Integrate Knowledge of Advanced Nursing Practice Essay

Integrate Knowledge of Advanced Nursing Practice Essay

Integrate Knowledge of Advanced Nursing Practice Essay

Purpose: To investigate & integrate knowledge of advanced nursing practice, scholarly inquiry, & leadership by examining a policy at the level of clinical practice, health care systems, or public/social health policy. Students are to submit a paper between 5-8 pages long excluding title page and reference pages. Paper must be organized according to the guidelines below and should include all the identified sections as required. Paper must be completed in APA format and contain current scholarly sources dated from 2014 until current. Integrate Knowledge of Advanced Nursing Practice Essay

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The Roles of Nurse Educator
Nurse educators are the first in line regarding advanced nursing practices. Nurse educators have the responsibility to create an environment in laboratories, classrooms, and clinical settings, which facilitate learning and achieving desirable psychomotor, affective, and cognitive outcomes (Parse, 1992). It is a general overview of what nurse educators do. Their sole purpose is to ensure learners in the nursing field to create a conducive environment for furthering their competencies. To do so, a nurse educator will implement different teaching strategies relevant to a learner’s requirements, needs and desired outcomes. A nurse educator will also undertake ground teaching strategies in evidence-based teaching and educational theories in order to enhance learners competencies (Bryant-Lukosius et al., 2004). In an attempt to improve oneself, a nurse educator will engage in self-reflection to gauge his or her competency and the progress of learning of the student’s. Student’s will also be required to have an understanding of information technology and use it to further the learning process. Furthermore, a nurse educator has to realize his or her responsibility to help learners develop as nurses and integrate into the behaviors and values, which should have people in their position. The main aim here is to facilitate learners’ development and socialization (Brown, 1998).

In order to achieve success in the above process, the nurse administrator will use assessment and evaluation strategies to gauge the progress of learners. Nurse administrators use different strategies to assess and evaluate learning in laboratories, classrooms and clinical settings, and other relevant domains of learning. They, however, do not take a backseat role as they can also participate in the design of the curriculum and entire evaluation of the teaching’s outcomes. Nurse educator has a little attitude to administrations as they spend the majority of their time in the educational settings. The aim of this category of nurses is to learn students to be able to handle varieties of problems in the nursing field. Therefore, they hardly engage in nursing practices like taking care of patients and diagnosing illnesses. Nurse educators are legally required to maintain work ethics such as disclosing all the relevant materials and facts to learners regarding their future positions as nurses. Integrate Knowledge of Advanced Nursing Practice Essay

The Roles of Nurse Informaticist
The role of nurse informaticist focuses on realizing ways to make a better management of information and communication among nurses in order to reduce costs, improve efficiency and enhance the overall quality of healthcare. Nurses in this field integrate data, information, and knowledge in order to facilitate decision-making in the industry. To support these information structures, information technology and information processes are utilized (Bryant-Lukosius et al., 2004). In addition, documentation plays a great role in nursing informatics; this is due to the fact that it focuses on effective communication among patients and healthcare providers. Utilized resources here include notes written in a patient’s chart, and nursing informatics seeks to improve timeliness, speed, and accuracy of patients’ charting (Brown, 1998). Integrate Knowledge of Advanced Nursing Practice Essay

Individuals who work in nursing informatics aspire to develop user-friendly and effective systems. They take into account that such systems will be used by both patients and nurses who may have little knowledge about their use. Nursing informatics include such positions as director of clinical informatics, informatics nurse specialist and clinical informatics coordinator. Regarding working conditions, nurse informaticists work in healthcare facilities, hospitals, consulting firms, universities, or organizations that develop and market healthcare information systems. However, a few of nurse informatics engage in patient care duties (Youngblood & Beitz, 2001). Majority in this group focus on developing, testing, improving and training nurses how to use the new healthcare information system. Having recognized the ability of nurse informaticists to reduce cost and improve quality care, varieties of hospitals and healthcare organizations are creating staff roles for nurse informaticists in their work settings (Youngblood & Beitz, 2001). Integrate Knowledge of Advanced Nursing Practice Essay

Moreover, the American Nurses Credentialing Center (ANCC) Informatics Nursing Board provides a certification examination that allows a reliable and valid assessment of the entry-level skills and clinical knowledge for registered nurses specializing in informatics. Once an individual completes a different eligibility requirement to take certification exams and passes, he/she is awarded the credential: Registered Nurse-Board Certified (RN-BC). This credential is valid for a period of five years, but the qualified individual can continue using it upon renewal. The ANCC certification is accredited by the National Commission for Certifying Agencies together with the Accreditation Board.

