Applying the Competencies Required for Nurse Practitioners in British Columbia

Applying the Competencies Required for
Nurse Practitioners in British Columbia
APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
2855 Arbutus Street
Vancouver, BC V6J 3Y8
Tel 604.736.7331 or
1.800.565.6505 (B.C. only)
www.crnbc.ca
© Copyright CRNBC/August 2013 Pub. 440
College of Registered Nurses of British Columbia
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Overview . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Section I: Primary Areas of Competence and Associated Activities . . . . . . . . . . . . . . . . . . . . . 6
1.
Establish and Maintain Professional Role, Responsibility and Accountability
2.
Assess and Diagnosis Client's Health/Illness Status
3.
Therapeutically Manage Client's Health Care
4.
Promote Health and Prevent Illness/Injury
Section 2: Knowledge and Skills Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
1.
Nurse Practitioner Client Relationship
2.
Clinical Practice
A. Assessing, Diagnosing and Managing Client Health Care
B. Promoting Health and Injury/Illness Prevention
3.
Collaboration and Change
4.
Professional Role Accountability and Responsibility
APPENDIX ONE
Diseases, Disorders and Conditions Diagnosed and Managed by an
Entry-Level Family Nurse Practitioner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Diseases, Disorders and Conditions Diagnosed and Managed by an
Entry-Level Adult Nurse Practitioner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Diseases, Disorders and Conditions Commonly Diagnosed and Managed by an
Entry-Level Pediatric Nurse Practitioner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
College of Registered Nurses of British Columbia
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
Introduction
Nurse practitioners registered to practice in British Columbia have acquired the competencies to
practice to the level and scope of practice1 as established in the CRNBC Competencies Required for
Nurse Practitioners in British Columbia*2 (CRNBC NP Competencies). Nurse practitioners
seeking registration to practice independently in BC must provide evidence of having achieved
these competencies in their educational program and demonstrate competence by successfully
completing the regulatory examinations, a written test and an OSCE (a performance-based
structured assessment). Once registered to practice in BC, nurse practitioners are expected to
maintain their competence and meet CRNBC standards of practice including the CRNBC Scope of
Practice for Nurse Practitioners: Standards, Limits and Conditions*. In accordance with College bylaws, CRNBC regularly reviews NP registrant practice via a Quality Assurance Program for Nurse
Practitioners. The program is intended to support registrants in maintaining competence and
meeting standards.
This document, Applying the Competencies Required for Nurse Practitioners in British Columbia,
demonstrates how the CRNBC NP Competencies are performed in practice. Measureable
indicators are listed for each of the CRNBC NP Competencies. The necessary knowledge and
skills required to enact CRNBC NP Competencies are also clearly outlined.
The purpose of the Applying the Competencies Required for Nurse Practitioners in British Columbia
document is to specify the competencies to enable CRNBC to establish objective criteria for
purposes of assessment and/or evaluation of individual nurse practitioner applicants or
registrants. It shows the connections between the requirements set out in the Competencies
Required for Nurse Practitioners in British Columbia with the competence assessment activities for
the various CRNBC purposes concerning individuals:

assessment of applicants’ eligibility for nurse practitioner registration,

development of the CRNBC NP OSCE, and

development of review tools and other resources for the NP Quality Assurance Program.
The information in this document may also be helpful to applicants seeking NP registration and to
CRNBC nurse practitioner registrants. For example, it could be used by individuals to reflect on the
degree of match between their areas of competence and the CRNBC NP Competencies. It may also
make clearer what the CRNBC NP Competencies look like as clinical activities, such as taking a
client health history, conducting a physical exam or prescribing drugs. The document is also used by
CRNBC Practice Support staff3 when discussing NP practice with registrants and other stakeholders.
1 See CRNBC Scope of Practice for Nurse Practitioners: Standards, Limits and Conditions
2 Web links to referenced documents can be found in the Resources Section. All resourced documents are marked with
an asterisk (*) the first time they appear in the text of this publication.
3 CRNBC registrants facing a complex practice situation or with questions about scope of practice, can discuss issues and
options with a Practice Support* Advisor or Consultant. Consultation is limited to matters within CRNBC’s mandate such as
legislation, scope and standards.
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
Overview
The document is organized into two sections:
Section One - elaborates the four Primary Areas of Competence, as set out in the Competencies
Required for Nurse Practitioners in British Columbia, along with Associated Activities of competence for
each primary area broken down into descriptive behavioural elements.
Section Two - sets out the Knowledge and Skills foundational to nurse practitioner practice in four key
areas of competence. The knowledge and skills are further organized into three groupings for each of
the four competence areas as follows: 1) Theories, Concepts and Principles; 2) Skills; and 3) Facts,
Data and Information.
Providing specificity enables the College programs which include competence assessment activities, to
establish objective criteria for purposes of assessment and/or evaluation of nurse practitioner practice.
The essence of nurse practitioner practice is nevertheless the integration and application of the
knowledge, skills and judgment as set out in the CRNBC NP Competencies. CRNBC recognizes that
effective clinical decision-making of nurse practitioners requires an integration and synthesis of client
information, scientific knowledge and clinical skills in all four areas of competence at an advanced
nursing practice level.
Some of the activities in Section One and much of the knowledge and skills in Section Two are
essential, but not unique to nurse practitioner practice. They are practice activities and/or knowledge
and skills common to all registered nursing practice (e.g., establishing relationships with clients;
promoting health; preventing illness/injury). The difference lies in the fact that the knowledge and
skills are integrated at the advanced practice level unique to the nurse practitioner scope of practice
and applied to client care needs within the context of how the nurse practitioner role is enacted.
The information in this document is intended to represent an integrated body of knowledge, skills and
abilities that is fully reflected in the four areas of competence common to nurse practitioner practice in
BC as set out in the CRNBC NP Competencies. The two sections are separately detailed in the
following pages.
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
Section 1: Primary Areas of Competence and
Associated Activities
The primary areas of nurse practitioner competence are grouped into four categories in the CRNBC
Competencies Required for Nurse Practitioner Practice in British Columbia:
1.
2.
3.
4.
Establish and Maintain Professional Role, Responsibility and Accountability
Assess and Diagnose Client Health/Illness Status
Therapeutically Manage Health Care
Promote Health and Prevent Illness/Injury.
The organization of the content or sub-categories of competence (activities) within each of the
Primary Areas of Competence differs from that of the CRNBC NP Competencies document. The main
difference lies in the content of the first category Professional Role, Responsibility and Accountability.
The CRNBC NP Competencies document situates the advanced nursing practice (ANP) core
competencies in this category (i.e., clinical practice; leadership; research; collaboration, consultation
and referral) and further specifies that nurse practitioners are expected to integrate these ANP
competencies into their practice. As the purpose of this document is to make clear how the CRNBC
NP Competencies are performed in practice, readers will find that a number of the advanced practice
core competencies are integrated into the clinical activities associated with each of the other three
primary areas of practice; i.e., Health Assessment and Diagnosis; Therapeutic Management; and
Health Promotion and Prevention of Illness and Injury.
Professional Role, Responsibility and Accountability includes those activities associated with the broad
concept of professional practice such as practising within scope, advocating for the role of nurse
practitioners, maintaining continuing competence, leadership & managing change and meeting legal,
ethical and professional requirements. See Table 1 for an overview of the four Primary Areas of
Competence and the respective subcategories of Associated Activities.
Each sub-category of Associated Activities is broken down into more measurable and descriptive
information. The elements listed in the breakdown set out either a desired outcome or the process by
which the activity is successfully performed at the level required by the CRNBC NP Competencies such
as conducting a history, performing a physical exam, formulating a differential diagnosis etc.
Within each primary area of competence, nurse practitioners carry out the associated activities as
delineated to work safely, appropriately and ethically with clients in the stream in which an NP is
registered to practise.
