2015 Nurse Practitioners Preceptor’s Guide

The University of New Brunswick

Faculty of Nursing

Master of Nursing Program P.O Box 4400

Fredericton NB E3B 5A3 (506) 451-6844 fperry@unb.ca

Table of Contents

I: Introduction ......................................................................................................... 3 Overview of Masters of Nursing at the University of New Brunswick .................................. 3 Underlying Assumptions of MN Education....................................................................... 3 General Information about the NP program .................................................................... 4 Objective and Composition of the Nurse Practitioner Stream ............................................ 4 Program Abilities and Outcomes ................................................................................... 4 Nurse Practitioner Competencies & Standards of Practice ................................................. 5 Roles and Responsibilities of the Faculty of Nursing, Preceptors, and Students .................. 6

Responsibilities of the Faculty of Nursing (FON) ............................................... 6 Responsibility of the Preceptor ......................................................................... 6 Responsibilities of the Student ......................................................................... 7

MN NP Calendar Course Descriptions ............................................................................. 8 II: Assessment of Student Learning ........................................................................ 9 III. Liabilities .......................................................................................................... 9IV. NB Government Payment for NP Clinical Supervision ....................................... 10

Appendix A ............................................................................................................ 11

Appendix B ............................................................................................................ 12 Typical Full-time Program of a NP Student ................................................................... 12

Appendix C ............................................................................................................ 13 UNB MN Program: Abilities and Program Outcomes ....................................................... 13

Clinical Practice Log ............. ................................................................................. 15

Appendix D ........................................................................................................... 16

Clinical Experiences For Primary Health Care Nurse Practitioner Students ......................... 16 Appendix E ............................................................................................................. 24

Primary Health Care Nurse Practitioner Preceptor Clinical Performance Evaluation ............. 24Appendix F ............................................................................................................ 31 NB Gov’t Form Payment for NP Clinical Supervision ..................................................... 31 Appendix G ............................................................................................................ 32 Guidelines for logging clinical practice hours .................................................................. 32

UNIVERSITY of PO BOX 4400 TEL 506 453-4642

NEW BRUNSWICK FREDERICTON, NB FAX 506 453-4519

FACULTY OF NURSING CANADA E3B 5A3 www.unb.ca

Dear Preceptor:

Welcome to the Nurse Practitioner (NP) Program at the University of New Brunswick (UNB). We are

pleased that you have agreed to participate in the education of a primary health care provider, and we

appreciate your contribution to our program.

The purpose of this Guide is to familiarize you with program at UNB. It sets out the responsibilities of the

NP Student, the Preceptor, and the Faculty of Nursing.

The program has been in existence since 1998, as part of the Masters of Nursing (MN) program within

the Faculty of Nursing. Graduates of the program receive a Master of Nursing degree and are eligible to

become registered as a Primary Health Care Nurse Practitioner by the Nurses Association of New

Brunswick, after successfully completing the Canadian Nurse Practitioner Exam: Family/All Ages (CNPE:

F/AA).

As a Preceptor the University requires you to have a legal affiliation agreement in place before our

student(s) begin their preceptorship with you. If you or your office fall under one of our Health

Networks (Horizon or Vitalité) an affiliation agreement which covers our students is already in place.

Note: along with our Health Networks, we also have agreements in place with many clinics and fee for

service physicians who have had students in the past. For more information please see our website

http://www.unb.ca/fredericton/nursing/_resources/pdf/graduate/contractinfo2015.pdf.

All students who are seeking a preceptor will be informed when they have been approved to begin

practicing in the selected site. If you are a fee for service physician who has never precepted for UNB, or

have cancelled your previous agreement, then a new one will need to be completed. Donna Gallant, the

Clinical Placement Coordinator in the Faculty of Nursing, will contact you about this well in advance of

the student starting, since the process could take several weeks.

Questions about working with students and the role of the preceptor often arise at unexpected times

during the experience. Please contact the faculty liaison at any time for clarification, direction or

suggestions about how to support students’ learning. It is always best to address concerns as they arise,

rather than to wait to be contacted later in the rotation.

Since this guide is always a work in progress, we would appreciate your suggestions for improving this

document and your orientation to becoming a preceptor. If something is not clear or you would like

further information, please feel free to contact the Graduate office by email at fperry@unb.ca or 506

451-6844. You will also find a copy of this guide on our website at

http://www.unb.ca/fredericton/nursing/graduate/forms.html.

Thank you for agreeing to serve as a Preceptor for a Nurse Practitioner (NP) student from UNB. The

success of our program is dependent on the support and mentoring provided by preceptors, such as

yourself, who are willing to invest the time and effort required to facilitate students’ learning.

Sincerely,

Kathy Wilson PhD, RN

Director of Graduate Studies

UNB Faculty of Nursing

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The purpose of this Preceptor Guide is to provide detailed information for preceptors concerning the nurse practitioner program.

I: Introduction Overview of Masters of Nursing at the University of New Brunswick

The Master's of Nursing (MN) Program in the Faculty of Nursing promotes leadership, innovation, and excellence in nursing through teaching, research, community service, and advanced nursing practice locally, nationally, and internationally. The goal of the MN program is to prepare nurses for advanced practice in clinical, educational, administrative, and research roles. Graduates of the MN program have advanced preparation focusing in selected areas of practice interest and expertise. The MN program is designed to ensure that students acquire a thorough, integrated knowledge of nursing research, theory, and practice.

Underlying Assumptions of MN Education

• is grounded in nursing practice, theory and research, and builds upon the learners’previous nursing education, knowledge, skills, and judgment,

• contributes to the learners’ lifelong learning process,

• fosters opportunities for learners to advance their knowledge, skills and judgmentwithin environments conducive to learning,

• provides opportunities to develop culturally competent practice,

• strengthens collaborative and leadership capacities to work effectively withininterdisciplinary, intersectoral environments,

• develops the capacity to anticipate, influence, and respond to emerging societaltrends and changing health patterns that have an impact on the determinants ofhealth, and

• enhances the capacity to create therapeutic partnerships that maximize clients’meaningful involvement.

The goal of the Master of Nursing (MN) program is to prepare nurses for advanced practice in clinical, educational, administrative, and research roles. Graduates of the MN program have advanced preparation focusing in a selected area of practice interest and expertise. There are three Advanced Practice MN programs; Nurse Practitioner (NP), Thesis/Report and Nurse Educator.

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General Information about the NP program

Currently, the NP program admits students every other year, mostly through distance education on a full-time basis. Students complete the clinical components of the program in areas where practicing NPs and members of the medical profession are available to be preceptors.

Applicants to the NP program must meet the general eligibility requirements set out by UNB’s School of Graduate Studies and the Faculty of Nursing. Nurse Practitioner students hold a BN or BScN, have a minimum of 2 years of nursing practice, and are registered as nurses in the province of New Brunswick.

Objective and Composition of the Nurse Practitioner Stream

The objective of the UNB NP Program is to prepare Advanced Practice Nurses who will function as Nurse Practitioners in caring for people across the life span according to principles of Primary Health Care.

The NP program is designed to build on students’ current nursing knowledge, skills, abilities, and judgments. The program offers 57 credit hours of theory and 700 hours of clinical practice. All NP students take 17 required courses that include 5 core courses (those that are generic to the MN program), 7 NP specific courses, and 5 NP practicum courses (4 of which have 100 clinical hours each), followed by a 300 hour Final Clinical Practicum. To complete the program each student must also submit a synthesis paper that addresses one aspect of NP practice. To see a typical full-time program, please see Appendix A.

Program Abilities and Outcomes

The MN program at UNB is designed around six core abilities which are complex combinations of knowledge, skills and attitudes required for advanced nursing practice. Abilities, because of their complexity, cannot be directly observed; thus program and course outcomes which are practice oriented statements are used to provide tangible goals for desired learning. Program and course outcomes provide structure for assessment of student learning. The six abilities and 29 related program outcomes for the MN program at UNB can be found in Appendix B. For practice courses in the NP program, the course outcomes have been intentionally aligned with the Nurses Association of New Brunswick (NANB) Competencies and Standards for Practice for Nurse Practitioners in Primary Health Care. On the course evaluation tool, each program outcome number is located in brackets after the relevant NANB competency.

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Nurse Practitioner Competencies & Standards of Practice

The Nurses Act was amended in July 2002 to enable the practice of nurse practitioners in New Brunswick. The nurse practitioner role is regulated in addition to that of a registered nurse because the nurse practitioner performs activities that are not considered part of the scope of practice of registered nurses. This role is a nursing role, and nurse practitioners must practice in accordance with all standards relevant to the nursing profession including the NANB Standards for Nursing Practice and the CNA Code of Ethics for Registered Nurses.

Nurse practitioners have the potential to make a significant contribution to new models of health care delivery based on primary health care principles. The Nurses Association of New Brunswick (NANB) has promoted the utilization of nurse practitioners in emergency rooms, community health centres, family practice, and nursing homes.

The document Competencies and Standards of Practice for Nurse Practitioner in Primary Health Care focuses on the responsibilities in nurse practitioner practice which require additional regulation by NANB.

For more detailed information on the NP Competencies & Standards of Practice and Schedules for Ordering, please see the following websites.

For more information on Nurse Practitioners in New Brunswick http://www.nanb.nb.ca/index.php/practice/np

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Roles and Responsibilities of the Faculty of Nursing, Preceptors, and Students

Responsibilities of the Faculty of Nursing (FON)

The Faculty of Nursing will:

1. Initiate a contract for the student’s clinical placement to be signed by the Preceptor,and a representative of UNB.

2. Provide the course work and laboratory experiences which are the foundation ofclinical practice.

3. Support the development of the student’s clinical skills and diagnostic reasoning.

4. Provide a UNB Faculty Member who is a licensed NP who will contact the preceptor byphone or visit in the office to discuss the student’s progress, if needed. The facultymember is available to provide support and consultation to the student and preceptoras necessary.

5. Provide materials to the student and preceptor for meeting course requirements.

6. Provide liability coverage for the student while working with the preceptor.

7. Support the student and the preceptor as necessary.

Responsibility of the Preceptor

The Preceptor will:

1. Provide a setting in which the student may see patients and gain experience inclinical practice.

2. Serve as a role model to students and provide opportunities for them to apply newskills and knowledge that have been learned in the classroom.

