Anp Kuliah Nursalam 11

8/12/2019 Anp Kuliah Nursalam 11

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aduate Course Syllabus

DV NCED NURSING PR CTICE: Paced/home-stdy!lectre! discssio"

: # c$

:

rse Coordi"ator : Nrsalam

dents review the characteristics and competencies of advanced nursing practice and examine issues related to theelopment of the role of an advanced practice nurse. Students build on their understanding of the competencies of advanced

sing practice to develop a vision of a future role in advanced nursing practice. As well, students develop a funding proposal

a project related to advanced nursing practice. Finally, students consider various futures scenarios that may shape theiranced nursing practice.

ter completing this course, students should be able to:

1. Discuss the characteristics and competencies of advanced nursing practice!. "valuate application of the competencies of advanced nursing practice in their own practice

#. Discuss issues related to implementation of advanced nursing practice roles, in particular the role of the nurse

practitioner$. Develop awareness of how advanced nursing practice %particularly the role of the nurse practitioner& is regulated in

his'her province'territory

(. Analy)e current issues influencing advanced nursing practice, with particular reference to the role of the nurse

practitioner*. "xplore various future scenarios for advanced nursing practice

+. rovide evidence-based clinical services to well clients of all ages and to those presenting with acute and chronic healthconcerns, at a level appropriate to a beginning practitioner, including

a. health history and physical examination

b. clinical decision ma/ingc. ordering of laboratory and diagnostic tests

d. prescription of medications

e. therapeutic communication

f. collaborative relationships

0. efer, to other health professionals, clients with health concerns that exceed the scope of practice of a beginningpractitioner offering clinical services

2. Demonstrate integration of medical and nursing management of health concerns of clients

s course consists of the following units

it 1 - Competencies of Advanced Nursing Practice I

his unit students review the characteristics of advanced nursing practice as identified by the 5anadian 6urses Association

consider the extent to which they are able to evidence these. Students then study the competencies of advanced nursingctice, reflecting on how the Advanced 6ursing ractice program has prepared them in these areas. 4t should be focused on

evelop multiple advanced assessment and intervention strategies within a

nt-centered framewor/ for individual clients, communities and populations
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se 9ualitative and 9uantitative data from multiple sources, often in ambiguous and complex situations, when ma/ingnical decisions and initiating and

naging change

naly)e the complex interaction of sociological, psychological and physiological processes, determinants of health andnts: lived experience

cipate and explain the wide range of client responses to actual or potential health problems and recommend action

it 2 - Competencies of Advanced Nursing Practice 2

his unit students review the characteristics of advanced nursing practice as identified by the 5anadian 6urses Association

consider the extent to which they are able to evidence these. Students then study the competencies of advanced nursing

ctice, reflecting on how the Advanced 6ursing ractice program has prepared them in these areas. 4t should be focused onuide decision-ma/ing in complex clinical situations

ngage clients and other team members in resolving issues at the individual, organi)ational and health-care system levels

entify and assess trends or patterns that have health implications for individuals, families, groups or communities

it - Competencies of Advanced Nursing Practice

his unit students review the characteristics of advanced nursing practice as identified by the 5anadian 6urses Associationconsider the extent to which they are able to evidence these. Students then study the competencies of advanced nursing

ctice, reflecting on how the Advanced 6ursing ractice program has prepared them in these areas. 4t should be focused on

enerate and incorporate new nursing /nowledge and develop new standards of care, programs and policies

an, initiate, coordinate and conduct educational programs based on needs, priorities and organi)ational resources andanage a wide range of patient responses to actual and potential health problems.

it ! - Advanced Nursing Practice "ole Implementation 1

his unit students study issues related to implementation of advanced nursing practice, including phases of role development,ministrative support for advanced nursing practice, and evaluation of advanced nursing practice. 4ssues related to

repreneurial opportunities and regulation of practice are explored. 3he unit closes with a loo/ at issues that may influence

future of advanced nursing practice.

it # - Advanced Nursing Practice "ole Implementation 2

his unit students study issues related to legal practice certainty from the government. 4ssues related to Nursing $ill %raft

explored. 3he unit closes with a loo/ at issues that may influence the future of advanced nursing practice.

it & - "esearc' in Advanced Nursing Practicesearch s/ills are an integral competency of advanced nursing practice and advanced practice nurses will be expected toically review research and utili)e research findings. As well, it is li/ely that advanced practice nurses will be expected tontify the need for and facilitate the development of research-based projects in their wor/ settings.

it ( ) *ealt' "esearc' +et'ods

oduction to the scientific method, experimental, 9uasi-experimental, descriptive and epidemiological research.

asurement issues 9uestionnaire development, reliability and validity of data, issues of sampling and sample si)e. "thicsesearch. Descriptive statistics, estimation and confidence intervals, inferential statistical tests. 8se of SSS statistical

tware. "lements of critical appraisal.

it , - Clinical Practicum and Community Assessment Processes and "e.uirements

s unit reviews the re9uirements of the clinical practicum and community assessment. 3he focus of the clinical practicumcommunity assessment of this course is =closure.= Students end their student relationship with their preceptors and with

mbers of the community with whom they have developed relationships during your community assessment.

it / - Advanced Nursing Practice Compre'ensive 0amination

ring this course students are re9uired to complete a comprehensive examination. 3he examination evaluates /nowledge inh the clinical services and community health development components of advanced nursing practice. Students must pass the

mprehensive examination in order to graduate from the Advanced 6ursing ractice program. 3his unit provides information

ut the examination and suggestions to assist students in preparing for the examination.

it 1 ) Clinical 3eaders'ip


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e unit consists of clinical leadership approaches'theories, decision ma/ing team building reflective practice, managingflict facilitating change and creating empowered wor/ environments. 3hese topics will be explored in the context of the

temporary healthcare environment and viewed from an ethico-legal stance. 4ncluded will be /nowledge of contemporary

ues in health care and trends in the development of effective clinical leadership in professional practice.

