Competency development and revalidation for advanced nursing

practice

Linda NazarkoMSc, PgDip, PgCert, BSc(Hons), RN, NIP, OBE, FRCN

London 11th March 2016,

Aims To enable those managing nurses

practicing at specialist and advanced level to understand the components of advanced practice and how they can support nurses

To enable nurses who are developing into advanced practitioners to understand what skills, knowledge and support they will require.

To enable nurses practicing at specialist and advanced levels to maintain and develop their skills

To enable nurses practicing at specialist and advanced levels to prepare for re-validation

Learning objectives To be aware of how to : Develop competence and confidence in accurate

assessment & diagnoses Provide nurses with suitable education and training Enable to develop competency Maintain competency in assessment, diagnosis &

prescribing Move beyond competency to capability Enable setting up & development of nurse led

services Develop protocols & guidelines Prepare for appraisal & revalidation

What is competency?“Nurses and nursing staff have

up-to-date knowledge and skills, and use these with intelligence, insight and understanding in line with the needs of each individual in their care”.

RCN (2012)

What does competency mean?

The ability to combine technical skills with humanistic care

Combining the art & the science of nursing

Defining advanced nursing practice

“A registered nurse who has command of an expert knowledge base and clinical competence, is able to make complex clinical decisions using expert clinical judgement, is an essential member of an interdependent health care team and whose role is determined by the context in which s/he practices”

NMC 2007

Components of advanced practice

Core competencies advanced practice

Practicing autonomously Making decisions and being accountable Admitting and discharging patients Ability to take a clinical history Ability to physically examine patient Ability to determine diagnosis Ability to determine when onward referral is

required Ability to prescribe

Generic clinical competencies

Practicing autonomously Making decisions and being accountable Admitting and discharging patients Ability to take a clinical history Ability to physically examine patient Ability to determine diagnosis Ability to determine when onward referral is required Ability to prescribe

Narrow or broad specialisms

Competencies should be related to the area of practice. Specialism may be narrow and deep, e.g. diabetes,

cardiology Specialism may be broad such as gerontology, nurse

practitioners.

Specific clinical competencies

Competencies specific to your service Competencies related to where your

service is delivered Competencies specific to the client group

Combining theory and practice

Education and training

Building on assessment & diagnostic skills

Practice! Working with more experienced

practitioners Reading Using “You Tube” and other media. Visiting, shadowing

Aim to look back at where you are now and see how far you have come.

Non medical prescribers

Where do nurse NMPs work?

Supporting new prescribers Remember writing your first

prescription is scary Grow nurture and support staff Help staff to develop, gain skills

and confidenceNone of us are born experts

Becoming a confident & competent prescriber

Prescribe Check everything three times Find a an experienced prescriber

“buddy” If possible get your buddy to check

your prescribing until you gain confidence

Maintaining & enhancing skills Find a mentor Work with others to audit prescribing Find out what you don’t know Fill the gaps Join or form an NMP group Read Attend conferences Organise your own conference Speak at conferences

Ways to use an NMP group To audit practice To develop skills- learn from experts To keep up to date with new medicines To keep up to date with alerts To share skills and knowledge To support each other To educate and enable

Moving beyond competencies

Setting up nurse led services Proposals Working up business case Showing benefits Winning hearts, minds and funding Minimising KPIs Maximising improvement

Protocols and guidelines You may not be

the first to explore this territory

Find out what exists, adapt and develop

Share new work by publishing and at conferences

What protocols and guidelines Admission/entry criteria Exclusion criteria Referral forms/protocols Escalation criteria Referral to other services Pathways, how often to see patient Follow up Discharge KPIs and reporting

Capability expert practice

“the combination of skills, knowledge,

values and self-esteem which enables

individuals to manage change, be

flexible and move beyond competency” (O’Connell et al, 2014)

Appraisal of nurses practicing at advanced level

Job description should spell out what the nurse actually does If prescribing this should be in JD Appraiser should if possible have expertise in nurse’s area of

practice Nurse consultants currently under-utilised in management of

specialist nurses

Questions to ask when appraising

How are you using your advanced skills?

How are you maintaining?

What barriers are you facing?

What do you most enjoy?

What can we do to support?

Advanced Practitioner Role

A new type of nurse Not a nurse at all An evolution of the nursing role Remains unregulated

Revalidation Aim to demonstrate how you meet all four

domains Use your hours log Use your CPD ensure relevant to scope of

practice Use your reflections ensure relevant and

demonstrate learning. Use the process to drive your practice

forward

Précis of a reflectionMrs Baker, 93, is px Sertaline and suffers severe postural hypotension. Efforts to address not successful and changed to Citalopram with effect. Unable to ascertain if sertraline caused or merely worsened existing postural hypotension

Précis reflection (2) Nurse led unit did not routinely check

L/S BP in those who had not fallen Change in practice – all patients have

L/S BP checked x 48 hours and not just those who have fallen

Nazarko (2016). Pain, sadness and ageinghttp://www.magonlinelibrary.com/doi/

10.12968/npre.2016.14.2.94

Fundamental nursing"Nursing is rooted from the needs of

humanity and is founded on the ideal of service. And that, “the nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence for the mother and the mouthpiece for those too weak or withdrawn to speak”

The fundamentals of nursing

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.”

Henderson V. (1966), The Nature of Nursing: 15: Macmillan Publishing, New York.

The value of nursing Goes beyond the medical model Nurse with the hands, the heart and the

head Develop a partnership a with the unique

human being Value the person’s perspective, hopes

and aspirations Enables us to provide humanistic care and

support

All is changed

Advanced practice changes every aspect of nursing

If we get this right then nursing and patient care moves forward and we provide compassionate life enhancing care

The art and scienceArt – trusting relationships. We meet

people in their darkest hours and they share their hopes, fears and aspirations

Science – working out what can be done to aid recovery or come to terms with changes

Art is in working with the person through these times

The art and science combine to provide kind, compassionate humane care.

Advanced nursing practice Contributes to

developing nursing Enables us to

nurse with the hands, the heart and the head

Enriches the lives of those we care for and our lives

Thank you for listening

Any questions?