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Assessment of RN(NP) PracticeSelf-Employed Practice Review

The following form is based on the Standards of Practice for Registered Nurses on the Extended Practice Register and the Competencies for Nurse Practitioners in Manitoba. Please fill in the form as completely and descriptively as possible. If you have developed policies or documents related to this practice please include them with your submission. Please include a copy of your job description. Return to:

Practice and Standards ConsultantCollege of Registered Nurses of Manitoba890 Pembina HwyWinnipeg, MB R3M 2M8

PART I: Employment Information

Name:

Name of Self-Employed RN(NP) Practice:

Business Phone #:

Home Phone #:

College Registration #:

What is your position title or what are you called?______________________________________________________

Please indicate which of the following descriptors best describes your registered nursing role:

Practitioner/Direct Care Provider Educator Administrator

Researcher Nursing Consultant Other (describe):

Please indicate your employment status:

Full-time Part-time If Part-time, please indicate EFT (i.e. 0.6 EFT) ____________________________

In Manitoba, the term RN(NP) is synonymous with Registered Nurse Extended Practice [RN(EP)]

Name: _________________________________

Please describe who your clients are.

Where do you provide registered nursing services to clients? (i.e. home office, client’s home, etc.)

Are your clients in Manitoba? If not, please describe where your clients reside.

How do your clients become aware of your services?

Please describe in detail the registered nursing services you provide:


Assessment of RN(NP) Practice 2

Name: _________________________________

PART II: Standards of Practice Self-EvaluationPlease reflect on the care that you provide and evaluate yourself according the Standards of Practice for Registered Nurses on the Extended Practice Register below. Review the Standard and indicators and indicate how you meet them in the comments section.

Standard I: Consultation and Collaboration Comments

RN(EP)s consult and collaborate with other health professionals as appropriate and in accordance with the Competencies for the Registered Nurse (Extended Practice) RN(EP) Register, to ensure that the overall health care needs of their clients are met.

Using the following indicators please describe how you consult and collaborate in your nurse practitioner practice.

Indicators:

1. Establishes a consultative relationship with a physician, pharmacist and other health professionals appropriate to the client population for whom the RN(EP) provides care.

2. Consults with family physicians and specialist physicians if appropriate to the situation and the practice setting.

3. Knows the consultation expectations and complies with these in a timely manner.

4. RN(EP)s who consult with another health professional are not necessarily required to transfer the care of the client to that individual. The decision to transfer care is made jointly between the RN(EP) and the health professional.

5. Seeks consultation at any stage of the acute/chronic illness continuum in the care of a client from the initial assessment to the evaluation of treatment effectiveness as deemed necessary by the RN(EP).

6. Develops appropriate structures and effective processes for consultation.

7. Establishes appropriate methods for keeping health professionals informed of their mutual clients’ health conditions and of their treatment decisions, including decisions to repeat particular drugs.



Name: _________________________________



Name: _________________________________

Standard II: Prescribing Drugs Comments

RN(EP)s prescribe drugs relevant to the nurse’s area of practice and client population served in accordance with the Extended Practice Regulation, all other relevant provincial and federal standards and legislation, the Competencies for the Registered Nurse (Extended Practice) RN(EP) Register, and recognized best practices.

Using the following indicators please describe how you prescribe drugs in your nurse practitioner practice.

Indicators:

8. Completes prescriptions accurately, completely and legibly including the following information:a) date of issue;b) name and address of the person for whom

the drug is prescribed;c) the weight of the client if a child or the age

of the client if it has a bearing on the dosage of the prescribed drug;

d) name, strength and quantity of the prescribed drug;

e) directions for use, including the frequency, route of administration, duration of drug therapy, and special instructions;

f) directions for number of allowable refills and interval between refills, where applicable. If a prescription includes more than one drug, any drug that may be refilled must be clearly identified with the number of allowable refills for each drug;

g) prescriber’s name, address, telephone number and fax number;

h) the treatment goal and/or diagnosis and/or clinical indication;

i) the prescriber’s hand signature;j) prescriptions produced by computer must

be hand-signed by the RN(EP) or with an electronic signature that is hand-initialed by the RN(EP).