The Roles of Nurse Administrator
A nursing administrator works in virtually all healthcare environments. In this regard, nurse administrators often manage a specific unit in the organization or a team of nurses. These nurses have adequate training in their respective fields and learn to hold their teams accountable for their actions and failures (Youngblood & Beitz, 2001). The major aim of a nurse administrator is to ensure his or her team works collaboratively to achieve desired outcomes. Such kind of nurses are essentially team leaders and act on what their teams have done. Nurse administrators can at times interact directly with their patients but are usually assigned managerial duties. As managers, they assume the top position in a healthcare organization, and they the ones to whom other employees in a healthcare setting report. A nurse administrator has different responsibilities including: Integrate Knowledge of Advanced Nursing Practice Essay

· Establishment and documentation of administrative procedures for the entire nursing team.

· Promotion of the development of their nursing staff.

· Ensuring overall responsibility for the entire nursing patient care.

· Ensuring economical budgeting and maintenance of standard guidelines in the workplace.

· Patient consultation and troubleshooting.

· Employee counseling and team-building exercises.

· Analyzing diagnosis decisions and nursing treatments by team members.

· Allowing effective communication between nursing and practice staff.

· Scheduling and supervising all team players.

As has been stated previously nurse administrator focuses majorly on administrative functions of the organization and hardly interact directly with patients. However, nurse administrators possess a range of knowledge regarding patient care as they often engage in consultation and must also know the practical aspects of healthcare. Nurse administrators master the knowledge of nursing protocol and procedures and are highly trained. In their capacity, they function as pivotal leaders in a healthcare organization but can also aspire for the executive position since all that is required is leadership skills and focus. Nurse administrators work best when managing people and processes rather than attending patients (Dossey et al., 1995). To become a nurse administrator, an individual must hold a bachelor’s or higher education degree in nursing. He/she must further possess a current active RN license within an identified locality in the United States. Furthermore, an added advantage is when a person has been in a mid-level administrative or higher administrative positions and has taken a faculty position handling graduate students in nursing. However, a master’s degree in nursing administration surpasses all the requirements (Youngblood & Beitz, 2001). Integrate Knowledge of Advanced Nursing Practice Essay

The Role of Nurse Practitioner
A nurse practitioner is the most common position in the nursing industry. A nurse practitioner, commonly referred to as NP, is an advanced practice registered nurse (APRN) who has completed advanced clinical education and coursework better than it is required for a normal registered nurse (RN). The International Council of Nurses defines a nurse practitioner as a registered nurse who has gained decision-making skills, the knowledge base and clinical competencies for higher practices beyond that of a registered nurse (RN). This characteristic is well determined by the context in which such a person is qualified to practice (Thomas et al., 2012). In the United States, owing to the state-regulation of the profession, care provided by nurse practitioners varies while they are largely limited to credentials and education qualifications. Some nurse practitioners aspire to work independently as physicians to be consulted at a personal level. However, some states require collaborative agreements with qualified physicians for a person to practice as a health practitioner. The degree of such collaborative agreements, the roles, responsibilities, duties, pharmacological recommendations, nursing treatments, also varies widely depending on a state’s certification procedures. Nurse practitioners, therefore have a range of roles, which may include the following: Integrate Knowledge of Advanced Nursing Practice Essay

· Diagnosis of medical conditions, treatment, and evaluation of a patient’s progress for both chronic and acute illnesses.

· Looking for patients’ histories and carrying out physical examinations.

· Performing and ordering diagnostic studies, such as x-rays and lab tests among others.

· Prescribing medication for acute and chronic diseases.

· Providing family planning services and prenatal care.

· Providing special and primary care services care involving health-maintenance for adults and regular follow-ups (Dossey et al., 1995).

