Name: ______
Assessment of
RN(NP) Practice
Self-Employed Practice Review
The following form is based on the Standards of Practice for Registered Nurses on the Extended Practice Register and the Entry-level Competencies for Nurse Practitioners. Please fill in the form as completely and descriptively as possible. Please include a copy of your job description. If you have developed policies or documents related to this practice, please include them with your submission. Return to:
Practice and Standards Consultant
College of Registered Nurses of Manitoba
890 Pembina Hwy
Winnipeg, MB R3M 2M8
Please note that all references to RN(NP) in this document also apply to RN(EP), NP and nurse practitioner.
PART I: Employment Information
______
NameCollege Registration #
______
Name of Self-Employed RN Practice
______
Business Phone NumberHome Phone NumberEmail
What is your position title or what are you called?______
Please indicate which of the following descriptors best describes your registered nursing role:
Practitioner/Direct Care Provider Educator Administrator
Researcher Nursing Consultant Other (describe):
Please indicate your employment status:
Full-time Part-timeIf part-time, please indicate EFT (eg. 0.6 EFT) ______
Please describe who your clients are.
Where do you provide registered nursing services to clients (eg. home office, client’s home, etc.)?
Are your clients in Manitoba? If not, please describe where your clients reside.
How did your clients become aware of your services?
Please describe in detail the registered nursing services you provide:
PART II: Standards of Practice Self-Evaluation
Please reflect on the care that you provide and evaluate yourself on according the Standards of Practice for Registered Nurses below. Please be specific and provide as much detail as possible. Provide examples for each of the indicators where applicable.
Practice Expectation #1:Use of Knowledge, Skill and Judgment / Comments
As an RN(NP), you apply your additional knowledge, skill and judgment to address the health needs of clients. As an RN(NP), you must:
1)Synthesize relevant knowledge with use of critical inquiry (eg. developmental and life stages, pathophysiology, psychopathology, pharmacology, epidemiology, environmental exposure, infectious diseases, behavioural sciences, demographics and family processes).
2)Conduct thorough and accurate assessment, history taking and consultation with clients.
3)Ensure an appropriate plan of care is developed in consultation with the client, family and other health-care professionals as needed, including a plan for follow-up/evaluation.
4)Use current evidence to support safe practice.
Practice Expectation #2:
Consultation and Collaboration / Comments
As an RN(NP), you consult and collaborate with other health-care professionals as appropriate and in accordance with competencies for RN(NP)s to ensure that the overall healthcare needs of your clients are met. As an RN(NP), you must:
1)Collaborate to facilitate critical inquiry in practice.
2)Establish consultative relationships with other health-care professionals appropriate to the clients you are providing care for.
3)Consult with other health-care providers according to your practice setting and client needs (eg. request for ongoing consultation from a health-care professional for client conditions that the RN(NP) does not typically address).
4)Consult with other health-care professionals at any stage in the care of a client from initial assessment to evaluation of treatment effectiveness (eg. request for a single-visit consultation by a health-care provider).
5)Fulfill consultation expectations in a timely manner.
6)During consultation with another health-care professional, jointly decide whether to transfer care to that health-care professional or remain as the primary health-care professional for that client.
7)Indicate the role and responsibilities of an RN(NP) as a member of the health-care team.
8)Establish appropriate methods for keeping health-care professionals informed about mutual clients’ health conditions and/or treatment decisions.
9)Maintain accurate information about your current employer and work contact information in your member profile with the College and other relevant health-care partners (eg. Diagnostic Services of Manitoba).
Practice Expectation #3:
Prescribing Drugs and Devices / Comments
As an RN(NP), you prescribe drugs and devices relevant to your client population in accordance with relevant provincial and federal legislation and standards, as well as evidence-informed decision-making. As an RN(NP), you must:
1)Prescribe drugs for clients for whom the RN(NP) has relevant knowledge of the client’s health history based on assessment obtained through direct client contact. In exceptional circumstances where direct client contact by the RN(NP) is not feasible for the client, you may facilitate access to care based on a timely assessment and recommendation of another regulated health-care professional. In these circumstances, you must:
- be satisfied that the prescription is appropriate for the client,
- document provision of client care, and
- provide timely access for the client to follow-up.