3. Support, share various tools and references, provide direction, encouragement, andprofessional feedback to students as they deal with difficult and complex patientsituations.

4. Assess the student’s clinical skills and critical reasoning, and assist the student toincrease skills, competence and expertise.

5. Provide ongoing feedback to the student and to the faculty.

6. Assist the Faculty member in grading the student by completing a clinical evaluationof the student. See sample in Appendix E.

7. Monitor and sign the student’s activity log. See sample in Appendix C.

8. Understand what is considered "clinical practice hours" See Appendix G

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Responsibilities of the Student

The Student will:

1. Perform assigned learning activities in the process of providing care to patients in thepreceptorship site.

2. Follow policies and procedures established in the preceptorship site, and will keep thepreceptor informed of cases and learning activities.

3. Provide the preceptor the learning outcomes for the clinical practicum, a copy of thecourse outcomes, an evaluation form and a copy of the form the student will use tolog the weekly clinical activities. Please see Appendices C and E.

4. Identify areas of concentration to augment knowledge, skills and judgment developedduring prior clinical experiences, using Appendix D as a guide.

5. Communicate openly with preceptor concerning clinical strengths and weaknesses.

6. Seek opportunities to expand clinical knowledge base.

7. Develop ability to function in the advanced nursing role of a nurse practitioner.

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MN NP Calendar Course Descriptions

The NP program consists of 17 courses of which 5 are core courses common to all streams. Please see our website at http://www.unb.ca/fredericton/nursing/graduate/npcourses.html for information on these courses. The following course descriptions are for the clinical courses.

Nurs 6202 Advanced Pharmacotherapeutics

This course's theoretical content focuses on the knowledge, judgement, skills and abilities necessary to apply the core nurse practitioner (NP) competency of management of the treatment of clients' health conditions by utilizing advanced pharmocotherapeutic methods.

Nurs 6212 Health Assessment Practicum

In this course students begin to apply their knowledge of the theoretical content required to provide primary health care (PHC) to individuals, families and communities across the lifespan. The focus is on the development of students' knowledge, judgement and skills related to the application of core nurse practitioner (NP) competencies of health assessment, health promotion and disease prevention and professional roles and responsibilities. This practicum includes 100 hours of supervised clinical practice.

Nurs 6214 Adult I Clinical Practicum

This clinical practicum accompanies the theory course NURS 6213: Primary Health Care Management: Adult I. This clinical practicum course provides the student with the opportunity to apply the knowledge, skill, and judgement from the theory course, managing care for young to middle aged adult clients. This practicum includes 100 hours of supervised clinical practice in the role of the Nurse Practitioner.

Nurs 6216 Pediatric Clinical Practicum

This clinical practicum accompanies the theory course NURS 6215: Primary Health Care Management: Pediatrics. This clinical practicum course provides the student with the opportunity to apply the knowledge, skill, and judgement from the theory course, managing care for pediatric clients. This practicum includes 100 hours of supervised clinical practice in the role of the Nurse Practitioner.

Nurs 6218 Adult II Clinical Practicum

This clinical practicum accompanies the theory course NURS 6217: Primary Health Care Management: Adult II. This clinical practicum course provides the student with the opportunity to apply the knowledge, skill, and judgement from the theory course, managing care for older adult clients. This practicum includes 100 hours of supervised clinical practice in the role of the Nurse Practitioner.

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Nurs 6219 Final Clinical Practicum

This concentrated practicum course provides an opportunity for synthesis of the specialized knowledge, skill, and judgement inherent in the role of the Nurse Practitioner within a collaborative, interdisciplinary team setting. Facilitated by a faculty advisor and clinical preceptor the student assumes responsibility for providing primary care to culturally diverse clients across the life span. In addition to the clinical hours of the practicum the course includes a seminar component that addresses professional, philosophical and ethical issues related to the role of the Nurse Practitioner. This practicum includes 300 hours of supervised clinical practice in the role of the Nurse Practitioner. Prerequisites: All required NP courses.

II: Assessment of Student Learning

The NP program uses a number of methods to assess student progress. Each course has assessment methods built in, with theory courses using a letter grade format, and clinical courses graded on a credit/non-credit basis. Preceptors for clinical courses are provided with an evaluation tool by the faculty to be used to assess the student’s performance during each clinical practicum. See Appendix E for an example of the preceptor’s evaluation form. In addition to the preceptor completing an assessment of the student’s performance, a faculty member will communicate by phone and will ONLY visit the clinical site if the preceptor feels it is required to assess the student’s progress. Determination of the final grade in the course is shared between the preceptor and the faculty member.

In addition to formal written evaluation, ongoing feedback about progress is critical to student success. We ask that preceptors make time at the end of each day to discuss strengths as well as areas requiring improvement with the student. This will provide the student with direction for developing his/her practice.

If at any time you have concerns about a student’s performance, please call the faculty member as soon as the problem is discovered. Early identification creates opportunities to develop strategies that support student’s learning and ability to meet course outcomes. When concerns are identified late in the clinical rotation, opportunities to develop NP practice are limited.

III. Liabilities

Because NP students must be registered in the province as nurses prior to coming into the NP program, they have the same protection as all other registered nurses in the province through the Canadian Nurses Protective Society (CNPS). In addition to this liability insurance, the University of New Brunswick covers all of its students with liability insurance to the total of $5,000,000.00. A copy of the Insurance Certificate can be found at http://www.unb.ca/fredericton/nursing/graduate/forms.html

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IV. NB Government Payment for NP ClinicalSupervision

Department of Health reimburses fee for service physicians $13 per hour to a maximum of 700 hours for clinical supervision of nurse practitioner students. Requests must be submitted by March 31 of the year in which clinical supervision occurred. Please contact the Chief Nursing Officer at the address below if you have any questions. The form can be found at the back as Appendix F

Francine Bordage Chief Nursing Officer/Nursing Resources Advisor Department of Health, PO Box 5100, Fredericton NB E3B 5G8

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Appendix A

Typical Full-time Program of a NP Student Year Fall Term (Sept.-Dec.) Winter Term (Jan.-April) Summer Term(May-July)

Course # Course Name Course # Course Name Course # Course Name 1 Nurs6011

Nurs6203 Nurs6211

Nurs6212

Foundations of Graduate Study

Advanced Pathophysiology Adv. Health Assessment, Health Promotion & Diagnostic Reasoning

Adv. Health Assessment Practicum (100 hrs)

Nurs6012

Nurs6202

Health Research Statistics

Adv. Pharmacotherapeutics

Nurs6016

Nurs6213

Nurs6214

Evidence Informed Nursing

Primary Health Care Management Adult I

Adult I Practicum (100 hrs)

Nurs6204 Roles and Issues is taught over the two terms

Nurs6204 Roles and Issues is taught over the two terms

2 Nurs6014

Nurs6215

Nurs6216

Programming in Health Care

Primary Health Care Management Pediatrics

Pediatrics Practicum (100 hrs)

Nurs6013

Nurs6217

Nurs6218

Theoretical Foundations of Nursing Primary Health Care Management Adult II

Adult II Practicum (100 hrs)

Nurs6219

Nurs6995

Final Clinical Practicum(300 hrs)

Synthesis Paper

Appendix B

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Abilities and Program Outcomes

1. Critical Reading and Thinking Critical readers look beyond the facts of a text. They consciously

apply strategies to uncover meaning and assure their understanding of how the text portrays the

subject matter. Critical thinkers are skeptical thinkers who employ conscious strategies for

evaluating information and ideas to guide decisions about what to accept and believe.

1.1. Critically appraises literature by questioning assumptions, considering alternative viewpoints,

determining credibility of the evidence and discerning the relevance to the discipline of

nursing.

1.2 Displays epistemic cognition, the capacity to say not only what one knows but also why one

knows it.

1.3 Constructs arguments that clearly justify one position as superior to other alternatives

2. Communication involves speaking, writing, listening, reading, quantitative literacy (numeracy) and

computer literacy. Graduates will be able to use discipline concepts and frameworks to

communicate purposefully, sensitively, knowledgeably and engagingly using a variety of media as

appropriate for a variety of audiences.

2.1. Demonstrates professional communication skills appropriate to the context

2.2. Composes text to present complex issues and reasoned arguments using concrete, concise and

scholarly language appropriate to the intended audience

2.3. Engages in effective communication in a variety of contexts understanding the boundaries of

social and professional access with clients, colleagues, administrators, stakeholders and people

over whom they have power.

2.4. Uses appropriate information systems and technology to enhance effective communication

2.5. Displays literacy with numbers and the capacity to think in quantitative terms.

3. Professional Sensibility is conduct that demonstrates an advanced level of understanding and

commitment to ethics, diversity, societal responsibility, self-management, knowledge, skill,

awareness and caring.

3.1. Uses a variety of competing forms of “knowledges” to construct a philosophy of nursing that

provides a lens for developing advanced nursing practice

3.2. Discerns moral dilemmas and injustices and uses a range of ethical theories to develop the

skills, commitment and comportment necessary to confront ethical dilemmas in health care.

3.3. Engages in intentional reflection to extend professional identity consistent with the advanced

practice role.

3.4. Recognizes implications of professional power in relationships.

Appendix B

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3.5. Integrates aspects of cultural awareness, cultural safety and cultural sensitivity to develop the

level of cultural competence expected in advanced nursing practice

4. Evidence-Informed Practice is the thoughtful integration of clinical expertise, individual (person or

population) characteristics, situations and preferences with the best available evidence to make

decisions that affect health outcomes. It incorporates critical evaluation of the strength of a wide

spectrum of evidence including, but not limited to, research, clinical guidelines and expert

opinion.

4.1. Differentiates between the ontological, epistemological and methodological assumptions of

different paradigms and their contribution to what is seen to constitute evidence

4.2. Distinguishes the major designs in qualitative and quantitative research methods and appraises

appropriateness of the method of decision making.

4.3. Demonstrates the ability to analyze, assess and weigh the evidence in considering the

credibility of the conceptual basis for decision making in nursing.

4.4. Develops an understanding of how to use a variety of evidence to inform and modify practice

(current research, theoretical knowledge, expert opinion, best practice guidelines and prior

experience).

4.5. Understands that in order to influence the highly political and rapidly changing context of policy

making, practitioners must not only provide credible evidence but also consider the capacity for

change

5. Leadership is a visionary approach demonstrated in an expanded array of settings through

advocacy for quality care, collaboration, articulate communication, mentorship, risk taking, role

modeling.

5.1. Ascertains effective strategies for advocating for change in organizing and delivering health

care based on adoption of evidence-based practices and innovations in care delivery.

5.2. Determines leadership, team building, negotiation, coalition building, and conflict resolution

skills required to develop and extend, disciplinary, interdisciplinary and intersectoral

partnerships.

5.3. Considers how availability and allocation of fiscal, physical and human resources influences

shaping of healthy public policy.

5.4. Mentors through providing expert guidance, role modeling and coaching.

6. Practice Excellence is nursing practice that draws from an expanded range of responses to

individuals, families, communities and populations.

6.1. Integrates an expanded range of theoretical, experiential and research knowledge to

understand the priorities and demands embedded in particular practice situations.

6.2. Develops nuanced awareness of and tolerance for ambiguity and complexity in health care

Appendix B

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6.3. Analyzes current and potential issues within nursing and health care considering contextual

factors that impact clients, nurses and organizations.

6.4. Collaborates, consults and demonstrates leadership to provide expert guidance and/or

coaching of others in navigating the health care system.

6.5. Integrates knowledge, skilled know-how, judgment and ethical comportment in reasoned

decision making.

6.6. Develops the capacity to influence health care institutional context so that good practice is

possible within organizations.

6.7. Uses a variety of resources and data to engage in systematic and ongoing evaluation of self and

others’ practice to ensure relevant and timely modifications.

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Appendix C

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Appendix D

Clinical Experiences For Primary Health Care Nurse Practitioner Students

The following list is not all-inclusive, but provides a compilation of skills as well as common acute and chronic health conditions that primary health care nurse practitioners can expect to assess, diagnose, treat and manage in their practice. Students develop familiarity and competency with these skills in the clinical practice area under the supervision of a preceptor and faculty member. Please review this list with the student that you are preceptoring for the selection of potential clients for which the student can provide care. Student Name_____________________

Management of patient health/illness status

Pediatric Adult Older Adult

I. Health history: able to obtain a complete health history of appropriate and applicable information for the patient/client’s concern including 1. Review of pertinent information from patient record2. Chief complaint and history of present illness (HPI)3. Past medical history4. Family history5. Psychosocial history6. Review of systems7. Able to record completely, accurately, and conciselyII. Physical Examination: Able to performappropriate physical exam related to: 1. Mental status2. Vital signs3. Skin4. HEENT including thyroid5. Respiratory system6. Cardiovascular system including lymphatic system7. Abdomen8. Musculoskeletal system9. Neurological system10. Genito-urinary

11. Breast exam12. Pelvic exam13. Hernia check14. Prostate exam15. Rectal exam

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III. Provide appropriate evaluation, diagnosis,management/referral, follow-up, and documentation of the following health concerns for clients of all ages:

Pediatric Adult Older Adult

A. Skin Problems Common Complaints

Alopecia Pigmentation changes Pruritus Rashes Urticaria Childhood exanthem

Parasitic Infestations Scabies Pediculosis

Fungal Infections Candidiasis Dermatophytoses (Tinea)

Bacterial Infections Cellulitis Impetigo Folliculitis Furuncles & Carbuncles

Viral Infections Herpes Simplex Herpes Zoster Molluscum Contagiosum Warts

Acne Acne vulgaris Acne Rosacea

Dermatitis Atopic Dermatitis Contact Dermatitis Seborrheic Dermatitis

Psoriasis Benign Skin Lesions of Infants and Children

Milia Mongolian Spots Hemangiomas Other (please specify)

Benign Skin Lesions of Adults Seborrheic Keratosis Cherry Angiomas Premalignant Skin Lesions

Cancers of the skin Basal cell Squamous cell Melanoma

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Procedures Pediatric Adult Older Adult

Suturing Liquid nitrogen use

B. Eyes, ears, nose and throat Problems Eyes

conjunctivitis hordeolium/chalazion iritis blepharitis foreign body corneal abrasion

retinal disease cataract glaucoma vascular events .cover/uncover tests strabismus visual impairments children/adults (specify)

Nose/Sinus epistaxis allergic or nonallergic rhinitis foreign body sinusitis

Ears otitis media serous otitis media infectious otitis externa Eustachian tube dysfunction vertigo ceruminosis hearing loss care of client with typmpanostomy tubes

Throat-mouth apthous stomatitis tonsillitis pharyngitis mononucleosis hoarseness buccal lesions parotitis peritonsilar abscess TMJ syndrome toothache periodontal disease

epiglottitis Neck

cervical adenopathy/adenitis thyroid disease carotid bruit

Respiratory Problems Paediatric Adult Older

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Adult Common Complaints persistent cough dyspnea hemoptysis