Required Competency for Nurse Practitioners
Scientific Foundation Competencies
These are the characteristics that allow nurse practitioners to critically analyze the data and information required to improve practices in nursing. Furthermore, such competencies allow practitioners to successfully integrate knowledge from the sciences and humanities into the context of nursing for decision-making (Thomas et al., 2012). Scientific foundation competencies also enable nurse practitioners to translate other forms of knowledge and research into useful information in order to improve health practices. Finally, practitioners develop new and better approaches after integrating theory and research into the field of nursing. Integrate Knowledge of Advanced Nursing Practice Essay

Leadership Competencies
Leadership is all about taking initiative in nursing. With leadership competencies, practitioners assume advanced and complex leadership roles to pioneer and guide change in the organization. They lead at the forefront to enhance collaboration between different stakeholders to improve patient care (Thomas et al., 2012). In addition, practitioners should demonstrate leadership skills that show reflective and critical thinking. As leaders, they have a further advocate for improved quality, cost and access to effective healthcare services.

Regarding quality competencies, nurse practitioners use the most appropriate and available evidence to regularly improve the quality of healthcare practices. Quality competencies come with an evaluation of the existing relationship among safety, cost and quality and their effects on healthcare (Thomas et al., 2012). Nurse practitioners also have to anticipate variations in healthcare practices and formulate strategies for facing future uncertainties. Integrate Knowledge of Advanced Nursing Practice Essay

Practice Inquiry Competencies
These are the competencies that allow nurse practitioners to be at the forefront of translating knowledge into practice. Nurses have to engage in day-to-day activities with specialists in order to generate the knowledge required for improving patients’ outcomes and practices. Nurse practitioners also should lead to practice inquiry either individually or with the help of a competent team (Thomas et al., 2012).

Technology and Information Literacy Competencies
Knowledge management is vital for success in nursing. This category of competency allows practitioners to appropriately integrate different available technologies in the field of nursing for efficiency. Nurse practitioners should have a deal with scientific and technical health information required for various needs in the workplace (Thomas et al., 2012). Furthermore, they have to be able to show the information literacy skills required for a host of decision-making situations. Nurse practitioners have the ability to contribute to the design of healthcare information systems that promote quality, safety, and cost-effective care. Integrate Knowledge of Advanced Nursing Practice Essay

Policy Competencies
Policy competencies allow nurse practitioners to show an understanding of the relationship between policies and practice. Policies in healthcare should be ethical and promote access, quality and equity in all aspects. For this reason, nurse practitioners having policy competencies have to analyze ethical, social and legal factors influencing the development of healthcare policies (Thomas et al., 2012). Finally, nurses can assess the implication of health policies in nursing before advocating for their use.

The organization, setting, and population with whom to work.
As previously mentioned, nurse practitioners have advanced and complex roles and their qualification differs from those of regular nurses. However, they work and operate in similar environments just like other nurses. The difference in qualifications and competencies allows the practitioners to work on a range of fields. Nurse practitioners acquire their competency with the help of mentoring patient care experiences with major emphasis on inter-professional and independent practices (Naylor & Kurtzman, 2010). They work in all kinds of healthcare organizations and hospitals as their duties range from patient care to leadership responsibilities. Since they can diagnose and make treatments, they are mostly found in hospitals. Nevertheless, the fact that they can integrate a team to work collaboratively implies that they also take managerial roles. In addition, it is previously mentioned that nurse practitioner participates in designing healthcare information systems, what puts them in a pole position to influence the work of the entire system (Naylor & Kurtzman, 2010).

Similarly, there are no limits of the population with whom nurse practitioners work. The nature of their job means that they interact with almost everyone in a healthcare setting. For instance, diagnosis and treatment require an individual who can handle all the types of patients, and this is what nurse practitioners do the best. They also work with professionals in designing healthcare information system. As a result, nurse practitioners are qualified for all duties available in the field and have no restriction on what to do (Naylor & Kurtzman, 2010). Integrate Knowledge of Advanced Nursing Practice Essay

Leadership Attributes of Nurse Practitioners
Lewin’s study provides three types of leadership styles and the one which I possess is the participative or democratic style of leadership (Cherry, 2013). I believe this is the most effective style of leadership as it incorporates everyone in decision-making. As a leader, I not only guide groups and teams to the achievement of the goals but also take part in doing most of the duties. For instance, Lewin’s study about leadership styles found that children subjected to this type of leadership had contributions of much higher quality even though they were less productive than members of the authoritarian category. However, I may need to develop leadership attributes such as intellectual stimulation and individualized consideration (Cherry, 2013). Intellectual stimulation implies that as a leader, I will not only challenge the status quo but also will inspire employees to be more creative. To achieve this, I need to study different fields related to healthcare and understand best practices that encourage creativity. Regarding individualized consideration, I will need to offer encouragement and support to my followers. Integrate Knowledge of Advanced Nursing Practice Essay