it 11 ) %evelopmental *ealt'

rrent research-based evidence on developmental and population health. 4nteraction of ecological, biological, psychological

social determinants. Developmental lifespan, including neurobiological, cognitive, social, emotional and moral

elopment. >io-psycho-social and cultural aspects utilising appropriate research findings and conceptual framewor/s to

ess, plan, implement and evaluate interventions targeting individuals, families and communities.

it 12 ) *ealt' Pro4ect Preparation

velopment of an investigation into an individual area of speciality. Development of a critical review of related literature,

dy design and methodology for the proposal in consultation with the project supervisor. reparation of a project'researchposal.

it 1 - Pro4ect %evelopment in Advanced Nursing Practice

his unit students learn how to develop project proposals.

it 1! - Preparation for Advanced Nursing Practice

his unit students consider possible futures of advanced nursing practice, including both components of extended healthvices and community health development.

ference

Affara F ? Schober lac/well

Association of egistered 6urses of 6ewfoundland and abrador. %!@@+&. Advanced practice-clinical nurse specialist

Bosition statementC. St. ohn:s Author.

De;rasse, 5., ? 6ic/lin, E. %!@@1&. Advanced nursing practice ld hat, new design. 5anadian ournal of 6ursing

eadership, 1$%$&, +-1!.

Furlong, "., ? Smith, . %!@@(&. Advanced nursing practice olicy, education and role development. ournal o

5linical 6ursing, 1$, 1@(2-1@**.

Gamric, A., Spross, ., ? Ganson, 5. %!@@2&.Advanced nursing practice: An integrative approach%$th ed.&. St. ouis"lsevier Saunders.

>ryant-u/osius, D., ? Di5enso, A. %!@@$&. A framewor/ for the introduction and evaluation of advanced practice

nursing roles. ournal of Advanced 6ursing, $0%(&, (#@-($@.

>ryant-u/osius, D., Di5enso, A., >rowne, ;., ? inelli, . %!@@$&. Advanced practice nursing roles Development,

implementation and evaluation. ournal of Advanced 6ursing, $0%(&, (12-(!2.

3extboo/s and readings from other Advanced 6ursing ractice courses will be used as appropriate.


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Advanced Nursing Practice

A National Framework

2008

www.cna-aiic .ca
http://www.cna/http://www.cna/


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3his document has been prepared by 56A in the pursuit of 56A:s mission,

vision and goals. 4t has been approved by the 56A >oard of Directors.

All rights reserved. ermission to photocopy or download for individual use is granted.

Further reproduction in any manner, including posting to a website, is

prohibited without prior written

permission of the publisher. ermission may be obtained by contacting

56A at permissionsHcna-aiic.ca.

I 5anadian 6urses Association

(@ Driveway

ttawa, 6 J! 1"!

3el. *1#-!#+-!1## or 1-0@@-#*1-0$@$

Fax *1#-!#+-#(!@

www.cna-aiic.ca

February !@@0

4S>6 2+0-1-((112- !1!-#
http://www.cna-aiic.ca/http://www.cna-aiic.ca/


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Contents

4ntroduction . . . 1

"volution of Advanced 6ursing ractice (

Definition and 5haracteristics . . . 2

Definition . . . 1@

5haracteristics . . . 1@

"ducational reparation 1#

oles 1(

egulation 12

5ompetencies . . . !1

5linical 5ompetencies . . . !!

esearch 5ompetencies !#eadership 5ompetencies !$

5onsultation and 5ollaboration 5ompetencies . . . !*

4mpact of Advanced 6ursing ractice !2

Support for Advanced 6ursing ractice . . . ##

oo/ing to the Future . . . #+

;lossary $@

Appendix A "A Framewor/ $!

Appendix > 3he 5onsultation rocess $#

Appendix 5


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Advanced nursing practice

is an umbrella term describing an

advanced level of clinical nursing

practice that maximizes the use of

graduate educational preparation,

in-depth nursing knowledge and

expertise in meeting the health needs

of individuals, families, groups, commu-

nities and populations. t involves

anal!zing and s!nthesizing knowledge"

understanding, interpreting and appl!ing

nursing theor! and research" and devel-

oping and advancing nursing knowledge

and the profession as a whole.


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ntroduction

Society and its health-care needs are always

evolving. As a result, health care in 5anada

today faces many challenges, including rising

costs, shortages of professionals, an aging

population, the introduction of new technology and difficulties with

access to care. 3he

demand for collaborative, innovative clinical practitioners to act as

leaders in health care

has never been stronger.

Advanced Nursing Practice : A National Framework 1


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Society and its health-care needs are always evolving. As a result, health care in

5anada today faces many challenges, including rising costs, shortages of

professionals, an aging population, the introduction of new technology and

difficulties with access to care. 3he demand for collaborative, innovative clinical

practitioners to act as leaders in health care has never been stronger. 6urses in

advanced nursing practice are well positioned to respond to the evolution of health

care. 4n particular, advanced nursing practice plays a /ey role in meeting the health

needs of 5anadians, by

building nursing /nowledge, advancing the nursing profession and contributing

to a sustainable and effective health-care system.

3he >oard of Directors of the 5anadian 6urses Association %56A& approved the

/ey elements of a national framewor/ for advanced nursing practice in une 1222.

3he first edition of Advanced 6ursing ractice A 6ational Framewor/ was

published in


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2 Advanced Nursing Practice : A NationalFramework


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thereby to increase consistency in role definition,

curricula and competency development.

3he framewor/ has already been used for a variety

of purposes, including developing educational

courses, outlining concepts for research, shaping

government position statements and interpreting

advanced nursing practice for employers, the public,

other health-care wor/ers and policy-ma/ers.

4n !@@(, 56A organi)ed the Dialogue on

Advanced 6ursing ractice to bring together

n #arch $ % % $ , the CNA &oard of

'irectors revised one of the ke! elements of

the framework b! establishing a graduate

degree in nursing as the minimum

educational re(uirement for

advanced nursing practice .

nursing sta/eholders - including educators, policy-ma/ers, administrators and

representatives of nursing organi)ations - to discuss what could be learned from

the existing advanced nursing practice roles, to identify what more could be done

to support the evolution of advanced nursing practice and to identify principles

and strategies that would promote the introduction of other advanced nursing

practice roles . articipants identified the national framewor/ for advanced

nursing practice as a useful guide in the continued development of this form of

practice in 5anada and recommended that it be updated periodically to respond

to the needs of its users and to reflect changes in health-care system

environments.