Name: _________________________________



Name: _________________________________


9. Provides educational information to clients about prescription and non-prescription drugs which includes information regarding:a) expected action of the drug;b) importance of compliance with prescribed

frequency and duration of the drug therapy;

c) potential side effects;d) signs and symptoms of potential adverse

effects (e.g. allergic reactions) and action to take if they occur;

e) potential interactions between the drug and certain foods, other drugs or substances such as herbal and homeopathic remedies;

f) specific precautions to take or instructions to follow; and

g) recommended follow-up;

10. Prescribes for clients based on assessment obtained through direct client contact.

11. Establishes a working relationship with the pharmacist(s) for purposes of consultation and education of clients.

12. Monitors and documents the client’s response to drug therapy. Based on the client’s response, the RN(EP) may decide to continue, adjust, or withdraw the drug, or to consult with a physician and/or pharmacist in accordance with the expectations for consultation.

13. Stores blank prescriptions in a secure area that is not accessible to the public. Does not provide any person with a blank, signed prescription.

14. Does not prescribe for their family members or for themselves.



Name: _________________________________



Name: _________________________________


15. Transmits a prescription by facsimile (pharmacists cannot accept email prescriptions) to a pharmacy provided that the following requirements are met:a) the prescription must be sent only to the

pharmacy of the client’s choice with no intervening person having access to the prescription;

b) the prescription must be sent directly from the prescriber’s office or directly from a health institution for a patient of that institution, or from another location providing that the pharmacist is confident of the prescription legitimacy;

c) the prescription must include all information listed in Indicator 8, and in addition must include:i. time and date of transmission;ii. name and fax number of the pharmacy

intended to receive the transmission; and

iii. a signed certification that the prescription represents the original of the prescription drug order, the addressee is the only recipient and there are no others, and the words “This certifies that the above prescription has been transmitted only to the pharmacy indicated.”

iv. the original prescription must be validated, securely filed, retained for 2 years, be available for inspection, and not transmitted elsewhere at another time.

16. Transmits all verbal prescriptions (new and refills) directly to the pharmacist.

17. Monitors adverse drug reactions and reports these in accordance with reporting requirements of Health Canada.

18. Maintains a record of all prescriptions written including refills.



Name: _________________________________



Name: _________________________________

Standard III: Ordering Screening and Diagnostic Tests Comments

RN(EP)s order specific screening and diagnostic tests relevant to the nurse’s area of practice and client population served in accordance with the Extended Practice Regulation, the Laboratory Requisition Regulation of The Health Services Insurances Act, the Competencies for the Registered Nurse (Extended Practice) RN(EP) Register, and recognized best practices.

Using the following indicators please describe how you order screening and diagnostic tests in your nurse practitioner practice.

Indicators:

19. Orders screening and diagnostic tests:

a) to confirm the diagnosis of a short term, episodic illness or injury as suggested by the client’s history and/or physical findings;

b) to rule out a potential diagnosis that, if present, would require consultation with an appropriate physician for treatment;

c) to assess/monitor ongoing conditions of clients with chronic illnesses;

d) for screening activities;

20. Develops efficient processes for receiving and tracking the results of screening and diagnostic tests and for ensuring that other health professionals involved in the mutual care of clients are informed of test results in a timely way.

21. Considers best practice evidence on appropriateness, contraindications, safety, and cost- effectiveness when ordering screening and diagnostic tests.

22. Explains to clients the reasons for ordering specific screening and diagnostic tests and the associated risk and benefits.

23. Adheres to provincial or agency standards for ordering, documenting and reporting results of screening and diagnostic tests.

24. Understands the significance of test results and the diagnostic interpretation made by a specialist. Consults with the specialist for clarification of the diagnostic interpretation when necessary.



Name: _________________________________



Name: _________________________________

Standard IV: Performing Minor Surgical and Invasive Procedures Comments

RN(EP)s perform minor surgical and invasive procedures competently and in accordance with the Extended Practice Regulation, Competencies for the Registered Nurse (Extended Practice), RN(EP) Register and recognized best practices.

Using the following indicators please describe how you perform minor surgical and invasive procedures in your nurse practitioner practice.

Indicators:

25. Assumes responsibility for maintaining competence in the minor surgical and invasive procedures required for the purpose of assessment, treatment, or management of an individual’s health.

26. Performs only those minor surgical and invasive procedures for which competence has been developed and maintained.

27. Performs only those minor surgical and invasive procedures which are required for the assessment, treatment or management of an individual’s health.

28. Obtains informed written consent prior to performing the procedure.

PART III: Competencies for Nurse Practitioners Self EvaluationRegistration on the RN(EP) register is based on the demonstration of competence at an advanced level in each of four competency areas.

Please reflect on the care that you provide and evaluate yourself according the Competencies for Nurse Practitioners in Manitoba below. Please provide supporting information.

