1. Practises within a collaborative practice model
The nurse practitioner will:
- define collaborative practice
2. Practises within scope of practice when making and communicating a diagnosis
The nurse practitioner will:
- state that NPs are authorized to communicate a diagnosis to clients and other health professionals
3. Practices within scope of practice when managing client care.
The nurse practitioner will:
- use best evidence and consider potential therapeutic benefit and risk when prescribing pharmacological and non-pharmacological therapies, including controlled drugs and substances.
- perform non-invasive and invasive interventions for which they have developed and maintained competence.
- use available drug information systems to verify history of clients’ medications.
4. Practises within scope of practice for consultation and referral
The nurse practitioner will be able to:
- describe the difference between consultation and referral
- describe when consultation or referral is required in the management of a client health condition
- identify that NPs can refer clients to other health providers, including specialist physicians
- identify that NPs can accept referrals and consultation from other health providers
SYNOPSIS OF INFORMATION
The practice of a nurse practitioner is defined as the application of advanced nursing knowledge, skills and judgment in addition to the practice of nursing in which a nurse practitioner in collaborative practice may, in accordance with standards for nurse practitioners, do one or more of the following:
- make a diagnosis identifying a disease, disorder or condition,
- communicate the diagnosis to the client and health care professionals as appropriate,
- perform procedures,
- initiate, order or prescribe consultations, referrals and other acts,
- order and interpret screening and diagnostic tests, and recommend, prescribe or reorder drugs, blood, blood products and related paraphernalia,
and also includes research, education, consultation, management, administration, regulation, policy or system development.
Collaborative practice is defined as a relationship among a nurse practitioner, a physician or group of physicians, an employing organization and other health professionals who are relevant to the nurse practitioner’s practice, that enables the health-care providers in this relationship to work together to use their separate and shared knowledge and skills to provide optimum client-centered care in accordance with standards of practice for nurse practitioners and the guidelines for collaborative practice teams and employers of nurse practitioners approved by the College.
NPs have the authority to prescribe pharmaceuticals listed in or approved for Schedule F of the Food and Drugs Act (Canada) and/or pharmaceuticals listed in Schedule I of the NAPRA (provincial) Schedules, including pharmaceuticals under the Controlled Drugs and Substances Act (CDSA). Non-prescription pharmaceuticals (NAPRA Schedule II and III) can be obtained without a prescription; however, NPs can write a prescription for such pharmaceuticals if required by clients for insurance coverage.
NPs use research evidence, clinical practice guidelines and best practice when prescribing and monitoring pharmacological therapies. When prescribing pharmaceuticals, NPs consider therapeutic benefits, potential risks, cost-effectiveness and provisions of public and private insurance plans. NPs evaluate clients’ responses to drug therapy and adjust treatments as necessary.
The Continued Care Prescriptions Agreement between the College of Registered Nurses of Nova Scotia and the Nova Scotia College of Pharmacists authorizes a pharmacist to provide a continued care prescription (CCP) to a patient where an urgent need for patient drug therapy management exists and the prescribing nurse practitioner is unavailable to provide refill authorization. This agreement enables patient to access continued care prescriptions and provides a mechanism for pharmacists to extend an existing prescription written by a nurse practitioner for up to 30 days. Under the Pharmacist Drug Prescribing Regulations, a pharmacist may prescribe a renewal of a prescription when certain standards are met.
Screening and Diagnostic Tests Authority
NPs have the authority to order and interpret laboratory and other screening and diagnostic tests in accordance with their educational preparation, competence and focus of practice. NPs order diagnostic imaging tests and act on radiologists’ interpretation. In specific practice areas, NPs may be required to interpret a diagnostic imaging test for which they have received specific education (e.g., endotracheal tube placement, simple fractures). NPs are responsible for any required follow-up.
All family physicians and NPs in Nova Scotia may order adult MRI services directly without prior approval from a specialist or radiologist. All requests for MRI services are screened by a local radiologist for appropriateness and triaged according to level of urgency.
Invasive and Non-Invasive Procedures Authority
NPs have the authority to perform both non-invasive and invasive procedures in accordance with their educational preparation, competence and focus of practice. NPs are responsible to obtain informed consent and for any required follow-up.
Consultation and Referral
Consultation is defined as a request for another health professional’s advice on the care of a client. The goal is to enhance patient care and/or improve the skills and confidence of the professional making the request (i.e. consultee). The consultant may or may not see the patient directly. The responsibility for clinical outcomes remains with the consultee, who is free to accept or reject the advice of the consultant.
Referral is defined as an explicit request for another health professional to become involved in the care of a client. Patient care is enhanced by relinquishing care, or aspects of care, to another expert provider whose is perceived to be more essential to the patient’s care. The responsibility for clinical outcomes is negotiable between the referring provider and the accepting provider, but responsibility is often assumed (at least for aspects of care) by the professional accepting the referral.
In accordance with the Nurse Practitioner Standards of Practice (2018), NPs collaborate, consult with and refer clients to the most appropriate health professional, when they determine that another professional’s expertise is required for competent and safe client care. NPs must communicate and document the reason, level of urgency and expected action from consultants (e.g., opinion, recommendation, shared care, transfer of care) when requesting a consultation or referral. Prior to acting on advice from other health professionals, NPs are required to evaluate and discuss the recommendations with the client. In addition, NPs accept referrals and requests for consultation from other healthcare providers and are accountable for the advice and recommendations they provide. Consultations may occur in person, by telephone, in writing or electronically, as appropriate to individual situations.