3he 5anadian 6urse ractitioner 4nitiative, launched in !@@$, helped in the development

of a framewor/ for the integration and sustainability of the nurse practitioner role in

5anada:s health-care system. ecommendations for practice, education, legislation

and regulation, and health human resources planning were considered in the current

revision of the advanced nursing practice framewor/.


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Advanced Nursing Practice : A National Framework #


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3he advanced nursing practice framewor/ contains the following /ey elements

7 evolution of advanced nursing practice

7 definition and characteristics

7 educational preparation

7 roles

7 regulation

7 competencies

7 impact of advanced nursing practice

7 support for advanced nursing practice

$ Advanced Nursing Practice : A NationalFramework


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)volution of Advanced

Nursing Practice

Advanced nursing practice has emerged

over the past decades as health-care systems

and governments around the world have come

to recogni)e Kthat optimi)ing the nursing

contribution to health care through expanding

their role is an effective strategy for improving

health servicesL %Schober ? Affara, !@@*, p. !&.

Advanced Nursing Practice : A National Framework %


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Nurses can choose from

a variet! of diverse and

e(uall! valuable practice

opportunities , of which

advanced nursing practice

is one .

Advanced nursing practice! has emerged over the past

decades as health-care systems and governments around

the world have come to recogni)e Kthat optimi)ing the

nursing contribution to health care through expanding

their role is an effective strategy for improving health

servicesL %Schober ? Affara, !@@*, p. !&. Despite the

common development of this realm of nursing practice,

the understanding of what constitutes advanced nursing practice varies from one country

to another and even within countries. Advanced practice nurses are viewed as experts in

their respective domains, engaged in activities that extend beyond the narrow application of

technically complex procedures. 4n particular, advanced nursing practice involves the

sophisticated use of /nowledge and s/ills %Daly ? 5arnwell, !@@#, p. 1*#&.

3wo advanced nursing practice roles are recogni)ed in 5anada today the clinical nurse

specialist and the nurse practitioner. 3hese two roles evolved from different roots.

5linical nurse specialists first emerged in the 12+@s as client care grew more complex.

3heir role was to provide clinical guidance and leadership to nursing staff managing

complex care, to improve the 9uality of care and to promote evidence-based practice.

5utbac/s in the 120@s and 122@s led to the elimination of many of these positions, but as

concern over the 9uality of care builds in the early !1st century, there is reason to

believe that the clinical nurse specialist role will regain prominence.

4n 5anada, the origin of the nurse practitioner lies in the wor/ of nurses who, decades ago,

provided care that was otherwise unavailable in rural and remote areas. 6urse practitioners

gained formal recognition in the 12+@s, when this role was recommended by policy-

ma/ers

as a way of providing health care to isolated populations. "ducation programs were started,

2 Advanced nursing ractice is used &y 'NA as the um&rella term for the advanced level of clinicalractice descri&ed inthis framework( individuals in advanced nursing ractice roles are referred to in this document asadvanced ractice nurses"Nurses refers to registered nurses"


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) Advanced Nursing Practice : A NationalFramework


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Canadian advanced practice nurses have

but a perceived oversupply of

physicians, a lac/ of enabling

legislation and problems related

to remuneration caused interest

to wane. 4nterest was re/indled

in the 122@s by health-care

the education , clinical expertise , leadership

skills and understanding of organizations , health polic! and

decision -making to pla! an important role in client and

health -care s!stem outcomes now and in the future .

reform, an increased demand for access to primary health care and the need for integrated

care. 3he 5anadian 6urse ractitioner 4nitiative was launched in !@@$ to develop a

pan5anadian framewor/ to encourage full integration of nurse practitioners into

5anadian

health care.

As demand, technology and /nowledge change the ways in which health care is delivered,

interest in advanced nursing practice is on the rise. 3rends in the delivery of health care

are providing opportunities for nurses to expand current roles and create new ones. 6urses

can choose from a variety of diverse and e9ually valuable practice opportunities, of which

advanced nursing practice is one. As nurses move along the continuum of experience and

education, they ac9uire additional competencies that become incorporated into their

practice. 3his evolution enables nurses to contribute to the health-care system in new ways.

Although all nurses contribute to the health-care system through their wor/ in

clinical practice, education, administration, research and policy, advanced nursing

practice focuses on the clinical domain in a wide array of practice settings. 5linical

practice not only incorporates direct client care but also involves a supportive and

consultative role. 5anadian advanced practice nurses have the education, clinical

expertise, leadership s/ills and understanding of organi)ations, health policy and

decisionma/ing to play an important role in client and health-care system outcomes

now and

in the future.


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Advanced Nursing Practice : A National Framework *


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'efinition and

Characteristics

'efinition

Advanced nursing practice is an umbrella term

describing an advanced level of clinical nursing

practice that maximi)es the use of graduate educationalpreparation, in-depth

nursing /nowledge and expertise in meeting the health needs of individuals,

families, groups, communities and populations.

Advanced Nursing Practice : A National Framework +


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'efinition

Advanced nursing practice is an umbrella term describing an advanced level of

clinical nursing practice that maximi)es the use of graduate educational preparation,

in-depth nursing /nowledge and expertise in meeting the health needs of individuals,

families, groups, communities and populations. 4t involves

7 analy)ing and synthesi)ing /nowledge

7 understanding, interpreting and applying nursing theory and research and

7 developing and advancing nursing /nowledge and the profession as a whole.