1. Professional Role, Responsibility and Accountability Comments

Clinical Practice

The nurse practitioner:

1.1. Practises in accordance with legislative acts, regulations, CRNM bylaws and Board of Directors policies relevant to the nurse’s area of practice and client population served.

1.2. Understands the changes in scope of practice from that of a registered nurse on the register of practicing registered nurses and how this affects responsibilities and accountabilities when functioning as registered nurses on the register of extended practice.



Name: _________________________________

1.3. Incorporates knowledge of diversity, cultural safety and determinants of health in the assessment, diagnosis and therapeutic management of clients and in the evaluation of outcomes.

1.4. Incorporates knowledge of developmental and life stages, pathophysiology, psychopathology, epidemiology, environmental exposure, infectious diseases, behavioural sciences, demographics and family processes when performing health assessments, making diagnoses and providing overall therapeutic management.

1.5. Incorporates knowledge of the clinical manifestations of normal health events, acute illness/injuries, chronic diseases, comorbidities and emergency health needs, including the effects of multiple etiologies in the assessment, diagnosis and therapeutic management of clients and in the evaluation of outcomes.

1.6. Integrates the principles of resource allocation and cost-effectiveness into clinical decision-making.

1.7. Provides client diagnostic information and education that are relevant, theory-based and evidence-informed, using appropriate teaching/learning strategies.

1.8. Promotes safe client care by mitigating harm and addressing immediate risks for clients and others affected by adverse events and near misses.

1.9. Discloses the facts of adverse events to clients, and reports adverse events to appropriate authorities, in keeping with relevant legislation and organizational policies.

1.10. Documents clinical data, assessment findings, diagnoses, plans of care, therapeutic interventions, client responses and clinical rationale in a timely and accurate manner.

1.11. Adheres to federal and provincial/territorial legislation, policies and standards related to privacy, documentation and information management.



Name: _________________________________

1.12. Engages in ongoing professional development and accepts personal responsibility for maintaining nurse practitioner competence.



Name: _________________________________

Collaboration, Consultation and Referral


1.13. Consults with and/or refers clients to other health-care providers at any point in the care continuum when the client’s condition is not within the nurse practitioner scope of practice or the individual nurse practitioner’s competence.

1.14. Acts as a consultant to and/or refers and accepts referrals from health-care providers, community agencies and allied non-healthcare professionals.

1.15. Advocates for clients in relation to therapeutic intervention, health-care access, the health-care system and policy decisions that affect health and quality of life.

1.16. Collaborates with members of the health-care team to provide and promote interprofessional client-centred care at the individual, organizational and systems levels.

1.17. Collaborates with members of the health-care team to promote and guide continuous quality improvement initiatives at the individual, organizational and systems levels.

1.18. Applies advanced knowledge and skills in communication, negotiation, coalition building, change management and conflict-resolution.

Research


1.19. Engages in evidence-informed practice by critically appraising and applying relevant research, best practice guidelines and theory when providing health-care services.

1.20. Develops, utilizes and evaluates processes within the practice setting to ensure that clients receive coordinated health services that identify client outcomes and contribute to knowledge development.

1.21. Identifies and implements research-based innovations for improving client care at the individual, organizational and systems levels.



Name: _________________________________

1.22. Identifies, collects data on, and evaluates the outcomes of, nurse practitioner practice for clients and the health-care system.

1.23. Collaborates with other members of the health-care team or the community to identify research opportunities and to conduct and/or support research.

1.24. Acts as a change agent through knowledge translation and dissemination of new knowledge that may include formal presentations, publication, informal discussions and the development of best practice guidelines and policies.

Leadership


1.25. Provides leadership in the management of clinical care and is a resource person, educator and role model.

1.26. Acts as a preceptor, mentor and coach to nursing colleagues, other members of the healthcare team and students.

1.27. Articulates and promotes the role of the nurse practitioner to clients, other health-care providers, social and public service sectors, the public, legislators and policy-makers.

1.28. Provides leadership in the development and integration of the nurse practitioner role within the health-care system.

1.29. Advocates for and participates in creating an organizational environment that supports safe client care, collaborative practice and professional growth.

1.30. Guides, initiates and provides leadership in the development and implementation of standards, practice guidelines, quality assurance, and education and research initiatives.

1.31. Guides, initiates and provides leadership in policy-related activities to influence practice, health services and public policy.



Name: _________________________________

2. Health Assessment and Diagnosis Comments


2.1. Performs a focused health assessment and/ or an advanced comprehensive health assessment, using and adapting assessment tools and techniques based on client needs and relevance to client stage of life.

2.2. Performs a complete or focused health history appropriate to the client’s situation, including physical, psychosocial, emotional, ethnic, cultural and spiritual dimensions of health.

2.3. Performs a complete or focused physical examination, and identifies and interprets normal and abnormal findings as appropriate to client presentation.

2.4. Synthesizes health assessment information using critical inquiry and clinical reasoning to diagnose health risks and states of health/illness.

2.5. Formulates differential diagnoses through the integration of client information and evidence-informed practice.

2.6. Anticipates and diagnoses emergent, urgent and life-threatening situations.

2.7. Orders and/or performs screening and diagnostic investigations, interprets results using evidence-informed clinical reasoning and critical inquiry, and assumes responsibility for follow-up.

2.8. Diagnoses diseases, disorders, injuries and conditions, and identifies health needs, while considering the client’s response to the health/illness experience.

2.9. Effectively communicates health findings and/or diagnoses to clients, discusses health outcomes/prognosis, reviews treatment options, assists/supports clients with personal responses to their health conditions and creates an environment in which effective learning can take place.



Name: _________________________________



Name: _________________________________

3. Therapeutic Management Comments


3.1. Creates an environment in which effective communication of diagnostic and therapeutic intervention can take place.

3.2. Explores therapeutic options, considering implications or clients through the integration of client information and evidence-informed practice.

3.3. Determines care options and initiates therapeutic interventions in collaboration with clients, while considering client perspectives, preferences, feasibility and best outcomes.

3.4. Initiates interventions for the purpose of stabilizing clients in emergent, urgent and life-threatening situations.

3.5. Supports, educates, coaches and counsels clients regarding diagnoses, prognoses and self-management, including their personal responses to diseases, disorders, conditions, injuries, risk factors, lifestyle changes and therapeutic interventions.

3.6. Promotes client self-efficacy in navigating the health-care system and in identifying and accessing the necessary resources.

3.7. Coordinates and facilitates client care with other health-care providers, agencies and community resources.

3.8. Performs invasive/non-invasive procedures for the clinical management and/or prevention of disease, injuries, disorders or conditions.

3.9. Prescribes pharmacotherapy based on the client’s health history, disease, disorder, condition and stage of life, and individual circumstances.

3.10.Applies knowledge of pharmacotherapy and evidence-informed practice in prescribing, monitoring and dispensing drugs.

3.11.Counsels clients on medication therapy, benefits, potential side effects, interactions, importance of compliance and recommended follow-up.

3.12.Demonstrates awareness of, and is mindful of, marketing strategies used to promote health products, medical devices, medications, alternative therapies and health programs.



Name: _________________________________

3.13.Intervenes, as appropriate, when potential or actual problematic substance use and/or misuse of drugs, including complementary and alternative therapies, is identified.

3.14.Prescribes and/or dispenses drugs in accordance with provincial, territorial and/or federal standards and legislative requirements.

3.15.Uses an evidence-informed approach in the selection or consideration of complementary and alternative therapies, and considers the benefits and risks to clients’ health and safety.

3.16.Collaborates with clients in monitoring their response to therapeutic interventions and in adjusting interventions, as needed.

3.17.Monitors, evaluates and revises the plan of care and therapeutic intervention based on current evidence-informed practice and on client goals, preferences, health status and outcomes.

4. Population Health, Health Promotion and Illness/Injury Prevention Comments


4.1. Assesses, identifies and critically analyzes information from a variety of sources to determine client and/or population trends and patterns that have health implications.

4.2. Initiates or participates in the development of strategies to address identified client and/or population health implications.

4.3. Initiates or participates in the design of services/interventions for health promotion, health protection, and the prevention of injury, illness, disease and complications.

4.4. Initiates or participates in the development and implementation of evaluation processes, including identification of indicators for ongoing monitoring of strategies, services and interventions.



Name: _________________________________

If you are self-employed, please describe how you track your hours and how these hours could be independently verified.

If you are self-employed, how do you set and collect your fees?

___________________________________________________ ________________________________Signature Date

OFFICE USE ONLY:

Reviewed by Practice Consultant(s):Date reviewed: _________________________________

Reviewed practice with memberDate reviewed: _________________________________

Approved Not Approved

Signature(s): ______________________________________

Date of decision: ___________________________________

Additional Notes:

