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Here at CRNNS, we need to ensure that all nurse practitioners are able to function in today’s realities and are well-equipped with the knowledge and skills to adapt to changes within the nursing and healthcare environment.

The Entry-Level Competencies for Nurse Practitioners reflect the knowledge, skills and judgement required of NPs to provide safe, competent, ethical and compassionate care. While specific roles and responsibilities may vary by context and client population, this document outlines the essential competencies that all NPs must possess to be proficient when they begin practice.

Entry-level competencies are one of the sentinel documents used by regulatory bodies in the regulation of nurse practitioner practice for the purpose of:

  • Recognition and approval of nurse practitioner education programs;
  • Development and approval of nurse practitioner entry-level examinations;
  • Assessment of nurse practitioners’ ongoing continuing competence; and
  • Providing information to the public, nurse practitioner education programs, employers and other stakeholders on the regulatory expectations of nurse practitioner practice.


Entry-Level Competencies for Nurse Practitioners

COMPETENCY CATEGORY I. CLIENT CARE

The client care competency category is made up of six sub-categories that define client care competencies.

A.    Client Relationship Building and Communication

The competent, entry-level nurse practitioner uses appropriate communication strategies to create a safe and therapeutic environment for client care.

  1. Clearly articulate the role of the nurse practitioner when interacting with the client
  2. Use developmentally and culturally-appropriate communication techniques and tools
  3. Create a safe environment for effective and trusting client interaction where privacy and confidentiality are maintained
  4. Use relational strategies (e.g., open-ended questioning, fostering partnerships) to establish therapeutic relationships
  5. Provide culturally-safe care, integrating clients’ cultural beliefs and values in all client interactions
  6. Identify personal beliefs and values and provide unbiased care
  7. Recognize moral or ethical dilemmas, and take appropriate action if necessary (e.g., consult with others, involve legal system)
  8. Document relevant aspects of client care in client record

B.    Assessment

The competent, entry-level nurse practitioner integrates an evidence-informed knowledge base with advanced assessment skills to obtain the necessary information to identify client diagnoses, strengths, and needs.

  1. Establish the reason for the client encounter
    1. Review information relevant to the client encounter (e.g., referral information, information from other healthcare providers, triage notes) if available
    2. Perform initial observational assessment of the client’s condition
    3. Ask pertinent questions to establish the context for client encounter and chief presenting issue
    4. Identify urgent, emergent, and life-threatening situations
    5. Establish priorities of client encounter
  2. Complete relevant health history appropriate to the client’s presentation
    1. Collect health history such as symptoms, history of presenting issue, past medical and mental health history, family health history, pre-natal history, growth and development history, sexual history, allergies, prescription and OTC medications, and complementary therapies
    2. Collect relevant information specific to the client’s psychosocial, behavioral, cultural, ethnic, spiritual, developmental life stage, and social determinants of health
    3. Determine the client’s potential risk profile or actual risk behaviors (e.g., alcohol, illicit drugs and/or controlled substances, suicide or self-harm, abuse or neglect, falls, infections)
    4. Assess client’s strengths and health promotion, illness prevention, or risk reduction needs
  3. Perform assessment
    1. Based on the client’s presenting condition and health history, identify level of assessment (focused or comprehensive) required, and perform review of relevant systems
    2. Select relevant assessment tools and techniques to examine the client
    3. Perform a relevant physical examination based on assessment findings and specific client characteristics (e.g., age, culture, developmental level, functional ability)
    4. Assess mental health, cognitive status, and vulnerability using relevant assessment tools
    5. Integrate laboratory and diagnostic results with history and physical assessment findings

C.    Diagnosis

The competent, entry-level nurse practitioner is engaged in the diagnostic process and develops differential diagnoses through identification, analysis, and interpretation of findings from a variety of sources.