Characteristics

4n advanced nursing practice, nurses build on their expertise in a specialty area,

integrating and consistently displaying the following features and

characteristics

7 provision of effective and efficient care, delivered with a high degree of

autonomy, to an identified population

7 demonstration of leadership and initiation of change to improve client,

organi)ation and system outcomes

7 deliberate, purposeful and integrated use of in-depth nursing /nowledge,

research and clinical expertise, as well as integration of /nowledge from

other disciplines

7 depth and breadth of /nowledge that draws on a wide range of strategies

to meet the needs of clients and to improve access to and 9uality of care

7 ability to explain and apply the theoretical, empirical, ethical and

experiential foundations of nursing practice

10 Advanced Nursing Practice : A National


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Framework


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7 understanding, development and dissemination of evidence-based nursing

/nowledge

7 ability to initiate or participate in planning, coordinating, implementing

and evaluating programs to meet client needs and support nursing

practice

7 use of /nowledge-transfer techni9ues to put research-based /nowledge

into practice

7 demonstration of advanced judgment and decision-ma/ing s/ills and

7 critical analysis of and influence on health policy.



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)ducational Preparation

3he minimum educational preparation for

advanced nursing practice is a graduate degree in nursing. A nurse

with this type of graduatepreparation has a thorough grounding in

the

theoretical foundation of nursing and can

promote nursing research, generate new

/nowledge and use academic preparation,

synthesis and /nowledge-transfer s/ills to

interpret and incorporate new /nowledge

into clinical practice.

Advanced Nursing Practice : A National Framework 1#


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3he minimum educational preparation for advanced nursing practice is a graduate

degree in nursing. A nurse with this type of graduate preparation has a thorough

grounding in the theoretical foundation of nursing and can promote nursing research,

generate new /nowledge and use academic preparation, synthesis and /nowledge-

transfer s/ills to interpret and incorporate new /nowledge into clinical practice.

Although a graduate degree is essential for advanced nursing practice, nurses who have

completed one or more graduate degrees cannot assume that their practice is at an

advanced level on the basis of these educational credentials alone. 4t is the

combination of graduate education and clinical experience that allows nurses to

develop the competencies re9uired in advanced nursing practice.

i/e all nurses, advanced practice nurses are committed to lifelong learning. 4n addition

to pursuing such learning for themselves, they are committed to promoting, leading and

contributing to the lifelong learning of others.

1$ Advanced Nursing Practice : A NationalFramework


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*oles

Advanced nursing practice focuses on clinical

practice, whether through a direct relationship

with clients or through a supportive and

consultative role. 6urse educators, researchers

and administrators must demonstrate compe-

tencies in advanced nursing practice and

must have clinical practice as a significant part

of their role if they are to be considered as

functioning within advanced nursing practice.

Advanced Nursing Practice : A National Framework 1%


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Advanced nursing practice focuses on clinical practice, whether through a direct

relationship with clients or through a supportive and consultative role. 6urse

educators, researchers and administrators must demonstrate competencies in advanced

nursingpractice and must have clinical practice as a significant part of their role if

they are to be considered as functioning within advanced nursing practice.

nly two advanced nursing practice roles are recogni)ed in 5anada today the clinical

nurse specialist and the nurse practitioner. 3hese two roles are fundamentally different.

5linical nurse specialists provide expert nursing care for speciali)ed client populations.

3hey play a leading role in the development of clinical guidelines and protocols,

promote the use of evidence, provide expert support and consultation, and facilitate

system change %Association of egistered 6urses of 6ewfoundland and abrador,

!@@+&. 4n contrast, nurse practitioners provide direct care focusing on health

promotion and the treatment and management of health conditions. 3hey are

Kregistered

nurses with additional educational preparation and experience who possess and

demonstrate the competencies to autonomously diagnose, order and interpret

diagnostic tests, prescribe pharmaceuticals and perform specific procedures within

their legislated scope of practiceL %56A, !@@*a&.

+ith a focus on health promotion and disease prevention , both

the clinical nurse specialist and the nurse practitioner enhance the

provision of timel! , accessible , cost -effective and (ualit! health

care for all Canadians

CNA , $ % % / b , p . 0 1 .

1) Advanced Nursing Practice : A NationalFramework


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2he clinical nurse specialist pla!s

5linical nurse specialists and nurse practitioners

spend different amounts of time providing direct

clinical care, but both roles incorporate education,

research, consultation and leadership components.

5lient, organi)ation and system needs will help to

shape and determine the role of individual clinical

nurse specialists and nurse practitioners.

Eith a focus on health promotion and disease

prevention, both the clinical nurse specialist and

the nurse practitioner Kenhance the provision of

timely, accessible, cost-effective and 9uality health

care for all 5anadiansL %56A, !@@*b, p. #&. 4t is

anticipated that new advanced nursing practice

roles will develop to meet the existing and emerging

health-care needs of 5anadians. For example, several

jurisdictions are exploring an advanced nursing

practice role within anesthesia care.

Advanced Nursing Practice : A National Framework

a pivotal role in the provision of

safe , effective , evidence -based care ,

supporting nurses to ensure that the!

maximize their skills

and abilities .

, -ernadine .allis/ clinical nursesecialist

.innieg/0anito&a

A nurse practitioner complements

rather than replaces other health -

care providers , bridges the gap

in service deliver! for patients , expands care

options , and supports a shift to wellness -based

care .

, 0ary Nugent/ nurseractitioner

Ta&er/Al&erta


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1*


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*egulation

A framewor/ describing advanced nursing

practice allows for a coordinated national

approach, permits flexibility among provinces

and territories, and allows new roles to develop.

Such a coordinated approach is necessary to

ensure that the public has access to consistent,

high-9uality nursing services across the country.

4t will also facilitate labour mobility for

advanced practice nurses who are subject to

specific provincial or territorial legislation.

Advanced Nursing Practice : A National Framework 1+


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A framewor/ describing advanced nursing practice allows for a coordinated national

approach, permits flexibility among provinces and territories, and allows new roles to

develop. Such a coordinated approach is necessary to ensure that the public has access

to consistent, high-9uality nursing services across the country. 4t will also facilitate

labour mobility for advanced practice nurses who are subject to specific provincial or

territorial legislation.