3)Complete prescriptions accurately, completely and legibly including:
- date of issue,
- name and address of the person for whom the drug is prescribed,
- weight of client if client is a child or weight has bearing on the dosage of the prescribed drug,
- age of the client if age has bearing on the dosage of the prescribed drug,
- name, strength and quantity of the prescribed drug,
- directions for use, including the dosage, frequency, route of administration, duration of drug therapy, and special instructions,
- direction for number of allowable refills and interval between refills, where applicable. If a prescription includes more than one drug, clearly identify the number of allowable refills for each drug,
- prescriber’s name, regulated title, address, telephone number and fax number,
- the treatment goal and/or diagnosis and/or clinical indication, and
- the prescriber’s signature in one of the following formats:
- hand-written signature
- electronic image of the prescriber’s signature if:
- the prescription is sent directly to a single pharmacy of the client’s choice through an approved electronic medical record, and
- there is no hard copy of the prescription.
- expected action of the drug,
- importance of compliance with prescribed frequency and duration of the drug therapy,
- potential side effects,
- signs and symptoms of adverse effects and actions to take if they occur (eg. allergic reactions),
- potential interactions between the drug and certain foods, other drugs or substances such as natural health products or herbal remedies,
- specific precautions to take or instructions to follow, and
- recommended follow-up.
6)Document client’s response to drug therapy including a record of all prescriptions and refills.
7)Securely store blank prescriptions (eg. store blank prescriptions in a non-public and locked drawer).
8)Not provide any person with a blank, signed prescription.
9)Not prescribe for yourself or family members.
10)Send a prescription to a pharmacy in one of the following ways:
- Provide the client with a written prescription to bring to a pharmacy of his or her choice.
- Provide all verbal prescriptions (new and refills) directly to the pharmacist.
- Facsimile to a pharmacy when the prescription is in compliance with the joint statement Facsimile Transmission of Prescriptions.
- Send an electronic transmission to pharmacy when the prescription is in compliance with the joint statement Electronic Transmission of Prescriptions.
Practice Expectation #4:
Ordering Screening and Diagnostic Tests / Comments
As an RN(NP), you order specific screening and diagnostic tests relevant to your client population in accordance with relevant provincial and federal legislation and standards, as well as evidence-informed decision-making. As an RN(NP), you must:
1)Order screening and diagnostic tests to:
- confirm a diagnosis as suggested by the client’s history and/or physical findings,
- assess/monitor ongoing conditions of clients with chronic illnesses, and
- carry out screening activities.
3)Consider best practice evidence on appropriateness, contraindications, safety and cost-effectiveness when ordering screening and diagnostic tests.
4)Explain to clients the reasons for ordering specific screening and diagnostic tests and the associated risks and benefits.
5)Adhere to provincial or agency standards for ordering, documenting and reporting results of screening and diagnostic tests.
6)Seek information to ensure understanding of test results and diagnostic interpretation by specialist(s) and follow-up as necessary.
PART III: Competencies for Nurse Practitioners Self Evaluation
Registration on the RN(NP) register is based on the demonstration of competence at an advanced level in each of four competency areas.Please reflect on the care that you provide and evaluate yourself according the Entry-level Competencies for Registered Nurse (Nurse Practitioners) below. Please provide supporting information.
and Accountability / Comments
Clinical Practice
The nurse practitioner:
1.1.Practises in accordance with legislative acts, regulations, CRNM bylaws and Board of Directors policies relevant to the nurse’s area of practice and client population served.
1.2.Understands the changes in scope of practice from that of a registered nurse on the register of practicing registered nurses and how this affects responsibilities and accountabilities when functioning as registered nurses on the register of extended practice.
