demonstrates an acceptable level of competencewith guidance from a mentor.

✦ Receives and understands information.

✦ Initiates actions as per pre-planned plan ofcare, guidelines or protocols.

3. Competent13,14

✦ Identifies important issues and aspects of care.

✦ Conscious planning and prioritisation of care.

✦ Able to co-ordinate complex needs/ processes.

✦ Reviews and undertakes planned care/tasksreferring to guidelines or protocols as required.

✦ Knowledge of major ideas.

4. Proficient13,14

✦ Perceives the whole picture rather thanindividual tasks.

✦ Able to identify deviation from expectedprogress/outcomes and to modify plansaccordingly.

✦ Reviews and initiates additional actions.

✦ Generalises from given facts.

✦ Relates knowledge from several areas.

5. Expert13,14

✦ Extensive experience.

✦ Intuitive grasp of situations.

✦ Translates prior experience, knowledge andskills to transform practice.

✦ Interprets and instigates.

✦ Uses old ideas to create new ones.

An individual CYP nurse may function at differentlevels within their particular role, as they could be‘expert’ in one area but only at a ‘competent’ level inanother.

The core children’s and youngpeople’s role descriptors andcompetencies

Core CYP nursing role descriptors and competenciesare divided into ‘direct care’ (see Table 1a) and‘indirect care’ (Table 1b) according to whether theyare directly related to patient care.

The primary sources for the core role descriptorsand competencies were the Agenda for ChangeKnowledge and Skills Framework5 and Skills forHealth competencies7. References to these are giventhus [italics] in the left-hand column of the tables.

2

Table 1a: Core CYP nursing role descriptors and competencies for direct care

6


Role descriptor components

[Note: references for Agenda for Change

Knowledge and Skills Framework (KSF) andSkills for Health (SfH) given in italics]

Core – for all CYP nurses:

✦ Professional, ethical and legal practice

✦ Care management– assessment– planning – delivery – evaluation (including assessment andmanagement of risk for accidents, harm, etc)[KSF D7,D8, SfH CS2,CS4, CS5, CS6, CS7]

✦ Communication – verbal

– written

– presentations

– non-verbal

– meetings

– interviewing

[KSF D1, SfH CS1]

✦ Teaching children, young people, parentsand families[KSF D8, SfH CS8]

✦ Promotion of health (includes physical,psychological and emotional wellbeing)[kSF D9, D10, SfH CS11]

✦ Child and adolescent mental health[KSF D10, SfH MH C1, C2]

✦ Protection of children and young people[KSF D10, SfH CS9, CS10]

✦ Support children, young people, parentsand families through change and difficultcircumstances[KSF D8, SfH CS12]

✦ Knowledge and information management[KSF D13]

✦ Working with other professionals/agencies[KSF D7, D18, SfH CS3]

Novice

✦ Aware of key principles of care andimplications for practice

✦ Uses clinical judgement and limitedindividual decision-making about nursingcare requirements; assesses, plans†,delivers, evaluates and records care with

supervision from an experiencedpractitioner to address health relatedproblems/needs

✦ Establishes and maintains communicationwith children and young people and theirparents/carers, to enable them and theirparents and families to make informedchoices and to participate in care

✦ Reinforces information provided to children,young people, parents, and families,supporting their learning of skills andknowledge about clinical practice

✦ Contributes to raising awareness of healthpromotion

✦ Identifies potential or actual mental healthproblems; refers to more experiencedpractitioners as required to address specificinterventions required

✦ Assists in monitoring and protectingchildren and young people with supportfrom others

✦ Assists with supporting children, youngpeople, parents and families to cope withchanges in health and well-being, referringto members of the multidisciplinary team

✦ Gathers and records information accurately,using prescribed rules and procedures

✦ Participates in partnership working withother professionals and agencies, sharinginformation to facilitate co-ordinatedpackages of care and support for children,young people, parents and families

Advanced beginner

✦ Knowledge of professional standards andlegal framework evident in everydaypractice

✦ Uses clinical judgement and limitedindividual decision-making aboutnursing care requirements; assesses,plans† delivers, evaluates and recordscare with minimal supervision from anexperienced practitioner to addresshealth related problems/needs

✦ Establishes and maintains communicationwith children and young people, includingparents/carers, about daily activities,appreciating developmental and culturaldifferences, to enable them and theirparents and families to make informedchoices and to participate in care

✦ Contributes to the teaching of skills andknowledge to individual children, youngpeople, parents and families

✦ Raises awareness of health promotionand actions that children, young peopleand families can take

✦ Identifies potential or actual mentalhealth problems; initiates plans of careto promote safety and emotional well-being; refers to more experiencedpractitioners as required

✦ Monitors and contributes to protectingchildren and young people at risk,providing children who have beenabused with support from others

✦ Participates in supporting distressedparents and families, referring tomembers of the multidisciplinary team

✦ Records and uses information fromsingle sources to underpin decision-making,using policies and procedureswith little guidance and support

✦ Participates in partnership working withindividuals, groups, communities andagencies, sharing information tofacilitate co-ordinated packages ofcare and support for children, youngpeople, parents and families

† Includes preventive and therapeutic interventions


7

Competent

✦ Contributes to the development andimplementation of policy and care deliverystrategies, acting as a source of advice forjunior members of the nursing team onclinical matters and decision-making

✦ Uses clinical judgement and individualdecision-making about nursing carerequirements; assesses, plans†, delivers,evaluates and records care withoutsupervision to address health relatedproblems/needs when needs are

relatively stable and consistent with

others in the caseload

✦ Establishes and maintains communicationwith individual children and young people(including parents/carers), and withgroups, about difficult or complex matters,overcoming developmental and culturaldifferences, to enable them and theirparents and families to make informedchoices and to participate in care

✦ Provides teaching sessions for individualchildren, young people, parents, families

✦ Promotes health through broadprogrammes/ initiatives

✦ Provides one to one counselling toindividual children and young peopleexperiencing potential and actual mentalhealth problems; refers to moreexperienced practitioners as required

✦ Promotes a culture to safeguardchildren/young people, providing supportto children and young people that havebeen abused

✦ Prepares children and young people fordeterioration in health status, supportingparents and families through the process,referring to members of themultidisciplinary team

✦ Interprets and analyses information froma variety of sources to underpin decision-making without guidance or support

✦ Develops and sustains partnership-workingwith individuals, groups, communities andagencies, sharing information andcontributing to co-ordinated packages ofcare and support for children, youngpeople, parents and families

Proficient

✦ Participates in the development andimplementation of policy and care deliverystrategies, acting as a source of advice forthe multidisciplinary team on clinicalmatters and decision-making

✦ Uses clinical judgement and autonomousdecision-making about nursing carerequirements; assesses, plans†, delivers,evaluates and records care to addresshealth related problems/needs of childrenand young people when those needs are

complex and likely to change

✦ Establishes and maintains effectivecommunication with various individualchildren and young people (includingparents/carers) and groups, on complex andpotentially stressful topics, to enable themand their parents and families to makeinformed choices and to participate in care

✦ Leads training sessions forindividual/groups of children, youngpeople, parents and families

✦ Promotes health through targetedinitiatives and programmes to meet specificneeds

✦ Provides one to one counselling for childrenand young people experiencing mentalhealth problems; liaises with members ofthe multidisciplinary team and refers tospecialist practitioners for specialistintervention as required

✦ Protects children and young people at riskand contributes to developments inpractice, supporting individuals whereabuse has been disclosed

✦ Participates in the development of policiesand support structures fordistressed/bereaved parents and families,liaising with members of themultidisciplinary team

✦ Initiates the use of systems and processesto maximise knowledge and informationmanagement across a range of areas,specifying data requirements to underpinclinical decision-making

✦ Develops, sustains and evaluatespartnership-working with individuals,groups, communities and agencies,identifying options and actions for co-ordinated packages of care and support forchildren, young people, parents and families

Expert

✦ Formulates policy and care strategies,acting as a prime source of authority oncurrent thinking

✦ Uses clinical judgement and autonomousdecision-making about nursing carerequirements; leads and develops practiceto meet specific health relatedproblems/needs of individual children and

young people across a diverse range of care

needs

✦ Develops and initiates strategies tocommunicate effectively key messages/information to the local community andpopulation to enable children, youngpeople, parents and families to makeinformed choices and to participate in care

✦ Designs and implements trainingprogrammes on a variety of topics forgroups of children, young people /parentsand families

✦ Promotes health of the local community andpopulation through the development ofpolicies and strategies

✦ Develops, implements and evaluatesstrategies for children and young peopleexperiencing mental health problems;promotes safety and emotional wellbeing

✦ Leads and develops strategies in practice toprotect and safeguard children and youngpeople

✦ Leads the development and implementationof policies and support structures fordistressed/bereaved parents and families,liaising with members of themultidisciplinary team

✦ Develops and implements new systems andprocesses to underpin effective knowledgeand information management and clinicaldecision-making across a range of areas

✦ Enables individuals, groups, communitiesand agencies to work effectively inpartnership, leading and establishingagreed mechanisms for instigating co-ordinated packages of care and support forchildren, young people, parents and families


8


Table 1b: Core CYP nursing role descriptors and competencies for indirect care




Core – all CYP nurses:

Core (Indirect)

✦ Development of self and others[KSF D2]

✦ Leadership [KSF D19]

✦ Teaching and education

✦ Research and evidence based practice[KSF D22]

✦ Health, safety and security[KSF D3]

✦ Equality, diversity and rights[KSF D6]

✦ Cultural competence[KSF D6]

✦ Quality[KSF D5]

✦ Service and practice development[KSF D4, SfH CS13]

Novice

✦ Assumes responsibility for own learningneeds with support of mentor/preceptor

✦ Aware of situations in which to seekclarification from a more experiencedpractitioner

✦ Reinforces basic information and supportsstudents’ learning of skills and knowledgein clinical practice settings

✦ Awareness of research and evidence andimplications for practice

✦ Assist in maintaining own and others’health, safety and security

✦ Ensures own actions support equality,diversity and rights

✦ Ensures own actions consider the influenceof cultural variations and spiritual beliefs onchild health practices including childrearing, nutrition and family dynamics;acknowledges own personal biases andprevents these from interfering with thedelivery of quality of care to children, youngpeople and their families

✦ Ensures own actions help to maintainquality of care and service provided

✦ Assists in maintaining and developingservices and practice

Advanced beginner

✦ Acts as a mentor to students, assessingand supporting the development ofothers’ skills as a preceptor

✦ Supervises others in the performance ofroutine activities, encouragingindividuals into action

✦ Contributes to teaching/educationsessions for students in clinical practicesettings

✦ Implements research and evidence ineveryday practice, participating in auditactivities

✦ Promotes maintenance of own andothers’ health, safety and security

✦ Supports others’ equality, diversity andrights

✦ Supports others to consider the influenceof cultural variations and spiritual beliefson child health practices including childrearing, nutrition and family dynamics;acknowledges own personal biases andprevents these from interfering with thedelivery of quality of care to children,young people and their families

✦ Ensures own actions promote quality andalerts others to quality issues

✦ Contributes to the implementation ofpractice enhancements, seeking supportand guidance


9

Competent

✦ Acts as a mentor/preceptor to juniormembers of staff, assessing andfacilitating development of others’ skillsand knowledge

✦ Co-ordinates and liaises withmultidisciplinary team members,delegating activities to a range of teammembers and influencing individuals toreach decisions and take resultant actions

✦ Provides education/teaching sessions forindividual students and junior members ofstaff in clinical practice settings

✦ Participates in clinical audit with supportfrom an experienced practitioner

✦ Monitors and maintains health, safety andsecurity of self and others in own workarea

✦ Promotes others’ equality, diversity andrights

✦ Promotes an understanding of theinfluence of cultural variations andspiritual beliefs on child health practicesincluding child rearing, nutrition andfamily dynamics; acknowledges ownpersonal biases and prevents these frominterfering with the delivery of quality ofcare to children, young people and theirfamilies

✦ Contributes to quality improvement,raising quality issues and related riskswith relevant people

✦ Contributes to the development ofservices and practice, evaluating careprovision and providing support to others

Proficient

✦ Provides clinical supervision, formallyassessing other staff, identifying trainingand development needs, and implementingstrategies for individuals’ and staff groups’personal development

✦ Sets clear goals, objectives andperformance standards for single-disciplineteams, contributing to setting staffing levelsand recruitment decisions, influencinggroups to reach decisions and develop planof action

✦ Leads education/teaching sessions forindividual/groups of staff and students inclinical practice and academic settings

✦ Identifies opportunities for clinical auditactivities, using knowledge of research tocreate an environment where researchawareness and an analytical approach tocare provision is valued by all staff in thecare environment

✦ Promotes best practice in health, safety andsecurity in immediate work area

✦ Enables others to exercise their rights andpromote their equality and diversity

✦ Enables others to appreciate the influenceof cultural variations and spiritual beliefs onchild health practices including childrearing, nutrition and family dynamics;acknowledges own personal biases andprevents these from interfering with thedelivery of quality of care to children, youngpeople and their families

✦ Acts as a role model in qualityimprovement, monitoring activities againstquality standards

✦ Develops and improves practice andservices, working with others to identifyareas for development

Expert

✦ Provides clinical supervision, formallyassessing other staff, identifying trainingand development needs, and developingand implementing strategies to facilitateknowledge and skills development acrossprofessional and organisational boundaries

✦ Lead and motivate multidisciplinary teams,managing and evaluating change in theclinical environment, influencing others totake action in a variety of contexts,overcoming significant resistance fromgroups and individuals

✦ Designs and implements trainingprogrammes on a variety of topics toaddress education needs across staffgroups

✦ Manages clinical audit processes toevaluate clinical practice, implementingresearch-based evidence, conductingsignificant clinical research and supportingothers to participate in local and nationalresearch activities

✦ Develops a working environment andculture that actively improves health, safetyand security

✦ Leads and implements practices, policiesand strategies which enable others toexercise their rights, promoting equalityand diversity

✦ Leads and implements practices, policiesand strategies which enable others toappreciate the influence of culturalvariations and spiritual beliefs on childhealth practices including child rearing,nutrition and family dynamics;acknowledges own personal biases andprevents these from interfering with thedelivery of quality of care to children, youngpeople and their families

✦ Leads and implement practices, policiesand strategies to improve quality, ensuringsystems are in place to monitor againstquality standards

✦ Leads innovations and developments inpractice and service, initiating discussionswith relevant people to secure support andresources


10


Specialist children’sand young people’snursing practice

This section sets out a role framework for specialistchildren’s and young people’s nursing practice,using paediatric diabetes nursing as an example.Associated job descriptions are set out in Appendix A.

Children’s and young people’s nursing specialtiesare categorised according to one or more of thefollowing:

✦ patient age group (neonate, adolescent etc)

✦ clinical need (pain management, familytherapy, child protection etc)

✦ medical specialty (diabetes, oncology etc)

✦ location of care (school, community, hospice etc).

Specialist role components

Besides the core CYP nursing role descriptors andcompetencies, there are specific attributes relatingto specialist roles. Specialist nursing rolesencompass the core CYP nursing competencies to aminimum of ‘competent’ level, as well ascompetencies in the particular specialist area ofpractice.

Note that nurse consultants’,15 who function at‘expert’ level in the core role framework, haveremits which encompass professional leadershipand consultancy, education, training anddevelopment, as well as practice and servicedevelopment, research and evaluation(see Appendix A).

The primary sources for the specialist CYP roledescriptors and competencies were the Agenda forChange Knowledge and Skills Framework5 and Skillsfor Health competencies7.

Applying the role framework inspecialist nursing

The CYP nursing role framework can be used tospecify national (UK wide) standards for specialistpractice in a particular specialty, or levels ofcompetency for sub-specialties.

Tables 2a and 2b show an example of how the roleframework could be applied to paediatric diabetesnursing. The role descriptors and competencieshave been mapped across the novice-to-expertcontinuum, according to the:

✦ scope of the individual CYP nurse’s role – thelevel of autonomy of a CYP nurse, increasingfrom novice to expert, for clinical actionsarising from their clinical reasoning anddecision-making

✦ setting(s) in which they practice

✦ level of underpinning knowledge and skillsacquired – the level of specialist knowledgeand related skills increasing from novice toexpert level

✦ length of experience in the specialty.

The example contains some applied core rolecomponents (for example, teaching and education)and some generic specialist role components (forexample, specialist clinical interventions).

3

Levels of practice in paediatricdiabetes specialist nursing

The RCN Paediatric and Adolescent DiabetesSpecial Interest Group specifies that:

✦ a paediatric diabetes specialist nurse functionsat a minimum of ‘proficient’ level

✦ a highly specialised paediatric diabetesspecialist nurse functions at ‘expert’ level

✦ a CYP nurse new to the clinical specialty wouldbe at ‘novice’ level

✦ an ‘advanced beginner’ would have 6-12months’ experience on a specialty ward≠

✦ ‘competent’ level nurses might function as aspecialty link nurse, participating in paediatricdiabetes outpatient clinics within a hospitalsetting.

So, for paediatric diabetes, a CYP nurse functioningat:

✦ novice level has limited autonomy, adhering toclinical protocols under supervision within aparticular setting

✦ advanced beginner level follows clinicalprotocols with minimal supervision in aparticular setting

✦ competent level works according to clinicalprotocols without supervision in a particularsetting

✦ proficient level works independently in a specificsetting, and uses their clinical reasoning todetermine appropriate clinical actions inmanaging an individual patient, referring toother specialists* as required

✦ expert level has a greater level of experience inthe specialty, working across a wider range ofsettings to completely manage the specialistnursing care of individuals and groups ofchildren, young people and their families.

Career development andworkforce planning

To show how the framework can be applied tosupport career development and education, andworkforce planning, Appendix A gives outline corerole descriptions and person specifications for CYPdiabetes nurse specialists functioning at ‘proficient’and ‘expert’ level. Section 5 looks at an outlineeducational framework.


11

≠ Length of experience or educational programmes given in this document are indicative and are based on recommendationsof the relevant stakeholders: exceptions would need to be justified.