Advanced practice nurses are registered nurses who are licensed by and accountable to

the registered nursing regulatory body established by legislation in each province and

territory. For many advanced practice nurses, additional regulation and standards are not

re9uired because they practise within the scope of registered nursing in their respective

jurisdictions. 4n some cases, the scope of practice includes additional responsibilities,

such as prescriptive authority, that may re9uire additional regulatory authority, but these

additional authorities are all within the scope of practice of nursing.

3he regulation of nursing practice is intended to safeguard the public by ensuring that

nurses meet standard levels of /nowledge and education. 4n 5anada, regulatory titles,

including Kregistered nurseL and K6,L are protected, but other titles, such as Knurse,L

Knurse practitionerL and K6,L may or may not be protected according to the legislation of

specific jurisdictions.

5urrently, the only advanced nursing practice

A framework describing advanced

nursing practice allows for a

coordinated national approach , permits

flexibilit! among provinces and territories , and

allows new

roles to develop .

20


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e with additional regulation and title protection

5anada is the nurse practitioner,

hough the specific title used

ies among the provinces and

itories. As new roles in advanced

sing

ctice emerge, they may or may not re9uire

ditional legislation and regulation.

Advanced Nursing Practice :A National Framework


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Competencies

5ompetencies are the specific /nowledge, s/ills,

judgment and personal attributes re9uired for a

registered nurse to practise safely and ethically in

a designated role and setting %56A, !@@(&. 5ore

competencies for advanced nursing practice are

based on an appropriate depth, breadth and range of nursing /nowledge,

theory and research, enhanced by clinical experience.



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5ompetencies are the specific /nowledge, s/ills, judgment and personal attributes re9uired

for a registered nurse to practise safely and ethically in a designated role and setting

%56A, !@@(&. 5ore competencies for advanced nursing practice are based on an appropriate

depth, breadth and range of nursing /nowledge, theory and research, enhanced by clinical

experience.# 3hey cut across specialty lines and are exhibited by all advanced practice nurses.

3his framewor/ separates competencies into four categories clinical, research, leadership,

and consultation and collaboration. Gowever, it is the effective and simultaneous interaction,

blending and execution of /nowledge, s/ills, judgment and personal attributes in a wide

variety of practice environments that characteri)es advanced nursing practice.

Clinical Competencies

3he cornerstone of advanced nursing practice is expertise in a speciali)ed area of nursing.

3hrough a holistic and integrated approach, the nurse wor/s in partnership with the client

and other members of the health-care team in the provision of comprehensive care.

An advanced practice nurse integrates extensive clinical experience with theory,

research and in-depth nursing and related /nowledge to

7 develop multiple advanced assessment and intervention strategies within a

client-centred framewor/ for individual clients, communities and

populations

7 use 9ualitative and 9uantitative data from multiple sources, often in ambiguous

and complex situations, when ma/ing clinical decisions and initiating and

managing change

7 analy)e the complex interaction of sociological, psychological and

physiological processes, determinants of health and clients: lived experience

# 'ometencies secific to the nurse ractitioner role and resonsi&ilities are identified in 'anadian Nurse Practitioner:'ore 'ometency Framework 1'NA/ 200%"


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7 anticipate and explain the wide range of client responses to actual or

potential health problems and recommend action

7 guide decision-ma/ing in complex clinical situations

7 engage clients and other team members in resolving issues at the individual,

organi)ational and health-care system levels

7 identify and assess trends or patterns that have health implications for

individuals, families, groups or communities

7 generate and incorporate new nursing /nowledge and develop new standards

of care, programs and policies

7 plan, initiate, coordinate and conduct educational programs based onneeds, priorities and organi)ational resources and

7 manage a wide range of patient responses to actual and potential health

problems.

*esearch Competencies

;enerating, synthesi)ing and using research evidence is central to advanced

nursing practice.

An advanced practice nurse is able to

7 identify and implement research-based innovations for improving client

care, organi)ations or systems

7 as either primary investigator or collaborator with other members of the

health-care team or community, identify, conduct and support research that

enhances or benefits nursing practice

Advanced Nursing Practice : A National Framework 2#


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Advanced practice

nurses are leaders in

the organizations and

communities where the!

work .

7 evaluate current practice at individual and system levels in

light of research findings

7 collect data on, and evaluate the outcomes of, advanced

nursing practice for clients, the nursing profession and thehealth-care system

7 criti9ue, interpret, apply and disseminate evidence-based findings and

7 contribute to nursing and the health-care system by disseminating new

/nowledge through formal and informal channels, including presentation

and publication at the local, regional, national and international levels.

3eadership Competencies

Advanced practice nurses are leaders in the organi)ations and communities where they

wor/. 3hey are agents of change, consistently see/ing effective new ways to practise, to

improve the delivery of care, to shape their organi)ations, to benefit the public and to

influence health policy.

An advanced practice nurse demonstrates leadership by

7 advocating for individuals, families, groups and communities in relation to

treatment, the health-care system and policy decisions that affect health and

9uality of life

7 identifying the learning needs of nurses and other members of the health-care

team and finding or developing programs and resources to meet those needs

7 mentoring and coaching nursing colleagues, other members of the

healthcare team, and students

7 advocating for and promoting the importance of health-care access and

advanced nursing practice to nurses and other health professionals, the

public, legislators and policy-ma/ers

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7 contributing to and advocating for an organi)ational culture that supports

professional growth, continuous learning and collaborative practice

7 evaluating programs in the organi)ation and the community and developing

innovative approaches to complex issues

7 understanding and integrating the principles of resource allocation and

cost-effectiveness in organi)ational and system-level decision-ma/ing

7 identifying gaps in the health-care system and developing partnerships to

facilitate and manage change

7 developing and clearly articulating a vision for nursing practice, influencing

and contributing to the organi)ation:s and the health-care system:s vision

and implementing approaches to reali)e that vision

7 advising clients, colleagues, the community, health-care institutions

and

policy-ma/ers on issues related to nursing, health and health care

7 identifying problems and initiating change to address challenges at the

individual, organi)ational or system level and

7 understanding legislative and socio-political issues that influence health

policy, and building strategies to improve health, health-care access and

healthy public policy.