1.3.Incorporates knowledge of diversity, cultural safety and determinants of health in the assessment, diagnosis and therapeutic management of clients and in the evaluation of outcomes.
1.4.Incorporates knowledge of developmental and life stages, pathophysiology, psychopathology, epidemiology, environmental exposure, infectious diseases, behavioural sciences, demographics and family processes when performing health assessments, making diagnoses and providing overall therapeutic management.
1.5.Incorporates knowledge of the clinical manifestations of normal health events, acute illness/injuries, chronic diseases, comorbidities and emergency health needs, including the effects of multiple etiologies in the assessment, diagnosis and therapeutic management of clients and in the evaluation of outcomes.
1.6.Integrates the principles of resource allocation and cost-effectiveness into clinical decision-making.
1.7.Provides client diagnostic information and education that are relevant, theory-based and evidence-informed, using appropriate teaching/learning strategies.
1.8.Promotes safe client care by mitigating harm and addressing immediate risks for clients and others affected by adverse events and near misses.
1.9.Discloses the facts of adverse events to clients and reports adverse events to appropriate authorities in keeping with relevant legislation and organizational policies.
1.10.Documents clinical data, assessment findings, diagnoses, plans of care, therapeutic interventions, client responses and clinical rationale in a timely and accurate manner.
1.11.Adheres to federal and provincial/territorial legislation, policies and standards related to privacy, documentation and information management.
1.12.Engages in ongoing professional development and accepts personal responsibility for maintaining nurse practitioner competence.
Collaboration, Consultation and Referral
The nurse practitioner:
1.13.Consults with and/or refers clients to other health-care providers at any point in the care continuum when the client’s condition is not within the nurse practitioner scope of practice or the individual nurse practitioner’s competence.
1.14.Acts as a consultant to and/or refers and accepts referrals from health-care providers, community agencies and allied non-healthcare professionals.
1.15.Advocates for clients in relation to therapeutic intervention, health-care access, the health-care system and policy decisions that affect health and quality of life.
1.16.Collaborates with members of the health-care team to provide and promote interprofessional client-centred care at the individual, organizational and systems levels.
1.17.Collaborates with members of the health-care team to promote and guide continuous quality improvement initiatives at the individual, organizational and systems levels.
1.18.Applies advanced knowledge and skills in communication, negotiation, coalition building, change management and conflict-resolution.
Research
The nurse practitioner:
1.19.Engages in evidence-informed practice by critically appraising and applying relevant research, best practice guidelines and theory when providing health-care services.
1.20.Develops, utilizes and evaluates processes within the practice setting to ensure that clients receive coordinated health services that identify client outcomes and contribute to knowledge development.
1.21.Identifies and implements research-based innovations for improving client care at the individual, organizational and systems levels.
1.22.Identifies, collects data on and evaluates the outcomes of nurse practitioner practice for clients and the health-care system.
1.23.Collaborates with other members of the health-care team or the community to identify research opportunities and to conduct and/or support research.
1.24.Acts as a change agent through knowledge translation and dissemination of new knowledge that may include formal presentations, publication, informal discussions and the development of best practice guidelines and policies.
Leadership
The nurse practitioner:
1.25.Provides leadership in the management of clinical care and is a resource person, educator and role model.
1.26.Acts as a preceptor, mentor and coach to nursing colleagues, other members of the healthcare team and students.
1.27.Articulates and promotes the role of the nurse practitioner to clients, other health-care providers, social and public service sectors, the public, legislators and policy-makers.
1.28.Provides leadership in the development and integration of the nurse practitioner role within the health-care system.
1.29.Advocates for and participates in creating an organizational environment that supports safe client care, collaborative practice and professional growth.
1.30.Guides, initiates and provides leadership in the development and implementation of standards, practice guidelines, quality assurance and education and research initiatives.
1.31.Guides, initiates and provides leadership in policy-related activities to influence practice, health services and public policy
2. Health Assessment and Diagnosis / Comments
The nurse practitioner:
2.1.Performs a focused health assessment and/or an advanced comprehensive health assessment, using and adapting assessment tools and techniques based on client needs and relevance to client stage of life.
2.2.Performs a complete or focused health history appropriate to the client’s situation, including physical, psychosocial, emotional, ethnic, cultural and spiritual dimensions of health.
2.3.Performs a complete or focused physical examination and identifies and interprets normal and abnormal findings as appropriate to client presentation.
2.4.Synthesizes health assessment information using critical inquiry and clinical reasoning to diagnose health risks and states of health/illness.
2.5.Formulates differential diagnoses through the integration of client information and evidence-informed practice.
2.6.Anticipates and diagnoses emergent, urgent and life-threatening situations.
2.7.Orders and/or performs screening and diagnostic investigations, interprets results using evidence-informed clinical reasoning and critical inquiry and assumes responsibility for follow-up.
2.8.Diagnoses diseases, disorders, injuries and conditions and identifies health needs while considering the client’s response to the health/illness experience.
2.9.Effectively communicates health findings and/or diagnoses to clients, discusses health outcomes/prognosis, reviews treatment options, assists/supports clients with personal responses to their health conditions and creates an environment in which effective learning can take place.
3. Therapeutic Management / Comments
The nurse practitioner:
3.1.Creates an environment in which effective communication of diagnostic and therapeutic intervention can take place.
3.2.Explores therapeutic options, considering implications or clients through the integration of client information and evidence-informed practice.
3.3.Determines care options and initiates therapeutic interventions in collaboration with clients while considering client perspectives, preferences, feasibility and best outcomes.
3.4.Initiates interventions for the purpose of stabilizing clients in emergent, urgent and life-threatening situations.
3.5.Supports, educates, coaches and counsels clients regarding diagnoses, prognoses and self-management, including their personal responses to diseases, disorders, conditions, injuries, risk factors, lifestyle changes and therapeutic interventions.
3.6.Promotes client self-efficacy in navigating the health-care system and in identifying and accessing the necessary resources.
3.7.Coordinates and facilitates client care with other health-care providers, agencies and community resources.
3.8.Performs invasive/non-invasive procedures for the clinical management and/or prevention of disease, injuries, disorders or conditions.
3.9.Prescribes pharmacotherapy based on the client’s health history, disease, disorder, condition and stage of life and individual circumstances.
3.10.Applies knowledge of pharmacotherapy and evidence-informed practice in prescribing, monitoring and dispensing drugs.
3.11.Counsels clients on medication therapy, benefits, potential side effects, interactions, importance of compliance and recommended follow-up.
3.12.Demonstrates awareness of, and is mindful of, marketing strategies used to promote health products, medical devices, medications, alternative therapies and health programs.
3.13.Intervenes, as appropriate, when potential or actual problematic substance use and/or misuse of drugs, including complementary and alternative therapies, is identified.
3.14.Prescribes and/or dispenses drugs in accordance with provincial, territorial and/or federal standards and legislative requirements.
3.15.Uses an evidence-informed approach in the selection or consideration of complementary and alternative therapies and considers the benefits and risks to clients’ health and safety.
3.16.Collaborates with clients in monitoring their response to therapeutic interventions and in adjusting interventions, as needed.
3.17.Monitors, evaluates and revises the plan of care and therapeutic intervention based on current evidence-informed practice and on client goals, preferences, health status and outcomes.
4. Population Health, Health Promotion
and Illness/Injury Prevention / Comments
The nurse practitioner:
4.1.Assesses, identifies and critically analyzes information from a variety of sources to determine client and/or population trends and patterns that have health implications.
4.2.Initiates or participates in the development of strategies to address identified client and/or population health implications.
4.3.Initiates or participates in the design of services/interventions for health promotion, health protection, and the prevention of injury, illness, disease and complications.
4.4.Initiates or participates in the development and implementation of evaluation processes, including identification of indicators for ongoing monitoring of strategies, services and interventions.
If you are self-employed, please describe how you track your hours and how these hours could be independently verified by a third party: