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Nurse practitioner standards for practice
Orientating statements
Nurse practitioners have the capability to provide high levels
of clinically focused nursing care in a variety of contexts
in Australia. Nurse practitioners care for people and
communities with problems of varying complexity.
The nurse practitioner (NP) scope of practice is built on the
platform of the registered nurse (RN) scope of practice, and
must meet the regulatory and professional requirements
for Australia including the National competency standards for
the registered nurse, Code of ethics and Code of professional
conduct.
The nurse practitioner standards (Standards) build on,
and expand upon, those required of a registered nurse.
When assuming the title and scope of practice of a nurse
practitioner, the NP understands the changes in the scope
of practice from that of a registered nurse, and the ways that
these changes affect responsibilities and accountabilities.
Fundamentally, a nurse practitioner provides nursing care
within their regulated scope.
The core Standards in this document are the minimum
Standards that are applicable across diverse practice
settings and patient/client populations for both beginning
and experienced NPs.
Nurse practitioner attributes are consciously cultivated
through formal learning that includes a work based
component. The educational requirement for endorsement
of NPs in Australia is a Masters degree. This formal learning
builds on demonstrable advanced practice within the RN
scope.
The nurse practitioner has a high degree of systems literacy
and can manage care across a variety of health systems to
maximize outcomes; NPs engage in complex and critical
thinking; integrate information and/or evidence; judiciously
use clinical investigations; and skilfully and empathetically
communicate with all involved in the care episode, including
the person receiving care and their family and community,
and health professional colleagues.
NP attributes are clinically focused, and NPs are capable
in research, education and leadership as applied to clinical
care (Refer Figure 1). Research includes processes to
support reflective practice, evidence-based care and quality
management. The NP has the capability to educate others
related to the focus of, and available options, of care. Nurse
practitioners are leaders and have an ability to lead care
and care teams. Nurse practitioners engage in reflective
practice and support others in this process through clinical
supervision or mentoring.
Nurse practitioners are capable of managing episodes of
care, including wellness focused care. Nurse practitioners
may be the primary provider of care or part of a care team.
They collaborate and consult with health consumers, their
families and community, other professionals, including
health personnel, to plan, implement and evaluate integrated
care that optimises outcomes for recipients and the systems
of care.
As part of providing care, NPs can order and interpret
investigations to facilitate diagnosis and care planning. Care
may include nursing interventions that involve initiation,
titration or cessation of medications. Nurse practitioners
take responsibility for following-up on any components of
care initiated. They are accountable for care provided and
self-monitor their work.
How to use these Standards
The Standards have been written so as to be easily accessible
to a variety of groups, including nurse practitioners,
governments, regulatory agencies, health care professionals
and the community. It should be noted that the Cues (refer
to Glossary) written below the Statements are indicative of
nurse practitioner behaviours, they are not intended to be
exhaustive. Rather, the cues are examples of activities that
demonstrate the Statement for that standard.
Read the Standards in conjunction with other relevant
documentation, including: the National competency standards
for the registered nurse, the Code of professional conduct for
nurses in Australia, the Code of ethics for nurses in Australia,
and a companion document, A nurse’s guide to professional
boundaries. They should also be read in conjunction with the
attached Glossary, which clearly stipulates the way in which
key terms are used in the Standards.
In Figure 1, the Nurse practitioners standards framework is
illustrated. There are four domains, namely:
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Nurse practitioner standards for practice
• clinical
• education
• research, and
• leadership.
The education, research and leadership domains are couched
within the clinically focused standards. The knowledge and
skills contained within the three domains of education,
research and leadership, are integrated in their expression in
the clinical role or work.
Collectively, these attributes expressed in nurse practitioners’
knowledge, skills and affect, are applied in the education
domain through educating those receiving care, peers and
colleagues. The use of knowledge in the research domain
is evidenced through the judicious application of research
evidence in formulating practice decisions, self- regulation
and the development of new systems of care. The domain
of leadership, initially evident in clinical work, increases in
capacity to include community and political engagement.
Figure 1: Representation of how the education,
research and leadership domains are couched
within the clinically focused standards
Nurse Practitioner Standards Framework
Standard 1
Standard 2
Standard 3
Standard 4
Assesses using diagnostic capability
Education
Domain
Clinical Domain
Research
Domain
Leadership
Domain
Plans care and engages others
Prescribes and implements therapeutic
interventions
Monitors outcomes to evaluate and
improve practice
Nurse practitioner standards
Standard 1: Assesses using diagnostic capability
Statement 1.1: Conducts comprehensive, relevant and holistic
health assessment
Cues:
• Demonstrates extensive knowledge of human sciences
and health assessment
• Demonstrates comprehensive and systematic skill in
obtaining relevant, appropriate and accurate data that
inform differential diagnoses
• Assesses the complex and/or unstable health care needs
of the person receiving care through synthesis and
prioritisation of historical and available data
• Assesses the impact of comorbidities, including the effects
of co-existing, multiple pathologies and prior treatments in
the assessment of the person receiving care
• Demonstrates comprehensive skill in clinical examination
including physical, mental health, social, ethnic and
cultural dimensions
• Consistently and accurately synthesises and interprets
assessment information specifically history, including prior
treatment outcomes, physical findings and diagnostic data
to identify normal, at risk and abnormal states of health
• Critically evaluates the impact of social determinants on
the person and population.