Health Policy: Drug Shortage
Drug shortage is currently an issue of high concern in nursing. Complex market relations have made it difficult for private sector leaders and the government to address the issue of drug shortage. Drug shortages not only reduce the quality of patient care but also result into indirect costs on the entire system by requiring money and time to be spent looking for alternatives, modifying drug usage protocols or rescheduling procedures (Stencel, 2014). Furthermore, there are cases when medicines cannot be substituted hence drug shortages have dire consequences on patients. Recognizing this problem, political leaders and healthcare professionals have taken different steps to mitigate the shortage of drugs. This policy affects practitioners’ duties directly as it affects the treatment of diseases. There is not much what nurse practitioner can do with drug shortage as there are limitations. However, the efforts to mitigate drug shortages have been made by the Food and Drug Administration with the help of Congress. Such efforts have largely focused on regulatory matters. Nonetheless, this paper proposes continued communication and collaboration between different stakeholders in healthcare and the government so that everyone is on the alert as far as drug shortage is concerned (Stencel, 2014). Integrate Knowledge of Advanced Nursing Practice Essay

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Advanced practice roles have really essential meaning for the success of activities in the nursing field. This research identifies four main advanced nursing practice roles, which are: nurse practitioners, nurse educators, nurse administrators, and nurse informaticists. For instance, a nurse practitioner’s competency is categorized into different sections, such as scientific foundation competencies, leadership competencies, quality competencies, practice inquiry competencies, and technological and information literacy competencies. A nurse practitioner is the selected advanced role for this paper and involves a host of competencies, such as scientific foundation, leadership, and policy competencies. Furthermore, nurse practitioners work in virtually all healthcare environments as they engage in different practices. They interact with everyone in the field as their knowledge is necessary for all the aspects. The International Council of Nurses defines a nurse practitioner as a registered nurse who has gained decision-making skills, the knowledge base and clinical competencies for higher practices beyond that of a registered nurse (RN). In a different perspective, this paper identifies drug shortage policy as the issue of the highest concern affecting nurse practitioners. It recommends more communication between all the stakeholders in nursing and also it recommends the government to enhance awareness of drug shortages and take relevant measures. Integrate Knowledge of Advanced Nursing Practice Essay