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
Table 1: Overview: Primary Areas of Competence4 and Associated Activities
1. ESTABLISH & MAINTAIN
2. ASSESS AND DIAGNOSE
3. THERAPEUTICALLY
4. PROMOTE HEALTH
A. Practice within scope of
practice
A. Establish and maintain
relationship with client
B. Advocate for the role of
nurse practitioner and the
profession of nursing
B. Assess client’s health status:
 Take history and gather
information from client,
family, caretaker(s), or
other health professionals
and/or records
 Conduct physical
examination
 Formulate differential
diagnosis
 Gather information and
data from diagnostic
and/or screening
investigations
A. Develop implement a plan
of care for management of
client’s episodic and chronic
diseases, disorders and
conditions:
 Establish priorities
 Provide information
 Make recommendations
 Support client to implement
and monitor the plan of care
 Evaluate the plan of care
A. Identify and respond to
trends or patterns that
have health
implications for clients.
PROFESSIONAL ROLE,
REPONSIBILITY &
ACCOUNTABILITY
C. Maintain continuing
competence
D. Demonstrate leadership
and manage change
E. Meet all legal, professional
and ethical requirements
CLIENT’S HEALTH/ILLNESS
STATUS
C. Make diagnoses/identify
health need
D. Communicate findings
E. Document findings
MANAGE CLIENT HEALTH
CARE
B. Order/provide treatments
and other therapeutic
interventions:
 Write orders and/or
document treatment plan
 Prescribe drugs
 Dispense drugs
 Perform advanced
therapeutic interventions
C. Document plan of care
D. Consult and make referrals
E. Develop follow-up and
information systems.
AND PREVENT ILLNESS/
INJURY
B. Contribute to health
promotion/prevention
strategies.
C. Advocate for clients and
their health care needs:
 Encourage/maximize
client
 Participation and
decision-making
 Advocate for policies
that support the health
and well-being of
individuals, families,
groups and
communities
 Provide leadership: to
address service gaps,
issues of continuity of
care, and needed health
services; and to promote
inter-professional client
care.
4 Advanced Nursing Practice Core Competencies, as set out in the CRNBC Competencies Required for Nurse Practitioners in
British Columbia (2010) are integrated into each of the four areas of primary competence of the framework, as appropriate.
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
Primary Area of Competence:
1. ESTABLISH AND MAINTAIN PROFESSIONAL ROLE, RESPONSIBILITY AND
ACCOUNTABILITY
This category of competence addresses those activities related to professional role and inherent
responsibilities and accountabilities fundamental to nurse practitioner practice including scope of
practice, continuing competence, leadership and professional requirements. Nurse practitioners enact
the role in the interest of excellence in delivery of client services - seeking opportunities to participate
in, guide and/or initiate the development and implementation of standards, practice guidelines, and
quality assurance, education & research initiatives.
Associated Activities:
A.
I.
II.
III.
IV.
V.
Practice within scope of practice
Practice is based on client populations, practice setting and competence of the nurse
practitioner.
Individual limitations to competence are identified and guide practice.
Accountability and responsibility of the nurse practitioner role are clearly defined.
CRNBC nurse practitioner Scope of Practice Standards, Limits and Conditions are met.
Practice reflects autonomous and accountable decision-making that is in keeping with the
nurse practitioner scope and stream of practice.
B. Advocate for the role of nurse practitioner and the profession of nursing
I.
II.
III.
The nurse practitioner role and responsibilities are explained to clients, other health care
providers, social and public service sectors, the public, legislators, and policy-makers.
Other nurse practitioners and registered nurses are mentored and supported in their learning
Networks with other colleagues are established to enhance, support and/or develop
knowledge, solve problems and set policy.
C. Maintain continuing competence
I.
II.
III.
IV.
V.
VI.
Self-assessment is based on reflective practice.
Own learning style and needs are evaluated and identified.
Practice is adapted to meet new patterns of health needs, trends, evolving practice guidelines
and evidence.
Current research is identified, interpreted and applied to improve practice as appropriate.
Methods and strategies used to maintain competence are identified.
Methods and strategies used to ensure quality improvement in practice are identified.
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
D. Demonstrate leadership and manage change
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
Raises awareness with members of the health care team and/or community to identify research
opportunities and to support and/or conduct research as appropriate.
Assumes a leadership role, when there is opportunity, to initiate or guide policy related
activities that will influence practice, health services and public policy.
Coalitions and effective partnerships are formed to initiate or manage change.
Change is initiated to reflect evidence-informed practice at the individual, organizational and
systems level.
Change is facilitated and managed effectively and with respect.
Communication is clear and appropriate to the communication styles of others.
Decision-making is collaborative.
Conflicts are resolved respectfully and through collaborative problem-solving.
Others are mentored and supported to develop their skills and knowledge.
Outcomes measures are predetermined and evaluated in follow-up of clients and data
information systems.
Outcomes are communicated and/or disseminated, when appropriate, to contribute:
 to nursing and other scientific knowledge; and
 to the development of evidence-informed practice guidelines and policies.
E. Meet all legal, professional and ethical requirements
I.
II.
III.
Relevant legislation and the implications for practice are identified.
Practice is performed in accordance with legislative acts and ethical and professional
standards.
Practice is documented and records maintained securely in accordance with CRNBC Practice
Standards and all legislation on privacy and security of client record.
2. ASSESS AND DIAGNOSE CLIENTS’ HEALTH/ILLNESS STATUS
“The nurse practitioner integrates a current, scientific knowledge base and critical appraisal to obtain
the required information for determining diagnoses and client needs. Throughout the process, the
nurse practitioner works collaboratively with the client to identify and mitigate health risks, promote
understanding of health issues and support healthy behaviour” (excerpted from CRNBC Competencies
Required for Nurse Practitioners in British Columbia). Nurse Practitioners assess and diagnose client
health/illness status in accordance with CRNBC’s Scope of Practice for Nurse Practitioners: Standards,
Limits and Conditions.
A. Establish and maintain relationship with client5
I.
Clients are welcomed and encouraged to feel at ease.
5 Client - an individual, family, group, or entire community who requires nursing expertise. In some clinical settings, the
words "patients" or "residents" may be used to refer to clients.
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II.
III.
IV.
V.
VI.
VII.
Clients are encouraged to describe their situations, feelings, concerns and attitudes.
Clients are encouraged to describe the meaning of their health/illness experiences and how
their daily living is affected.
Clients are treated respectfully and in accordance with their cultural beliefs.
Clients’ health status and concerns are acknowledged.
Clients are assisted to understand the range and boundaries of NP practice.
Clients are supported to address concerns.
B. Assess client’s health status
(a) Take history and gather information from client, family6, caretaker(s) or other health professionals
and/or records.
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
The method of history taking, which may be either focused or comprehensive, is appropriate
to the client’s presenting concern.
Information includes a comprehensive (or focused) and relevant holistic health history.
History comprises the reason for seeking care, present health or history of present illness,
including a review of systems, past health, family health history, personal and social history
(psychosocial, emotional, ethnic, cultural and spiritual assessment of health and identification
of support network), and a functional assessment and the client’s perception of his or her
health and well being.
History is based on knowledge of normal health events, acute illness/injuries, chronic
diseases, co-morbidities and emergency health needs, including the effects of multiple
etiologies and the history incorporates knowledge of developmental and life stages,
pathophysiology, psychopathology, epidemiology, environmental exposure, infectious
diseases, determinants of health, behavioural sciences, demographics and family process.
Information gathering tools and techniques are appropriate to client needs and age &/or
developmental stage.
Information is gathered and recorded in a standard, systematic and organized manner.
Information is gathered respectfully in a sensitive manner and confidentiality is appropriately
maintained within a family interview.
Information is analyzed and interpreted from appropriate sources.
Clarification is sought to enhance understanding and improve ongoing differential diagnoses.
Interpreter services are used, when necessary, to enhance understanding and communication.
Indicators of potential health concerns are noted.
Opportunities are taken for prevention and ongoing monitoring/screening as client choices
and resources allow.
(b) Conduct physical examination
6 Family - two or more individuals who depend on one another for emotional, physical and/or economic support. the
members of the family are defined by the individual.
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
Clear instruction about the examination is provided to the client and verbal communication
during the examination is intended to maintain the client relationship.
Examination is done in a systematic and organized manner with minimal discomfort to the
client.