Statement 1.2: Demonstrates timely and considered use of
diagnostic investigations to inform clinical decision making
Cues:
• Makes decisions about the use of person-focused
diagnostic investigations that are informed by clinical
findings and research evidence
• Demonstrates accountability in considering access, cost,
clinical efficacy and the informed decision of the person
receiving care when ordering diagnostic investigations
• Orders and/or performs selected screening and diagnostic
investigations
• Is responsible and accountable for the interpretation of
results and for following-up the appropriate course of
action
• Uses effective communication strategies to inform the
person receiving care and relevant health professionals of
the health assessment findings and diagnoses.
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Nurse practitioner standards for practice
Statement 1.3: Applies diagnostic reasoning to formulate
diagnoses
Cues:
• Synthesises knowledge of developmental and life stages,
epidemiology, pathophysiology, behavioural sciences,
psychopathology, environmental risks, demographics and
societal processes when making a diagnosis
• Considers the person’s expectations of assessment,
diagnosis and cost of health care
• Acts to prevent and/or diagnose urgent and emergent and
life threatening situations
• Determines clinical significance in the formulation of an
accurate diagnosis from an informed set of differential
diagnoses through the integration of the person’s history
and best available evidence.
Standard 2: Plans care and engages others
Statement 2.1: Translates and integrates evidence into
planning care
Cues:
• Takes personal responsibility to critically evaluate and
integrate relevant research findings into decision making
about health care management and interventions
• Ethically explores therapeutic options considering
implications for care through the integration of
assessment information, the person’s informed decision
and best available evidence
• Is proactive and analytical in acquiring new knowledge
related to nurse practitioner practice.
Statement 2.2: Educates and supports others to enable their
active participation in care
Cues:
• Respects the rights of the person to make informed
decisions throughout their health/illness experience
or episode, whilst ensuring access to accurate and
appropriately interpreted information
• Uses appropriate teaching/learning strategies to provide
diagnostic information that is relevant, theory-based and
evidence-informed
• Communicates about health assessment findings and/or
diagnoses, including outcomes and prognosis
• Works to meet identified needs for educating others
regarding clinical and ongoing care.
Statement 2.3: Considers quality use of medicines and
therapeutic interventions in planning care
Cues:
• Develops an individual plan of care and communicates
this to appropriate members of the healthcare team and
relevant agencies
• Exhibits a comprehensive knowledge of pharmacology and
pharmacokinetics related to nurse practitioner scope of
practice
• Works in partnership with the person receiving care to
determine therapeutic goals and options
• Verifies the suitability of evidence-based treatment
options including medicines, in regard to commencing,
maintaining/titrating or ceasing interventions
• Demonstrates accountability in considering access, cost
and clinical efficacy when planning treatment.
Statement 2.4: Refers and consults for care decisions to obtain
optimal outcomes for the person receiving care
Cues:
• Collaborates with other health professionals to make and
accept referrals as appropriate
• Consults with and/or refers to other health services,
disability services, aged-care providers and community
agencies at any point in the care continuum.
Standard 3: Prescribes and implements
therapeutic interventions
Statement 3.1: Prescribes indicated non-pharmacological and
pharmacological interventions
Cues:
• Contributes to health literacy by sharing knowledge with
the person receiving care to achieve evidence-informed
management plan
• Safely prescribes therapeutic interventions based on
accurate knowledge of the characteristics and concurrent
therapies of the person receiving care
• Demonstrates professional integrity and ethical conduct
in relation to therapeutic product manufacturers and
pharmaceutical organisations
• Safely and effectively performs evidence-informed
invasive/non-invasive interventions for the clinical
management and/or prevention of illness, disease,
injuries, disorders or conditions
• Interprets and follows-up the findings of screening and
diagnostic investigations in an appropriate time frame
during the implementation of care.
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Nurse practitioner standards for practice
Statement 3.2: Maintains relationships with people at the
centre of care
Cues:
• Supports, educates, coaches and counsels the person
receiving care regarding diagnoses, prognoses and
self-management, including their personal responses to
illness, injuries, risk factors and therapeutic interventions
• Advises the person receiving care on therapeutic
interventions including benefits, potential side effects,
unexpected effects, interactions, importance of compliance
and recommended follow-up
• Shares information with others in consultation with the
person receiving care
• Coordinates care with other health, disability and aged-
care providers, agencies and community resources
• Discloses the facts of adverse events to the person
receiving care and other health professionals; mitigates
harm, and reports adverse events to appropriate
authorities in keeping with relevant legislation and
organisational policy
• Advocates for improved access to health care, the health
care system and policy decisions that affect health and
quality of life.
Statement 3.3: Practises in accordance with federal, state and
territorial legislation and professional regulation governing
nurse practitioner practice
Cues:
• Defines duty of care in accordance with relevant legislation
and regulation
• Remains informed of changes to legislation and
professional regulations, and implements appropriate
alterations to practice in response to such changes
• Contributes to the development of policy and procedures
appropriate to context and specialty.
Standard 4: Evaluates outcomes and improves
practice
Statement 4.1: Evaluates the outcomes of own practice
Cues:
• Monitors, evaluates and documents treatments/
interventions in accordance with person- determined goals
and health care system outcomes
• Considers a plan for appropriately ceasing and/or
modifying treatment in consultation with the person
receiving care and other members of the health care team
• Applies the best available evidence to identify and select
appropriate outcomes measures of practice
• Uses indicators to monitor and measure the effectiveness
of strategies, services and interventions to promote safe
practice
• Participates in clinical supervision and review
• Implements research-based innovations for improving
care
• Contributes to research that addresses identified gaps in
the provision of care and/or services.
Statement 4.2: Advocates for, participates in, or leads systems
that support safe care, partnership and professional growth
Cues:
• Advocates and provides evidence for expansion to nurse
practitioner service where it is believed that such an
expansion will improve access to quality and cost-effective
health care for specific populations
• Demonstrates clinical leadership in the design and
evaluation of services for health promotion, health
protection or the prevention of injury and/or illness
• Articulates and promotes the nurse practitioner role in
clinical, political and professional contexts
• Acts as an educator and/or mentor to nursing colleagues
and others in the healthcare team
• Critiques health care policies for their implications on the
nurse practitioner role and the populations for whom they
care
• Influences health, disability and aged-care policy and
practice through leadership and active participation in
workplace and professional organisations.
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Nurse practitioner standards for practice
Glossary
Advanced nursing practice (ANP): ANP is a continuum along
which nurses develop their professional knowledge, clinical
reasoning and judgement, skills and behaviours to higher
levels of capability (that is recognisable). Nurses practising
at an advanced level incorporate professional leadership,
education and research into their clinically based practice.
Their practice is effective and safe. They work within a
generalist or specialist context and they are responsible and
accountable in managing people who have complex health care
requirements.
Advanced nursing practice is a level of practice and not a
role. It is acknowledged that advanced nursing practice
is individually attributed within a regulated nursing scope
(enrolled nurse, registered nurse or nurse practitioner).
Advanced practice nursing (APN): APN in the Australian
nursing context identifies the additional legislative functions
of an endorsed nurse practitioner that are outside the
contemporary registered nurse scope of practice.
Advanced practice nursing as a nurse practitioner is a
qualitatively different level of advanced nursing practice to
that of the registered nurse due to the additional legislative
functions and the regulatory requirements. The requirements
include a prescribed educational level, a specified advanced
nursing practice experience; and continuing professional
development.
Advanced practice nursing should not be confused with the
term ‘practice nurse’ that is used colloquially to describe
nurses working in the general practice setting.
Attributes: Are characteristics that underpin competent
performance. Refer to National competency standards for the
registered nurse under Codes and guidelines on the Nursing and
Midwifery Board of Australia website.
Competence: The combination of skills, knowledge, attitudes,
values and abilities that underpin effective and/or superior
performance in a profession/occupational area. Refer to
National competency standards for the registered nurse under
Codes and guidelines on the Nursing and Midwifery Board of
Australia website.
Cues: Key generic examples of competent performance. They
are neither comprehensive nor exhaustive. They assist the
assessor when using their professional judgement in assessing
nursing practice. They further assist curriculum development.
Refer to National competency standards for the registered nurse
under Codes and guidelines on the Nursing and Midwifery Board
of Australia website.
Nurse Practitioner: A nurse practitioner is an advanced
practice nurse endorsed by the Nursing and Midwifery Board of
Australia to practise within their scope under the legislatively
protected title ‘nurse practitioner’.
Person/ people: In these Standards, person/ people is used to
refer to those individuals who have entered into a relationship
with a nurse practitioner. Person/ people encompass patients,
clients, consumers and families that fall within the NP scope
and context of practice.
Prescribing: is defined as the steps of information gathering,
clinical decision making, communication and evaluation which
results in the initiation, continuation or cessation of a medicine.
Scope of practice: The scope of nursing practice is that
in which nurses are educated, competent to perform and
permitted by law. The actual scope of practice of individual
practitioners is influenced by the settings in which they
practise, the health needs of people, the level of competence
and confidence of the nurse and the policy requirements of the
service provider.
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