* More experienced CYP specialist practitioners or other members of the CYP specialist team

12


Table 2a: Role descriptors and competencies for specialist paediatric

diabetes care – applied CYP core role descriptor components




Core CYP nursing

Meet core CYP role descriptors andcompetencies to a minimum of ‘competent’level (see Tables 1a and 1b)

Specialist CYP nursing

Paediatric diabetes nursing

✦ Differentiation of levels

✦ Practice and service development

✦ Teaching and education

Novice

✦ Uses clinical judgement and limitedindividual decision-making about thespecialist nursing care and management ofpatients; undertakes a range of specialistclinical actions with supervision from anexperienced practitioner

✦ Demonstrates a basic understanding of thekey principles of diabetes specialist nursingcare and management

✦ Works with supervision, advice and supportto care for children and young people withdiabetes

✦ Adheres to policy, standards and caredelivery strategies on the care andmanagement of children and young peoplewith diabetes

✦ Contributes to the evaluation of innovationsin the care of children and young peoplewith diabetes

✦ Reinforces information provided to children,young people, parents/families, supportinglearning of skills and knowledge about themanagement of diabetes

Advanced beginner

✦ Uses clinical judgement and limiteddecision-making about the specialistnursing care and management ofpatients; undertakes a range of specialistclinical actions with minimal supervisionfrom an experienced practitioner

✦ Demonstrates basic proficiency in thespecialist nursing care of children andyoung people with diabetes

✦ Works in specialist in-patient area withminimal supervision, providing supportand guidance to more junior members ofstaff caring for children and young peoplewith diabetes

✦ Adheres to policy, standards and caredelivery strategies on the care andmanagement of children and youngpeople with diabetes

✦ Participates in the evaluation ofinnovations in the care of children andyoung people with diabetes

✦ Contributes to the education and trainingof individual children, young people,parents and families in the managementof diabetes


13

Competent

✦ Uses clinical judgement and individualdecision-making about the specialistnursing care and management of patients;undertakes a range of specialist clinicalactions without supervision or direction

✦ Demonstrates a good understanding andproficiency in the specialist nursing careand management of children and youngpeople with diabetes

✦ Works independently in specialist in-patient area, acting as a role model forother staff in the area in deliveringspecialist care, working with PDSN teamas link/liaison nurse

✦ Promotes adherence to policy, standardsand care delivery strategies on the careand management of children and youngpeople with diabetes

✦ Implements and participates in theevaluation of innovations in the care ofchildren and young people with diabetes

✦ Participates in group education andtraining of children, young people, carersand junior nursing staff in themanagement of diabetes

Proficient

✦ Uses clinical judgement and autonomousdecision-making about the specialistnursing care and management of patients;undertakes a range of specialist clinicalactions in a specific setting afterassessment of patient need and care

✦ Demonstrates a sound understanding andproficiency in all aspects of the specialistnursing care and management of childrenand young people with diabetes

✦ Acts as a source of advice and expertise formembers of the paediatric diabetes team,as well as in-patient paediatric team andprimary care team members

✦ Contributes to policy/standardsdevelopment/care delivery strategies onthe care and management of children andyoung people with diabetes

✦ Recommends, implements and evaluatesinnovations in the care of children andyoung people with diabetes across thecatchment area of the organisation

✦ Leads/provides group education andtraining of children, young people, carers,nursing staff and other professionals in themanagement of diabetes

Expert

✦ Uses clinical judgement and autonomousdecision-making about the specialistnursing care and management of patients;undertakes a range of specialist clinicalactions across a variety of settings afterassessment of patient need and care

✦ Demonstrates thorough understanding andexpertise in all aspects of the specialistnursing care and management of childrenand young people with diabetes

✦ Acts as a prime source of authority on allclinical issues related to the specialistnursing care and management of childrenand young people with diabetes

✦ Formulates policy, standards and caredelivery strategies on the care andmanagement of children and young peoplewith diabetes (including, for example,management of DKA, hypoglycaemia)

✦ Leads the implementation and evaluation ofinnovations in the care of children andyoung people with diabetes across a varietyof settings within a strategic healthauthority catchment area

✦ Leads and develops specific education andtraining programmes for children, youngpeople, carers, nursing staff and otherprofessionals across all care sectors,including teachers, peers and lay carers, inthe management of diabetes


14


Table 2b: Role descriptors and competencies for paediatric diabetes care –

specialist clinical role descriptor components




Specialist psychological/ psycho-social/

physical interventions

✦ Counselling

✦ Care management of children and youngpeople with diabetes

✦ Lifestyle

✦ Management of hypoglycaemia

✦ Management of diabetic ketoacidosis(DKA)

✦ Management of period of illness

Novice

✦ Identifies need for specialist support,advice and counselling, and refers to PDSNteam and other members of themultidisciplinary team

✦ Assists with initial investigations, providessupport to children, young people, parentsand family in the event of initial diagnosis ofdiabetes, referring to an experiencedpractitioner

✦ Undertakes pre-planned specialist careactivities as directed under supervision

✦ Supports and provides basic information tochildren, young people and parents,referring to experienced practitioner asappropriate

✦ Aware of signs of hypoglycaemia, able toinstigate immediate treatment for minorhypoglycaemia and support children, youngpeople and parents, referring toexperienced practitioner

✦ Aware of signs of DKA, provides support tochildren, young people and parents,referring to experienced practitioner

✦ Aware of signs of illness and implicationsfor diabetes management, provide supportto children, young people and parents,referring to experienced practitioner

Advanced beginner

✦ Provides outline information andguidance about long term healthoutcomes and refers to PDSN team andother members of the multidisciplinaryteam

✦ Assesses children, young people,assisting with initial investigations,provides basic information, supportschildren, young people, parents and familyat initial diagnosis, referring to PDSN team

✦ Undertakes pre-planned specialist careactivities, adhering to set protocols withminimal supervision

✦ Provides support, information and basicadvice to children, young people andparents, referring to PDSN team asappropriate

✦ Recognises signs of mild and severehypoglycaemia, instigating immediatetreatment, supporting children, youngpeople and parents, and referring toPDSN team

✦ Recognises signs of DKA, instigatingimmediate treatment, supportingchildren, young people and parents, andreferring to PDSN team

✦ Recognises signs of illness andimplications for diabetes management,instigating immediate treatment and/orpreliminary investigations, supportingchildren, young people and parents, andreferring to PDSN team


15

Competent

✦ Proactive in counselling children, youngpeople, parents and families about longterm health outcomes, following pre-determined guidelines/protocols andpolicies, referring to other members of themultidisciplinary team

✦ Assesses children, young people, assistswith investigations, provides information,details initial plan of care in conjunctionwith PDSN at initial diagnosis of diabetes

✦ Undertakes pre-planned specialist careactivities, participates in paediatric diabetesclinics, supporting paediatric diabetesmedical staff and other members of themultidisciplinary team in key activities

✦ Provides support, information and advice tochildren, young people and parents onlifestyle changes and implications (includingmeasures to reduce complications) as aresult of a diagnosis of diabetes, referring toPDSN team as appropriate

✦ Recognises hypoglycaemia, instigatestreatment, advising children, youngpeople and parents about potentialcauses of hypoglycaemia andmechanisms to reduce recurrence,referring to experienced PDSN

✦ Recognises DKA, instigates treatment,advising children, young people andparents about potential causes of DKAand mechanisms to reduce recurrence,referring to experienced PDSN

✦ Recognises signs of illness andimplications for diabetes management,instigates treatment and investigations,providing basic advice to children, youngpeople and parents about managementduring period of illness, referring toexperienced PDSN

Proficient

✦ Proactive in counselling children, youngpeople, parents and families about longterm health outcomes, liaising with othermembers of the multidisciplinary team

✦ Provides information to children, youngpeople, parents and family; details initialand ongoing programme of care at initialdiagnosis of diabetes, referring to othermembers of the paediatric diabetes team asappropriate

✦ Undertakes nurse led clinics, undertakingbaseline physiological assessments,referring to paediatric diabetes medicalstaff as appropriate for support and advice

✦ Provides support, information and detailedadvice on lifestyle changes and long-termimplications (including measures to reducecomplications) as a result of a diagnosis ofdiabetes, referring to other members of thepaediatric diabetes team as appropriate

✦ Recognises hypoglycaemia, instigatestreatment, advising children, young peopleand parents about potential causes ofhypoglycaemia and mechanisms to reducerecurrence, adjusting treatment asappropriate according to local protocols

✦ Recognises DKA, instigates treatment,advising children, young people andparents about potential causes of DKA andmechanisms to reduce recurrence,adjusting treatment as appropriateaccording to local protocols

✦ Recognises signs of illness and implicationsfor diabetes management, instigatestreatment and investigations, providingdetailed advice and guidance about sickday rules, adjusting treatment asappropriate according to local protocols

Expert

✦ Develops, implements and evaluates avariety of counselling and supportivestrategies for children, young people,parents and families, liaising with othermembers of the multidisciplinary team

✦ Provides information to children, youngpeople, parents and family; details initialand ongoing programme of care at initialdiagnosis of diabetes

✦ Undertakes nurse led clinics, undertakingbaseline physiological assessments andannual reviews of children and youngpeople with diabetes

✦ Provides support, information and detailedadvice on lifestyle changes and long-termimplications (including measures to reducecomplications) as a result of a diagnosis ofdiabetes, including facilitating attendanceat school, transition to adult services andindependent living away from home

✦ Recognises hypoglycaemia, instigatestreatment, advising children, young peopleand parents about potential causes ofhypoglycaemia and mechanisms to reducerecurrence, adjusting treatmentappropriately

✦ Recognises DKA, instigates treatment,advising children, young people andparents about potential causes of DKA andmechanisms to reduce recurrence,adjusting treatment appropriately

✦ Provides advice on unusual/difficult caseswith rare or multiple pathology, instigatingtreatment and investigations, educatingother professionals and advising children,young people and parents about sick dayrules, adjusting treatment and managementas appropriate


16


Table 2b: Role descriptors and competencies for paediatric diabetes care –

specialist clinical role descriptor components (continued)




Specialist clinical interventions

✦ Insulin

✦ Blood glucose monitoring (BGM)

✦ Urine monitoring

✦ Dietary management

✦ Teaching self care skills

Novice

✦ Assists with administration ofinsulin/supporting children and youngpeople or their families to administerinsulin as prescribed

✦ Undertakes BGM, and supports child/youngperson to perform routine BGM test,documenting and reporting result to anexperienced practitioner

✦ Undertake urine test and supports childrenand young people or their families toperform urine test, documenting andreporting result to an experiencedpractitioner

✦ Understands the basic dietary managementprinciples to ensure that the child/youngperson receives the appropriate diet at theright time

✦ Support child/young person to self care,reporting any concerns that may affectchild’s/families’ ability to care forown/child’s diabetes to experiencedpractitioner

Advanced beginner

✦ Administers insulin/support childrenand young people or their families toadminister insulin as prescribed

