What is the NP Role?

What is the Nurse Practitioner Role?

The purpose of the following section is to provide an overview of the nurse practitioner role as an advanced nursing practice role. After reviewing this section, employers and preceptors should have a better understanding of the role of the nurse practitioner (NP), the types of educational experiences needed to educate nurses to make the transition to the NP role, and the suitability of a preceptorship program in your agency. The information is organized according to key points which will assist in your decision-making for becoming a clinical site. Key concepts and terms within each point have been elaborated on in the boxes below. A variety of resources have been used with links to the library or other sites for further information.

Who are these students?

There are similarities but also differences when precepting nursing students in undergraduate programs versus those entering nurse practitioner programs. First, they are both students, and therefore share common concerns based on adult learning. The major difference is that NP students are already registered nurses and bring with them nursing expertise. They are in the process of gaining the knowledge and skills to develop their nursing practice beyond what is now the legislated scope of practice for registered nurses. Traditional models of perceptorship for undergraduate nursing students can provide information applicable for NP education; however modifications are required to meet the unique characteristics of the advanced nursing practice role.

Point #1: The nurse practitioner is an advanced practice nurse who engages in advanced nursing practice.

Point #2: The nurse practitioner role is a valued member of the health care team and can benefit your organization by providing services as educator, leader, consultant, practitioner and/or researcher.

Point #3: The scope of practice for the nurse practitioner in Ontario is defined by additional controlled acts above those legislated to Registered Nurses.

Point #4: The successful implementation of the nurse practitioner role into agencies is important for successful integration into the health care system.

Point #1: The nurse practitioner is an advanced practice nurse who engages in advanced nursing practice.

Canadian Nurses Association

The preceptor is a health professional with ongoing responsibility for client care who can assist the learner in developing knowledge and skill because of his/her clinical expertise and proximity to clients.

Advanced Nursing Practice (ANP)

Describes an advanced level of nursing practice.
Maximizes the use of in-depth nursing knowledge and skill in meeting health needs.
Extends the boundaries of nursing’s scope of practice.
Contributes to nursing knowledge and the development and advancement of the profession.

Characteristics of ANP

Involves integrated use of in-depth nursing knowledge, research and clinical expertise.
Involves integrating knowledge from other disciplines into the practice of nursing.
Involves leadership and initiation of change to improve client, organization and system outcomes.
Uses advanced judgement and decision-making skills to provide a range of strategies to meet needs of clients and to improve access to and quality of care.
Explains and applies the theoretical, empirical, ethical and experiential foundation of nursing practice.
Disseminates evidenced based nursing practice
Contributes to evidence-based nursing through research and evaluation and utilization of relevant research findings.
Influences the practice of nursing.
Involves planning, coordinating, implementing and evaluating programs to meet client needs and support nursing practice.
Involves critically analyzing and influencing health policy.
Uses knowledge transfer techniques to put research-based knowledge into practice.
Reflects autonomy and independence, with a high level of accountability.

The Nurse Practitioner: Position Statement

A nurse practitioner (NP) is an advanced practice nurse. The NP’s practice is:

focused on providing services to manage the health needs of individuals, families, groups and communities and diverse populations across the continuum of care
grounded in the nursing profession’s values, knowledge, theories and practice
based in health promotion, disease prevention and illness management

NPs can:

potentially contribute to new models of health care based on the principles of primary health care
diagnose, order and interpret diagnostic tests, prescribe pharmaceuticals and perform specific procedures within their legislated scope of practice
provide leadership, act as consultants, researchers and educators and incorporate new knowledge from research studies and other sources into their practice
work autonomously as well as collaborate with other health care professional in interprofessional teams

NPs work:

in a variety of community, acute care and long term care settings
in community health centers, nursing outposts, specialty units and clinics, nursing outposts, emergency departments and long-term facilities

NPs practice requires:

in-depth knowledge of nursing gained through additional clinical practice, education and experience

For more information, refer to:

Advanced Nursing Practice Framework, Canadian Nurses Association: http://cna-aiic.ca/CNA/documents/pdf/publications/ ANP_National_Framework_e.pdf
Position Statement: Advanced Nursing Practice: http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS_Nurse_Practitioner_e.pdf
Report of 2005 Dialogue on Advanced Nursing Practice, Canadian Nurses Association: http://cna-aiic.ca/CNA/documents/pdf/publications/ Report_2005_ANP_Dialogue_e.pdf
For more information, refer to Position Statement: The Nurse Practitioner: http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS_Nurse_Practitioner_e.pdf

Canadian Nurse Practitioner Initiative

In a literature review prepared by Jane Fahey-Walsh for the Practice Component of the Canadian Nurse Practitioner Initiative, she reported an historical account of the development of the concept of advanced nursing practice. A few statements are listed below; however, for a more comprehensive overview go to the link provided.

Engage in activities which contribute to and improve nursing knowledge and practice.
Define the boundaries of practice within the philosophical beliefs intrinsic to their profession in order to meet the demands of nursing, patients and society.
Apply advanced nursing and related knowledge, critical thinking skills and judgment, clinical expertise and a collaborative approach to care in order to enhance quality of care.