Different techniques and strategies are used to gain comprehensive (or focused as
appropriate) data that is appropriate to the client presentation and in consideration of client
age and developmental stage.
Physical examination is done in a manner that respects the client’s privacy and dignity and
ensures client safety.
Physical examinations are performed in keeping with standardized and accepted practice.
Physical examination is congruent with the history and assessment findings and is
comprehensive and appropriate to differential diagnoses.
Indicators of potential health concerns are noted.
Findings - both normal and abnormal are identified and accurately interpreted, as appropriate
to client presentation.
Information regarding the findings is provided during the exam, as relevant and appropriate.
(c) Formulate differential diagnosis (es)
I.
Differential diagnoses are:

congruent with findings from history and physical assessment;

based on critical inquiry;

accurate &comprehensive; and

Reflective of sound clinical reasoning.
(d) Gather information and data from diagnostic and/or screening investigations
I.
II.
III.
Investigations are performed or ordered appropriately to monitor and screen for health
concerns and/ or to diagnose or confirm differential diagnoses.
Appropriate investigations are ordered or performed accurately, safely and in keeping with
evidence- informed practice.
Results of investigations are followed-up using an effective system that is timely and
minimizes error occurrence.
C. Makes Diagnoses7 and/or Identifies Health Need
I.
II.
Interpretation of diagnostic investigations is accurate and reflects sound clinical reasoning.
Diagnosis integrates information from the history, including the presenting symptoms,
response to illness, physical and mental/cognitive examination, and diagnostic and screening
investigations in ruling out differential diagnoses and determining the most likely diagnosis.
7 Diseases, Disorders and Conditions Managed by an Entry-Level Family Nurse Practitioner (and Adult or Pediatric Nurse
Practitioner) are found in Appendix One of this document.
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
III.
IV.
V.
VI.
VII.
VIII.
Diagnosis includes consideration of culture and determinants of health as appropriate.
Diagnosis is based on sound scientific evidence and clinical reasoning.
Diagnosis (es) is (are) comprehensive and accurate.
Urgent, emergent and life threatening situations are appropriately anticipated and recognized
Consultation and collaboration are used as appropriate, to confirm a diagnosis and/or identify
a health need.
Consultations with and referrals to other health care professionals are concise, succinct and
accurate, and done in a timely manner and in keeping with the needs of the clients.
D. Communicate Findings
I.
II.
III.
IV.
V.
VI.
VII.
Health assessment findings and/or diagnosis, including outcomes and prognosis are
appropriately communicated.
Findings including outcomes and prognosis are communicated directly to the client in
keeping with practice ethics as set out in the CRNBC Professional Standards for Registered
Nurses and Nurse Practitioners*.
Findings including outcomes and prognosis are communicated at a level and in a manner that
maximizes client understanding.
Opportunities are taken for health promotion and disease and injury prevention.
Clients are encouraged to ask questions and raise concerns.
Clients’ questions and concerns are responded to.
Consultations with or referrals to other health care professionals are communicated
effectively.
E. Document Findings
Documentation reflects findings from history and physical examinations, diagnostic testing and
clinical reasoning including ruling in and ruling out of differential diagnoses as appropriate.
I.
Documentation is timely, clear, accurate and complete and in accordance with relevant
CRNBC Practice Standards.
3. THERAPEUTICALLY MANAGE CLIENT HEALTH CARE
“Nurse practitioners collaborate and share decision-making with clients to set priorities for the
provision and overall coordination of care along the health/illness continuum. The nurse practitioner
selects appropriate interventions from a range of non-pharmacological and pharmacological
interventions to assist clients in promoting, restoring or maintaining functional, physiological,
emotional and mental stability to achieve optimal client health” (excerpted from CRNBC Competencies
Required for Nurse Practitioners in British Columbia). Nurse Practitioners undertake the therapeutic
management of client health/illness status in accordance with CRNBC’s Scope of Practice for Nurse
Practitioners: Standards, Limits and Conditions.
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
A. Develop and implement a plan of care for the management of the client’s acute and chronic
physical and mental diseases, disorders and conditions
(a) Establish priorities with the client for desired health outcomes
I.
II.
III.
IV.
V.
VI.
VII.
Priorities reflect recognition and appropriate response to urgent and emergent health needs.
Priorities take into account clients’ acute and chronic diseases, disorders and conditions.
Priorities consider clients’ health risks.
Priorities are negotiated with the client.
Priorities reflect clients’ circumstances.
Priorities are based on clients’ choices and decisions.
Priorities reflect realistic health outcomes.
(b) Provide information
I.
II.
III.
IV.
Information is current, relevant and evidence-based.
Information reflects the degree of the strength of the evidence.
Information meets legislative, professional and ethical standards.
Information is provided in a manner that maximizes client participation and understanding.
(c) Make recommendations to the client
I.
II.
Recommendations include the benefits and risks of the plan of care and possible alternative
approaches.
Recommendations incorporate knowledge of both:

normal health events, acute illness/injuries, chronic diseases, comorbidities and
emergency health needs, including the effects of multiple etiologies; and

III.
IV.
V.
VI.
VII.
VIII.
IX.
developmental and life stages, pathophysiology, psychopathology, epidemiology,
environmental exposure, infectious diseases, determinants of health, behavioural
sciences, demographics and family process.
Recommendations are undertaken collaboratively with clients.
Recommendations reflect client's circumstances, feasibility, needs and choices and ensure
best health outcomes for the client.
Recommendations are made in a manner that maximizes client's participation and
understanding.
Recommendations include consideration of relevant information provided by other health
care providers and family where appropriate.
Recommendations are evidence-informed and take resources and cost-effectiveness into
consideration
Recommendations are accurately and consistently documented, including those declined by
clients.
Consent for the agreed-upon plan of care is obtained, in accordance with CRNBC Practice
Standard Consent*, before implementation.
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
(d) Support8 clients to implement and monitor the negotiated plan of care
Nurse Practitioners support clients regarding diagnoses, prognoses, and self-management including
their personal responses to diseases, disorders, conditions, injuries, risk factors, lifestyle changes and
therapeutic interventions.
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
Clients are supported to follow the recommended and accepted drug therapy, including
frequency and duration, and all other recommended treatments and therapeutic
interventions.
Anticipated clinical outcomes are clearly communicated and explored with client and a plan
negotiated in the event that outcomes cannot be met.
Clients’ responses to drugs, treatments or other therapeutic interventions are monitored and
managed.
Clients are encouraged to manage their own plan of care, to report difficulties in
implementation of the plan of care and to work with the provider to resolve situations of
conflict or to address barriers to implementation.
Clients are encouraged to report signs, symptoms, side-effects or potential adverse reactions.
Accurate information and helpful support are provided to the client on a regular basis.
Counselling/coaching is offered to enhance clients’ ability to meet their health and quality of
life goals.
Follow-up is provided as needed or as requested and is negotiated with the client.
Support includes advocacy to ensure health needs are met.
Connection with other health care providers, agencies and community resources is
coordinated and/or facilitated, as appropriate, to the client's health care needs and their
interest /decision.
(e) Evaluate the plan of care
I.
II.
III.
IV.
V.
Data are gathered to determine the appropriateness of the plan.
Status of health and health concerns are identified.
Established outcome criteria, appropriate practice guidelines and relevant evidence are used to
evaluate the plan of care.
Plan of care is modified to reflect changes, circumstances and goals and preferences of the
client
Monitoring and evaluation of plan of care is ongoing.
B. Order and/or Provide Treatments and other Therapeutic Interventions
(a) Write orders and/or documents treatment /plan of care
I.
Orders or treatment plan are thorough and written clearly and accurately.
8 Support includes educating, coaching and/or counselling clients.
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II.
III.
IV.
Orders or treatment plan reflect evidence-based practice for specific client populations.
Orders or treatment plan take resources and cost-effectiveness into consideration.
Orders or treatment plan are appropriate to client needs and circumstances and in accordance
with the standards, limits and conditions on diagnosing and managing health care as set out
in CRNBC Scope of Practice for Nurse Practitioners: Standards, Limits and Conditions.
(b) Prescribe drugs
Applies knowledge of pharmacotherapeutics and relevant evidence when prescribing drugs
I.
II.
III.
IV.
V.
VI.
VII.
Prescriptions meet all legislated, professional and ethical requirements.
Prescribing, including when recommending complementary or alternative health therapies, is
conducted in accordance with Scope of Practice for Nurse Practitioners: Standards, Limits and
Conditions- for Prescribing Drugs and all other relevant CRNBC Practice Standards including
Consent*and Conflict of Interest* .
Prescriptions are based on client’s ability to understand and follow treatment regime.
Prescriptions are appropriate to the needs of the client, acceptable to the client and
evidence-informed.
Medication prescriptions (or drug therapy) take into account all contraindications, potential
drug interactions, client’s health history, current health status, lifestyle, gender, circumstances,
client’s perspective and other relevant factors such as cost effectiveness and affordability.
Adverse events related to medications are reported to client and others in accordance with
CRNBC Scope of Practice for Nurse Practitioners: Standards, Limits and Conditions - for
Prescribing Drugs
Potential or actual problematic substance use and/or misuse of drugs, including
complementary and alternative therapies, is identified and managed as appropriate.
(c) Dispense drugs
Drugs are dispensed in keeping with all legal, professional and ethical requirements and in accordance
with CRNBC’s Practice Standard Dispensing Medications*.
(d) Perform advanced therapeutic interventions/procedures
Interventions are within the CRNBC scope of practice limits and conditions for diagnosing and health
care management and the competence of the nurse practitioner.
I.
II.
III.
IV.
Interventions are necessary for the health and well-being of the client.
The purpose, benefits and risks of the interventions are explained to the client
Informed consent is obtained.
Therapeutic interventions reflect current standards of care and current technology and are
evidence informed.
C. Document plan of care
I.
Documentation of the plan of care includes:

clinical rationale for the plan;
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II.

all therapeutic interventions provided &/or written orders;

ongoing monitoring of client’s response to the plan of care and evaluation of outcomes;
and
 revisions of the plan of care as appropriate.
Documentation is timely, clear, accurate and complete and in accordance with CRNBC
Practice Standard Documentation.
D. Consult and make referrals
I.
II.
III.
Consultations and referrals are made in accordance with CRNBC’s Scope of Practice for Nurse
Practitioners: Standards, Limits and Conditions for Physician Consultation and Referral.
Consultations and referrals are timely, effective and appropriate to the needs of the client.
Accepts referrals from and/ or provides consultation to other health-care providers,
community agencies and allied non-health-care professionals
E. Develop follow-up and information systems
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
Systems are developed to promote safe client care and demonstrate effective outcomes
Follow-up and quality improvement strategies are used.
Risk management strategies are taken to promote safe practice.
Systems minimize practice errors and unsafe practices.
Critical incidents are reviewed with colleagues.
Systems are logical, appropriate, and reflect legal and professional requirements.
Client confidentiality is protected in accordance with CRNBC practice standards.
Systems capture anticipated evidence- informed client outcomes including those identified in
relevant practice guidelines.
4. PROMOTE HEALTH AND PREVENT ILLNESS/INJURY
Nurse practitioners in all practice settings focus on promoting, improving and restoring health. The nurse
practitioner may lead or collaborate with other health-care team members, other sectors and/or the
community by participating in initiatives that promote health and reduce the risk of complications, illness
and injury for their individual clients, client groups and/or the population as a whole (excerpted from
CRNBC Competencies Required for Nurse Practitioners in British Columbia).
A. Identify and respond to trends or patterns that have health implications for clients
I.
II.
III.
IV.
Clients are supported to identify trends and patterns affecting their health and well-being.
Information and data are gathered from clients, health care providers and others in the
community as well as health indicators related to the community.
Individuals and groups who are identified as being at risk, including those outside the formal
health care setting, are given special consideration.
Health care goals are established collaboratively to respond to trends or patterns.
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V.
Goals are set based on information and data that have been critically analyzed and interpreted
correctly.
B. Contribute to health promotion/prevention strategies
I.
II.
III.
IV.
V.
VI.
Clients are supported to identify health promotion/prevention strategies and take appropriate
action.
Health promotion/prevention strategies are planned and developed in collaboration with
others.
Advocacy strategies are used to support the introduction or the development of health
promotion/prevention strategies including screening populations at risk and population based
harm reduction.
Health promotion/prevention strategies are evidence - informed and implemented to reflect
the of client's unique attributes with attention to cultural safety9.
Evaluation activities are conducted and monitored in collaboration with others.
Changes in practice are based on the evaluation of health promotion and prevention
strategies.
C. Advocate for clients and their health care needs and well-being
Health and well being activities are grounded in the knowledge of determinants of health and wellness,
cultural diversity and safety and other relevant theories/concepts and related skills and facts.
(a) Encourage/maximize participation and decision-making.
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
Environments are created to encourage participation and learning.
The particular needs of diverse populations are identified and addressed in collaboration with
the community.
Clients are supported to identify and take action to address their own health care needs and
decisions including those related to living with chronic disease.
Clients are encouraged to advocate for positive community change to address health concerns.
Problem-solving and decision-making is fostered within available resources.
A community development process is used.
Information and achievable options are provided to enable decision-making
Information provided is current, relevant and evidence- informed.
Barriers to community participation and decision-making are minimized.
Interactions with other health team and community members are facilitated to maximize
participation and decision-making.
9 A manner that affirms, respects and fosters the cultural expression of clients. This usually requires nurses to have undertaken
a process of reflection on their own cultural identity and to have learned to practice in a way that affirms the culture of clients
and nurses. Unsafe cultural practice is any action which demeans, diminishes or disempowers the cultural identity and well
being of people. Cultural safety addresses power relationships between the service provider and the people who use the
service.
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(b) Advocate for policies that support the health and well-being of clients
I.
II.
III.
Health trends and risks affecting the well-being of clients are identified.
Contributions are made to policies that protect the health of clients, support diversity and
promote community well-being.
Community support is encouraged for policies and programs that promote health and
well-being.
(c) Provide leadership: to address service gaps, issues of continuity of care, & needed health services
and to promote inter-professional client centered care
I.
II.
III.
IV.
V.
Service gaps are identified.
Contributions are made to enhance communication strategies among health .providers and
others to address service gaps and maximize continuity of care.
Communication within the community is facilitated to create or promote change.
Contributions are made to the development and maintenance of appropriate programs and
services.
Problem-solving is facilitated to enable communities to address problems using a community
development process.
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Section 2: Knowledge and Skills
Nurse practitioners require a strong foundation in a wide range of knowledge and skills to perform the
CRNBC Competencies Required for Nurse Practitioners in British Columbia. Section 2 is organized as
follows:
1. Nurse Practitioner-Client Relationship
2. Clinical Practice:
A. Assessing, Diagnosing and Managing Client Health Care including Consultation/Referral
B. Promoting Health and Illness/Injury Prevention
3. Collaboration and Change
4. Professional Accountability, Leadership and Evidence-Informed Practice
Each of the above four sections is subcategorized into:
i)
Theories, Concepts and Principles,
ii)
Skills, and
iii)
Facts, Data and Information.
As previously discussed, the advanced nursing practice (ANP) core competencies are pivotal to
effective performance of the nurse practitioner role. Advanced nursing practice includes competencies
such as evidence-based practice, leadership, collaboration and change. The knowledge and skills
associated with practice at an advanced level are either integrated or stand alone in the four areas
outlined above.
Section 2 emphasizes the primacy of the client-relationship to the NP's successful delivery of health
care services. This involves understanding with clients, at individual and group levels, the meaning of
their health/illness experience and how their daily life is affected. It involves a wide range of knowledge
and skills such as theories of personhood, principles of group dynamics and communication as well as
being able to skilfully apply such theories and principles - from a professionally ethical perspective.
The essential knowledge and skills for diagnosing and managing health and illness and promoting
health and preventing illness /injury are extensively detailed in the Clinical Practice section of the
Knowledge and Skills.