✦ Undertakes BGM, and supportschild/young person to perform routineBGM test, interpreting the result andreporting immediately toPDSN/paediatric diabetes medical teamif abnormal result

✦ Undertakes urine test and supportschildren and young people or theirfamilies to perform urine test,interpreting the result and reportingimmediately to PDSN/paediatricdiabetes medical team if abnormal

✦ Able to provide basic advice/informationabout elements of a suitable diet forchildren/young people with diabetes,referring to an experienced practitioneror other professional for specificspecialist advice

✦ Aware of potential limitations ofindividual child/young person /parent tocare for own/child’s diabetes; supportschild, young person and parents todevelop self care knowledge and skills


17

Competent

✦ Adjusts insulin treatment followingdiscussion with experienced PDSN orpaediatric diabetes medical staff

✦ Undertakes BGM, and supportschild/young person to perform initial androutine BGM test, interpreting the resultand assessing other parameters,including checking urine for ketones ifraised and initiating appropriate action asper local protocol

✦ Undertakes urine test and supportschildren and young people or theirfamilies to perform urine test, interpretingthe result and assessing otherparameters, including blood glucose,initiating appropriate action as per localprotocol

✦ Able to provide basic advice/informationabout elements of a suitable diet forchildren/young people with diabetes,referring to other professionals asappropriate

✦ Facilitates child/young person’sempowerment by teaching them and theirfamily/parents basic technical knowledgeand theoretical understanding of selfmanagement, including BGM, treatmentand actions

Proficient

✦ Adjusts insulin treatment according to age,diagnosis and individual child/youngperson’s needs adhering to local protocols

✦ Undertakes BGM and supports child/youngperson to perform initial and routine BGMtest, interpreting the result to optimisefuture treatment regime and instigatingfurther test such as HbA1c or random bloodglucose initiating appropriate action as perlocal protocol

✦ Undertakes urine test and supportschildren and young people or their familiesto perform urine test, interpreting the resultto optimise future treatment regime andinstigating further test such as randomblood glucose before initiating appropriateaction as per local protocol

✦ Able to provide basic information andadvice about dietary regimes, particularly inrelation to exercise

✦ Facilitates child/young person’sempowerment by assessing and teachingthem and their family/parents basic andcomplex technical knowledge andtheoretical understanding of selfmanagement, including BGM, treatmentand actions such as insulin adjustment andthe effect of exercise on blood glucose

Expert

✦ Adjusts insulin treatment according to age,diagnosis and individual child/youngperson’s needs

✦ Develops specific guidelines for particularscenarios; undertakes BGM and supportschildren/young people to perform initialand routine BGM tests, interpreting theresult to optimise future treatment regimeand instigating further tests such as HbA1cor random blood glucose initiatingappropriate action

✦ Develops specific guidelines for particularscenarios; undertakes urine test andsupports children and young people or theirfamilies to perform urine test, interpretingthe result to optimise future treatmentregime and instigating further tests such asrandom blood glucose before initiatingappropriate action

✦ Good knowledge of the principles of dietarymanagement, reinforcinginformation/teaching from paediatricdietician (and able to substitute forpaediatric dietician when required) toimprove glycaemic control

✦ Facilitates child/young person’sempowerment by assessing and teachingthem and their family/parents basic andcomplex technical knowledge andtheoretical understanding of selfmanagement, including BGM, treatmentand actions such as insulin adjustment andthe effect of exercise on blood glucose,facilitating access to appropriate expertisefrom other professionals as required


Expanded children’sand young people’snursing roles

This section sets out a role framework forexpanded children’s and young people’s nursingpractice, using the paediatric nurse practitioner asan example. Job descriptions are described inAppendix B. An associated outline educationframework is discussed in Section 5.

Expanded CYP nursing roles now encompassinterventions, assessment, diagnosis (includinginitiation and interpretation of investigations anddiagnostic tests), treatment or care previouslyundertaken by other professional groups. To fulfilthese new roles, nurses need to acquire newknowledge and skills, ranging from cannulation tocounselling. Practices considered to be part of anexpanded role will of course vary in differentsettings and over time. Some role components maygradually become ‘core’ – for example,administration of intravenous antibiotics was atone time outside the scope of core nursing practice.

The primary sources for the derivation of the corerole descriptors and competencies are Agenda forChange Knowledge and Skills Framework5, Skills forHealth competencies7 and competency frameworksdeveloped by the RCN Paediatric Advanced PracticeGroup.

Applying the role framework forexpanded nursing roles

The CYP nursing role framework can be applied toexpanded nursing remits, with expanded roledescriptors and competencies mapped along thenovice-to-expert continuum, according to the:

✦ scope of the individual CYP nurse’s role – thelevel of autonomy and level of skill

✦ limitations of the domain in which they practice– for example, within single unit or across manyunits

✦ level of underpinning knowledge acquired –the level of expanded practice knowledgeand related skills increasing from novice toexpert level

✦ length of experience in an expanded role.

Paediatric nurse practitioneras an example

Table 3 shows how the role framework could beapplied to one example of an expanded nursingrole – a paediatric nurse practitioner.

A CYP nurse undertaking a nurse practitioner8 roleassesses, diagnoses, forms and implements a planof treatment and care, managing and discharging(as appropriate) the neonate, child or young personwithout reference to a medical practitioner.Applying the CYP nursing role framework to thepaediatric nurse practitioner role identifies theincreasing autonomy, range of knowledge andskills, scope and range of clinical reasoning, clinicaldecision-making and clinical actions, in differentsettings, from novice to expert levels offunctioning. We have given an outline roledescription and person specification for apaediatric nurse practitioner in Appendix B.

18


4

Levels of functioning for thepaediatric nurse practitioner

The CYP nurse undertaking any expanded roleshould function to a minimum of ‘competent’level in the core CYP nursing role descriptors(see Section 2), and may also undertake aspectsof specialist nursing care management(see Section 3)4.

In their role as paediatric nurse practitioner:

✦ the practitioner functions at ‘competent’ levelwithin the framework, following completion ofan approved educational programme. They areable to undertake clinical assessment, initiatinga range of investigations and first linemanagement or treatment, referring as neededto a more experienced practitioner asappropriate for definitive diagnoses.

✦ at ‘proficient’ level, the nurse practitioner willhave consolidated learning and gainedexperience, working within a limited clinicalarea or with a specific client group

✦ at ‘expert’ level, they will demonstrate a broaderrange of decision-making, working across awider sphere in terms of clinical settings orundifferentiated CYP client groups.

There is, however, a variation in the level of nursepractitioner-type roles. For example, the nursefunctioning at a ‘novice’ level could be workingunder supervision and, having received in-servicetraining, assess and triage children and youngpeople according to set criteria. An ‘advancedbeginner’ could be working under minimaldirection and, having assessed a child, is able toinitiate initial investigations according to setprotocols.

For the protection of the public and to maintainstandards, paediatric nurse practitioners andeducational programmes need to be accredited – aconsultation is underway to establish a process andstructure for this to be achieved in the UK.


19

20


Table 3: Example of expanded paediatric nursing role profile:

role descriptors and competencies for the paediatric nurse practitioner




Core CYP nursing

Meet core CYP role descriptors andcompetencies to a minimum of ‘competent’level (see Tables 1a and 1b)

Expanded nursing role

✦ Differentiation of levels

Clinical management

✦ Assessment of health status

✦ Diagnosis

✦ Plan of care/implementation of treatment

Teaching and education

Professional practice

Quality of health care practice

Novice

✦ Uses clinical judgement and limitedindividual decision-making in theassessment, diagnosis and management ofpatients; undertakes a range of clinicalactions† as directed following set protocolswith supervision

✦ Demonstrates history taking andassessment as per set criteria, triaging andreferring to appropriate service/professional for investigation and treatment

✦ Undertakes history and assessment ofchildren/ young people as per set criteria

✦ Identifies potential differential diagnosis,referring to appropriate service/professional for investigation and diagnosis

✦ Refers to appropriate service/professionalfor definitive diagnosis and plan oftreatment

✦ Educates children, young people andfamilies about outcomes of assessment andtriage process

✦ Aware of scope of responsibilities, sourcesof referral and lines of accountability forexpanded practice

✦ Adheres to clinical protocols, policies andstandards concerning the assessment andtriage of children and young people

✦ Contributes to the evaluation of innovationsin practice

Advanced beginner

✦ Uses clinical judgement and limiteddecision-making in the assessment,diagnosis and management of patients;undertakes a range of clinical actions† with minimal direction following setprotocols with minimal supervision

✦ Demonstrates history taking andassessment, and, following protocols,initiates a limited range of initialinvestigations e.g. blood tests, X-rays

✦ Undertakes history and assessment ofchildren/ young people as per set criteria

✦ Identifies potential differential diagnosisand initiates initial investigationsaccording to clinical protocols

✦ Refers to appropriate service/professional for definitive diagnosisand plan of treatment

✦ Educates children, young people andfamilies about outcomes of assessment,including purpose and rationale for initialtests/investigations to be undertaken

✦ Aware of scope of responsibilities,sources of referral and lines ofaccountability for expanded practice

✦ Adheres to clinical protocols, policiesand standards concerning theassessment and initial managementof children and young people

✦ Participates in the evaluation ofinnovations in practice

† Related to health promotion, health protection, disease prevention and illness management (see Appendix C: Paediatric nursepractitioner competencies)


21

Competent

✦ Uses clinical judgement and decision-making in the assessment, diagnosis andmanagement of patients; undertakes arange of clinical actions† acrossprofessional boundaries, following setprotocols without supervision or direction

✦ Demonstrates history taking and assessmentand following protocols; initiates a range ofinvestigations, interpreting results andinitiating first-line management according toagreed clinical protocols

✦ Undertakes detailed history andassessment of children/ young people

✦ Identifies potential differential diagnosis,initiates a range of investigations accordingto protocols and interprets results,consulting with an experienced practitionerto reach definitive diagnosis as required

✦ Devises and implements initial plan ofcare/treatment, including administrationof range of drugs via Patient GroupDirections (PGDs) as directed by setclinical protocols, referring to a specialistpractitioner as required

✦ Educates children, young people andfamilies about outcomes of assessment,purpose and rationale for undertakingidentified tests/investigations and initialfirst line management/treatment

✦ Aware of scope of responsibilities,sources of referral, mechanisms forseeking advice and lines of accountabilityfor expanded practice

✦ Promotes adherence to clinical protocols,policies and standards concerning theassessment and initial management ofchildren and young people

✦ Implements and participates in theevaluation of innovations in practice

Proficient

✦ Uses clinical judgement and autonomousdecision-making in the assessment,diagnosis and management of patients;undertakes a range of clinical actions†across professional boundaries within aspecific setting or a CYP focused client

group following assessment of patient needand care requirements

✦ Demonstrates the complete management ofcomplex and/or unstable health careproblems in a focused CYP client group orwithin a specific setting

✦ Undertakes assessment of children/ youngpeople related to specific area ofpractice/focused CYP client group, toaddress needs and problems

✦ Identifies potential differential diagnosis,initiating a range of investigations relatedto specific area of practice/focused CYPclient group to reach a definitive diagnosis

✦ Devises and implements a plan of treatment(including prescribing a range of drugs as asupplementary prescriber and/or via PGDs)for specific area of practice/focused CYPclient group, discharging and/or referring toa specialist practitioner as required

✦ Educates children, young people andfamilies about assessment process,rationale for undertakingtests/investigations, subsequent resultsand plan of care/treatment

✦ Aware of scope of responsibilities, sourcesof referral, mechanisms for seeking adviceand lines of accountability for expandedpractice

✦ Contributes to clinical protocols, policiesand standards development concerning theassessment and management of a focusedCYP client group/specific setting

✦ Recommends, implements and evaluatesinnovations in practice

Expert

✦ Uses clinical judgement and autonomousdecision-making in the assessment,diagnosis and management of patients;undertakes a range of clinical actions†across a variety of settings or CYP client

groups and professional boundariesfollowing assessment of patient need andcare requirements

✦ Demonstrates the complete management ofcomplex and/or unstable health careproblems across range of CYP client groupsand/or range of settings

✦ Undertakes assessment of children/ youngpeople across broad range of CYP clientgroups/settings to address needs andproblems

✦ Identifies potential differential diagnosis,initiating a range of investigations across arange of CYP client groups/settings to reacha definitive diagnosis

✦ Following diagnosis, devises and implementsa plan of treatment (including prescribing arange of drugs as an independent prescriberand/or via PGDs) for broad range of CYPclient groups/settings, discharging and/orreferring to a specialist practitioner asrequired

✦ Educates children, young people andfamilies about assessment process,rationale for undertakingtests/investigations, subsequent resultsand plan of care/treatment

✦ Aware of scope of responsibilities, sourcesof referral, mechanisms for seeking adviceand lines of accountability for expandedpractice

✦ Formulates clinical protocols, policies andstandards concerning the assessment andmanagement of a broad range of CYP clientgroups or across settings

✦ Leads the implementation and evaluation ofinnovations in practice


Paediatric nurse practitioner

Educationalprovision and careerpathways

This section proposes an educational framework tounderpin CYP specialist and expanded nursing roles.

Using the role framework todevelop education provision

Components of the CYP role framework need to beunderpinned by appropriate education provision,delivered in ways that meet local needs but whichalso ensure consistency in standards of bothpractice and education. From a base of first degreeat registration, the level of clinical reasoning, careprovision, skills and knowledge required for therole/role components dictate the education leveland the level of acquired practical experience(see Figure 2).

Figure 2: Potential career pathways

supported by experience and education

As Figure 2 shows, core CYP nursing rolecomponents can be further developed fromregistration along the continuum to expert, eitheras part of specialist or expanded role developmentor separately, perhaps as part of PREP.

Role profiles agreed at a national level† will providethe basis for curriculum planning, educationalcommissioning and individuals’ careerdevelopment. For example, the detail of the roledescriptors for diabetes specialist nurses agreed bythe RCN Paediatric and Adolescent Diabetes SpecialInterest Group will underpin future CYPeducational provision in preparation for such roles.

Types of post-registrationeducation

Five main types of post-registration educationalprovision support the development of the clinicalnursing roles which are required to deliver servicesto children and young people in the future:

✦ induction/orientation to a new clinical area orspecialty

✦ in-service education with local certification(e.g. IV cannulation and IV drugadministration)

✦ in-service or other local education withnationally agreed certification (e.g.supplementary and independent prescribing)

✦ post-graduate diploma (e.g. specialist neonatalintensive care nursing with nationally agreedaccreditation)

✦ (Clinical) Masters degree (e.g. nursepractitioner with nationally agreedaccreditation).

22


5

First degree at registrationQualified CYP nurse

Expert CYP nurse

CYPspecialist

nurse

Paediatricnurse

practitioner

Experience andfurther education

Novice inspecialty /

expanded role Furthereducation &experience

† UK wide

Education for specialist nursing practice

A CYP specialist practitioner pathway would commence at postgraduate diploma, moving on to Masterslevel that encompasses a specialist component. Core modules would facilitate shared learning betweenspecialist practitioner pathways.

Figure 3: Proposed educational preparation for the CYP specialist nurse


23

Example: paediatric diabetesspecialist nurse education

The content of educational provision wouldencompass:

Induction programmeOverview of care of child/young person withdiabetes to include:

✦ blood glucose monitoring

✦ administration of insulin

✦ diet

✦ signs of/management of hypoglycaemia/hyperglycaemia

✦ role of paediatric diabetes specialist nurse

In-service education

✦ supporting a child/young person newlydiagnosed with diabetes

✦ blood sugar testing and use of meters

✦ insulin regimes and devices

Postgraduate award, certificate, diplomaand Masters level

✦ encompassing specialist paediatric diabetescomponent

✦ dissertation focused on paediatric diabetes

Proposed content and course structure

✦ Postgraduate Award: single module

✦ Postgraduate Certificate: 3 modules(core modules)

✦ Postgraduate Diploma: 6 modules(5 core modules + 1 optional module)

✦ Masters level: 8 core modules (5 core modules+ 3 optional modules and dissertation focusedon paediatric diabetes) – see Table 4.

Novice

Induction to specialty

Advanced beginner

In-service education+ experiential learning

(minimum6-12 months in

specialty)

Competent

In-service education+ experiential learning(minimum of 2 years

in specialty)

Proficient

Post-graduatediploma + experientiallearning (minimum of3 years in specialty)

Expert

Masters level[incl. specialistcomponent] +

experiential learning(minimum of 5 years

in specialty)

Table 4: Proposed content and course structure for paediatric diabetes specialist nurse education

24


Core modules

✦ Principles of diabetes care

✦ Further principles in diabetes care

✦ Applied pharmacology and therapeutics in

diabetes care

✦ Diabetes patient education – behavioural

modification

✦ Research in health care

Optional modules include areas such as:

✦ Access and equality in health care

✦ Cardiovascular risk

✦ Clinical governance in the NHS

✦ Counselling skills for health care professionals

in diabetes

✦ Diabetes and retinopathy

✦ Diabetes and the foot

✦ Diabetes and sexual health

✦ Experiential learning

✦ Health care ethics

✦ Health promotion in primary health care

✦ Hypertension and nephropathy

✦ Insulin initiation and management

✦ Learning in practice

✦ Metabolism and therapeutics in diabetes

✦ Organisations in primary health care

✦ Patient and public involvement in health care

✦ Self management in health

Shared learning in conjunction with those undertaking paediatric nurse practitioner education preparationcould encompass: advancing professional practice, clinical assessment, diagnostic skills and decision-making, pathophysiology and pharmokinetics, working across organisational boundaries

Education for expanded nursing practice

Educational preparation for expanded roles will range from in-service education provision to Mastersdegree courses (see Types of post-registration education, above). There could be shared learning betweenpaediatric nurse practitioner and CYP specialist nurse practitioner educational programmes on aspectssuch as decision-making, communication and pharmocology.

Figure 4: Example – Paediatric nurse practitioner education

Paediatric nurse practitioner preparation will be to Masters level over a minimum of one year, encompassing180 Level M credit theoretical modules and 500 hours clinical placements (see Table 5). The paediatricnurse practitioner role descriptors/role components set out in Table 3 and competencies (see Appendix C)underpin this outline curricula content.

Novice Advanced beginner Competent

Masters level PNPprogramme[see Table 5]

Proficient

Masters level PNPprogramme

[see Table 5] +experiential learning/

consolidation(2 years experience)

Expert

Masters level PNPprogramme

[see Table 5]+experiential learning (5 years experience)

Paediatric nurse practitioner in training

Table 5: Proposed curriculum content for paediatric nurse practitioner preparation (adapted from9,16 )


25

Core theme

✦ Therapeutic communication

✦ Childhood growth and development

✦ Family and cultural dynamics

✦ Advanced paediatric health assessment

✦ Child health promotion/protection and disease

prevention

✦ Management of paediatric illness, problems and

chronic disease management

✦ Health care delivery systems, policies and standards of

practice

✦ Advanced professional role development

✦ Advanced pharmacology

✦ Legal and ethical issues

✦ Advanced paediatric pathophysiology

✦ Evidence-based practice and research

✦ Leadership

✦ Advanced clinical reasoning, critical thinking and

creative problem-solving in the assessment and

management of child health and paediatric illness

Modules

✦ advanced health assessment; ambulatory care 1, 2, 3;

chronic disease management; seminars in advanced

paediatrics

✦ pathophysiology; advanced health assessment,

ambulatory care 1, 2, 3; pharmacology, chronic disease

management; seminars in advanced paediatrics

✦ advanced health assessment; ambulatory care 1, 2, 3;

chronic disease management; seminars in advanced

paediatrics


ambulatory care 1, 2, 3; chronic disease management;

seminars in advanced paediatrics







✦ advanced professional role development;

pathophysiology; advanced health assessment,

ambulatory care 1, 2, 3; chronic disease management;

seminars in advanced paediatrics

✦ advanced professional role development; ambulatory

care 1, 2, 3; chronic disease management; seminars in

advanced paediatrics




✦ pathophysiology; advanced health assessment;

ambulatory care 1, 2, 3; pharmacology; chronic disease

management; seminars in advanced paediatrics;

research; advanced professional development




✦ all programme modules

✦ advanced professional role development; ambulatory

care 1, 2, 3; chronic disease management; seminars in

advanced paediatrics

✦ advanced professional role development;

pathophysiology; advanced health assessment,

ambulatory care 1, 2, 3; pharmacology; chronic disease


Conclusion

The aim of this work by the RCN is to developexplicit, nationally† agreed role profiles for core,specialist and expanded clinical practice inchildren’s and young people’s nursing, in order to:

✦ support the practitioner in career planning andpersonal development

✦ guide further role development and educationalpreparation

✦ inform future pay negotiations

✦ support managers in workforce planning and indeveloping role requirements / job descriptionsfor specific posts.

The RCN Children’s and Young People’s Field ofPractice invites your feedback on the frameworkand specifications, so that we can update andamend the framework in preparation for thepublication of a second version. The plannedpublication date for version 2 of the document isDecember 2005.

If you would like to comment on the framework,please write to:

RCN Adviser in Children’s and Young People’sNursing

Royal College of Nursing, 20 Cavendish Square,London, W1G 0RN.

26


The RCN fully supports its members in raisingconcerns about the care of children and youngpeople. If you feel you are not getting the helpyou need in your workplace, contact RCN Directon 0845 772 1066 or ring your local RCN office(contact numbers can be found in your RCNMembers’ Handbook).

† UK wide

Appendix A

Paediatric diabetes specialist nursing roles – job descriptionsand person specifications

The role descriptors and role elements contained within the children’s and young people’s (CYP) nursingrole framework have been summarised to produce these job descriptions.

Job description


27

Diabetes nurse specialist

Proficient

Registered children’s nurse

Teaching qualification

Postgraduate Diploma encompassingspecialist paediatric diabetes component

In conjunction with other members of thepaediatric diabetes team, co-ordinate carefor children and young people withdiabetes and their families, assessing,developing, implementing and evaluatingprogrammes of holistic care andproviding specialist clinical advice tohealth care and others.

Uses clinical judgement and autonomousdecision-making concerning the specialist nursingcare and management of patients. Undertakes arange of specialist clinical actions within a specificsetting following assessment of patient need andcare

Diabetes clinical nurse specialist

Expert



Masters Degree encompassing specialistpaediatric diabetes component

In conjunction with other members of themultidisciplinary diabetes team, willenable the development of district-wideservices for children with diabetes,families and professionals, identifyingneeds and facilitating the implementationof services whilst setting standards forcare.

Uses clinical judgement and autonomousdecision-making concerning the specialist nursingcare and management of patients. Undertakes arange of specialist clinical actions across a varietyof settings following assessment of patient needand care

Paediatric diabetes nurseconsultant

Expert +

To provide the highest level of expertnursing practice for paediatric diabetes,acting autonomously and with authority,using advanced knowledge and skills, toshape and develop high quality paediatricdiabetes services across the trust andstrategic health authority

NB. Additional expert responsibilities for a nurseconsultant are shown in italics

Post:

Level:

Qualifications:

Role summary:

28


✦ Assess, plan, implement and evaluateholistic specialist diabetes nursing careand management of a caseload ofchildren and young people withdiabetes in the hospital or home setting

✦ Act as source of specialist advice forchildren, young people and families onthe specialist nursing care andmanagement of diabetes, including theprovision of advice on dietarymanagement and the management ofacute complications

✦ Provide individual specialist teachingfor children, young people and families,facilitating the development of self careskills and knowledge

✦ Assess, plan, implement and evaluateholistic specialist diabetes nursing careand management of a caseload ofchildren and young people withdiabetes in the hospital or home setting

✦ Act as a source of specialist advice forchildren, young people and families onthe specialist nursing care andmanagement of diabetes, including theprovision of advice on dietarymanagement and the management ofacute complications

✦ Lead and develop specific specialisteducation and training programmesfor children, young people, families andlay carers, facilitating the developmentof self care skills and knowledge

Nurse consultant✦ Provide expert clinical care for a

caseload of children with rare/ unusualforms of diabetes and those withpersistently poorly controlled diabetes

Specialistdiabetes caremanagement

Key responsibilities

✦ Provide counselling and support tochildren, young people and families 24hours a day

✦ Provide information about diabetes,sick day rules, life-style changes andlong-term implications for children,young people and families

✦ Undertake nurse led clinics andbaseline assessments

✦ Instigate treatment and adjust insulinaccording to protocols

✦ Undertake specialist investigations,interpret results and initiateappropriate action

✦ Develop and evaluate counsellingstrategies and provide support tochildren, young people and families 24hours a day

✦ Provide information about diabetes,sick day rules, life-style changes andlong-term implications for children,young people and families

✦ Undertake nurse led clinics, baselineassessments and annual reviews

✦ Instigate treatment and adjust insulinaccording to protocols

✦ Undertake specialist investigations,interpret results and initiateappropriate action

Specialistpsychological/psycho-social/physical andclinicalinterventions


29

✦ Contribute to policy, standards anddevelopment of specialist diabetes caredelivery strategies

✦ Implement and evaluate specialistdiabetes care innovations across thecatchment area of the organisation

✦ Formulate policy, standards andspecialist diabetes care deliverystrategies

✦ Lead the implementation andevaluation of specialist diabetes careinnovations across the catchment areaof the strategic health authority to meetnational and international standards

✦ Identify needs and facilitateimplementation of services

Nurse consultant✦ Act as a catalyst for change, challenging

professional and organisationalboundaries, generating new solutionswhich will best meet the needs ofchildren and their families

Practice andservicedevelopment(includingquality)

✦ Provide specialist education/ trainingfor nursing and other professionals

✦ Lead and develop specific specialisteducation programmes for nursing andother professionals across all caresectors including education

Nurse consultant✦ Proactively identify educational needs

across the strategic health authority area,leading and developing multidisciplinarytraining and development, lobbying forresources as necessary

✦ Work in partnership with educationproviders (HEIs) to ensure continuingprofessional development provisionmeets local needs, participating in thedevelopment of new courses as required

Teaching andeducation

✦ Act in accordance with NMC Code ofProfessional Conduct

✦ Act as source of specialist advice forstaff on the specialist nursing care andmanagement of diabetes


✦ Act as a prime source of authority forthe specialist advice for staff on thespecialist nursing care andmanagement of diabetes

Professional,ethical and legalpractice

✦ Maintain own professionaldevelopment

✦ Support the development of skills andknowledge amongst students andjunior members of the team


✦ Enhance the development of skills andknowledge of team members,providing clinical supervision forjunior team members

Development ofself and others


✦ Act as a role model for junior membersof staff and non-specialists

✦ Lead and manage personnel, servicesand resources, facilitating teamworkthrough the identification of a sharedvision

Nurse consultant✦ Contribute to policy making at local,

strategic health authority, national andinternational levels

✦ Identify opportunities for clinical auditand research, promoting a culture ofresearch awareness within thespecialist area of practice

✦ Initiate nursing research, clinical auditand development programmes

Nurse consultant✦ Undertake research projects in

conjunction with education providers(HEI’s), participating in the formationof research bids and national centreresearch and clinical audit activities

✦ Facilitate multidisciplinary and crosssector clinical audit activities

✦ Maintain effective communicationwith children, young people andfamilies to impart information aboutpaediatric diabetes to enable informedchoices

✦ Establish and maintain effectivecommunication with members of themultidisciplinary team

✦ Develop and initiate strategies toeffectively communicate key messagesand information about paediatricdiabetes to enable informed choices


Nurse consultant✦ Facilitate communication with teams,

other centres and networks

✦ Liaise with members of the primarycare team and other organisations i.e.schools to provide co-ordinatedpackages of care

✦ Liaise with members of the primarycare team and other organisations e.g.schools, to provide co-ordinatedpackages of care

✦ Interpret and analyse information froma variety of sources to underpindecision-making

✦ Maintain accurate and legible clinicaland legal documents



✦ Promote best practice in health, safetyand security of self and others in areaof specialist practice


✦ Enable others to exercise their rightsand promote equality and diversity

✦ Lead and implement practices, policiesand strategies which enable others toexercise their rights, promotion ofequality and diversity

30


Leadership


Research andevidence-basedpractice

Communication

Workingwith otherprofessionals/agencies

Knowledge andInformationmanagement

Health, safetyand security

Equality,diversity andrights


31

Essential

✦ Registered children’s nurse✦ Teaching qualification✦ Postgraduate Diploma encompassing

specialist diabetes component✦ Minimum of two years’ experience

caring for children and young peoplewith diabetes

✦ Excellent communication skills✦ Teaching and presentation skills✦ Ability to work in collaboration with

other professionals/teams✦ Knowledge of standards setting, audit

and research✦ Good IT skills✦ Car driver/owner

Desirable

✦ Experience as a paediatricdiabetes link

✦ Experience of working in acommunity setting

Professionalqualifications

Experience

Skills

Other

Person specification

Paediatric diabetes nurse specialist

Essential

✦ Registered children’s nurse✦ Teaching qualification✦ Masters Degree qualification

encompassing specialist diabetescomponent

✦ Minimum of five years’ experience inpaediatric diabetes nursing

✦ Excellent communication skills✦ Teaching and presentation skills ✦ Research/audit skills and knowledge✦ Clinical leadership and knowledge✦ Ability to work in collaboration with

other professionals/teams✦ Time management✦ Good IT skills✦ Car driver/owner

Desirable

✦ Experience as a paediatric diabetesspecialist nurse



Experience

Skills

Other


Paediatric diabetes clinical nurse specialist

32


Essential

✦ Registered children’s nurse✦ Teaching qualification✦ Masters Degree qualification

encompassing specialist diabetescomponent

✦ Minimum of five years’ experience inpaediatric diabetes nursing

✦ Demonstrable teaching experience atdiploma level and above

✦ Excellent communication skills✦ Proven teaching and presentation

skills at diploma level and above✦ Proven research/audit skills and

knowledge✦ Extensive clinical leadership and

knowledge✦ Ability to work in collaboration with

other professionals/teams✦ Time management✦ Good IT skills✦ Car driver/owner

Desirable

✦ Experience as a paediatric diabetesspecialist nurse at highly specialisedlevel


✦ Demonstrable participation/involvement in research and auditactivities


Experience

Skills

Other


Paediatric diabetes nurse consultant


33

Appendix B

Paediatric nurse practitioner – job description and personspecification

The role descriptors and role elements contained in the children’s and young people’s (CYP) nursing roleframework have been summarised to produce these job descriptions.

Job description

Paediatric nurse practitioner †

Proficient



Masters Degree qualification

The paediatric nurse practitionerfunctions within a clinical team of otherprofessionals, working autonomously inrelation to the complete management ofchildren and young people,complementing other professionals in thedelivery of high quality service provision.

Uses clinical judgement and autonomousdecision-making in relation to the assessment,diagnosis and management of patients,undertaking a range of clinical actions acrossprofessional boundaries within a specific setting ora CYP focused client group following assessment ofpatient need and care requirements

Expert



Masters Degree qualification

The paediatric nurse practitionerfunctions within a clinical team of otherprofessionals, working autonomously inrelation to the complete management ofchildren and young people,complementing other professionals in thedelivery of high quality service provision.

Uses clinical judgement and autonomousdecision-making in relation to the assessment,diagnosis and management of patients,undertaking a range of clinical actions across avariety of settings or CYP client groups andprofessional boundaries following assessment ofpatient need and care requirements

Post:

Level:

Qualifications:

Role summary:

† The role includes the assessment, diagnosis, treatment and management/discharge of patients without

reference to a medical practitioner.

34


✦ Assess, order (and interpret)investigations, undertake practicalprocedures, make diagnosis andformulate treatment/managementplans, including prescribing ofmedications via PGDs/supplementaryor independent prescribing

✦ Refer to consultants/otherspecialists/members of themultidisciplinary team

Depending on setting/area of practice:✦ Admit and discharge patients for

emergency/new admissions includingelective patients

✦ Assess and plan care and ongoingmanagement within ambulatory caresettings

✦ Undertake transfer and retrieval ofchildren

✦ Manage resuscitation including airway,breathing and circulation management

✦ Undertake outpatient/follow-upassessment

✦ Undertake health promotion/prevention through direct and indirectinterventions

✦ Assess, order (and interpret)investigations, undertake practicalprocedures, make diagnosis andformulate treatment/managementplans, including prescribing ofmedications via PGDs/supplementaryor independent prescribing

✦ Refer to consultants/otherspecialists/members of themultidisciplinary team

Depending on setting/area of practice:✦ Admit and discharge patients for

emergency/new admissions includingelective patients

✦ Assess and plan care and ongoingmanagement within ambulatory caresettings

✦ Undertake transfer and retrieval ofchildren

✦ Manage resuscitation including airway,breathing and circulation management

✦ Undertake outpatient/follow-upassessment

✦ Undertake health promotion/prevention through direct and indirectinterventions

Clinicalmanagement

✦ Educate children, young people andparents about assessment process,rationale for undertakingtests/investigations, subsequent resultsand plan of care/treatment

✦ Participate in induction/orientation ofjunior doctors and other staff

✦ Educate children, young people andparents about assessment process,rationale for undertakingtests/investigations, subsequent resultsand plan of care/treatment

✦ Participate in induction/orientation ofjunior doctors and other staff

Teaching andeducation

✦ Contribute to clinical protocols, policiesand standards development related tothe assessment and management of afocused CYP client group/specificsetting

✦ Recommend, implement and evaluateinnovations in practice

✦ Formulate clinical protocols, policiesand standards related to theassessment and management of abroad range of CYP client groups oracross settings

✦ Lead the implementation andevaluation of innovations in practice

Quality of healthcare practice(includingservice andpracticedevelopment)

✦ Liaise with other professionals andagencies to develop and provideco-ordinated packages of care

✦ Liaise with other professionals andagencies to develop and provideco-ordinated packages of care

Workingwith otherprofessionals/agencies




Professional,ethical and legalpractice


✦ Support the development of skills andknowledge amongst junior members ofthe team


✦ Enhance the development of skills andknowledge of team members,providing clinical supervision forjunior team members

Development ofself and others


35


✦ Act as a role model for junior membersof the multidisciplinary team

✦ Act as a role model for junior membersof the multidisciplinary team

Leadership

✦ Identify opportunities for clinical auditand research, promoting a culture ofresearch awareness within area ofpractice

✦ Initiate research, clinical audit anddevelopment programmes, includingevaluation of expanded practice

Research andevidence-basedpractice

✦ Maintain effective communicationwith children, young people andfamilies to impart information toenable informed choices


✦ Develop and initiate strategies toeffectively communicate key messagesand information to enable informedchoices


Communication





Knowledge andinformationmanagement



Health, safetyand security

✦ Enable others to exercise their rightsand promote their equality anddiversity

✦ Lead and implement practices, policiesand strategies which enable others toexercise their rights, promotion ofequality and diversity

Equality,diversity andrights

36


Essential

✦ Registered children’s nurse✦ Teaching qualification✦ Masters Degree PNP qualification ✦ Minimum of two years’ post-

registration experience as a PNP✦ Working across professional

boundaries✦ Working autonomously✦ Involvement with audit and

implementation of change✦ Excellent organisational and

communication skills✦ Ability to work in collaboration with

other professionals/teams✦ Clinical decision-making and critical

thinking skills✦ Assertiveness skills✦ Ability to initiate, manage and sustain

change✦ Highly developed clinical skills✦ Teaching skills ✦ Research/audit skills and knowledge✦ Time management✦ Good IT skills

Desirable

✦ PALS or APLSProfessionalqualifications

Experience

Skills


Proficient level paediatric nurse practitioner (PNP)


37

Essential

✦ Registered children’s nurse✦ Teaching qualification✦ Masters Degree PNP qualification ✦ Minimum of five years’

post-registration experience as PNP✦ Working across professional

boundaries✦ Working autonomously✦ Involvement with audit and

implementation of change✦ Excellent organisational and

communication skills✦ Ability to work in collaboration with

other professionals/teams✦ Clinical decision-making and critical

thinking skills✦ Assertiveness skills✦ Ability to initiate, manage and sustain

change✦ Highly developed clinical skills✦ Teaching skills ✦ Research/audit skills and knowledge✦ Time management✦ Good IT skills

Desirable

✦ PALS or APLSProfessionalqualifications

Experience

Skills


Expert level paediatric nurse practitioner

38


Appendix C

Paediatric nursepractitioner competencies

(adapted from the National Organisation of NursePractitioner Faculties, USA 9)

Assessment of health status

1. Obtains and documents a relevant history

2. Performs age-appropriate screening fordevelopmental and behavioural concerns i.e.speech/language development, learningdisabilities, and behavioural/mental healthconcerns

3. Assesses the child/young person’s developmentaltheories, recognising individual differences intemperament, reactions to selecteddevelopmental tasks/situational crises, andcoping styles/strategies

4. Identifies and analyses factors that affect thechild’s growth and development such as geneticbackground, prenatal factors, temperament,family and cultural influences, parenting style,environmental milieu (e.g. nursery, school)

5. Adapts and performs history and screeningprocedures according to the child’sdevelopmental age, behaviour and reason forcontact.

6. Performs and records a complete, accurate andsystematic paediatric physical assessment.

7. Recognises variations of normal includinggenetic, ethnic, physiologic, anatomic anddevelopmental differences.

8. Assesses for evidence of child abuse/neglect andthe effects of violence on the child.Additionallyidentifies situations and conditions of the child,family, school and community that put the childat risk for abuse/neglect; identifies behaviouralsigns in the child that are associated withabuse/neglect; and differentiates normal

physical findings or health practices from thosefindings of child abuse/neglect.

9. Analyses the family system to identify factorsthat influence the health of the child including:parent occupation/education/developmentallevel; family support system; family dynamics;family values and beliefs; family managementstyle; family stressors; social morbiditiesincluding poverty and illiteracy; management ofand coping with acute/chronic illness.

10. Assesses patient’s health risks including:developmental level; genetic/family history;immunisation status; nutritional status; risk-taking behaviour; environmental factors; familyissues; social support.

11. Assesses patient’s and family’s knowledge andbehaviour with regard to leading healthindicators including: physical activity; eatingdisorders; tobacco use; substance use andmisuse; responsible sexual behaviour; mentalhealth; injury and violence; environmentalquality; immunisations and access to healthcare.

Diagnosis of health status

1. Differentiates between normal and abnormaldevelopment in relation to anatomical,physiological, motor, cognitive, psychologicalfindings and the social behaviour of the child.