For more information, refer to:

Canadian Nurse Practitioner Initiative: Canadian Nurse Practitioner Initiative Technical Report, Practice Chapter http://206.191.29.104/documents/pdf/tech-report/section3/01_Practice%20Chapter.pdf

Point #2: The nurse practitioner role is a valued member of the health care team and can benefit your organization by providing services as educator, leader, consultant, practitioner and/or researcher.

Role Functions of Nurse Practitioners in Clinical Practice

Clinical Practice	Provides care to clients independently or collaboratively in primary or acute care settings. Assesses the needs of clients by collecting, integrating and validating a wide range of complex information from various sources. Collects a comprehensive or focused health data base through a history and physical examination. Performs physical examinations. Diagnoses illness, injuries and health-related issues according to legal, professional and institutional criteria. Prescribes medication according to legal, professional and institutional criteria. Orders and interprets tests according to legal, professional and institutional criteria. Performs nursing and selected medical interventions, counselling, health education and supportive care. Evaluates outcomes of patient care. Documents findings and plan of care. Acts as a patient/family/ community advocate. Promotes continuity of care through continued assessment and evaluation of patient care. Communicates and collaborates with an interprofessional team, patient and family in setting mutual goals.
Leadership in Clinical Practice	Participates in the development of clinical guidelines, policies and procedures. Identifies barriers to provide quality of care. Acts as a resource to nurses and other team members. Demonstrates leadership skills and expertise consistent with advanced nursing practice. Demonstrates skills in role development.
Education	Contributes to the dissemination of nursing knowledge. Participates in nursing and interprofessional education. Participates in the development of community programs. Participates in the development of educational programs. Maintains competency of practice through the use of resources and educational programs.
Consultation	Accepts and makes referrals to other health professionals. Consults with other members of the health care system. Represents nursing on internal/ external committees for political initiatives and matters affecting nursing clinical practice. Acts as a consultant in the community for quality health care.
Research	Critically analyses and demonstrates evidence-based practice. Initiates and conducts nursing and collaborative research. Disseminates research findings.

Patterson, C. (1999). Are nurse practitioners contributing to the growth of the nursing profession. In C. Patterson (Ed.), Visions and voices: The nurse practitioner today (pp.23-24). Brantford, ON: JPatt Publishing Inc. (see p.226 in APA manual)

For more information, refer to:

The Nurse Practitioner Association of Ontario: http://www.npao.org/

Point #3: The scope of practice for the nurse practitioner in Ontario is defined by additional controlled acts above those legislated to Registered Nurses.

Practice Standards: Registered Nurses in Extended Class

A Registered Nurse (RN) who earns Extended Class designation [RN(EC)] has successfully demonstrated her/his competence to the College of Nurses of Ontario (CNO) as a Primary Health Care Nurse Practitioner (NP-PHC). In addition to upholding the standards of practice for RNs in the General Class, RN(EC)s are expected to meet the following Extended Class standards of practice.

Competencies specific to the NP scope of practice

NPs can diagnose and manage the care of clients with acute and/or chronic physical and/or mental disease, disorders or conditions. NPs are also a resource to other nurses and health care professionals; they provide leadership in advocating for clients at the point of care, across organizations and/or at the health system/policy level.

NPs demonstrate competencies in the following areas:

health assessment and diagnosis;
health care management and therapeutic intervention;
health promotion and prevention of illness, injury and complications; and
professional role and responsibility.

In addition to the above controlled acts for nurses, NPs can initiate and perform the following controlled acts:

1) communicate to a client or his or her representative a diagnosis made by the NP that determines, as the cause of a client’s symptoms, a disease or disorder identified from the client’s health history, the findings of a comprehensive examination, or the results of any laboratory tests or other tests and investigations that the NP can order or perform;

2) prescribe a drug, or category of drugs, as designated in the regulations;

3) administer a drug by inhalation or injection that NPs may prescribe; and

4) order the application of a form of energy as prescribed in the regulations, such as an

ultrasound.

For more information, refer to:

Practice Standards: Nurse Practitioner: http://www.cno.org/Global/docs/prac/41038_StrdRnec.pdf

Lists:

Ministry of Health and Long Term Care: Regulated Health Professions Statute Law Amendment Act, 2009: http://www.health.gov.on.ca/english/public/legislation/regulated/regulated_health_professions.html

Point #4: The successful implementation of the nurse practitioner role into agencies is important for successful integration into the health care system.

Implementation and Evaluation Toolkit for Nurse Practitioners in Canada

A Toolkit was developed to assist users to assess the need for NP services and to provide a stepwise approach to integration and evaluation of the NP role in agencies. Other Canadian Nurse Practitioner Initiative documents on the Canadian Nurses Association website may also be useful as you explore the need for nurse practitioners in your agency.

The toolkit will be able to answer many of your questions on entry to practice issues such as establishing policies, creating supportive environments, negotiating the role, deciding on reimbursement mechanisms, building teams, networking and much more.