The primary mandate of the Association of Registered Nurses of Newfoundland and Labrador (ARNNL) is to act
as an advocate for the public in the delivery of safe, competent, and ethical nursing care. Rapid advancements
in health knowledge and technology, along with the introduction of new approaches to health care delivery and
new types of health care workers, have necessitated that the ARNNL engage in an ongoing review of its
process for defining and determining the scope of nursing practice.
This new ARNNL document, Scope of Nursing Practice: Definition, Decision-Making, & Delegation,
defines the scope of practice for Registered Nurses in Newfoundland and Labrador and outlines the decisionmaking framework that agencies are to use when they are evaluating the merit of introducing specific nursing
competencies within the practice of nurses employed in their organization. As such, this document serves
as the interpretation for: Integrate Knowledge of Advanced Nursing Practice Essay
Nursing Practice Standard
Registered Nurses must “function within the legally recognized scope of practice of nursing and within all
relevant legislation.”
This new scope of practice decision-making framework delegates the decision-making authority for specialty
and shared competencies from the ARNNL, College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL), and any other applicable health professional regulatory associations, to the agency(s) and registered nurses involved in incorporating the particular competency into nursing practice. The framework is based
upon a principle-based approach to professional practice and outlines individual registered nurse and agency
accountabilities. Integrate Knowledge of Advanced Nursing Practice Essay
The principles are illustrated as a series of questions and/or criteria designed to stimulate critical evaluation of any
proposed scope of nursing practice changes. Agencies must develop or adopt a standard review process for their
organization as a means of ensuring a consistent, comprehensive, and professional review of all requests to change
the scope of nursing practice. This review must be done in accordance with the ARNNL principles outlined in this
document. A step-by-step process is presented to promote consistency between agencies/health care authorities.
This process is designed to ensure public safety and competent nursing practice by mandating that input be sought
from all relevant professionals, contextual issues are thoroughly explored, and the necessary safeguards, including
nursing education and policy, are established. Integrate Knowledge of Advanced Nursing Practice Essay
This document is divided into three sections. In the first section the scope of nursing practice is described. The second
addresses the process for scope of practice decision-making related to specialty, shared, and new/emerging nursing
competencies. The third section provides specific direction to nurses, employers, and other health professionals on the
processes for delegation of specific competencies to registered nurses.
ARNNL.CA 55 Military Road | St. John’s | NL | Canada | A1C2C5 | Tel: (709) 753-6040 | 1 (800) 563-3200 | Fax: (709) 753-4940 |
Association of Registered Nurses of Newfoundland and Labrador
Scope of Nursing Practice: Definition
Nursing Practice
The scope of nursing practice is defined as the range of roles, functions, responsibilities, and activities which
registered nurses are educated and authorized to perform.
The broad scope of nursing practice reflects all of the roles and activities undertaken by registered nurses to
address the full range of human experiences and responses to health and illness. This includes: health promotion,
health protection, health maintenance, health restoration, rehabilitation, and palliation. Integrate Knowledge of Advanced Nursing Practice Essay
Nursing practice is directed towards the goal of assisting clients to achieve and maintain optimal health in order to
maximize quality of life across the lifespan (ARNNL, 1995; CNA, 2002). Client, referring also to patient and
resident, is defined as an individual, a family, a group of individuals, a community, or a population. Nursing
practice is accomplished through:
 Utilization of nursing knowledge through the application of critical thinking, judgment and skill. It is grounded
in the principles of nursing, medicine, social and public health sciences and expressed as the art of nursing.
 Adoption of a holistic approach to care, addressing the biological, psychological, social, and spiritual needs
of clients.
 Promotion of client self-reliance and self-determination by actively involving the client as a partner in all aspects of care.
 Use of nursing theories to define and organize practice and the nursing process to comprehensively assess,
diagnose, plan, implement, evaluate, and document client care.
 Application of the model of nursing care delivery adopted within the agency or practice setting. Integrate Knowledge of Advanced Nursing Practice Essay
 Collaboration with other members of the health care team and partnering with diverse sectors of the
 Advocating for and/or creating quality health care systems, population health, and healthy public policy.
 Adherence to relevant legislation, professional guidelines, including the Standards for Nursing Practice in
Newfoundland and Labrador (ARNNL, 1995) and the Code of Ethics for Registered Nurses (CNA, 2002),
and in accordance with applicable employer policies.
To be responsive to the evolving health-related needs of the public, the boundaries of the scope of nursing practice
must be flexible. Nursing practice takes place in the context of continuing change and development resulting from
advances in research and technology, the introduction of new approaches to care delivery, and a greater variety of
practitioners sharing more areas of common ability. The dynamic nature of the health care environment requires
that nurses respond to client’s needs by continually expanding their knowledge and skills and making judgments
about the limits of their practice.
The overall scope of nursing practice refers to the outer limits or boundaries for the profession and everything
therein. The actual scope of practice of individual nurses is always narrower than that of the scope of the nursing
profession as a whole. The scope of practice of the individual nurse is influenced by the nurses’ knowledge,
practice setting, employer requirements, and client needs (CNA, 2002c). It is often described in job descriptions
and/or illustrated in practice settings as competencies.
Scope of Nursing Practice: Definition, Decision-Making and Delegation
55 Military Road | St. John’s | NL | Canada | A1C2C5 | Tel: (709) 753-6040 | 1 (800) 563-3200 | Fax: (709) 753-4940 | ARNNL.CA
Advanced Nursing Practice (ANP) Integrate Knowledge of Advanced Nursing Practice Essay
ANP roles have evolved in response to the changing needs of clients and society, and trends in the delivery of
health care. Advanced nursing practice is within the regulated scope of nursing practice, however, advanced
practice nurses constantly challenge and extend the boundaries of nursing practice.
At a national level, the Canadian Nurses Association (CNA) and jurisdictional members, including ARNNL, have
approved concepts put forth in Advanced Nursing Practice – A National Framework (2002). This document defines
Advanced Nursing Practice and identifies nine characteristics of ANP that must be consistently evident for a
practice to be considered advanced. In this way the CNA ANP framework contributes to defining the boundaries
of the scope of nursing practice.
Some advanced nursing practice competencies include activities that, in the past, were exclusive to the scope of
another health care profession (e.g. prescriptive authority). Nurse practitioner (NP) roles are in this category. In
Newfoundland and Labrador, NP roles are the most prominent ANP roles. Nurses in NP roles have moved along
the continuum of experience and education and have acquired new competencies that are incorporated into their
practice. These roles are examples of how the scope of nursing practice changes over time. ARNNL, through the
Registered Nurses Act and Regulations, recognizes and licenses NPs – Primary Health Care and NPs – Specialist.
The NP license is a regulatory safeguard that addresses public protection and authorizes NP practice in the new
competency areas of health assessment, diagnosis, treatment, and health care management. NPs are also
authorized to perform activities approved through delegation of function, provided the appropriate criteria are met
as outlined in this document.
For further information on advanced practice competencies see the most recent version of the ARNNL’s, The Professional Regulatory Framework for Nurse Practitioners Province of Newfoundland and Labrador.