Respiratory Common Problems upper & lower respiratory infections influenza-flu vaccine croup asthma paediatric/adult pneumonia chronic obstructive pulmonary disease tuberculosis sleep apnea lung cancer (risk factors)

Health Promotion/Disease Prevention smoking cessation other (please specify)

Cardiovascular Problems Common Complaints

chest pain dyspnea leg aches syncope/presyncope palpatations peripheral edema

Common Problems hypertension coronary artery disease angina stable and unstable hypercholesterolemia myocardial infarction heart failure arrhythmias valvular disorders and murmurs Thrombophlebitis & deep vein thrombosis

peripheral vascular disease leg ulcers

Health Promotion/Disease Prevention heart disease risk factors diet/exercise

Abdomen Problems Common Complaints

abdominal pain acute/recurrent constipation diarrhea dyspepsia/heartburn nausea/vomiting colic Dysphagia

Common Problems Pediatric Adult Older

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Adult GERD peptic ulcer disease gastroenteritis-viral, bacterial, parasitic

irritable bowel syndrome abdominal hernia hepatitis

Abdominal Common Problems cholecystities/gall bladder disease hemmorhoids GI bleeding-referral & follow-up acute appendicitis-referral & follow-up

Health Promotion/Disease Prevention Musculoskeletal Problems Common Complaints

generalized muscle ache/pain/cramps neck pain shoulder pain arm pain back pain hip pain knee pain ankle pain foot pain

Common Problems arthralgia carpul tunnel syndrome fractures fibromyalgia gout low back pain

meniscal/ligament tears orthopedic deformities osteoarthritis osteoporosis overuse syndrome (repetitive motion syndrome) plantar fasciitis radicular pain rheumatoid arthritis rotator cuff tear scoliosis sprain strain tendonitis

Health Promotion/Disease Prevention Neurological Problems Common Complaints

confusion Dizziness/vertigo headache Weakness

Common Problems Pediatric Adult Older

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Adult seizure disorder degenerative disorders

Alzheimer’s disease Muscular Sclerosis Parkinson’s disease

neurovascular disorders cerebrovascular accidents

Neurological Common Problems headache

Infectious and inflammatory disorders trigeminal neuralgia menigitis encephalitis Bell’s palsy

Health Promotion/Disease Prevention Genito-Urinary Problems Female Common Complaints

dysfunctional uterine bleeding breast mass dyspareunia pelvic pain vulvovaginitis

Common Problems annual gyn exam abnormal pap pelvic pain/ R.O. ectopic referral/follow-up contraception visit urinary tract infection vaginitis

trichomonas yeast (candida) bacterial vaginosis non-specific vaginitis atrophic vaginitis

sexually transmitted infections gonorrhea syphilis herpes AIDS/HIV genital warts chlamydia non-specific urethritis

prenatal assessment breast

masses tenderness mastitis breast feeding breast exam/SBE

menopausal symptoms Male Common Complaints Pediatric Adult Older

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Adult erectile dysfunction testicular pain

Common Problems prostatitis benign prostatic hypertrophy epididymitis testicular torsion hydrocele

Male Common Problems sexually transmitted infections

Health Promotion/Disease Prevention Renal Problems Common Complaints

dysuria hematuria proteinuria

Common Problems urinary incontinence

pyelonephritis nephrolithiasis chronic renal failure

Endocrine and Metabolic Problems Common Problems

hypothyroidism hyperthyroidism diabetes type II diabetes type I hypoglycemia Cushing syndrome obesity

Psych-Mental Health Common Problems anxiety depression substance abuse

Health Promotion/Disease Prevention Paediatrics/Prenatal

immunizations well-child exams/G&D anticipatory guidance initial prenatal exam drugs during pregnancy and breast-feeding follow-up prenatal exams prenatal education post-partum exam

Provides anticipatory guidance and counselling to reduce risk factors and prevent disease and disabilities to client and families Discusses smoking cessation with appropriate clients Discusses need for appropriate exercise with all clients

Pediatric Adult Older

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Adult Discusses need for stress management with appropriate clients Nutrition

Understands basic food pyramid Discusses special diets with appropriate clients and families

Lab/Diagnostic Ordering Procedures (according to NANB schedules) Demonstrates understanding and indication for

Yes No Not sure

CXR mammogram skeletal x-ray blood chemistries/haematology urinalysis, C&S, 24-hour cultures ECG spirometry procedure for community referral resources

Proper prescription request/refill (according to NANB schedules) accurately identifies most effective treatment for condition

Selects and/or prescribes appropriate pharmacological treatments for health condition Selects and/or prescribes appropriate nonpharmacological treatments for health condition Articulates knowledge of pharmacology, pharmacokinetics and pharmacodynamics of therapeutic agents Incorporates cultural & spiritual beliefs of all clients into health planning Applies theories of teaching and learning when providing health education to individuals, families and groups Professional Role Development Demonstrates autonomous and collaborative practice within full scope of NP practice Participates as a member of an interdisciplinary team in provision of health care Actively seeks learning and continuing educational opportunities Articulates scope of practice of nurse practitioners Articulates advanced nursing practice competencies

Students are expected to move from a novice beginner in many, if not most, of these skills to proficiency before completion of the NP program.

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Appendix E

Primary Health Care Nurse Practitioner Preceptor Clinical Performance Evaluation

SAMPLE Clinical Evaluation by Preceptor

Student___________________________ Preceptor/Site____________________________________ Date________________ Please evaluate the student’s performance using the following evaluation form. Not all of the Standards listed below may have been observed by you during this clinical rotation. If that is the case simply check the not observed column. If you feel the student excels and is ready for independent practice, or if you feel the student is unsafe for NP practice, please give specific examples why you feel this way in the comments section at the end of this form. If there are any questions or concerns please contact the faculty member responsible for the course. Your willingness to precept students is greatly appreciated. Thank you.

Older Adult Population (65+ years) Other Populations

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NO UP CG MG LG IP NO UP CG MG LG IP

Standard 1: Professional Responsibility and Accountability

1.3 Engages in evidence-informed practice by critically appraising and applying relevant research, best practice guidelines and theory (UNB Outcomes: 4.3.1, 4.4.1)

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1.4 Incorporates knowledge of diversity, cultural safety and the determinants of health in assessment, diagnosis, and therapeutic management of the client (UNB Outcome: 3.3.1, 3.4.1)

1.5 Integrates he principles of resource allocation and cost-effectiveness in clinical decision-making (UNB Outcome: 5.3.1)

1.6 collaborates, consults and/or refers to other health care providers when the diagnosis and/or treatment plan is unclear or is not within the NP scope of practice (UNB Outcome: 6.4.1)

1.7 Provides consultation to and accepts referrals from other health care providers for clients whose health conditions are within the NP scope of practice and individual expertise (UNB Outcome: 6.4.3)

1.8 Documents clinical data, assessment findings, diagnoses, plan of care, therapeutic intervention, client’s response and clinical rationale in a timely and accurate manner (UNB Outcome: 2.2.1, 2.4.1)

1.9 Maintains and retains client health records according to relevant legislation, professional standards and employer policies (UNB Outcome: 2.2.1, 2.4.1)

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1.14 Articulates the role of the NP to clients, health care professionals and key stakeholders (UNB Outcome: 6.4.3)

Standard 2 Health Assessment and Diagnosis

2.1 Applies advanced assessment techniques, critical thinking and clinical decision making skills when assessing clients (UNB Outcome: 1.3.1)

2.2 Systematically collects and interprets health data by performing a comprehensive and focused health assessment using multiple tools and sources of data (UNB Outcome: 4.4.1)

2.3 Orders diagnostic imaging tests, laboratory and other tests when clinically indicated in accordance with Nurse Practitioner Schedules for Ordering: Schedules “A” and “B” (UNB Outcome: 4.3.1)

2.4 Ensures that diagnostic tests are interpreted and results are acted upon in an appropriate and timely manner (UNB Outcome: 1.3.1, 3.4.2)

2.5 Makes a diagnosis based on the client’s health history, findings of health assessment and results of any investigations; (UNB Outcome: 4.4.1)

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2.6 Documents all diagnostic tests ordered and/or discontinued on the client’s permanent health record (UNB Outcome: 2.2.1)

2.7 Communicates the diagnosis to clients and to interdisciplinary team members as required (UNB Outcome: 2.3.1, 2.3.2)

2.8 Discusses prognosis and treatment options with the client (UNB Outcome: 2.3.2, 3.4.1)

2.9 Involves clients in the development, implementation and evaluation of their plan of care (UNB Outcome: 3.4.2)

2.10 Synthesizes information from individual clients to identify broader implications for health within the family or community (UNB Outcome: 3.4.2, 6.4.3)

Standard 3 Therapeutic Management

3.1 Utilizes an authoritative source of evidence-based drug and therapeutic information when prescribing drugs and other interventions (UNB Outcome: 6.5.2)

3.2 Considers the known risks and benefits to the client, the anticipated outcome, and ensures safeguards and resources are available to manage outcomes when initiating interventions (UNB Outcome: 3.4.1, 6.5.1)

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3.3 Provides client education about interventions including: expected action, importance of compliance, side effects, potential adverse reactions, possible interactions and follow-up plan (UNB Outcome: 6.5.3)

3.4 Obtains and documents informed consent from clients prior to performing procedures (UNB Outcome: 2.2.1, 2.3.2)

3.5 Performs procedures (non -invasive and invasive) for the clinical management/prevention of disease, injuries, disorders or conditions; (UNB Outcome: 4.4.1)

3.6 Prescribes drugs in accordance with the NANB NP Schedules for Ordering: Schedule C (UNB Outcome: 6.5.2)

3.7 Provides specific medications in small quantities in situations where a pharmacist is not available or accessible and/or it is in the best interest of the client (UNB Outcome: 6.5.2)

3.8 Evaluates client outcomes of selected treatments and interventions (UNB Outcome: 6.4.2)

3.9 Documents interventions and client’s response to interventions in the client’s permanent health record (UNB Outcome: 2.2.1, 2.4.1)