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Advanced Nursing Practice : A National Framework 2%


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Consultation and Collaboration Competencies

"ffective collaboration and communication with clients and others on the health-care

team represent important aspects of any nursing practice. 3he ability to consult and

collaborate with colleagues across sectors and at the organi)ational, provincial,

national and international level is a characteristic of nurses in advanced practice.

A nurse in advanced practice is able to

7 initiate timely and appropriate consultation, referrals and collaboration with

other health-care providers

7 consult and collaborate with members of the health-care team to develop

9uality-improvement and ris/-management strategies

7 wor/ with others to gather and synthesi)e 9ualitative and 9uantitative

information on determinants of health from a variety of sources

7 practise collaboratively and build effective coalitions

7 apply theories related to group dynamics, roles and organi)ations

Collaboration is a complex process re(uiring knowledge sharing and 4oint

responsibilit! for patient care ,

management and outcomes .

, 3andra 4uke/ nurse

ractitioner5alifa!/ Nova

3cotia

2) Advanced Nursing Practice : A NationalFramework


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7 demonstrate /nowledge and s/ill in communication, negotiation and conflict

resolution, including the ability to analy)e, manage and negotiate conflict

7 clearly articulate the contribution of advanced nursing practice within

the interprofessional health-care team

7 participate in collaborative projects with academic institutions and maintain

cross-appointments and

7 advocate for changes in health policy by participating on regional, provincial'

territorial, and federal committees that influence decision-ma/ing at

those levels.

Advanced Nursing Practice : A National Framework 2*


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mpact of Advanced

Nursing Practice

Advanced nursing practice has evolved to meet the demands of

modern health care through

increasingly advanced /nowledge and s/ills.

4t is not merely technical and educational

progress that has driven the development of

advanced nursing practice the health needs

of clients and the growing complexity of care

have also contributed.

Advanced Nursing Practice : A National Framework 2+


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Advanced practice nurses

have used their experienceAdvanced nursing practice has evolved to meet the

and education to take nurs -demands of modern health care through increasingly

ing practice to new levels ,

as the! have moved from a

supportive to a leading role in client

care .

advanced /nowledge and s/ills. 4t is not merely technical

and educational progress that has driven the development

of advanced nursing practice the health needs of

clients and the growing complexity of care have also

contributed. Advanced practice nurses have used their

experience and education to ta/e nursing practice to new levels, as they have

moved from a supportive to a leading role in client care.

"vidence about the benefits of advanced nursing practice is now building. 5unningham

%!@@$, p. !12& has stated that nurses in advanced nursing practice KenrichL health care by

adding value to the delivery of health-care services. >ryant-u/osius, Di5enso, >rowne

and inelli %!@@$, p. (!*& found that advanced practice nurses may improve client and

health-care system outcomes related to health status, functional status, 9uality of life,

satisfaction with care and cost efficiency. De;rasse and 6ic/lin %!@@1, p. 0& reported

that the use of advanced practice nurses decreased

the number of hospital admissions and emergency

Clinical nurse specialists , with

their focus on patient care from a

nursing perspective , can advance

nursing practice through education,

research and the development of

s!stems that meet patient and

famil! needs .

, 6rlene 3ea&orne/ clinical nurse secialist

5amilton/ 7ntario

#0

department visits, shortened lengths of stay and

resulted in cost savings for the institutions where they

were employed. ther outcomes that improved with

advanced nursing practice included fewer

readmissions for heart failure, shorter lengths of

stay when patients were readmitted and lower rates

of urinary tract infections, s/in brea/down and

pneumonia %Jleinpell, !@@+, p. !@&. Jleinpell also

reported that advanced nursing practice helped

promote evidence-based care, improved patients:


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vance urs ngPractice : A NationalFramework


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Clinical nurse specialists support and

teach other health -care providers and

adherence to health promotion and built the

evidence base of nursing. Advanced nursing

practice is an innovative and exciting develop-

ment that provides nurses with an opportunity

to wor/ at an advanced level of clinical

practice %Furlong ? Smith, !@@(, p. 1@*!&.

can influence and improve health care

at the individual and the s!stem level .

, 8inda 9ead Paul/ clinical nurse

secialist'algary/ Al&erta

3he role of the nurse practitioner has been studied for many years. 4n a literature

review commissioned by the 5ollege of egistered 6urses of 6ova Scotia and released in

une !@@+, Sangster-;ormley reported that client satisfaction and education are the most

commonly researched outcomes of nurse practitioner care. Gowever, the author went on

to describe solid evidence for many other benefits to care nurse practitioners are more

li/ely to follow practice guidelines, and their patients have shorter stays, fewer

readmissions and other successful outcomes.

3he body of research on advanced nursing practice is smaller than is the case for many

other topics in nursing. 4n another review of recent research, erman and Floyd

%!@@!, p. 1$@& identified and described this lac/ of evidence. 3hey found that research

on outcomes has focused too much on cost savings, ignoring important aspects of the

wor/ of advanced practice nurses such as resolution of symptoms, enhancement of

clients: 9uality of life and improvements in /nowledge among patients and families.

3hey called for advanced practice nurses to lead more research on the results of specific

nursing interventions.

For their annotated bibliography, published in !@@$, Fulton and >aldwin reviewed

+@ research papers that had been written by nurses or had examined the impact of

clinical nurse specialists. Fulton and >aldwin identified many ways in which

clinical

nurse specialists improved care, such as reducing the number of visits to emergency

departments by clients with asthma and improving prenatal care of and generating


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Advanced Nursing Practice : A National Framework #1


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better outcomes for very low birth weight babies they also found that cancer

patients whose care team included a clinical nurse specialist had fewer

complications. erhaps the most important aspect of the article was the scope of

information it

covered in addition to the research pieces, the authors reviewed #1 publications about

program development and evaluation and !( anecdotal accounts. 3hese numbers are

a sign that the /nowledge base for advanced nursing practice is building, but Fulton

and >aldwin %!@@$, p. !!& warned that Kalthough the number of articles had drastically

increased, the scope of everyday Bclinical nurse specialistC accomplishments is not

completely captured in published wor/. B5linical nurse specialistsC improve care

practice on a daily basis.L

#2 Advanced Nursing Practice : A National


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Framework


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Advanced nursing practice must be supported at many levels if it is to operate effectively

and provide a full range of benefits to clients, other members of the health team,

organi)ations and the community as a whole. 3he 8niversity Gealth 6etwor/

Framewor/ for

Advanced 6ursing ractice states that Ksignificant challenges have emerged in role

imple-

mentation and development, as a result of inconsistent professional and organi)ational

support for Badvanced nursing practiceC. ole clarity, demonstrated value and consistent

support have been identified in the literature as /eys to successful role implementationL

%


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7 support for professional development and lifelong learning

7 funding for research about and by nurses in advanced nursing practice

7 interprofessional education and organi)ations that foster team wor/

7 resources to put in place the positions, technology, administrative infrastructure

and culture for advanced practice nurses to wor/ most effectively and

7 policy processes that promote advanced nursing practice and are shaped by the

expertise of advanced practice nurses.

Advanced Nursing Practice : A National Framework #%


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#) Advanced Nursing Practice : A NationalFramework


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3ooking to the 6uture

5anada:s health-care needs are growing

with the aging of the population, continued

shortages in the supply of health human

resources, increasing complexity of the health-

care system and mounting pressure to contain

costs. Advanced nursing practice is helping

to meet these growing needs. 3o have a far-

reaching impact, however, advanced nursing

practice must be promoted and sustained.

Advanced Nursing Practice : A National Framework #*


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5anada:s health-care needs are growing with the aging of the population, continued

shortages in the supply of health human resources, increasing complexity of the health-care

system and mounting pressure to contain costs. Advanced nursing practice is helping to

meet these growing needs. 3o have a far-reaching impact, however, advanced nursing

practice must be promoted and sustained.

6ew advanced nursing practice roles should be introduced only in response to the health-

care needs of 5anadians and must be based on solid evidence of those needs. 56A:s position

statement 6ational lanning for Guman esources in the Gealth Sector states that

needs-based planning anticipates health needs on the basis of Kdemographic,

epidemiological, and cultural factorsL and includes benchmar/ing for regional variation and

review of specialty mix within and between disciplines %56A, !@@*c&.

New approaches to health

care , based on strategies

that will enhance access

to service deliver! while

improving the health of

the population , must be

developed collaborativel! .

rogress has been made in providing guidelines for the

introduction and evaluation of advanced nursing practice

roles %>ryant-u/osius ? Di5enso, !@@$, p. (#1 Einnipeg

egional Gealth Authority, !@@(, !@@*&. 4n particular, >ryant-

u/osius and Di5enso %!@@$, p. (#!& presented the "A

framewor/, a Kparticipatory, evidence-based, patient-centred

process for Badvanced nursing practiceC role development,

implementation and evaluation,L which set out nine steps for

determining whether a new advanced nursing practice role is

needed and whether it will be effective. 3hese steps include defining the patient population,

defining new models of care and the place of the advanced practice nurse within them,

implementing the new models of care and long-term monitoring.

3he 5anadian 6urse ractitioner 4nitiative includes an implementation and evaluation

tool/it, which serves as a practical guide to assessing the need and readiness for the nurse

practitioner role. 4n addition, the tool/it identifies /ey steps and factors to support the

implementation of this role and ongoing monitoring of its effectiveness through a

#8 Advanced Nursing Practice : A NationalFramework


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structured, forward-loo/ing evaluative approach. 4n particular, the tool/it offers guidance on

tailoring the planning, implementation and evaluation of the nurse practitioner role to the

uni9ue re9uirements of specific practice settings. 3he design of the tool/it was based on the

"A framewor/, extensive literature review and experimental research, /ey sta/eholder

con-

sultation and a review of best practices %56A, !@@*d&. 4n addition, a needs-based simulation

model for health human resources planning was developed in conjunction with the 5anadian

6urse ractitioner 4nitiative this model is applicable to primary health care nurse practitioners

across all jurisdictions in 5anada. 4t goes beyond the traditional planning models, which are

based on supply and projected population-to-provider ratios, to consider population health

needs and the level of services re9uired to meet those needs %56A, !@@*e&.

5oordination of the preparation and roles for advanced nursing practice is another necessary

step. 3he development of educational and experiential goals and programs for advanced

practice nurses should be aligned across the provinces and territories, to reinforce their place

in health care overall and to permit labour mobility. 3he goal must be to ensure that all

5anadians have access to similar types of expertise.

3o effectively develop and sustain the health-care system, the roles of health-care providers,

including advanced practice nurses, must be optimi)ed. 5anadians can anticipate many new chal-

lenges to their health-care system, including increases in chronic diseases such as diabetes mellitus

and arthritis. 6onetheless, a shift in focus from illness to health is expected, whereby clients will

become more educated and more strongly engaged and will participate more actively in developing

and maintaining their own health %Milleneuve ?


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Advanced Nursing Practice : A National Framework #+


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7lossar!

Advanced nursing practice

8mbrella term for an advanced level of clinical nursing practice that

maximi)es the use of

graduate educational preparation, in-depth nursing /nowledge and

expertise in meeting the

health needs of individuals, families, groups, communities and

populations. 4t involves

7 analy)ing and synthesi)ing /nowledge

7 understanding, interpreting and applying nursing theory and research and

7 developing and advancing nursing /nowledge and the profession as a whole.