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1. NURSE PRACTITIONER-CLIENT RELATIONSHIP
Theories, Concepts and Principles
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
Personhood
Effective interviewing and therapeutic communication
Cultural diversity and trans-cultural expressions of health and illness
Cultural safety and cultural competence
Family systems and family as client
Community as client
Group dynamics and facilitation, including families
The role played by gender, socioeconomic, cultural and social experiences on communication
The range of communication styles and modalities
The impact of personal communication styles on practice
Skills
i.
ii.
iii.
iv.
v.
vi.
vii.
Build rapport with the client to initiate and establish a continuing therapeutic relationship
that will facilitate future diagnoses, planning and treatment and the client’s daily lived
experience
Demonstrate effective active listening skills using both verbal and non-verbal communication
methods
Use open-ended and closed questions to gather information and use appropriate response
techniques to assist with the narrative
Demonstrate cultural sensitivity by working effectively with people from diverse backgrounds
Work effectively with diverse individuals and families and be able to differentiate
appropriately between family as a client and the family as the context for an individual client
Respect and accept the moral and ethical values/decisions of others even when they are in
conflict with own belief systems
Use interpretation services and other augmentative communication methods appropriately
Facts, Data, and Information
i.
ii.
iii.
Resources, supports and technology to facilitate communication strategies and relationship
building
Ethical standards, practice guidelines and standards of practice
Available interpretation services and resources
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2. CLINICAL PRACTICE
A. Assessing, Diagnosing and Managing Health & Illness.
Theories, Concepts and Principles
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
Growth and development, including normal health requirements/events [e.g., nutrition, sleep
and exercise; sexual orientation and sexual health; life transitions; and perinatal health (family
only)].
Family systems and family as client.
Abuse/violence – impact and effects.
Substance abuse.
Advanced pathophysiology and psychopathology, including relational anatomy for each body
system, normal physiology, homeostasis mechanisms, pathophysiology of each body system,
including those affecting mental health and age-related changes.
Genetics.
Determinants, manifestations, risk factors and age-related implications of a wide range of
common physical and mental diseases, disorders and conditions, including episodic and
chronic disease/illnesses including infectious diseases.
Epidemiology, Demographics and Environmental exposure & health hazards as defined by
the Public Health Agency of Canada*
Evidence-informed practice and concepts of investigative research and data gathering.
Advanced assessment, including history-taking and physical and mental status examination.
Process of clinical reasoning and differential diagnosing, including pattern recognition, body
systems analysis, data interpretation, including interpretation of pertinent negative results.
Diagnosis and management of common physical and mental acute and chronic disease, disorders and
conditions, infectious diseases and problematic substance use according to the CRNBC Scope of
Practice for Nurse Practitioners: Standards, Limits and Conditions - for Diagnosing and Health Care
Management.
(Please Note: Diseases, disorders and conditions nurse practitioners are able to manage at entry to
practice - for each of the three streams in which CRNBC registers NPs to practice (Family, Adult and
Pediatric) - are contained in Appendix 1 of this document.
i.
ii.
iii.
Advanced pharmacotherapeutics including pharmacodynamics, pharmacokinetics and the
therapeutic and adverse affects of drug therapies (and drug interactions
Complementary and alternative therapies
Advanced counselling techniques and strategies, such as crisis and substance abuse
intervention, critical incidence debriefing, coping and stress management, intervention, grief
management and managing end-of-life issues
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Skills
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
xii.
xiii.
xiv.
xv.
xvi.
Use an accepted standard format for history taking and physical and mental examination
Review and assess relevance of past medical history, family history, personal habits and
functional abilities and determine risk factors
Perform an age-related, complete, comprehensive head-to-toe (or focused as appropriate)
physical assessment and cognitive assessment including using invasive assessment techniques
or screening examinations such as rectal and anal examination, pelvic, prostate and testicular
examinations, and breast exam and pap smear
Interpret results of a mental status examination
Differentiate normal from abnormal and/or variations of normal of the assessment
Perform point of service diagnostic investigations, such as: taking samples (e.g., skin
scrapings/urinalysis and preparing a wet mount to analyze sample under a microscope); taking
and analyzing swabs and blood samples for rapid strep and mono testing, A1C hemoglobins,
gonorrhea and pregnancy test; and using a peak flow meter
Determine comprehensive and appropriate differential diagnoses
Solve problems, set priorities and think critically in a range of situations, such as diagnostic
complexity, client background (socioeconomic, cultural, political, etc.) and emergent
conditions
Analyze the strength of the literature/evidence and apply appropriate evidence-based
guidelines
Consider cost effectiveness when ordering /providing therapeutic interventions
Effectively perform and implement a range of interventions, such as simple wound closure
(suture), incision and drainage, punch biopsy, splinting, wound management, eye abrasion
care and reading basic x-rays for purposes of screening, urgent treatment.
Consider/evaluate the influence of pharmaceutical companies.
Recommend/order laboratory and other diagnostic services effectively and appropriately in
accordance with the CRNBC Scope of Practice for Nurse Practitioners: Standards, Limits and
Conditions for Diagnosing and Health Care Management
Use current technology effectively and appropriately
Effectively manage the clients health care needs
Provide end-of-life counsel
Facts, Data, and Information
i.
ii.
iii.
iv.
Diagnostic testing/screening, including when and why to order and normal parameters (and
age-related differences)
Current evidence-informed practice guidelines and standards for clinical and preventative
practices (where, when and how to use) (e.g., for hypertension, type II diabetes, growth and
development)
References and resources for drug information and therapies
Relevant and available community resources
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v.
vi.
vii.
viii.
ix.
CRNBC Scope for Nurse Practitioner of Practice Standards, Limits and Conditions
Prescribing Drugs and all relevant practice standards such as Consent, Conflict of Interest, and
Documentation etc.
CRNBC Scope of Practice for Nurse Practitioners; Standards, Limits and Conditions - for
Physician Consultation and Referral.
Relevant legislation, regulations and policies affecting practice and the population served as
outlined in CRNBC publications on legislation*
Canadian Patient Safety Institute information and publications*
Canadian Adverse Drug Reporting Program*
B. Promoting Health and Preventing Illness/Injury
Theories, Concepts and Principles
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
Levels of care: primary, secondary, tertiary.
Determinants of health and wellness.
Cultural diversity and trans-cultural expressions of health and illness.
Issues related to national health policy.
Concept of community as a system.
Community planning and development.
Health screening at the individual and systems level.
Health education and health promotion.
Interventions for health promotion, such as nutrition, exercise and stress management
counselling.
Workplace safety (adult, family).
Skills
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
Recognize the relevance of social and economic determinants of health.
Assess relevance of trends.
Use harm reduction strategies that are population based.
Use capacity development appropriately.
Conduct periodic and screening health assessments and physical examinations for the
population served, incorporating counselling related to health promotion, health maintenance
and disease prevention strategies.
Promote reproductive health through assessment and management of contraceptive needs for
childbearing individuals and families.
Provide routine prenatal care for low risk women and their families, including monitoring
anticipatory guidance and management of common conditions during pregnancy (family).
Assess, counsel and manage the health needs of menopausal women, including health teaching
about pharmacological and non-pharmacological therapies (family, adult).
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Facts, Data, and Information
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
Demographics of the community or population served.
The social and political history of the community and local economic information.
Epidemiological information.
Information on health promotion strategies.
National and provincial screening guidelines.
Immunization schedules and guidelines.
Health maintenance schedules
Information on injury prevention strategies.
Workers Compensation Act and other relevant standards and regulations (adult, family).
3. COLLABORATION AND CHANGE
Theories, Concepts and Principles
i.
ii.
iii.
iv.
v.
vi.
vii.
Group dynamics and facilitation.
Team building and development.
Change theory.
Social, demographic and economic change.
Learning theories.
The role and function of mentoring, motivation, networking and other learning strategies.
Conflict resolution theories.
Skills
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
xii.
Develop, facilitate and contribute effectively to partnerships, coalitions and teams.
Initiate problem-solving strategies.
Delegate and assign responsibilities appropriately.
Serve as a role model and mentor.
Establish and support formal and informal networks.
Demonstrate and model empathy and respect for the views and beliefs of others.
Provide effective feedback.
Support others to provide effective feedback.
Motivate and engage others.
Balance competing priorities and link available resources with needs.
Work with a range of individuals, networks and stakeholders to meet the needs of the client.
Skilfully and effectively manage situations of conflict.
Facts, Data, and Information
i.
The nature, availability and contact information of community services, supports and
resources, including health, family and professional resources.
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ii.
iii.
Responsibilities, mandates and roles of members of teams, networks and organizations.
Training and education resources.
4. PROFESSIONAL ROLE, ACCOUNTABILITY AND RESPONSIBILITY
This content area addresses knowledge and skills related to expectations of the nurse practitioner role
including: i) NP practice is evidence-informed, ii) NPs provide leadership in the clinical arena, and iii)
NPs assume accountability and responsibility for ensuring quality care, and effective utilization and
risk management in the delivery of health services.
Theories, Concepts and Principles
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
xii.
xiii.
xiv.
xv.
Policy development/analysis and influencing health policy.
Health care systems – role of economic constraints, role and function of other related
formal/informal services and supports, system evaluation.
Critical components of systems theory – impact of change on systems and impact of power
imbalance.
Evidence-informed practice.
Leadership.
Quality management/quality improvement processes.
Utilization and risk management.
Ethical and moral standards/ethical decision-making and their influence on professional
practice.
The role of advanced practice nursing in the health care system.
Concepts of lifelong learning.
The importance of reflection and self-awareness.
Continuous improvement.
Information technology systems.
Effective strategies for presentations/public speaking.
Effective report writing and documentation.
Skills
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
Develop and evaluate innovative approaches for complex practice issues.
Apply a broad range of theories and relevant evidence to practice.
Provide leadership while enacting the leadership role.
Evaluate and improve care delivery systems.
Create and implement workplace systems for managing and evaluating client/program
outcomes.
Interpret and implement policies.
Incorporate and use ethical frameworks and decision-making into day-to-day practice.
Use current technology effectively and appropriately.
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ix.
x.
xi.
Create written and electronic documentation that promotes ease of use, understanding and
retrieval.
Write effective reports.
Give effective presentations.
Facts, Data and Information
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
Key government and professional bodies influencing nursing practice.
Barriers and challenges that exist within health care delivery systems.
Current economic influences on health care systems.
Ethical standards, practice guidelines and standards of practice.
Relevant information on insurance and other professional resources.
Parameters of legal liability and liability insurance for nurse practitioner role.
Legislation, regulations and standards relevant to practice, including issues of privacy,
freedom of information, reporting, and child protection.
Know the CRNBC scope of practice standards, limits and conditions of nurse practitioner
practice.
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APPENDIX ONE
Diseases, Disorders and Conditions Diagnosed and Managed by an EntryLevel Family Nurse Practitioner
Code:
D
The nurse practitioner diagnoses and manages independently or refers as appropriate. Will refer to physician at any
point as deemed necessary or at some stage as per accepted guidelines. Referrals are in accordance with CRNBC’s
standards for nurse practitioner- physician consultation.
C
The nurse practitioner establishes or strongly suspects the diagnosis and consults with a physician for the
management plan or consults with a physician to confirm the diagnosis, and as a result of the consultation:
i)
the nurse practitioner receives an opinion and recommendation, and assumes ongoing primary responsibility
and authority for the plan of care;
ii)
the physician assumes concurrent responsibility for some aspects of the plan of care; or
iii)
the care is transferred to the physician or emergency medicine as appropriate.
1. Infectious and Parasitic Diseases
D Chickenpox
D Coxsackie viral infection
D German measles (Rubella)
D Measles (Rubeola)
D Infectious mononucleosis
D Mumps
D Pertussis
D Strep throat
D Syphilis
D Hepatitis A
C Hepatitis B
C Hepatitis C
C HIV
C Tuberculosis
D Fifth disease
D Roseola
2. Endocrine, Nutritional and Metabolic Diseases
C Diabetes type I in adults
D Diabetes type II
D Hypothyroidism in adults
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D Obesity
C Cushing’s syndrome in adults
D Gout
C Hyperthyroidism
3. Mental and Behavioural Disorders
D Anxiety disorders in adults
D Depression in adults
C Attention deficit disorder
D Obsessive compulsive disorder in adults
D Substance abuse
D Substance dependence
C Post traumatic stress disorder
C Autistic spectrum disorder
C Fetal alcohol spectrum disorder
4. Diseases of the Nervous System
D Headaches-primary headaches without structural or systemic pathology
D Bell’s palsy-with any eye symptoms refer immediately to ophthalmologist
D Simple febrile seizure disorder in children
C Chronic seizure disorders in adults
C Meningitis
D Benign essential tremors
D Delirium
D Herpes zoster-immediate referral if ophthalmic involvement
D Restless leg syndrome in adults
C Trigeminal neuralgia
C Parkinson’s disease
C Multiple sclerosis
C Cerebral vascular disorder/transient ischemic attacks
D Peripheral neuropathies
C Alzheimer’s disease and related dementias
5. Diseases of the Eyes, Ears, Nose and Throat
Eyes
D Blepharitis
D Chalazion
D Conjunctivitis
D Simple corneal abrasion
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D Nasolacrimal duct obstruction
D Simple foreign body
D Hordeolum
C Cataracts
C Glaucoma
C Periorbital cellulitis
C Uveitis
Ears
D Otitis media
D Otitis externa
D Cerumen impaction
D Benign positional paroxysmal vertigo
D Foreign body
D Labyrinthitis
C Ménière’s disease in adults
Nose and Throat
D Rhinitis
D Cervical adenitis
D Anterior epistaxis
D Gingivitis
D Sinusitis
D Tonsillitis
D Pharyngitis
D Stomatitis
D Temporomandibular joint dysfunction
6. Diseases of the Circulatory System
D Hypertension in adults
D Peripheral vascular disease
D Stasis ulcers
D Superficial thrombophlebitis
D Varicose veins
C Heart failure
C Arrhythmias
D Stable coronary artery disease
D Chronic stable angina pectoris
D Dyslipidemia
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7. Diseases of the Respiratory System
D Asthma
D Bronchitis
D Bronchiolitis
D Influenza
D Nicotine dependence
C Tuberculosis
C Epiglotittis
D Chronic obstructive pulmonary disease, mild to moderate
C Interstitial lung disease
D Croup
D Upper respiratory infection
D Community acquired pneumonia
D Pertussis
8. Diseases of the Digestive System
D Anal fissures
D Constipation
D Gastroesophogeal reflux disease
D Irritable bowel syndrome
D Parasitic infections-roundworm, pinworm
D Peptic ulcer in adults
D Dysphagia in adults
C Hernia-inguinal, hiatal, umbilical
D Diverticular disease in adults
D Hemorrhoids in adults
C Cholecystitis in adults
C Chronic inflammatory bowel disease in adults
C Pancreatitis
D Gastroenteritis
D Encopresis
D Hyperbilirubinemia
D Colic
9. Diseases of the Skin and Subcutaneous Tissue
D Parasitic-scabies, pediculosis
D Fungal-candidiasis, dermatophytoses tinea, onychomycosis
D Bacterial-impetigo, folliculitis, furuncles, carbuncles, cellulitis
D Viral-warts and herpes simplex
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D Psoriasis in adults
D Pityriasis rosea
D Non-malignant skin lesions
C Malignant skin lesions
D Acne vulgaris
D Dermatitis-atopic (eczema), contact and seborrheic
D Sunburn
D Lyme disease
D Bacterial-cellulitis
10. Diseases of the Musculoskeletal System and Connective Tissue
D Bursitis
D Cervicalgia
D Costochondritis
D Plantar fasciitis
D Tendinitis/tenosynovitis
C Meniscus and ligament tears
D Carpal tunnel syndrome
D Fibromyalgia
D Impingement syndromes
D Osteoarthritis
D Osteoporosis
D Herniated disc
D Subluxation of the radial head
D Repetitive motion syndrome
11. Diseases of the Genitourinary System
D Lower urinary tract infections
D Pyelonephritis
D Primary nocturnal enuresis
D Urinary incontinence
D Nephrolithiasis
D Chronic kidney disease
C Acute renal failure
12. Pregnancy
C Gestational hypertension
D Post partum depression
D Hyperemesis gravidarum
C Gestational diabetes
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13. Injury, Poisoning, and other Consequences of External Causes
(All within the nurse practitioner’s scope and competence depending on the severity. Referral
would be indicated when beyond scope and competence.)
