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Nurse Practitioner Quality Monitoring Program

The Nurse Practitioner Quality Monitoring and Improvement Program (NP-QMP) ™ is a revolutionary program and the first of its kind in Canada. The program supports NPs in continuously improving their work by providing them with a 360 degree snapshot of their nursing practice.

The NP-QMP™ provides participating NPs with detailed performance feedback from a comprehensive self-assessment and assessments from four other touch points within their practice: NP and physician colleagues, health professionals and colleagues and clients and/or parents/guardians.

This feedback is presented to participating NPs and provides them with the information they need to set goals, make practice improvements and continue to deliver high quality care to Nova Scotians. It also enables NPs to reflect on their practice and identify areas of strength and areas that can be improved upon, resulting in improved client care and NP satisfaction and it assists NPs in identifying system barriers that may not have been previously evident.


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How is the NP-QMP™ administered?

The Interdisciplinary Nurse Practitioner Practice Review Committee (IDPRC) develops, implements and evaluates the NP-QMP™ and Pivotal Research Inc. administers the process so all NP information is kept confidential and anonymous. In addition, Pivotal Research Inc. also administers the annual feedback surveys and reports. IDPRC committee members do not know the names of participating NPs.

Is it mandatory to participate in the NP-QMP™ regardless of practice setting?

Yes, all NPs who have been in practice for a minimum of two full-time years will be expected to participate.

I’m an NP participant this year. How does the NP-QMP™ process work?

The NP-QMP™ program involves two phases: the primary and secondary review. The majority of NPs will only complete the primary review.

The primary review consists of:

  1. Pivotal Research Inc. will collect feedback, through comprehensive surveys, from NP and physician colleagues, other healthcare professionals and colleagues and clients (clients, parents, guardians).
  2. You will complete a self-assessment
  3. All feedback is sent to Pivotal Research Inc. to ensure anonymity
  4. You will receive an individual report based on the feedback

A secondary review will only be conducted if you do not meet the expected criteria of the primary review.

What are my responsibilities regarding the NP-QMP™ process?

You must:

  • Verify your personal contact information on the secure and confidential website developed by Pivotal Research Inc.
  • Estimate the size of your practice (the number of patients that you see in a given year)
  • Submit the names and contact information of 10 NP and physician colleagues on the online secure website (it is suggested that you contact them to request their participation prior to submitting their names)
  • Submit the names and contact information of 10 other members of the health team or health providers with whom you have regular contact on the online secure website
  • Arrange for patients, residents, parents or legal guardians to complete the patient or parent/guardian surveys
  • Complete an online self-assessment

In what areas of practice will I be evaluated?

You’ll be evaluated on the following areas of practice:

  • Management of health including assessment and diagnosis, therapeutics, consultation and referral
  • Communication
  • Professional accountability and leadership

How am I selected for review?

Every year, we provide Pivotal Research Inc. with a list of all NPs who are eligible to participate in the NP-QMP™. Pivotal Research Inc. randomly selects approximately 20% of the eligible NPs to participate. Participation is required only once every five years.

Can I ask to withdraw from the program when selected in a particular year?

Once you have been notified that you have been selected to participate in the NP-QMP ™, if you feel that there is work or personal circumstances (i.e. maternity leave of absence, recently changed NP position, etc.) which will make it difficult for you to participate, you have the option to request an exemption for that year through Pivotal Research Inc.

Pivotal Research Inc. will notify us that an anonymous NP has requested to be exempt, including the reason for the request. Our staff will make a determination about the exemption based on criteria established by the Interdisciplinary NP Practice Review Committee.

Nurse practitioners who are exempted in a given year must participate in the NP-QMP™ the following year.

What is the Exception Review Process?

The Exception Review process is a component of the primary practice review. An exception is generated when a survey respondent rates a competency statement as “does not meet expectations” or a client “disagrees” with any competency statement.  Based on the Exception Report and using criteria determined by IDPRC, CRNNS staff may contact you to gather more information about your practice to assist IDPRC in deciding if further action is required, which may include a secondary practice review. To learn more about this process, please review the CRNNS Exception Review Process.

What happens if I require a secondary review?

A secondary practice review is conducted when the IDPRC decides that more information is required about your practice, based on their review of the exception and CRNNS staff reports.

The secondary practice review consists of a a site visit with NP practice reviewer whose practice background is similar to yours. If needed, a site visit will include but is not limited to interview(s) with you and other individuals involved with your practice, a formal chart audit, a chart-stimulated recall interview, and an on-site practice assessment.

You and your employer are required to provide the NP reviewer and/or any delegate of the IDPRC with access to your practice site and any information (e.g. health records or colleague interviews) they may require to support the review process.

The NP practice reviewer will prepare a report for the IDPRC based on the results of their review. In keeping with the NP-QMP™ policy, this report is also anonymous. The IDPRC may then decide that no further action is needed or they may set specific remedial requirements and follow-up.

If, during the secondary practice review process, the NP reviewer observes behavior, and/or obtains information of practice activities that may pose a risk to the public, the NP reviewer will immediately report their observation(s) to the CRNNS staff support.

Who should I fill out my feedback surveys?

Those who interact with you on a regular basis will be most informed and objective about you and your practice.

Some logical choices for the nurse practitioner and physician surveys include:

  • NPs with whom you consult about patient care
  • NPs to whom you refer patients
  • Collaborating physician(s)
  • Physicians with whom you regularly consult (radiologists, emergency physicians)
  • Physicians to whom you regularly refer patients

Some examples of other collaborative team members or healthcare providers, with whom you regularly consult, and might consider asking to complete the Colleague Survey include:

  • Pharmacists
  • Physiotherapists or occupational therapists
  • Social workers
  • Addictions counselors
  • Public health or school nurses
  • Registered nurses and/or licensed practical nurses
  • Clinic or office receptionist of the practice

Choose a variety of clients and/or parents/guardians based on the composition of your client population. For example, your client selection process could be:

  • 25% who are parents of newborns
  • 25% who are over the age of 65
  • 25% who are adults with chronic illness
  • 25% who are adults with acute illness/injury

If there are clients that you would like to provide feedback and they are not scheduled for a visit within the allotted timeframe, it is acceptable to mail the survey and a self-addressed stamped envelope to them.

Ideally, someone other than yourself should approach eligible clients or parents/guardians to participate in the NP-QMP™ (e.g. receptionist, ward clerk). However, in circumstances when this is not possible, it is acceptable for you to do this. Regardless of who makes the request, it must be understood by the client and/or parent/guardian that the information provided is anonymous and client care will not be affected whether they participate or not.

If you’re having difficulty supplying the number of NPs, physicians or other health providers required, please contact Pivotal Research Inc. to ask for direction.

Below are some sample surveys, which are based on the Nurse Practitioner Competency Framework:

Could my NP-QMP ™ be used in a disciplinary process if I advance to a secondary assessment?

The NP-QMP™ has been designed as a quality monitoring and improvement process. However, there may be circumstances when the IDPRC must disclose information about the practice review. These circumstances include when an NP does not cooperate with the review, does not complete the remediation requirements set out by the IDPRC, or when the IDPRC has reasonable grounds to believe that the NP poses a risk to the public that cannot be addressed within the NP-QMP™. The information is disclosed to the CRNNS CEO and Registrar and may be disclosed to the employer depending on the situation so that appropriate action can be taken.

What should I do if I am asked to complete a survey about a colleague?

We encourage you to participate because if you’ve chosen to provide feedback it’s because the participating NP respects you and values your comments. Be objective and honest, as your feedback will contribute to the quality of the assessment process. Follow the instructions for completing the survey and return it promptly.

Can the NP-QMP™ be used for or as part of my workplace performance evaluation?

The intent of the NP-QMP™ is to be used to provide NPs with the information they need to reflect on and improve their practice and is not to be a measure of individual competence.

The report generated from the feedback is your property and as such, you do not have to share the information with anyone, including your employer. If you wish to share the information, we request that you call and discuss this decision with us before you provide the information.

How can I get more information about the NP-QMP™ policies?

If you would like to learn more about the NP-QMP program policies or would like to obtain a copy of the policies, please contact tmacisaac@crnns.ca or lmiller@crnns.ca.

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