5lient 3he beneficiary of care may be an individual, family, group, population or entire

community

5lient-centred care

K6urses achieve client-centred care by actively including the client and

significant others

as partners in the care, Band byC identifying the client:s goals, wishesand preferences

and ma/ing these the basis of the plan of care...L %5ollege of 6urses of

ntario, !@@*&

5linical nurse specialist

A registered nurse who holds a master:s or doctoral degree in nursing

with expertise in a clinical nursing specialty uses in-depth /nowledge

and s/ills, advanced judgment and

clinical experience in a nursing specialty to assist in providing solutions

for complexhealth-care issues

5ompetencies

5redentials $0


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egrated /nowledge, s/ills,gment and personal attributesuired of a registered

se to practise safely and ethicallya designated role and setting6A, !@@(&

r/s or

ampsL of

lity andievement

mmunicating

mployers,

ers and

sumers what

xpect from a

edentialedL

se, specialist

rse or

gram of

dy,titution of

her

ucation,

pital or

lth service,

health-care

duct,

hnology or device

AdvancedNursingPractice :

ANational

Framework


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;raduate education

"ducation beyond the baccalaureate level, including master:s, doctoral

and postdoctoral levels %Field, Stinson ? 3hibaudeau, 122!&


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Advanced Nursing Practice : A National Framework $1


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Appendix &

2he Consultation Process

3he >oard of Directors of the 5anadian 6urses Association %56A& approved the /ey

elements of a national framewor/ for advanced nursing practice in une 1222. 3he

framewor/ was first published in oard of Directors created a national wor/ing group to guide revision

of the framewor/. 4ts consultations involved one face-to-face meeting, numerous tele-

conferences and circulation of several draft documents among member jurisdictions

and national nursing and other health-care organi)ations. 4n addition, a discussion of

the draft framewor/ by the 56A >oard of Directors helped to guide the final version.

Feedbac/ from the consultation process was extensive. Gundreds of responses were

received from associations, organi)ations and individual nurses. Although views on specific

aspects of the framewor/ differed, there was strong consensus on the /ey concepts for

advanced nursing practice. 3a/ing into consideration the feedbac/ received and the con-

sensus recommendations from the national wor/ing group, the 56A >oard of Directors

approved the updated framewor/ for advanced nursing practice in 6ovember !@@+.

Advanced Nursing Practice : A National Framework $#


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Appendix C

#embers of the National +orking 7roup

Co-Chairs

5hristine iec/ >uc/ley 5anadian 6urses Association

Debbie hilipchu/ 5ollege ? Association of egistered 6urses of Alberta

#embers

Jaren Antoni 5anadian Association of Advanced ractice 6urses

;ail >eatty egistered 6urses: Association of ntario

rennan 5ollege of egistered 6urses of 6ova Scotia

Su)anne Durand rdre des infirmiNres et infirmiers du OuPbec

Stephen ec/ egistered 6urses Association of 6orthwest 3erritories and 6unavut

Francis oos Sas/atchewan egistered 6urses: Association

>etty undrigan Association of egistered 6urses of 6ewfoundland and abrador

atricia la/e ar/in Association of egistered 6urses of rince "dward 4sland

5heri Migar 5ollege of 6urses of ntario

>arb Eaters 6urse ractitioner 5ouncil of 5anada

o Eearing 5ollege of egistered 6urses of >ritish 5olumbia

Doug Eheeler 6urses Association of 6ew >runswic/

oanne Einsor 5ollege of egistered 6urses of


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*eferences

Association of egistered 6urses of 6ewfoundland and abrador. %!@@+&.

Advanced practice-clinical nurse specialist Bosition statementC. St. ohn:s Author.

>ryant-u/osius, D., ? Di5enso, A. %!@@$&. A framewor/ for the introduction

and evaluation of advanced practice nursing roles. ournal of Advanced

6ursing, $0%(&, (#@-($@.

>ryant-u/osius, D., Di5enso, A., >rowne, ;., ? inelli, . %!@@$&. Advanced

practice nursing roles Development, implementation and evaluation. ournal of

Advanced 6ursing, $0%(&, (12-(!2.

5anadian 6urses Association. %!@@(&. 5anadian nurse practitioner

5ore competency framewor/. Fttawa Author.

5anadian 6urses Association. %!@@*a&. ractice framewor/ for nurse practitioners

in 5anada. ttawa Author.

5anadian 6urses Association. %!@@*b&. eport of !@@( dialogue on advanced

nursing practice. ttawa Author.

5anadian 6urses Association. %!@@*c&. 6ational planning for human resources

in the health sector Bosition statementC. ttawa Author.

5anadian 6urses Association. %!@@*d&. 5anadian nurse practitioner

initiative 4mplementation and evaluation tool/it for nurse practitioners in

5anada. Fttawa Author.

5anadian 6urses Association. %!@@*e&. Gealth human resources chapter. 4n

5anadian nurse practitioner technical report. ttawa Author.

5ollege of 6urses of ntario. %!@@*&. earning module 3herapeutic

communication and client-centred

care. 3herapeutic 6urse-5lient 1elationship, 1evised !@@*, practicestandard 3herapeutic 5ommunication

and 5lient-5entred 5are, slide 0. etrieved February +, !@@0, from

http''www.cno.org'prac'learn'

modules'tncr'pdf'365-5hapter#.pdf

5unningham, . S. %!@@$&. Advanced practice nursing outcomes A review of

selected empirical literature. ncology 6ursing Forum, #1%!&, !12-!#@.

Daly, E., ? 5arnwell, . %!@@#&. 6ursing roles and levels of practice A

framewor/ for differentiating

between elementary, specialist and advancing nursing practice. ournal of 5linical

6ursing, 1!, 1(0-1*+.
http://www.cno.org/prac/learn/http://www.cno.org/prac/learn/


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De;rasse, 5., ? 6ic/lin, E. %!@@1&. Advanced nursing practice ld hat, new

design. 5anadian ournal of 6ursing eadership, 1$%$&, +-1!.

Advanced Nursing Practice : A National Framework $%


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Field, . A., Stinson, S., ? 3hibaudeau, aumgart ? . arsen %"ds.&, 5anadian nursing faces

the future. 3oronto 5M aldwin, J. %!@@$&. An annotated bibliography reflecting 56S

practice and outcomes. 5linical 6urse Specialist, 10%1&, !1-#2.

Furlong, "., ? Smith, . %!@@(&. Advanced nursing practice olicy, education

and role development. ournal of 5linical 6ursing, 1$, 1@(2-1@**.

Jleinpell, .


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$) Advanced Nursing Practice : A NationalFramework


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http://www.cna/http://www.cna/


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