Competencies are defined as the integrated knowledge, skills, attitudes, and judgment required to safely and
effectively practice nursing. Competencies are more specific than scope of practice statements and reflect what is
required of the registered nurse to function in a specific role or practice setting. The term competency, versus the
word skill, reflects the level of critical thinking and knowledge involved in nursing interventions. Integrate Knowledge of Advanced Nursing Practice Essay
Nursing competencies are classified into four categories:
 Entry to Practice Nursing Competencies are identified as the knowledge, attitudes, judgment, critical
thinking, communication, and psychomotor interventions, expected of the entry-level registered nurse. These
competencies are acquired through a basic nursing education program and are in accordance with the
Requirements outlined in the current version of the ARNNL document, Competencies in the Context of
Entry-Level Registered Nurse Practice.
Examples: wound care, counseling, and health assessment.
 Specialty Nursing Competencies are identified as activities currently practiced and new/emerging interventions that involve a higher level of complexity then entry level competencies in application and/or critical
thinking. The concepts underlying these competencies may have been introduced in a basic nursing
education program but further learning and/or experience must be obtained through continuing education
before these competencies can be implemented in clinical practice. Integrate Knowledge of Advanced Nursing Practice Essay
Examples: removal of chest tubes, administering chemotherapy, changing established outer tracheotomy tubes,
counseling clients with acute mental illness, community development, and competencies used in emerging roles
such as complementary therapy (e.g. healing touch), esthetic services (e.g. collagen therapy), and select skills
needed for roles involving advanced technology such as telehealth.
ARNNL.CA 55 Military Road | St. John’s | NL | Canada | A1C2C5 | Tel: (709) 753-6040 | 1 (800) 563-3200 | Fax: (709) 753-4940 |
Association of Registered Nurses of Newfoundland and Labrador
In keeping with the direction of the Canadian Nurses Association, the label advanced is reserved for advanced
practice roles e.g. Clinical Nurse Specialist or Nurse Practitioner. Nursing competencies that had been classified
as advanced nursing and/or medical nursing shared skills, as well as new and emerging interventions, are
re-named as specialty competencies.
 Shared Competencies are identified as health related client interventions that are determined to be within
the scope of practice of more than one health care profession. These competencies may be shared between
nursing and other disciplines such as medicine or allied health professionals. Shared competencies may be
performed by either professional(s) competent in the skill and authorized to do so through agency policy.
Examples: Medication administration is a shared competency of Registered Nurses and Licensed Practical Nurses.
Maintenance of airways is a shared competency with Respiratory Therapists. Immunization is a shared competency with Physicians. Counseling is a shared competency with Social Workers. Integrate Knowledge of Advanced Nursing Practice Essay
 Non-Delegated Competencies are identified as activities that are articulated in legislation, or directives arising out of legislation e.g. regulations and/or agency by-laws, to be the exclusive domain of a particular profession or professions. Authority to perform competencies in this category by members of another discipline
requires a change in the related legislation or delegation of function. Collaboration with the ARNNL and other
relevant professional regulatory authorities (e.g. CPSNL) is required before a nurse can perform
competencies identified to be non-delegated. (See page 11 for more information).
Examples: prescriptive authority, examination of individuals detained under the Mental Health Act.
Portability refers to the ability of a nurse, who is competent in a particular intervention, to safely perform the
competency with a different client population or in another practice setting. The decision to perform a competency
in a different area of practice must reflect best practices, self-assessment of competency, and be supported by
agency policy. If these criteria are not met, the competency should not be considered portable. Before a nurse
performs any competency, he/she must be familiar with the policies and guidelines for performing the competency
within the specific setting and seek required information and support if he/she has not obtained proficiency in the
relevant competency. Integrate Knowledge of Advanced Nursing Practice Essay
Examples: If a nurse obtains proficiency in the competency of venipuncture or irrigation of a nephrostomy tube
while employed in an institution, he/she can continue to perform these skills in the community, if the practice is
supported as a nursing intervention in the new setting. Likewise, the nurse moving from community health into an
institution may be able to continue to provide immunizations. The skill of removing central venous catheter lines
may be deemed to be portable for a nurse transferring from ICU to a medical unit, if he/she maintains competency
and the practice is supporting by agency policy.
A provincial ARNNL list of specialty, shared or non-delegated competencies is no longer collected or published.
The ARNNL document, Advanced Nursing and Medical Nursing Shared Skills, which included a list of advanced
and medical nursing shared skills has been rescinded. RNs are expected to be aware of the competencies for
which they are proficient and are approved for nursing in their area of practice. Agencies are expected to keep a
record of the competencies that are approved to be within the scope of practice for nurses within their own health
authority. Integrate Knowledge of Advanced Nursing Practice Essay
Non-delegated competencies are identified within the numerous pieces of legislation, regulations, and by-laws for
the various disciplines and health related organizations in our province. There is no consolidated provincial listing
of non-delegated competencies. ARNNL consultants are available to any agency wishing assistance in
determining if a particular competency may be restricted to another discipline and/or if a competency is appropriate
to consider for nursing. ARNNL will continue to develop and identify competencies required for initial RN and NP
licensure purposes, in collaboration with the schools of nursing and other stakeholders.
Scope of Nursing Practice: Definition, Decision-Making and Delegation
55 Military Road | St. John’s | NL | Canada | A1C2C5 | Tel: (709) 753-6040 | 1 (800) 563-3200 | Fax: (709) 753-4940 | ARNNL.CA
Role Preparation