3.10 Documents and reports adverse events associated with drugs and other interventions (UNB Outcome: 2.2.1, 2.3.1)

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3.11 Continues to enhance knowledge base as required to provide comprehensive, quality, and evidenced-based care (UNB Outcome: 3.3.1)

Clinical expectations for consultation with a physician

1. The NP involves the client in the consultation processstarting with the identification of the need for consultation and the desired outcomes (UNB Outcome: 3.4.2, 6.4.3)

2. The NP initiates a consultation with a physician when thediagnosis and/or treatment plan is unclear or beyond the scope of the NP (UNB Outcome: 6.4.1)

Clinical expectations for completing a prescription

• The NP completes a prescription accurately andcompletely according to relevant legislation, standardsand policies. Prescriptions must include:a. date;b. client name;c. address (if known);d. name, strength, and quantity of prescribed drug(refer to generic name of the drug when possible for single entity products; brand name may be used for compound products); e. directions for use; including dose, frequency, theroute and expected duration of treatment (if known); f. number of refills.

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Standard 4 Health Promotion and Prevention of Illness and Injury

4.2 Implements health promotion and prevention strategies for individuals, families and communities, or for specific age and cultural groups (UNB Outcome: 3.4.1, 6.5.3)

4.3 Initiates or participates in the evaluation process of health promotion and prevention strategies (UNB Outcome: 6.5.1)

Comments:

Please review this evaluation with the student prior to signing and ask the student to sign as well. The evaluation may be given to the student or mailed to: Francis Perry, UNB Faculty of Nursing, MacLaggan Hall PO Box 4400 Fredericton, NB E3B 5A3. _______________________________________Signature of Student

Date_________________ _______________________________________Signature of Preceptor

Date_________________ _______________________________________Signature of Faculty

Date_______________

Clinical Supervision - Student Nurse Pactitioner Encadrement clinique - Étudiante-infirmière praticienne

Name of Student Nurse Practitioner / Nom de l’étudiante-infirmière praticienne :

Signature :

University / Université :

Number of hours supervised / Nombre d’heures de supervision :

Specific Dates of Supervision sessions / Dates detaillées des sessions supervision :

Amount requested (Max $13 per hour) / Montant demandé (max. 13 $ l’heure) :

Name, address and signature of physician who provided the clinical supervision / Nom, adresse et signature du médecin qui a assuré la supervision clinique :

Signature :

Signature of Dean of Nursing Faculty or designate / Signature de la directrice de l’école ou de la personne désignée :

Please note: This program started April 1st, 2005. All invoices must be received by March 31 for the ending fiscal year. A maximum of 700 hours will be permitted per student. Veuillez noter : Le programme a débuté le 1er avril 2005. Toutes les factures doivent être soumises avant le 31 mars pour l’année financière en cours. Un maximum de 700 heures sera permis pour chaque étudiant(e).

The Nursing Faculty must send this invoice to: / L’école de science infirmière doit soumettre la facture à :

Chief Nursing Officer & Nursing Resources Advisor / Agente principale de soins infirmiers et conseillère en ressources infirmières Department of Health / Ministère de la Santé PO Box / C.P. 5100, 520 rue King Street Fredericton, NB E3B 5G8

Signature of DH official / Signature de la personne représentant le MSME :

FIS Code / Code SIF :

September / Septembre 2011

Appendix F

NB Gov’t Form Payment for NP Clinical Supervision

Guidelines for Logging Clinical Practice Hours

The Faculty of Nursing must provide the Nurses Association of New Brunswick (NANB) with confirmation that each student has successfully completed the NP program including 700 required hours of clinical practice. Students who have not completed 700 hours will not be eligible to write the registration exam and register with NANB. Therefore, it is very important that each student accurately log and submit all practice hours for each clinical practicum. The following guidelines apply to logging hours:

Logs must be submitted at midway and final points of EACH clinicalpracticum.

Only patient contact hours are counted toward the 700 required practicehours. This includes time spent with patients, on-site collection of relevantdata, collaboration with health care professionals and documentation relatedto patient care. Hours logged must represent reasonable contact time. Aspractice progresses throughout the program and students develop theirpractice, it is expected that contact time will decrease. For example, duringNURS 6212: Advanced Health Assessment Practicum students might spend60 minutes doing a thorough health assessment, however by NURS 6219:Final Practicum, most students would spend 30-40 minutes which wouldinclude the time for collaboration and documentation of the visit for aroutine patient visit. What constitutes a “reasonable” amount of time perpatient visit during a rotation will be determined through consultation withthe student, preceptor and faculty liaison.

Attending continuing medical education (CME) events is encouraged,however, hours cannot be counted as practice hours. Meeting withpharmaceutical representatives do not count toward practice hours.

For NURS 6216: Primary Health Care Management Paediatric ClinicalPracticum and NURS 6218: Primary Health Care Management Adult IIClinical Practicum 75 percent of the required 100 practice hours must becompleted in the area of course focus. Hours logged during the rotation withthose who do not fit the course patient demographic and that are in excess ofthe 100 required hours for the course may be carried forward to NURS 6219:Final Practicum.

Appendix G