2. Identifies the aetiology, natural history,developmental considerations, pathogenesis andclinical manifestations of disease processes inchildren.

3. Identifies nutritional conditions and behaviouralfeeding issues.

4. Orders and interprets age and situationappropriate screening, laboratory, and otherdiagnostic tests including: FBC, urinalysis, ovaand parasite, X-rays, urine culture, etc.

5. Collaborates in the diagnosis of children withspecial health needs and disabilities.

6. Seeks consultation, advice and referralappropriately from the multidisciplinary team.

Plan of care and implementation oftreatment

1. Promotes healthy nutritional practices includingpromotion and management of breast-feeding,national nutrition guidelines, and healthynutritional intake considering food preferences,cultural practices and food sensitivities.

2. Provides interventions to modify behaviourassociated with health risks such as tobacco,substance use/misuse, lack of physical activity,nutritional patterns, sexual activity andviolence.

3. Refers children with developmental disabilitiesand chronic illness to appropriate communityservices, family support, and specialty care asneeded.

4. Incorporates health objectives into individualeducation plans for children with special needs.

5. Assists the parent/child in coping withdevelopmental behaviours and in facilitating thechild’s developmental potential.

6. Manages paediatric illness/conditions, injuriesand behavioural problems in children.

7. Performs a variety of acute/primary careinterventions/procedures such as suturing,splinting, smear tests, phlebotomy, cannulationand culturing as appropriate.

8. Develops, implements and evaluates healthmaintenance and health promotion services forthe child/family by incorporating teaching,counselling, anticipatory guidance and parentalsupport into paediatric nurse practitioner (PNP)care provision.

9. Develops, implements and evaluates a variety ofcounselling and supportive strategies asappropriate (for example, CAMHS actions).

10. Activates child protection services and otherresources on behalf of children at risk.

11. Prescribes appropriate drugs and othertherapies recognising pharmacodynamic andpharmacokinetic processes and the effects ofdrug selection and dosing regimens on children.

12. Collaborates in the transition planning for adulthealth care services.

13. Applies research that is child-centred andcontributes to positive change in the health andhealth care delivered to children.

14. Seeks consultation, advice and referralappropriately from the multidisciplinary team.

Relationships between child/youngperson/family and clinician

1. Creates a climate of mutual trust and establishespartnerships with children and families thatacknowledge their strengths and assists them inaddressing their needs.

2. Adapts the relationship between PNP andpatient/family to the changing nature of thechild’s cognitive, physical and psychosocialdevelopment.

3. Communicates effectively with children of alldevelopmental levels.

4. Communicates effectively with family members,including multi-generational family members.

5. Maintains confidentiality while communicatinginformation, plans of care and results in amanner that preserves the dignity and privacyof the child and provides a legal record of care.

6. Considers the unique needs of adolescents andchildren in care with regard to their autonomy inhealth care access and management.

Teaching

1. Assesses the child and family’s on-going andchanging needs for teaching based on: thechild’s growth and developmental stage; specificskills requisite for care management; and thechild and family’s understanding of the healthissue.

2. Provides anticipatory guidance that is ageand/or developmentally appropriate.

3. Advises and supports effective parenting skills.

4. Assists the child in assuming responsibilities forself-care and healthy behaviours in accordancewith age and developmental readiness.


39

5. Negotiates a plan of care that is mutuallyacceptable to both the child and family.

6. Monitors behaviours and specific outcomes as auseful guide to evaluating the effectiveness andneed to change or maintain teaching/coachingstrategies.

7. Coaches the child and family through theapplication of modelling, tutoring, supporting,encouraging, empathising and advocacybehaviours.

Develops and implements the PNP role

1. Interprets the PNP role to other health careproviders and the public.

2. Uses scientific theories and research toimplement the PNP role.

3. Functions in a variety of role dimensions asnecessary including: health care provider,co-ordinator, consultant, educator, coach,advocate, researcher and leader.

Directs care

1. Prioritises, co-ordinates and meets multipleneeds for culturally diverse children andfamilies.

2. Uses sound judgement in assessing conflictingpriorities and needs.

3. Obtains advice, consultation and referral forchildren as required.

4. Acts as an advocate for the child and family toensure health needs are met.

5. Incorporates current technology appropriatelyin care delivery.

6. Uses information systems and technology tosupport decision-making and to improve care.

Provides leadership

1. Recognises the importance of participating inprofessional and community organisations thatinfluence the health of children and supports therole of PNP

2. Serves as a resource in the design anddevelopment of paediatric community-basedhealth services.

3. Participates in legislative policy-makingactivities that influence advanced nursingpractice and the health of children, youngpeople, families and communities.

4. Advocates for access to appropriate and qualityhealth care for children.

5. Recognises the relationship betweenacute/community/public health issues andsocial problems as they impact on the health ofchildren and their families (e.g. poverty,violence, illiteracy).

Managing and negotiating healthcare delivery

1. Maintains current knowledge of theorganisation of care for children within thelarger health system, including local andregional referral sites.

2. Participates in organisational decision-makingabout child health and uses data frominformation systems to improve practice.

3. Demonstrates knowledge of relevant regulationsfor paediatric nurse practice including the NMCCode of Professional Conduct and otherapplicable legislation.

4. Collaboratively assesses, plans, implements,evaluates and refers to other health careprofessionals as necessary.

5. Participates as a member of themultidisciplinary team through thedevelopment of collaborative and innovativepractices.

40


Ensuring quality of health care practice

1. Interprets own professional strengths, role andscope of practice to children, families andcolleagues.

2. Incorporates professional and legal standardsinto practice.

3. Acts ethically to meet the needs of children andtheir families.

4. Monitors public issues that impact on thedelivery of health care services for children andtheir families

5. Assumes accountability for own practice.

6. Engages in clinical supervision and self-reflection to improve care and practice forchildren and their families.

7. Collaborates and consults with other memberof the health care team as appropriate

8. Uses an evidence-based approach to themanagement of child health and illnessincluding the critical application of researchfindings relevant to the management ofchildren and their families.

9. Evaluates the child’s response to care and theeffectiveness of care provided.

10. Uses the outcomes of care to revise subsequentmanagement plans.

11. Accepts personal responsibility for continuingprofessional development and the maintenanceof professional competence and credentials.

Monitoring quality of health care practice

1. Monitors the quality of own practice andparticipates in continuous qualityimprovements.

2. Monitors current research and policy guidancein order to improve quality of care.

Culture and diversity

1. Recognises the influence of cultural variationsand spiritual beliefs on child health practicesincluding child rearing, nutrition, and familydynamics.

2. Shows respect to the inherent dignity of everychild and family irrespective of their age,gender, religion, socio-economic class, sexualorientation, ethnicity or cultural group.

3. Acknowledges own personal biases andprevents these from interfering with thedelivery of quality care to children and familiesfrom other cultures.

4. Develops and/or accesses child and familyappropriate educational materials that addresstheir language and cultural beliefs.


41

42


References

1 Australian Confederation of Paediatric and ChildHealth Nurses (2000) Competencies for thespecialist paediatric and child health nurse,Sydney, Australia: ACPCHN

2 International Council of Nurses (2003) Animplementation model for the ICN framework ofcompetencies for the generalist nurse, Geneva: ICN

3 Royal College of Nursing (2000) A framework fordeveloping practice in paediatric oncologynursing, London: RCN. Publication code: 001 062

4 American Nurses Association (2003) Nursing’ssocial policy statement 2003, Washington, D.C.:ANA

5 Department of Health (2003) The NHS knowledgeand skills framework (NHS KSF) and developmentreview guidance – working draft, London: DH

6 International Council of Nurses Definition andcharacteristics of nurse practitioners/advancedpractice nurse, Geneva: ICN Available atwww.icn.ch. Accessed 23/09/04

7 Skills for Health (2003) Children’s skills andcompetency framework (draft for consultation),London: Skills for Health

8 Royal College of Nursing (2003) Nursepractitioners – an RCN guide to the nursepractitioner role, competencies and programmeaccreditation, London: RCN.Publication code: 001 797

9 National Organisation of Nurse PractitionerFaculties (2002) Nurse practitioner primary carecompetencies in speciality areas: adult, family,gerentological, pediatric and women’s health,Washington: National Organisation of NursePractitioner Faculties

10 National Organisation of Nurse PractitionerFaculties (2000) Domains and competencies ofnurse practitioner practice, Washington: NationalOrganisation of Nurse Practitioner Faculties

11 Nursing Council of New Zealand (2002) Thenurse practitioner – responding to health needs inNew Zealand, Wellington: New Zealand

12 New Zealand (2002) Nurse practitionerendorsement – guidelines for applicants,Wellington: New Zealand

13 Benner P. (1984) From novice to expert: excellenceand power in clinical nursing practice, MentoPark, California: Addison-Wesley PublishingCompany

14 Gately E (1992) PREP: from novice to expert,British Journal of Nursing,Vol.1, No.2, p.88-91

15 NHS Executive (1999) Health Service Circular1999/217 Nurse, midwife and health visitorconsultants – establishing posts and makingappointments

16 Brady M, Fuller S, Hellings P, Swartz M (1966)Philosophy and conceptual model’s terminalcompetencies for the education of pediatric nursepractitioners; Washington: Association of FacultyPediatric Nurse Practitioner programmes

Notes


43

Notes

44


October 2004

Published by theRoyal College of Nursing20 Cavendish SquareLondonW1G 0RN

020 7409 3333

The RCN represents nurses and nursing,promotes excellence in practice and shapeshealth policies.

Publication code 002 454

Documents

Services for children and young people ix C: Paediatric nurse practitioner competencies 38 References 42 Contents Introduction Health care practitioners are usin g many different role