Nurses obtain the competencies required to practice nursing through basic and continuing education, including
formal and informal learning opportunities. Basic nursing education programs prepare generalists, rather than
specialists, to engage in beginning nursing practice. Basic nursing education includes academic content in
nursing, the humanities, and the physical and social sciences. This knowledge is utilized in providing
evidence-based or best-practice nursing care to clients in various practice settings throughout the basic nursing
program. These programs enable students to acquire the knowledge, skills, and attitudes required for entry-level
practice and to pursue life-long learning. For more information see the current version of the ARNNL document,
Competencies in the Context of Entry-Level Registered Nurse Practice and/or contact one of the provincial schools
of nursing. Integrate Knowledge of Advanced Nursing Practice Essay
Nursing practice ranges on a continuum from novice to expert (Benner, 1984). Beginning practitioners enter
nursing practice at the novice level. Nurses develop along this continuum through experience and continuing
formal and informal education. Informal education includes active involvement in such activities as: self-directed
reading/study; unit level presentations; case study analysis; attendance at workshops, seminars, in-services,
nursing rounds; and membership in special interest groups. Formal continuing education programs include postbasic courses and certificate and degree programs.
Nurses are accountable to obtain and maintain continuing competency within their defined roles through a
commitment to life-long learning. It is also the responsibility of the RN to assess his/her own competence to
perform required nursing functions and to make judgments about any limitations of their practice. When aspects of
care are beyond their level of competence, he/she must seek additional education or experience (ARNNL,
Standards for Nursing Practice).
Examples: Nurses may be taught the fundamentals of caring for a client requiring pertineonal dialysis, to initiate an
IV, or to administer immunizations in their basic education program. However, before they are deemedcompetent
to perform the skill in practice, they may require additional education and practice, which includes both theoretical
education and supervised practice. (see Appendix F for more information). Integrate Knowledge of Advanced Nursing Practice Essay
Practice Settings
Nursing is practiced in a variety of settings and in diverse roles, for example: direct care provider, educator,
manager, researcher, community developer, counselor, consultant, and public policy developer. Nurses may be
employers, employees, private practitioners, and/or volunteers.
The practice of nursing involves working with individuals, families, groups, communities, and populations. Nursing
practice may range from one-on-one interventions, up to and including policy development to meet the needs of an
entire population. Services range from episodic illness-focused care to health promotion across the lifespan based
on the principles of primary health care. Integrate Knowledge of Advanced Nursing Practice Essay
Continuity of Nursing Care
Continuity of care refers to consistent quality nursing services across settings and/or within settings. Continuity of
nursing services across settings refers to the provision of consistent client care practices between agencies for
example, the hospital and community. Continuity of nursing services within settings promotes consistent client
care practices among nurses in the same setting, for example, between ICU and a medical unit, between nurses in
two different community health districts or two long term care facilities.
There may however be significant differences in the availability of resources and expertise to support safe and
competent performance of a particular competency by nurses in different settings. When scope of practice
decisions are made in one setting or area of practice, consideration must be given to the ability of nursing staff to
meet the client’s ongoing nursing needs across and/or within the continuum of care.
Examples: A client has an abdominal drainage system inserted while in hospital but is a permanent resident of a
rural long-term care facility. Education on the required nursing care and relevant policy information is shared with
the nursing staff in the long term care facility in advance of the client’s transfer or, a client with diabetes who is
managing his own insulin requirements at home, is supported to continue self care while in hospital. Integrate Knowledge of Advanced Nursing Practice Essay
ARNNL.CA 55 Military Road | St. John’s | NL | Canada | A1C2C5 | Tel: (709) 753-6040 | 1 (800) 563-3200 | Fax: (709) 753-4940 |
Association of Registered Nurses of Newfoundland and Labrador
Scope of Nursing Practice:
Decision-Making Process
In the past ARNNL approved all scope of nursing practice changes. This process was extensive, time consuming,
and often requiring the approval of other relevant disciplines thus resulting in delayed implementation. Nursing
skills approved through this process were identified in an ARNNL centralized list. The list was neither exhaustive
nor exclusive and did not capture the complexity or holistic philosophy of nursing practice. The legislation
governing the practice of nursing in our province does not mandate this level of detail or approach to determining
the scope of nursing practice. Consequently, ARNNL has introduced a more flexible framework to address scope
of practice requests. The new decision-making framework recognizes:
 ARNNL’s responsibility to set the parameters for scope of practice decision making to promote safe,
competent and ethical nursing practice
 Registered Nurses’ professional accountability for their own practice, and
 Agencies/health authorities responsibility to provide quality health care services in response to client needs,
available resources, and internal quality initiatives (see Appendix B for more details).
ARNNL’s new framework outlines the process whereby decision-making authority within the categories of specialty
and shared competencies moves from the ARNNL, the College of Physicians and Surgeons of Newfoundland and
Labrador, and any other applicable health professional regulatory association, to the agency(s) and registered
nurses involved in incorporating the particular competency into nursing practice. Scope of practice decisions made
within the health care agency must involve collaboration between the management/leadership team and registered
nurse(s), as well as other relevant health care professional(s). As appropriate, communication may also be
required between health care professionals across the continuum (e.g. between different agencies/departments/
programs if client care is to be provided in different settings). Integrate Knowledge of Advanced Nursing Practice Essay