D Wounds and lacerations
D Burns
D Animal and human bites
D Arthropod bites and stings
D Poisoning
D Mild traumatic brain injury/concussion
D Fractures-not requiring reduction or casting
D Foreign body obstructions
14. Diseases and Conditions of the Reproductive System
Male
D Balanitis
D Epididymitis in adults
D Epididymitis in children after puberty
D Sexually transmitted infections
D Benign prostatic hyperplasia
D impotence/erectile dysfunction
D Prostatitis in adults
D Hydrocele in adults
C Varicocele
D Phimosis
Female
C Primary amenorrhea
D Dysmenorrhea
D Pelvic inflammatory disease
D Vulovaginal infections
D Family planning and contraception
D Premenstrual syndrome
D Simple ovarian cyst
D Mastitis
D Menopause
C Polycystic ovary syndrome
C Endometriosis
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15. Hematological and Immune Diseases
Hematologic
D Anemia
C Sickle cell anemia
Immune
D Allergic reactions
D Chronic fatigue syndrome
C Rheumatoid arthritis
C Sjögren’s syndrome
C Systemic lupus erythematosus
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
Diseases, Disorders and Conditions Diagnosed and Managed by an EntryLevel Adult Nurse Practitioner
Code:
D The nurse practitioner diagnoses and manages independently or refers as appropriate. Will refer to physician at any
point as deemed necessary or at some stage as per accepted guidelines. Referrals are in accordance with CRNBC’s
standards for nurse practitioner- physician consultation.
C
The nurse practitioner establishes or strongly suspects the diagnosis and consults with a physician for the
management plan or consults with a physician to confirm the diagnosis, and as a result of the consultation:
i)
the nurse practitioner receives an opinion and recommendation, and assumes ongoing primary responsibility
and authority for the plan of care;
ii)
the physician assumes concurrent responsibility for some aspects of the plan of care; or
iii)
the care is transferred to the physician or emergency medicine as appropriate.
1. Infectious and Parasitic Diseases
D Chickenpox
D Coxsackie viral infection
D German measles (Rubella)
D Measles (Rubeola)
D Infectious mononucleosis
D Mumps
D Pertussis
D Strep throat
D Syphilis
D Hepatitis A
C Hepatitis B
C Hepatitis C
C HIV
C Tuberculosis
D Giardiasis
2. Endocrine, Nutritional and Metabolic Diseases
C Diabetes type I
D Diabetes type II
C Diabetes insipidus
D Primary hypothyroidism
D Obesity
C Cushing’s syndrome
D Gout
C Hyperthyroidism
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
3. Mental and Behavioural Disorders
D Anxiety disorders-panic attacks, generalized anxiety disorders, adjustment disorders
D Depression
C Attention deficit disorder
D Obsessive compulsive disorder
D Substance abuse
D Substance dependence
D Post traumatic stress disorder
D Hypochondriasis
D Alcohol abuse
D Alcohol dependence
C Eating disorders
C Personality disorders
4. Diseases of the Nervous System
D Headaches-primary headaches without structural or systemic pathology
D Bell’s palsy
C Chronic Seizure disorder
C Meningitis
D Benign essential tremors
D Delirium
D Herpes Zoster-immediate referral if ophthalmic involvement
D Restless leg syndrome
D Trigeminal neuralgia-immediate referral if ophthalmic involvement
C Parkinson’s disease
C Multiple sclerosis
C Cerebral vascular disease/transient ischemic attacks
C Alzheimer’s and related dementias
5. Diseases of the Eyes, Ears, Nose and Throat
Eyes
D Blepharitis
D Chalazion
D Conjunctivitis
D Simple corneal abrasion
D Nasolacrimal duct obstruction
D Simple foreign body
C Cataracts
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
C Glaucoma
C Periorbital cellulitis
C Uveitis
Ears
D Otitis media
D Otitis externa
D Cerumen impaction
D Benign positional paroxysmal vertigo
D Labyrinthitis
C Meniere’s syndrome
D Mastoiditis
D Perforated eardrum
Nose/Throat
D Rhinitis
D Cervical adenitis
D Anterior epistaxis
D Gingivitis
D Sinusitis
D Tonsillitis
D Pharyngitis
D Stomatitis
D Temporomandibular joint dysfunction
6. Diseases of the Circulatory System
D Hypertension
D Peripheral vascular disease
D Stasis ulcers
D Superficial thrombophlebitis
D Varicose veins
C Heart Failure
C Arrhythmias
D Stable coronary artery disease
D Raynaud’s disease
C Beurger’s disease
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
7. Diseases of the Respiratory System
D Asthma
D Bronchitis
D Bronchiolitis
D Influenza
D Nicotine dependence
C Tuberculosis
C Epiglottitis
D Chronic obstructive lung disease, mild to moderate
C Interstitial lung disease
C Sleep apnea
C Bronchiectasis
8. Diseases of the Digestive System
D Anal fissures
D Constipation
D Gastroesophageal reflux disease
D Irritable bowel syndrome
D Parasitic infections-roundworm, pinworm
D Peptic ulcer disease
C Dysphagia
D Hernia-hiatal, inguinal, umbilical
D Diverticular disease
D Hemorrhoids
C Cholecystitis
C Chronic inflammatory bowel disease-ulcerative colitis, Crohn’s disease
C Pancreatitis
C Celiac disease
9. Diseases of the Skin and Subcutaneous Tissue
D Parasitic-scabies, pediculosis
D Fungal-candidiasis, dermaphytoses tinea, oncyhomycosis
D Bacterial-impetigo, folliculitis, furuncles, carbuncles, cellulitis
D Viral-warts, molluscum cantagiosum, herpes simplex
D Psoriasis
D Pityriasis rosea
D Non malignant skin lesions
C Malignant skin lesions
D Lichen planus
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
10. Diseases of the Musculoskeletal System and Connective Tissue
D Bursitis
D Cervicalgia
D Costochondritis
D Plantar fasciitis
D Tendonitis/tendosynovitis
C Meniscus and ligament tears
D Carpal tunnel syndrome
D Fibromyalgia
D Impingement syndromes
D Osteoarthritis
D Osteoporosis
D Herniated disk
D Low back pain
11. Diseases of the Genitourinary Systems
D Lower urinary tract infections
D Pyelonephritis
D Urinary incontinence
D Nephrolithiasis
D Chronic kidney disease
C Acute renal failure
D Interstitial cystitis
12. Pregnancy – not in scope of practice for NP (Adult)
13. Injury, Poisoning and other Consequences of External Causes
D Wounds and lacerations
D Burns
D Animal and human bites
D Arthropod stings and bites
D Poisoning
D Mild traumatic brain injury/concussion
D Fractures-not requiring reduction or casting
14. Diseases of the Reproductive System
Male
D Balantitis
D Epididymitis
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
D Sexually transmitted infections
D Benign prostatic hypertrophy
D Impotence/erectile dysfunction
D Prostatitis
D Hydrocele
C Varicocele
Female
D Primary Amenorrhea
D Dysmenorrhea
D Pelvic inflammatory disease
D Vulvovaginal infections
D Family planning and contraception
D Premenstrual symptoms
D Simple ovarian cyst
D Mastitis
D Menopause
C Polycystic ovary syndrome
D Abnormal uterine bleeding
D Atrophic vaginitis
C Post menopausal bleeding
15. Hematological and Immune Diseases
Hematologic
D Anaemia
C Sickle cell anaemia
C Chronic lymphocytic leukemia
C Disseminated intravascular coagulation
C Non-Hodgkin’s lymphoma
C Polycythemia vera
Immunological
D Allergic reactions
D Chronic fatigue syndrome
C Rheumatoid arthritis
C Sjogren’s syndrome
C Systemic lupus erythematosus
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
Diseases, Disorders and Conditions Commonly Diagnosed and Managed by an
Entry-Level Pediatric Nurse Practitioner
Code:
D The nurse practitioner diagnoses and manages independently or refers as appropriate. Will refer to physician at any
point as deemed necessary or at some stage as per accepted guidelines. Referrals are in accordance with CRNBC’s
standards for nurse practitioner- physician consultation.
C
The nurse practitioner establishes or strongly suspects the diagnosis and consults with a physician for the
management plan or consults with a physician to confirm the diagnosis, and as a result of the consultation:
i)
the nurse practitioner receives an opinion and recommendation, and assumes ongoing primary responsibility
and authority for the plan of care;
ii)
the physician assumes concurrent responsibility for some aspects of the plan of care; or
iii)
the care is transferred to the physician or emergency medicine as appropriate.
1. Infectious and Parasitic Diseases in Children
D Chickenpox
D Coxsackie viral infection
D German measles (Rubella)
D Measles (Rubeola)
D Infectious mononucleosis
D Mumps
D Pertussis
D Strep throat
D Fifth disease
D Roseola
2. Endocrine, Nutritional and Metabolic Diseases
C Diabetes type I
C Diabetes type II
C Juvenile hypothyroidism
D Obesity
C Phenylketonuria
3. Mental and Behavioural Disorders
D Anxiety Disorders-separation, generalized, panic disorders and school phobias
D Dysthymia
C Depression
C Attention deficit hyperactivity disorder
C Anorexia/bulimia
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
C Autistic spectrum disorders
C Fetal alcohol spectrum disorders
4. Diseases of the Nervous System
D Headaches-primary headaches without structural or systemic pathology
D Bell’s Palsy-with any eye symptoms refer immediately to ophthalmologist
D Simple febrile seizures
C Seizure disorder
C Meningitis
5. Diseases of the Eyes, Ears, Nose and Throat
Eyes
D Blepharitis
D Chalazion
D Conjunctivitis
C Simple corneal abrasion
D Nasolacrimal duct obstruction
D Simple foreign body
D Hordeolum
C Periorbital cellulitus
C Strabismus
Ears
D Otitis media
D Otitis externa
D Cerumen impaction
D Foreign body
D Perforated tympanic membrane
Nose/Throat
D Rhinitis
C Cervical adenitis
D Anterior epistaxis
D Gingivitis
D Sinusitis
D Tonsillitis
D Pharyngitis
D Stomatitis
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
D Nasal foreign body
C Peritonsillar abscess
6. Diseases of the Circulatory System
C Hypertension
D Innocent heart murmur
D Presyncope/syncope
C Rheumatic fever
C Congenital heart disease
C Dyslipidemia
7. Diseases of the Respiratory System
D Asthma
D Bronchitis
D Bronchiolitis
D Influenza
D Nicotine dependence
C Tuberculosis
C Epiglottis
D Croup
D Upper respiratory infection
D Pneumonia
8. Diseases of the Digestive System
D Anal fissures
D Constipation
D Gastroesophageal reflux disease
D Hepatitis A viral
D Irritable bowel syndrome
D Parasitic infections-roundworm, pinworm
D Peptic ulcer disease
C Dysphagia
D Hernia-inguinal, hiatal, umbilical
D Gastroenteritis
D Encoporesis
D Hyperbilirubinemia
D Colic
C Celiac disease
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
D Failure to thrive (inorganic)
D Feeding disorders
D Lactose intolerance
D Malabsorption syndrome
D Obesity
9. Diseases of the Skin and Subcutaneous Tissue
D Parasitic-scabies and pediculosis
D Fungal-candidiasis; dermatophytosese tinea, onychomycosis
D Bacterial-impetigo, follculitis, furuncles, carbuncles, paronychia, cellulitis
D Viral-warts, molluscum contagiosum, herpes simplex and herpes zoster
D Psoriasis
D Pityriasis rosea
D Non-malignant skin lesions
C Malignant skin lesion
D Acne vulgaris
D Dermatitis-atopic (eczema), contact, seborrheic and diaper
D Sunburn
D Drug eruptions, urticaria and erythema multiforme (minor)
10. Diseases of the Musculoskeletal System and Connective Tissue
D Bursitis
D Cervicalgia
D Costochondritis
D Plantar fasciitis
D Tendonitis/tendosynovitis
C Meniscus and ligament tears
D Subluxation of the radial head
D Lumbar lordosis
D Osgood-Schlatter disease
D Scoliosis
C Brachial plexus injury
C Clavicle fracture
C Septic arthritis
C Osteomyelitis
C Transient synovitis
11. Diseases of the Genitourinary System
D Lower urinary tract infection (female)
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
C Lower urinary tract infection (male)
D Pyelonephritis
D Primary nocturnal enuresis
C Vesicoureteral reflux
12. Pregnancy – not in scope of practice for NP (Pediatric)
13. Injury, Poisoning and other Consequences of External Causes
D Wounds and lacerations
D Burns
D Animal and human bites
D Arthropod bites and stings
D Poisoning
D Mild traumatic brain injury/concussion
D Foreign bodies
D Contusions and hematomas
14. Diseases of the Reproductive System
Male
D Balanitis
D Epididymitis in children after puberty
D Sexually transmitted infections
D Phimosis and Paraphimosis
D Gynecomastia
D Undescended testes
C Hypospadias
Female
C Primary amenorrhea
D Dysmennorrhea
D Pelvic inflammatory disease
D Vulvovaginal infections
D Contraception
D Premenstrual syndrome
D Simple ovarian cyst
C Dysfunction uterine bleeding
D Precocious puberty
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
15. Hematological and Immune Diseases
Hematologic
D Anemia
C Sickle cell anemia
C Thalassemia minor (trait)
C Idiopathic thrombocytopenia purpura
C Hemophilia
C G6PD deficiency
Immune
D Allergic reactions
C Chronic fatigue syndrome
C Juvenile rheumatoid arthritis
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
Resources
CRNBC Resources
Practice Support: General Enquiries: [email protected] 604.736.7331 ext. 332 or toll-free
1.800.565.6505, ext. 332 (see CRNBC website for more information www.crnbc.ca)
Quality Assurance and Continuing Competence for Nurse Practitioners (available in the Registration
& Renewal section of the CRNBC website: www.crnbc.ca)
Competencies Required for Nurse Practitioners in British Columbia (available in the Registration &
Renewal/Nurse Practitioner 'How to Register' section of the CRNBC website: www.crnbc.ca)
Regulatory Framework for Nurse Practitioners in British Columbia (available in the Registration &
Renewal/Nurse Practitioner 'How to Register' section of the CRNBC website: www.crnbc.ca)
Glossary (search "glossary" on the Home page of the CRNBC website: www.crnbc.ca)
Legislation Relevant to Nurse Practitioner Practice and Legislation Relevant to Nurses Practice (available
in the Standards Section of the CRNBC website: www.crnbc.ca)
Overview of: Health Professions Act; Nurses (Registered) and Nurse Practitioners Regulation; and CRNBC
Bylaws (search title on the Home page of the CRNBC website: www.crnbc.ca)
CRNBC Standards of Practice
See the complete list on the CRNBC website: www.crnbc.ca. Nurse practitioners are expected to
review all CRNBC Practice Standards to determine relevance to their practice. Standards referenced in
this publication are:
Scope of Practice for Nurse Practitioners: Standards, Limits and Conditions
Professional Standards for Registered Nurses and Nurse Practitioners
Conflict of Interest Practice Standard (includes information related to communicating with
pharmaceutical companies)
Consent Practice Standard
Dispensing Medications Practice Standard
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APPLYING THE COMPETENCIES REQUIRED FOR NURSE PRACTITIONERS IN BRITISH COLUMBIA
Documentation Practice Standard
Communicable Diseases: Preventing Nurse-to-Client Transmission (includes information related to
treating members of a nurse practitioner’s family or friends)
Other Resources
Canadian Patient Safety Institute (www.patientsafetyinstitute.ca)
Canadian Adverse Drug Reporting Program (available on the Health Canada web site, see Drugs and
Health Products "medeffect adverse reporting" www.hc-sc.gc.ca)
Public Health Agency of Canada (available on web site: www.publichealth.gc.ca)
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