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Nurse practitioners have the capability to provide high levels of clinically focused nursing care in a variety of contexts in Australia. Nurse practitioners care for people and communities with problems of varying complexity.
The nurse practitioner (NP) scope of practice is built on the platform of the registered nurse (RN) scope of practice, and must meet the regulatory and professional requirements for Australia including the National competency standards for the registered nurse, Code of ethics and Code of professional conduct.
The nurse practitioner standards (Standards) build on, and expand upon, those required of a registered nurse. When assuming the title and scope of practice of a nurse practitioner, the NP understands the changes in the scope of practice from that of a registered nurse, and the ways that these changes affect responsibilities and accountabilities. Fundamentally, a nurse practitioner provides nursing care within their regulated scope.
The core Standards in this document are the minimal Standards that are applicable across diverse practice settings and patient/client populations for both beginning and experienced NPs.
Nurse practitioner attributes are consciously cultivated through formal learning that includes a work based component. The educational requirement for endorsement of NPs in Australia is a Masters degree. This formal learning builds on demonstrable advanced practice within the RN scope.
The nurse practitioner has a high degree of systems literacy and can manage care across a variety of health systems to maximize outcomes; NPs engage in complex and critical thinking; integrate information and/or evidence; judiciously use clinical investigations; and skilfully and empathetically communicate with all involved in the care episode, including the person receiving care and their family and community, and health professional colleagues.
NP attributes are clinically focused, and NPs are capable in research, education and leadership as applied to clinical care (Refer Figure 1). Research includes processes to support reflective practice, evidence-based care and quality management. The NP has the capability to educate others related to the focus of, and available options, of care. Nurse practitioners are leaders and have an ability to lead care and care teams. Nurse practitioners engage in reflective practice and support others in this process through clinical supervision or mentoring.
Nurse practitioners are capable of managing episodes of care, including wellness focused care. Nurse practitioners may be the primary provider of care or part of a care team. They collaborate and consult with health consumers, their families and community, other professionals, including health personnel, to plan, implement and evaluate integrated care that optimises outcomes for recipients and the systems of care.
As part of providing care, NPs can order and interpret investigations to facilitate diagnosis and care planning. Care may include nursing interventions that involve initiation, titration or cessation of medications. Nurse practitioners take responsibility for following-up on any components of care initiated. They are accountable for care provided and self-monitor their work.
The Standards have been written so as to be easily accessible to a variety of groups, including nurse practitioners, governments, regulatory agencies, health care professionals and the community. It should be noted that the Cues (refer to Glossary) written below the Statements are indicative of nurse practitioner behaviours, they are not intended to be exhaustive. Rather, the cues are examples of activities that demonstrate the Statement for that standard.
Read the Standards in conjunction with other relevant documentation, including: the National competency standards for the registered nurse, the Code of professional conduct for nurses in Australia, the Code of ethics for nurses in Australia, and a companion document, A nurse’s guide to professional boundaries. They should also be read in conjunction with the attached Glossary, which clearly stipulates the way in which key terms are used in the Standards.
In Figure 1, the Nurse practitioners standards framework is illustrated. There are four domains, namely:
The education, research and leadership domains are couched within the clinically focused standards. The knowledge and skills contained within the three domains of education, research and leadership, are integrated in their expression in the clinical role or work.
Collectively, these attributes expressed in nurse practitioners’ knowledge, skills and affect, are applied in the education domain through educating those receiving care, peers and colleagues. The use of knowledge in the research domain is evidenced through the judicious application of research evidence in formulating practice decisions, self- regulation and the development of new systems of care. The domain of leadership, initially evident in clinical work, increases in capacity to include community and political engagement.
Figure 1: Representation of how the education, research and leadership domains are couched within the clinically focused standards
Advanced nursing practice (ANP): ANP is a continuum along which nurses develop their professional knowledge, clinical reasoning and judgement, skills and behaviours to higher levels of capability (that is recognisable). Nurses practising at an advanced level incorporate professional leadership, education and research into their clinically based practice. Their practice is effective and safe. They work within a generalist or specialist context and they are responsible and accountable in managing people who have complex health care requirements.
Advanced nursing practice is a level of practice and not a role. It is acknowledged that advanced nursing practice is individually attributed within a regulated nursing scope (enrolled nurse, registered nurse or nurse practitioner).
Advanced practice nursing (APN): APN in the Australian nursing context identifies the additional legislative functions of an endorsed nurse practitioner that are outside the contemporary registered nurse scope of practice.
Advanced practice nursing as a nurse practitioner is a qualitatively different level of advanced nursing practice to that of the registered nurse due to the additional legislative functions and the regulatory requirements. The requirements include a prescribed educational level, a specified advanced nursing practice experience; and continuing professional development.
Advanced practice nursing should not be confused with the term ‘practice nurse’ that is used colloquially to describe nurses working in the general practice setting.
Attributes: Are characteristics that underpin competent performance. Refer to National competency standards for the registered nurse under Codes and guidelines on the National Board website.
Competence: The combination of skills, knowledge, attitudes, values and abilities that underpin effective and/or superior performance in a profession/occupational area. Refer to National competency standards for the registered nurse under Codes and guidelines on the National Board website.
Cues: Key generic examples of competent performance. They are neither comprehensive nor exhaustive. They assist the assessor when using their professional judgement in assessing nursing practice. They further assist curriculum development. Refer to National competency standards for the registered nurse under Codes and guidelines on the National Board website.
Nurse Practitioner: A nurse practitioner is an advanced practice nurse endorsed by the Nursing and Midwifery Board of Australia (National Board) to practise within their scope under the legislatively protected title ‘nurse practitioner’.
Person/people: In these Standards, person/ people is used to refer to those individuals who have entered into a relationship with a nurse practitioner. Person/ people encompass patients, clients, consumers and families that fall within the NP scope and context of practice.
Prescribing: is defined as the steps of information gathering, clinical decision making, communication and evaluation which results in the initiation, continuation or cessation of a medicine.
Scope of practice: The scope of nursing practice is that in which nurses are educated, competent to perform and permitted by law. The actual scope of practice of individual practitioners is influenced by the settings in which they practise, the health needs of people, the level of competence and confidence of the nurse and the policy requirements of the service provider.