My own perspective on Advanced Practice Nursing ABSTRACT: The need for continuing education in nursing has been accentuated in response to rapidly changing health care environment. Expanding knowledge by pursuing higher education allows nurses to enlarge one’s practice. Furthermore, higher education in nursing has been shown that a nurse’s level of education can become a critical factor to the patient-centered quality of care. This essay describes increased demand for higher education in nursing and emphasizes the necessity of continuing education to provide optimum patient care in various setting. Techniques and technologies in the medical field constantly evolve and change. With such a huge increase in information, there is…show more content…
As people’s life expectancy increases, the nursing field needs to keep pace with the rapid changes. There’s increased needs for nurses in many different field as well such as nursing home, hospitals, ambulatory cares, palliative care, and hospices. Therefore, an expectation of a role as a nurse has been rise. Nursing skills and knowledge cannot remain limited, but need to utilize in more various setting. In order to provide better care in various nursing field, continuing education is essential. For example, as population and their lifespan increases there’s also new diseases and new treatment has been developed. A competence nurse must embrace old and new skills and thorough knowledge to achieve best quality of care and optimum patient’s overall outcome. The quality of patient care heavily depends on nurses’ level of education. One research proves that nurses who received higher level of education showed lower mortality rate, less medical errors, and higher patient satisfaction. This outcome is related to higher education which prepared nurses to handle various circumstances with appropriate answers. Nurses are people who spend most of time with ill individuals at the bed side. Nursing education will provide new demanding roles of nurses’ requirement such as seeing the patient as a whole, providing appropriate response to patient’s condition, and integrating knowledge and skills accordingly. Integrate Knowledge of Advanced Nursing Practice Essay


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