  1. Determine differential diagnoses for acute, chronic, and life threatening conditions
    1. Analyze and interpret multiple sources of data, including results of diagnostic and screening tests, health history, and physical examination
    2. Synthesize assessment findings with scientific knowledge, determinants of health, knowledge of normal and abnormal states of health/illness, patient and population-level characteristics, epidemiology, health risks
    3. Generate differential diagnoses
    4. Inform the client of the rationale for ordering diagnostic tests
    5. Determine most likely diagnoses based on clinical reasoning and available evidence
    6. Order and/or perform screening and diagnostic investigations using best available evidence to support or rule out differential diagnoses
    7. Assume responsibility for follow-up of test results
    8. Interpret the results of screening and diagnostic investigations using evidence-informed clinical reasoning
    9. Confirm most likely diagnoses
  2. Explain assessment findings and communicate diagnosis to client
    1. Explain results of clinical investigations to client
    2. Communicate diagnosis to client, including implications for short- and long-term outcomes and prognosis
    3. Ascertain client understanding of information related to findings and diagnoses

D.    Management

The competent, entry-level nurse practitioner, on the basis of assessment and diagnosis, formulates the most appropriate plan of care for the client, implementing evidence-informed therapeutic interventions in partnership with the client to optimize health.

  1. Initiate interventions for the purpose of stabilizing the client in, urgent, emergent, and life-threatening situations (e.g., establish and maintain airway, breathing and circulation; suicidal ideation)
  2. Formulate plan of care based on diagnosis and evidence-informed practice
    1. Determine and discuss options for managing the client’s diagnosis, incorporating client considerations (e.g., socioeconomic factors, geography, developmental stage)
    2. Select appropriate interventions, synthesizing information including determinants of health, evidence- informed practice and client preferences
      c.    Initiate appropriate plan of care (e.g. non-pharmacological, pharmacological, diagnostic tests, referral)
      d.    Consider resource implications of therapeutic choices (e.g. cost, availability)
  3. Provide pharmacological interventions, treatment, or therapy
    1. Select pharmacotherapeutic options as indicated by diagnosis based on determinants of health, evidence- informed practice, and client preference
    2. Counsel client on pharmacotherapeutics, including rationale, cost, potential adverse effects, interactions, contraindications and precautions as well as reasons to adhere to the prescribed regimen and required monitoring and follow up
    3. Complete accurate prescription(s) in accordance with applicable jurisdictional and institutional requirements
    4. Establish a plan to monitor clients’ responses to medication therapy and continue, adjust or discontinue a medication based on assessment of the client’s response.
    5. Apply strategies to reduce risk of harm involving controlled substances, including medication abuse, addiction, and diversion
  4. Provide non-pharmacological interventions, treatments, or therapies
    1. Select therapeutic options (including complementary and alternative approaches) as indicated by diagnosis based on determinants of health, evidence-informed practice, and client preference
    2. Counsel client on therapeutic option(s), including rationale, potential risks and benefits, adverse effects, required after care, and follow-up
    3. Order required treatments (e.g., wound care, phlebotomy)
    4. Discuss and arrange follow-up
  5. Perform invasive and non-invasive procedures
    1. Inform client about the procedure, including rationale, potential risks and benefits, adverse effects, and anticipated aftercare and follow-up
    2. Obtain and document informed consent from the client
    3. Perform procedures using evidence-informed techniques
    4. Review clinical findings, aftercare, and follow-up
  6. Provide oversight of care across the continuum for clients with complex and/or chronic conditions
  7. Follow up and provide ongoing management
    1. Develop a systematic and timely process for monitoring client progress
    2. Evaluate response to plan of care in collaboration with the client
    3. Revise plan of care based on client’s response and preferences

E: Collaboration, Consultation, and Referral

The competent, entry-level nurse practitioner identifies when collaboration, consultation, and referral are necessary for safe, competent, and comprehensive client care.

  1. Establish collaborative relationships with healthcare providers and community-based services (e.g., school, police, child protection services, rehabilitation, home care)
  2. Provide recommendations or relevant treatment in response to consultation requests or incoming referrals
  3. Identify need for consultation and/or referral (e.g., to confirm a diagnosis, to augment a plan of care, to assume care when a client’s health condition is beyond the nurse practitioner’s individual competence or legal scope of practice)
  4. Initiate a consultation and/or referral, specifying relevant information (e.g., client history, assessment findings, diagnosis) and expectations
  5. Review consultation and/or referral recommendations with the client and integrate into plan of care as appropriate

F.    Health Promotion

The competent, entry-level nurse practitioner uses evidence and collaborates with community partners and other healthcare providers to optimize the health of individuals, families, communities, and populations.

  1. Identify individual, family, community and/or population strengths and health needs to collaboratively develop strategies to address issues
  2. Analyze information from a variety of sources to determine population trends that have health implications
  3. Select and implement evidence-informed strategies for health promotion and primary, secondary, and tertiary prevention
  4. Evaluate outcomes of selected health promotion strategies and revise the plan accordingly

COMPETENCY CATEGORY II. QUALITY IMPROVEMENT AND RESEARCH

The competent, entry-level nurse practitioner uses evidence-informed practice, seeks to optimize client care and health service delivery, and participates in research.

  1. Identify, appraise, and apply research, practice guidelines, and current best practice
  2. Identify the need for improvements in health service delivery
  3. Analyze the implications (e.g., opportunity costs, unintended consequences) for the client and/or the system of implementing changes in practice
  4. Implement planned improvements in healthcare and delivery structures and processes
  5. Participate in quality improvement and evaluation of client care outcomes and health service delivery
  6. Identify and manage risks to individual, families, populations, and the healthcare system to support quality improvement
  7. Report adverse events to clients and/or appropriate authorities, in keeping with relevant legislation and organizational policies
  8. Analyze factors that contribute to the occurrence of adverse events and near misses and develop strategies to mitigate risks
  9. Participate in research
  10. Contribute to the evaluation of the impact of nurse practitioner practice on client outcomes and healthcare delivery.

COMPETENCY CATEGORY III. LEADERSHIP

The competent entry-level nurse practitioner demonstrates leadership by using the nurse practitioner role to improve client care and facilitate system change.

  1. Promote the benefits of the nurse practitioner role in client care to other healthcare providers and stakeholders (e.g., employers, social and public service sectors, the public, legislators, policy-makers)
  2. Implement strategies to integrate and optimize the nurse practitioner role within healthcare teams and systems to improve client care
  3. Coordinate interprofessional teams in the provision of client care
  4. Create opportunities to learn with, from, and about other healthcare providers to optimize client care
  5. Contribute to team members’ and other healthcare providers’ knowledge, clinical skills, and client care (e.g., by responding to clinical questions, sharing evidence)
  6. Identify gaps and/or opportunities to improve processes and practices, and provide evidence-informed recommendations for change
  7. Utilize theories of and skill in communication, negotiation, conflict resolution, coalition building, and change management
  8. Identify the need and advocate for policy development to enhance client care
  9. Participate in program planning and development to optimize client care

COMPETENCY CATEGORY IV. EDUCATION

The competent, entry-level nurse practitioner integrates formal and informal education into practice. This includes but is not limited to educating self, clients, the community, and members of the healthcare team.

Client, Community, and Healthcare Team Education

  1. Assess and prioritize learning needs of intended recipients
  2. Apply relevant, theory-based, and evidence-informed content when providing education
  3. Utilize applicable learning theories, develop education plans and select appropriate delivery methods, considering available resources (e.g., human, material, financial)
  4. Disseminate knowledge using appropriate delivery methods (e.g., pamphlets, visual aids, presentations, publications)
  5. Recognize the need for and plan outcome measurements (e.g., obtaining client feedback, conduct pre- and post-surveys)

Continuing Competence

  1. Engage in self-reflection to determine continuing education competence needs
  2. Engage in ongoing professional development
  3. Seek mentorship opportunities to support one’s professional development

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